A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.

During a nine-month period (1974–75), 1,050 students (846 male, 204 female) at Ain Shams University, Cairo, attended the Student Health Centre. Fifty-two per cent were referred there by their general practitioners, 5 per cent by their families and 3 per cent through their faculties; the remainder (41 per cent) were self-referred.

Male patients represented 2·8 per cent of the male students, but female patients only 0·9 per cent of the female students. In faculties dealing with practical subjects the male-female ratio was higher than in those dealing with more theoretical subjects. The diagnoses included anxiety neurosis (36 per cent of the cases), schizophrenia (18 per cent), depression (15 per cent) and neurotic depression (12 per cent).

The survey of 140 children under 16 in two subnormality hospitals showed that 3 per cent of the children had definitely been rendered mentally handicapped as a consequence of violent abuse, and that a possible maximum total of 11 per cent might have been thus rendered mentally handicapped. In 24 per cent of the children, neglect was considered to be a contributory factor in reducing intellectual potential.

Impairment of intellect from abuse and neglect, especially in those with ‘vulnerable’ brains due to pre-existing abnormality, may be much commoner in children than is generally realized.

In an investigation of the relation between life events (stressors) and illness, 87 medical students reported on a prospective basis their health and life events history over a three year period. There were a few positive findings, e.g. that subjects who reported more life events during the period also reported more illnesses during that period. Overall, however, the study showed a lack of statistically significant association between life events and illness.

A survey of 1,811 mentally handicapped males in eighteen hospitals is described. Males discovered with supernumerary Y chromosomes numbered 15, of whom 12 were 47,XYY. Some of the physical, social, psychological and psychiatric findings are described and compared with groups matched for IQ and height.

The main psychiatric findings are diminished intelligence, retardation in development of secondary sexual characteristics, and poor emotional control leading to inadequate social adaptive patterns which are described and discussed.

A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

A Special Committee of the College was appointed in May 1976 after the President had received a request from Dr Porter, the Regional Medical Officer of the SE Thames Regional Health Authority, for the College's advice on the problems of administration of ECT, especially when consent is withheld or given reluctantly. Although the Regional Authority had been concerned earlier with the problem, the situation which prompted further action was the publication in March of the Report of the Inquiry on St Augustine's Hospital, pages 63–71 of which dealt with the administration of ECT and recommended that the College ‘should give urgent consideration to these problems and issue clear guidance’.

The possible ill-effects of cannabis on the peripheral nervous system were examined in 27 male subjects with respect to their motor and sensory nerve conduction. They were classified by their previous cannabis use into casual and heavy users. The nerve conduction studies were done after a baseline period of five days and then repeated after a three-week period during which the subjects could acquire and smoke standardized cannabis cigarettes. The casual users smoked a mean of 54·3 and the heavy users a mean of 109·5, cigarettes during the smoking period. No deterioration of peripheral nerve function could be demonstrated.

Forty-six mentally ill women with radiologically verified hyperostosis frontalis interna (HFI) were compared with 46 matched mentally ill women without HFI in respect of mental morbidity among the full siblings of the two groups. It was found that mental morbidity was lower among the siblings of mentally ill women with HFI than among those of similar mentally ill women without HFI. A reasonable interpretation of these findings is that the combination mental illness-HFI is more often exogenously determined than other forms of mental illness.

During a study of drug incidents dealt with in one month by 62 casualty departments in Greater London, 395 drug-dependent individuals were identified. The great majority of these patients were seen in hospital following an overdose, and barbiturates were the drugs used most frequently. A high incidence of multi-drug use was noted, and many individuals had obtained their drugs from an illicit source. A history of repeated overdosing was common, and one fifth of the patients behaved aggressively while they were in casualty. The implications of these findings are discussed, with particular reference to the demands that are made on casualty departments by drug-dependent individuals.

A computer-administered ‘interview’ was developed for eliciting evidence relating to alcohol problems. Thirty-six volunteer male patients on their first visits to a specialist alcohol clinic were interviewed three times, by two psychiatrists and by the computer; information was sought about 72 predefined indicants concerning alcohol consumption, drinking behaviour, and symptoms. Each patient was asked to complete an attitude questionnaire anonymously.

The extent of agreement between the evidence elicited by the computer and by the psychiatrists was quite high, and their estimated error rates were very similar, all between 10 per cent and 12 per cent in total. With respects to amounts of alcohol consumed, patients reported significantly greater amounts to the computer than they reported to the psychiatrists. The median amounts of pure ethanol consumed ranged from 1 · 19 kg per week calculated from reports made to one of the psychiatrists, up to 1 · 58 kg per week calculated from reports made to the computer. The results from the attitude questionnaire indicated a high level of acceptability to patients of computer interrogation.

