The medical schools of origin of 531 psychiatrists who had qualified in the U.K. in the period 1961–1970 were ascertained. Psychiatrists were for the purpose of the study operationally defined as those who had taken the Royal College of Psychiatrists' Membership examinations since its inception. There were large discrepancies, as much as five-fold, between different medical schools, and no ready explanation is forthcoming. There were also discrepancies in the proportion of women graduates opting for psychiatry.

Between 1953 and 1974 the author made psychiatric examinations for the prosecution of 400 persons, 367 males and 33 females, accused of the murders of 307 victims, 194 males and 113 females. The 367 males were accused of 273 murders, 172 male and 101 female victims, and the 33 females were accused of 34 murders, 22 male and 12 female victims. The salient features amongst the accused were maleness, youthfulness, the causal importance of alcohol, the rarity of suicide after murder and the high percentage of psychiatrically normal persons: in these last two respects the picture differed from that reported in England and Wales. The normality of these Scottish accused was further shown by the finding that in the decade 1965 to 1974 no material psychiatric abnormality was seen in 90 per cent of the males examined.

Many psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

These documents were prepared by Dr J. A. Baldwin, Dr J. Leff and Professor J. K. Wing at the request of the Executive Committee of the Social and Community Psychiatry Group of the College. After extensive consultation they were approved by the Executive and Finance Committee as representing the policy of the Royal College of Psychiatrists.

Copies of the Code of Practice (Annex B), and of the unpublished Annex C, Technical Arrangements for Ensuring Confidentiality and Annex D, General Features of Medical Information Systems, are obtainable from Professor J. K. Wing, M.R.C. Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.

Fifty-five patients with presenile dementia were examined. There were 28 women and 27 men, and the mean age was 59 and 56 years respectively at the time of the study. A large series of psychometric tests was used, and with the aid of age-matched non-demented controls five significantly different cognitive reduction groups could be identified. In the demented patients the regional cerebral blood flow (rCBF) was determined with an eight-detector or 32-detector equipment. There was a rough proportionality between the cognitive reduction and a decrease of the cerebral blood flow (especially the flow in the grey matter). In addition, certain regional flow abnormalities correlated with specific cognitive functions in a manner resembling the cognitive defects found in focal brain lesions in the same region. Thus, patients who showed only memory disturbances demonstrated a focal flow reduction in the temporal region. More severely affected patients, with reduction of verbal abilities and signs of agnosia, showed very low flows in occipitotemporo-parietal parts of the hemisphere. The results offer a principal confirmation of the dynamic field theory concerning the functional organization of the cerebral cortex (Luria, 1966).

A representative sample (R.S.) of 79 subjects living in Edinburgh common lodging houses was compared with a clinical series (O.S.) of 44 patients from the same type of residence. C.S. patients were more likely to be out of work, to be under 55 years of age, and to have been married at some time. They had spent much shorter times in lodging houses, in Edinburgh and at their current address. Alcoholism was rather more often diagnosed in the C.S., and personality disorder much more often. Schizophrenia tended to be found more in the R.S. The O.S. obtained higher Personal Illness and ‘Character Disorder’ scores. It is concluded that those subjects presenting to the psychiatric services are a highly selected group quite unrepresentative of homeless single persons in general.

One-hundred husbands, diagnosed as suffering from alcoholism, and their wives, were followed up twelve months after initial consultation and assessment. Follow-up information was complete in 89 cases. On the basis of both husband and wife accounts of the husband's drinking behaviour during the follow-up period, and their assessment of the drinking problem at twelve-months follow-up, 28 were classified as having a ‘good’ outcome and 29 as having a ‘bad’ outcome. In the remaining 32 cases outcome was considered ‘equivocal‘.

A composite measure of marital cohesion was predictive of twelve-month outcome classification, cohesive marriages being significantly more likely to have a good outcome. The measure of marital cohesion was based upon husband and wife reports of mutual affection and of husband involvement in family tasks, favourable spouse perceptions and meta-perceptions, and optimism about the future of the marriage. Composite measures of dominance balance within the marriage were not predictive of outcome.

