This paper reports some aspects of a survey made of the training experiences of a group of recently appointed consultants in general psychiatry; it is the third such survey made by the author. The original enquiry was a postal one and asked about the training and education received by all consultants who had been appointed for the first time to a post in general psychiatry, with at least 6 N.H.S. sessions, between 1 October 1963 and 30 September 1969 (R.M.P.A., 1969). A second survey, using a questionnaire much modified from the first, was made of consultants appointed between 1 October 1966 and 30 September 1969, using the same criteria of eligibility as the first group (Brook, 1972, 1973). The present enquiry used a postal questionnaire almost identical to that used for the previous group, which was circulated to consultants in general psychiatry appointed between 1 October 1969 and 30 September 1972.

In a number of previous papers in this series (Roth et al., 1972; Gurney et al., 1972; Kerr et al., 1972; Schapira et al., 1972) evidence was adduced to suggest that depressive illnesses and anxiety states could be clinically differentiated from one another. It was shown also that with the aid of appropriate statistical techniques patients exhibiting these disorders could be separated into two distinct groups with relatively little overlap. The possibility that these findings were due to diagnostic preconceptions or other forms of bias was excluded by the results of follow-up studies conducted over an average period of 3.8 years in which the outcome of the entire patient population was evaluated by independent observers. The clinical picture found was consistent over the period of observation, with little diagnostic interchange between the groups. Moreover, the outcome of the depressions was significantly better than that of the anxiety states, and this provided external and independent validation of the view that the groups initially separated with the aid of clinical observation were indeed distinct from one another.

Despite the monumental follow-up studies of patients with manic-depressive illness by Lundquist (1945), Rennie (1942), Hastings (1958), and more recently, Shobe (1971), the development of the concept of unipolar and bipolar forms of affective disorders with clinical (Brodie and Leff, 1971), genetic (Dunner et al., 1970; Winokur et al., 1969), and biologic differences (Buchsbaum et al., 1971; Cohn et al., 1970), has necessitated a revaluation of the question of outcome in this psychiatric illness. The availability of lithium carbonate for both acute and prophylactic treatment of mania (Schou, 1968; Coppen et al., 1971), and possibly depression (Goodwin et al., 1972), has also increased the clinical importance of the unipolar-bipolar distinction. The purpose of this study is to provide further information regarding the course of bipolar manic-depressive illness by reporting the level of functioning, recurrence of episodes, and quality of life at follow-up assessed in a group of patients formerly hospitalized for mania at the National Institutes of Health.

Steinberg et al. (11) have recently described, in a case report in this Journal, a combination of manic psychosis in the course of and following an influenza infection with high levels of complement fixing (CF) antibody titre, with a view to encouraging further research-work in this direction. Following their suggestions, we should like to describe a similar observation. At the same time, we will take the opportunity to make some critical remarks on the comments made by Steinberg et al. as to the correlation between the specificity of an exogenic noxious agent and a mental reaction, since, in our opinion, it might lead to a certain misunderstanding to talk about a direct or even specific relationship between influenza infection and manic psychosis.

It is generally accepted that in mammalian evolution from rodents to primates, including man, aggressiveness, and more particularly intra-species aggression related to the assertion of dominance in the social hierarchy of the group, is a characteristic of the male (Gray, 1971). There is also an increasing body of evidence which shows that mammalian behaviour patterns are basically female and that male patterns are determined by the action of the sex hormone testosterone on neural structures during critical phases of intra-uterine development (Seymour Levine, 1966). Ounsted and Taylor (1972) have proposed that the X chromosome is sexually neutral, essentially equivalent to an autosome, and that its role in sexual differentiation lies in that it maintains ovarian function in the female. The Y chromosome is sex-determining by causing potential autosomal and X-coded information to become manifest in the phenotype. This is achieved in part by determining the development of foetal testosterone during a critical phase of foetal life. In the absence of testosterone the fundamental female morphology would be established in either sex.

Phenothiazines and other neuroleptic drugs are known to cause extrapyramidal side-effects. Consequently antiparkinsonian (AP) drugs are commonly prescribed at the same time as antipsychotic medication in order to prevent these complications. Once this medication has been started it may be continued for prolonged periods.

The incidence of Trichuris trichiura infestation in the United Kingdom appears to be particularly high in hospitals for the mentally subnormal (Lynch et al., 1972) and amongst immigrant children (Thompson et al., 1972). Whether or not these, mainly light to moderate, infestations are harmful appears to be in doubt, but in view of the recommendations of the WHO Expert Committee (1964), the possibility of spread of the infestation to ward attendants, and the publicity (Western Mail, 1970) which may attend attempts to eliminate the parasite from the environment of a subnormality hospital, treatment is desirable if not obligatory.

Anorexia nervosa is a disorder characterized by loss of appetite, amenorrhoea, and weight loss in the absence of any primary psychiatric or physical illness (Dally and Sargant, 1966). Features which have recently been stated to be of value in distinguishing it from anorexia due to other causes are: denial of illness, bradycardia and lanugo hair (Wright et al., 1969). The weight losses in this condition are usually at least 20 per cent of ideal body weight, depending on the quality and promptness of treatment.

Although some reservations have been expressed about the value of sustained release phenothiazines (Hicks and Ovenstone, 1966; West, 1970), the majority reaction has been favourable. Many authors have emphasized the usefulness of an approach which by-passes a patient's impaired insight as to the need for regular medication (e.g. Capstick, 1968; Lehmann, 1970).

Despite controversy about whether cerebral arteriosclerosis is a valid clinical entity and independent of senile dementia and/or ‘functional’ senile psychoses (Post, 1971), there is a good reason for differentiating it in clinical practice, and its incidence is increasing (Registrar General, 1960).

The incidence and prevalence of transsexualism are difficult to establish, as the syndrome is not sufficiently common to lend itself to the usual methods of epidemiological research.

There have been many studies of the incidence with regard to marital status of admissions to mental hospital. Each has reported the same pattern of highest rates for the divorced, followed by the widowed and single and lowest rates for the married, the pattern being the same for both sexes (Adler, 1953; Brooke, 1963; Dayton, 1940; Frumkin, 1955; Malzberg, 1964; Norris, 1956; Ødegaard, 1946; Stevens, 1969; Thomas and Locke. 1963).

As the staff in a psychiatric adolescent service become more experienced, they invariably develop hunches and hypotheses about the young people referred to them. These ideas, which are essentially clinical in origin, can often be tested if relevant information is systematically collected; previously unsuspected associations may also be found in such a body of data. For these reasons, the Young People's Unit adopted the routine use of a pre-coded assessment form.

Very little research has been conducted on drug-takers in the community. Goode (1970) and Reeves (1973) are notable American and British exceptions. Both used non-random methods to collect information from drug-takers in non-clinical settings. In the present study, carried out in Cheltenham, I used participant observation as a means of approaching drug-takers in their ‘natural’ settings. I employed an anthropological technique called ‘snowballing’. This involved introducing myself to a few drug-takers. These individuals, when satisfied about my identity and intentions, introduced me to their drug-taking friends, who in turn introduced me to the network of other drug-takers whom they knew. During the period August 1970–October 1972, I was able, informally, to observe the life-styles and drug-taking behaviour of a number of drug-taking groups within the community. In addition, I collected statistical information about the biographical characteristics of 200 individuals I encountered. A standardized interview schedule was used which investigated family backgrounds, employment, education, social relationships, delinquency, drug histories, living conditions, ideology and sexual behaviour.

The increasing awareness of the social needs of young patients in a mental hospital where the care of elderly people is the major task started with comments from visiting medical students, and eventually met with a response from hospital personnel and community volunteers.