The mode of inheritance of affective psychoses was studied in 800 first degree and 582 second degree relatives of 122 probands. Morbidity risk for unipolar depression was 12·0±3·2 and 11·4±2·7 per cent respectively for parents and siblings of probands suffering from unipolar depression. Morbidity risk for manic-depressive psychosis for the respective groups of first degree relatives of manic-depressive probands was 15·1±3·2 and 16·9±3·2 per cent. In second degree relatives the morbidity risk was 3·4±1·0 and 5·3±1·4 per cent for unipolar depression and manic-depressive psychosis respectively.

The results indicate the role of genetical factors in the etiology of both types of affective disorder and show that unipolar depression and manic-depressive psychosis are distinct entities. The hypothesis of X-linked dominant transmission was not confirmed in either of these affective disorders. By means of the computational model of Slater, no results compatible with a polygenic inheritance of unipolar depression or manic-depressive psychosis were found.

During a ten year study, 10 per cent of patients at a general hospital in-patient unit had unsolved diagnostic problems at the time of discharge from hospital. These 132 cases were designated ‘uncertain’ and were followed up. Eighty-three patients were ultimately diagnosed, and 300 consecutive in-patients discharged from the same unit with a definite diagnosis were also studied. The clinical features and diagnoses of the two groups were compared. Special features associated with uncertainty were: a presenting complaint of pain; apathy without apparent mental or physical cause; hallucinosis or major paranoid symptoms without other good evidence of psychosis. Age was found to be relevant; compared with patients receiving confident diagnoses, those with uncertain diagnosis due to depressive psychosis were more often younger, while those due to neurosis or personality disorder tended to be older. Atypical psychotic depression was the condition most commonly associated with diagnostic doubt.

A case of multiple personality is presented and described. Psychological and neurophysiological parameters obtained on the personalities are evaluated. Major differences between the personalities in the processing of sensory information (augmenting-reducing parameter) are discussed.

Historically, in mediaeval times, the epoch of childhood was less clearly defined. If babyhood was survived, all but the most favoured children became little adults and a convenient source of labour. Instances of the barbarous treatment of children, infanticide, exploitation, starvation, flogging and mutilation, abound (Mause, 1976) and until comparatively recently these seemed to have caused little public reaction.

Fifty-one out-patients with social skills deficits (two-thirds men) completed ten weekly sessions of 75-minute group treatment; 44 were followed up for a mean of 16 months. Random assignment was to one of three conditions: (1) Cohesive group discussion; (2) Modelling and role-rehearsal; or (3) Modelling and role-rehearsal+daily social homework.

All three treatment conditions produced significant but incomplete improvement at the end of treatment and follow-up. The two role-rehearsal conditions were significantly superior to group discussion on several measures. Patients who completed daily social homework assignments did significantly better than patients who completed control homework. Alcohol and drug abuse patients usually dropped out. Schizophrenic patients in remission had lost their improvement at follow-up. Patients with other diagnoses retained their gains to 16-month follow-up.

A double-blind clinical trial of phenelzine and diazepam against placebo and diazepam in neurotic patients over a four-week period showed phenelzine to be superior to placebo on three rating scales in some groups of patients who completed the trial. The findings suggest that phenelzine may exert a beneficial effect on some as yet undefined features of anxiety and depression which were not revealed by a multiple regression analysis of clinical symptomatology or premorbid personality.

An 18-month controlled experiment was conducted into the effects of a token economy programme on the ward behaviour and symptoms of chronic schizophrenic patients. An experimental group received tokens dependent upon appropriate behaviour, while a matched control group on the same ward received every aspect of the ward programme similarly except that tokens were not dependent upon their behaviour. Regular assessment showed that both groups improved substantially in social withdrawal. Over twelve months of treatment the experimental group improved no more than the control group. There were no symptomatic changes. The conclusions were that token economy is a treatment affecting withdrawal and social behaviour rather than symptomatology, and that factors other than reinforcement by tokens were responsible for the main changes.

Seven frequently-occurring, more or less stereotyped, adolescent presentations are described to illustrate the relevance of a specific clinical framework for adolescent disorder. This recognizes the maturational background in adolescence, the family involvement in this process and the various factors that can affect it. Disorder is viewed in terms of inappropriate identity choice at this time, a state of maturational deadlock, and can be categorized according to the types and severity of the maladaptive responses. Treatment, capitalizing on the adolescent's state of change and flux, concentrates on more adaptive future identity formation, and can be most rewarding. Orthodox assessment procedures, as used with adult patients, stand the risk of reinforcing a dependent ‘psychiatric patient’ identity.