Husband's job status, husband's self-esteem, and wife's reported hardship were not independent of marital cohesion, and were themselves predictive of twelve-months outcome. When these variables were partially controlled it was found that marital cohesion remained predictive for husbands with relatively low status jobs and husbands with relatively low levels of self-esteem. It is an over-simplification to state that either the marriage, the spouse, or the severity of the patient's condition is alone the cause of variation in outcome.

It is possible to integrate these findings with those of other studies on the influence of family variables on the outcome of conditions other than alcoholism. Together these studies suggest a general hypothesis linking a breakdown in the cohesiveness, or mutual rewardingness, of family relationships and unfavourable outcomes following treatment or consultation for psychological disorder.

The welcome visit of the Royal College of Psychiatrists brings to mind the close links which exist between the University of Padua and Britain.

The subjects of this study were eighty misusers of heroin who lived in the New Town of Crawley, West Sussex. The relationship between their criminal histories and their histories of drug misuse were examined. It was found that more of the heroin misusers than would be expected had been convicted of criminal offences before they began to misuse drugs, while the reduction or cessation of heroin use during a four-year follow-up period was accompanied by a reduction in convictions. Some social characteristics of the male heroin misusers were compared with those of two other Crawley groups—a group of juvenile offenders who did not misuse heroin and their control group of non-delinquents. Characteristics commonly associated with maladjustment did not distinguish the heroin misusers from the juvenile offenders, nor were they found to be associated with the continued use of heroin. Analysis of the data in epidemiological terms suggested that among the necessary conditions for an outbreak of drug misuse in a particular community the availability of drugs together with socializing drug users were more important than the presence of predisposed individuals.

Those who were labelled as depressives in a rural survey were randomly divided into a Medicine group (who received antidepressive drug treatment), a Placebo group (who received placebo) and a Natural Process group (who received no treatment). The depth of their depression was assessed by Hamilton's Depressive Rating Scale before the beginning of the trial, on the 14th day and on the 28th day of trial. They were compared with a matched group of healthy controls and again with a matched group of depressives who attended an urban clinic for treatment.

The results indicate that the rural depressives who never sought treatment voluntarily were not different from those who sought treatment in clinics, so far as their response to treatment is concerned.

This retrospective study describes the epidemiology of attempted suicide among Asian (Bangladesh, India and Pakistan) immigrants in Birmingham during the period 1969–1972.

The hypothesis of no difference in the distribution of attempted suicide among native and immigrant groups was not upheld. The immigrant group was under-represented among all the admissions to Birmingham's hospitals. It is estimated that the crude adjusted rates for attempted suicide among the male and female Asian immigrants aged 15–64 years are 57 and 126 per 100,000 population per annum respectively. These are lower than the rates found among natives in Britain, but the female immigrant rate is higher than that found in India.

Asian patients who attempt suicide in India and Birmingham are younger than 45 years of age, rarely abuse drugs and alcohol, and make repeated attempts infrequently. In Birmingham, however, immigrants and native patients swallow similar, mostly psychotropic, tablets and not insecticides as in India. It is noteworthy that an interpersonal dispute precedes attempted suicide more frequently among immigrant patients than among native ones in either area.

Six cases of Gilles de la Tourette's syndrome are discussed in the light of conflicting views on the aetiology of the condition. It is hypothesized that the onset of coprolalia in patients with persistent childhood tics indicates a disturbance of the normal balance between a need for tension relief by swearing and a capacity to control such vocal activity. Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Seventy-three male alcoholics permitted information to be obtained from official sources about time recorded as lost from work in receipt of sickness or unemployment benefits and about their weekly state insurance contributions. The average yearly time loss was 121.7 working days per person, comprising an average yearly loss through sickness of 86.1 and through unemployment of 35.6 working days respectively. By contrast the recorded national sickness loss for men in a comparable twelve months period averaged 15.9 working days per person.

Thirteen alcoholics showed over five years, prolonged deficiency in work attendance. State benefits to the subjects, over twelve months during the early 1970s, totalled £18,434.80. Diagnoses on their medical certificates underestimated incapacity from alcoholism.

