The radioreceptor assay for the measurement of neuroleptic drugs in serum has been used to study the relationship between dose and serum level in schizophrenic patients receiving these drugs. The assay was found to be reproducible and capable of detecting neuroleptics in the sera of patients receiving a range of both oral and depot drugs, with the exception of trifluoperazine spansules. Linear correlations were obtained between daily dose and serum level for each drug both in individual patients on different doses and between patients on a stable dose. Extrapyramidal side effects were related to the serum neuroleptic level within, but not between, patients. The assay may be of use in clinical practice, including the assessment of compliance or poor response to neuroleptics.

The dexamethasone suppression test (DST) has been widely used in psychiatry as a laboratory aid for the diagnosis of endogenous depression; failure to suppress serum cortisol levels is interpreted as confirming a clinical diagnosis of endogenous depression. We found that serum dexamethasone concentrations in this test vary widely and are determinants of the DST response: non-suppression of serum cortisol levels is associated with low serum dexamethasone concentrations, and suppression is associated with high concentrations.

A psychometric study on Swedish and Dutch samples used the EMBU, a self-report instrument designed to assess memories of parents' rearing behaviour. Of the four primary factors identified previously with Dutch individuals (Rejection, Emotional Warmth, Over-protection, and Favouring Subject), the first three were retrieved in a similar form in the two Swedish groups (depressives and healthy, non-patients). Examination of the metric equivalence of the scales and the strength of the factors for each group indicated that comparisons of patterns and levels between groups from the respective countries on the three factors showing cross-national constancy would be warranted. Scale-level factor analyses of these dimensions produced identical two-factor compositions (CARE and PROTECTION) across national groups which further supported this conclusion.

In a study of cases of recent onset of schizophrenia, schizophreniform psychosis and hypomania (DSM-III criteria), threatening life events were significantly related to the onset of schizophreniform psychosis but not schizophrenia. The results also suggest that threatening events may precipitate hypomanic episodes.

The interrelationships of ‘blues' and later postpartum depression with a number of biochemical, medical, and psychosocial variables have been examined in 52 subjects. The two syndromes shared only an impressive association with a prior history of gynaecological problems. Puerperal ‘blues' was characterised in addition by associations with primiparity, tearfulness during pregnancy, and reduced plasma total tryptophan in the early Puerperium. Depressive symptomatology up to nine months postpartum was related to an excess of male births and to an altered pattern of decline of non-esterified fatty acids immediately postpartum. In each case, the ‘risk’ variables were statistically independent and combined linearly. Stepwise discriminant analysis successfully discriminated ‘blues' and depression from their respective non-cases. ‘Blues and postpartum depression were only weakly related and, apart from gynaecological history, each was associated with separate and independent causative factors.

The twin register of the Maudsley Hospital was used to select a series of monozygotic (MZ) and same-sexed dizygotic (DZ) twins who had been given an ICD8 diagnosis related to alcoholism. They and their co-twins were traced. Medical and drinking histories were compiled (from records and by interview) for 56 twin-pairs, to permit current and retrospective diagnosis of any neurotic disorders. RDC diagnoses of panic disorder generalised anxiety disorder, obsessive–compulsive disorder and phobias were more common in the alcoholic probands and the co-twins who were also alcoholics than in the normal-drinking co-twins. The Eysenck Personality Questionnaire (EPQ) and the Severity of Alcohol Dependence Questionnaire (SADQ) were completed by 54 individuals. Neuroticism scores were significantly higher for both male and female alcoholics than for their normal-drinking co-twins; and intra-pair differences in neuroticism were significantly correlated with intra-pair differences in severity of dependence. These results suggest that both clinically diagnosed neurotic illness and high neuroticism scores are more often a consequence than a cause of alcoholism.

Psychological and social difficulties are common amongst both medical and surgical patients, but psychiatrists are able to see only a very small proportion, and though hospital doctors have the main responsibility for psychological treatment, very little is known of what they actually do. Physicians and surgeons in Oxford answered a questionnaire on their attitudes and clinical practice: virtually all believed that emotional care is important, but what they do and what they would like to do in the assessment, treatment, and referral of their patients varied widely. There were associations with the extent of responsibility for chronic care, speciality, and seniority.

We ascertained the one-year prevalence of schizophrenia amongst individuals aged 15 years or older living in six villages in a remote area of Botswana. All cases were diagnosed independently by two experienced psychiatrists, following ICD9 rubrics. DSM-III criteria were also applied, separately. Accurate contemporary population estimates of the villages were available. The age-adjusted prevalence of schizophrenia was 5⋅3 per 1000 in terms of ICD9, or 4.3 per 1000 by DSM-III, which has an upper age limit for onset of 45 years. These figures are well within the range generally reported for industrial communities. Remote village life in Botswana appears to offer no protection against the development of schizophrenia.

In 1965 a psychiatric in-patient population was surveyed for the prevalence of facial dyskinesia. The present investigation reports on their survival time. Among male and female patients with functional disorders (mostly schizophrenia) there was a strong association between moderate or severe facial dyskinesia and shortened survival, but no clinical factors were found to explain this. Mild facial dyskinesia in functional disorders was not associated with reduced life expectancy and may be attributable to the general effects of ageing rather than to a specific pathological process. Among patients with primary organic brain syndromes, dyskinesia was not associated with reduced life expectancy.

The diagnostic importance of vegetative symptoms for melancholia was examined through DSM-III, the Newcastle Scale, and Extracted Criteria for melancholia. Statistically significant differences were diagnostically unimpressive in the case of DSM-III and the Newcastle criteria. With the Extracted Criteria, initial insomnia, early waking, anorexia, weight loss, loss of libido, and worsened mood in the morning were all significantly more common in melancholia than in non-melancholic depression, while increased appetite was more common in non-melancholia. Only diurnal variation of mood (worse in the morning) showed predictive value for melancholia; whereas the other traditional vegetative symptoms (disturbed sleep, weight, and libido) did not. Increased appetite and diurnal variation of mood (worse in the evening) were predictive for non-melancholia.

An impairment in lymphocyte response to mitogen stimulation, a correlate of cell-mediated immunity, has been reported in patients with depressive illness. To investigate whether such impairment in lymphocyte function is related to excessive secretion of cortisol, an immunosuppressive hormone, we compared mitogen-induced lymphocyte proliferation in three groups of subjects: (1) depressed patients with elevated 24-hour urinary free Cortisol (UFC) excretion; (2) depressed patients with normal UFC excretion; and (3) normal controls. Depressed patients in both groups showed significant reductions in lymphocyte mitogenic activity, in comparison with the normal controls, but the two depressive groups did not significantly differ from each other in their lymphocytic responses to any of the mitogens used. Furthermore, no significant correlations were found, within depressed patients, between UFC excretion and lymphocyte mitogenic responses. Depression is therefore associated with an impairment in lymphocyte function that cannot be explained solely on the basis of increased cortisol secretion.

A total of 576 women aged 18–65, drawn from an area in Edinburgh, were interviewed. Data on life events and long-term difficulties over a six-month period prior to interview were gathered and classified according to area of life, the Bedford system, the Edinburgh system, and the independence of the event or difficulty from the subject's own actions. The highest rates of Bedford system ‘provoking’ situations were found in the working class, among those not employed, among women with three or more children under 14, and in the separated, divorced, widowed or cohabitating group. Similar findings emerged for hopeless situations involving choice or loss. Dependent situations were four times more common in the youngest group than the oldest, and showed a high rate among those divorced, separated, widowed, or cohabiting. It is suggested that both dependent and independent life situations should be studied.

A double-blind control trial of gluten-free versus a gluten-containing diet was carried out in a ward of maximum security hospital: 24 patients were studied for 14 weeks. Most suffered from psychotic disorders, particularly schizophrenia. Various dimensions of behaviour were rated on the Psychotic In-Patient profile (PIP) at different stages. There were beneficial changes in the whole group of patients between pre-trial and gluten-free period in five dimensions of the PIP, maintained during the gluten challenge period; these changes could be attributed to the attention the patients received. Two patients improved during the gluten-free period and relapsed when the gluten diet was reintroduced.