A six-point predictive scale for parasuicide repetition developed by Buglass and Horton (1974a) was tested on a group of patients admitted for parasuicide to a psychiatric ward of one of the city hospitals of Verona. The scale gave a range of probability of repetition within 12 months of 15 per cent at a score of 0 up to 45.5 per cent at the scores 3, 4, 5 and 6. Moreover the scale discriminated significantly between repeaters and non-repeaters. Items significantly associated with repetition in the Italian sample, which are not represented by the six-point scale were: previous parasuicide not admitted to hospital, violence received, alcohol taken at time of act, less than one year at the present address.

Sixty-six patients were assessed clinically, psychologically and physiologically before operation, at six weeks and at a mean of 16 months following stereotactic limbic leucotomy. Seventy-three per cent were clinically improved at six weeks and 76 per cent at 16 months. In obsessional neurosis, 89 per cent of patients showed definite clinical improvement at 16 months; in chronic anxiety, 66 per cent were improved; in depression, 78 per cent; and in the small number of schizophrenics treated the improvement rate was over 80 per cent. Self-assessment and observer-assessment questionnaires and scales measuring Depression, Anxiety, Neuroticism, Hysterical symptoms and Obsessional symptoms and traits all showed highly significant reductions of mean scores at 16 months. There was no fall-off in intelligence, and adverse effects were minimal. Limbic leucotomy, with its enhanced accuracy and safety, compares very favourably with similarly assessed, more extensive ‘free-hand’ procedures, and in obsessional neurosis and chronic anxiety the results are superior.

Four circumstances—in addition to my own limitations as a historian—have determined my choice of subject for this evening. Last November this Institute celebrated its Jubilee—that is, the 50th anniversary of the recognition of the Maudsley Hospital as a School of the University of London. In the following month the one-time Medico-Psychological Association, which owed its very name to a suggestion by Henry Maudsley, and has now developed into the Royal College of Psychiatrists, moved into its new headquarters in Belgrave Square. Since then we have had to mourn the death of Sir Aubrey Lewis, one of whose outstanding contributions to the Association, and to psychiatric history, was his Maudsley Lecture of 1951, devoted to the work and influence of Henry Maudsley.† Moreover, the early ‘70s are the centenary years of Maudsley's period of office as the senior editor of the Journal of Mental Science, now the British Journal of Psychiatry, with which I myself have long been associated. So it seemed that it might be appropriate for me to tell you something about the history of the Association, about Maudsley's relations with it, and about the various ideas, proposals and actions which eventually led to the foundation of this Hospital and Institute. In doing this I hope to furnish a few footnotes, as it were, to Sir Aubrey's Maudsley and Mapother Lectures, and these will be my personal tribute to one whom so many of us have held in affectionate admiration.

In a double blind trial, 50 male chronic alcoholic patients were treated with either fenfluramine in a dose of 60 mg or 120 mg daily, or with identically prepared placebo tablets. Patients were interviewed on admission to the trial and then at four-weekly intervals for a period of one year and blood levels of delta-aminolaevulinic acid dehydratase (ALAD) and gamma-glutamyl transpeptidase (γGT) and fenfluramine were determined. The efficacy of fenfluramine at the two dose levels was compared with placebo on the basis of the number of lapses indicated by the clinical history and also by alterations in the biochemical indices.

Twenty-seven patients completed the period of observation, there being 9 in each of the three groups. Those receiving 120 mg fenfluramine daily showed significantly fewer lapses than either of the other two groups (p < 0.01) on biochemical but not on clinical criteria. Overall assessment revealed that 3 of the 9 patients receiving the high dose of fenfluramine had a good result during the period of the trial, but there were none in the 60 mg group or in those receiving placebo. More extensive trials of fenfluramine in the treatment of chronic alcoholism are indicated.

The epidemiology of attempted suicide among Irish immigrants in Birmingham is described from data concerning 352 (138 male, 214 female) hospital admissions made during the period 1969 to 1972.

Admissions from the Irish Republic and from Northern Ireland were similarly distributed, but were both grossly over-represented. The average annual rate of admission (222 male, 362 female) was probably higher than the rates in Dublin, Belfast and Edinburgh. The female patient rate (286) was greater than that of Edinburgh, but the male rate (143) was not. Fewer Irish than British admissions gave a history of previous attempted suicide or repeated this attempt. Indices of stress among immigrants were, however, greater. The importance of sociocultural factors is discussed.