We used multiple regression analysis to modify and shorten two scales for measuring practitioners' attitudes to psychotherapy and drug therapy. The resulting scales have been combined in a 21-item questionnaire (Treatment Attitudes in Psychiatry Scales (TAPS)) which is brief and easy to use, and should have wide application in psychiatry. The results of a concurrent validation of the scales, using two large groups of consultant psychiatrists who were members of either the Biological Psychiatry or Psychotherapy Section of the Royal College of Psychiatrists, show the extent to which their attitudes to psychotherapy or drug therapy tend to overlap. Polarisation of attitudes was more evident in the results from the Biological Psychiatry Section. A method is described by which scores obtained with the TAPS can readily be compared with those obtained by the criterion groups.

Lateral ventricular size, as assessed by computed tomography, was not significantly greater in manic-depressive cases than in neurotic patients, but 19% of manic-depressive cases had ventricular brain ratios (VBR) more than two standard deviations above the neurotic mean. Few correlates of VBR were found in the features of the illness and the treatment given, apart from the fact that in the outpatient sample, there was a significant association between increased VBR and hypothyroidism. Hypothyroidism was relatively common in this sample, but was treated and not associated with cognitive impairment. There was no relationship between lithium administration and VBR.

Of 25 primiparous women, investigated prospectively for six months post-partum, 19 persisted with breast feeding and six changed to artificial during the first six weeks. Sexual activity, mood, and feeding patterns were recorded in weekly diaries. Hormones were measured from weekly urine samples (oestrogen and pregnanediol) and fortnightly blood samples (prolactin, testosterone, androstenedione, and sex hormone binding globulin). In breast-feeding women, testosterone and androstenedione levels were significantly lower in those who reported severe reduction in sexual interest. Changes in sexuality or mood were not related to levels of prolactin or oestrogen, or to the return of follicular activity, which was delayed in persistent breast feeders. The relationships of mood, sexuality, and hormones are discussed.

Fifty-three urban general practitioners were questioned about alcoholism. They mostly had reasonably good, if sometimes muddled knowledge of the condition, when to suspect it, and how to confirm its presence. Social harms were seen as predominant over somatic ones. The majority had had postgraduate instruction supplemented by reading. Most were prepared to treat alcoholics, and revealed tolerant and sympathetic attitudes towards them and their families. The survey negates the general impression of unwillingness by general practitioners to engage with alcoholism.

The clinical, psychometric, and computed tomographic (CT) status of previously fit elderly volunteers is described at follow-up for up to four years. A number of relationships were found between psychometric and CT scores, but a dementing group could not be determined on the basis of a single scan. However, a subtle reduction in cognition over time was significantly related to CT changes, and occurred in 10%. Larger ventricles were also found in a small sub-group, who developed late-onset depressive disorders; recent bereavement was related to ventricular size. Thus a single CT scan may not be a useful discriminatory test in early dementia, but a repeat demonstrating ventricular enlargement, is likely to be significant. In the elderly, cognitive and CT scan deterioration should not be expected unless a disease process is occurring; this may be indicated by subtle cognitive impairment or by late-onset depressive disorder.

The terms positive and negative symptoms have slipped into the language of contemporary psychiatry with comparative ease. It is not uncommon for these expressions to be used with little explanation, both at meeting and in written communications, with the implicit understanding that their meaning is understood and that somehow they are of value to our knowledge of psychopathology. However, that there are no clear guide-lines at present for our use of these terms is shown from a recent survey of psychiatrists' opinions from a market research company (Martin Hamblin Research-Personal Communication). As part of a series of questions asked to many psychiatrists of differing age, geographical location, and status, they were asked about the meaning of these terms, positive and negative symptoms and the proportion of schizophrenic patients having them. Of the categories quoted by Crow (1980–81) as positive symptoms, 68% considered that delusions were positive symptoms, 63% hallucinations, and only 35% thought disorder. In contrast, 18% thought that behaviour disturbance was a positive symptom, a similar figure (15%) being given for passivity feelings. Considerable variation was noted, however, with hallucinations being considered positive by only 33% of London psychiatrists, thought disorder by only 11% of those qualified 16–25 years, and one-quarter of all registrars and psychiatrists from Midland Health Districts considered passivity feelings to fall into this category. Even greater disagreement was recorded for negative symptoms. Thus, the symptom most often associated with this category was apathy, by 52% of respondents. Only 26% considered that withdrawal was a negative symptom, the percentage data for lack of motivation and blunting of affect being 37% and 15% respectively.