This investigation was concerned with the description, treatment, and follow-up of a group of patients selected by age (18–55 years), diagnosis (psychotic), and the presence of work problems (unemployed for more than 12 months). The patients were of below average intelligence, and substantial numbers were characterized by low drive to return to work, unrealistic attitudes, a lack of self-confidence, and adverse attitudes towards the existence and extent of handicap. An evaluative and experimental study subsequently indicated that a rehabilitation programme was unsuccessful in changing attitudes and returning patients to industrial roles in the community. Aspects of outcome such as work status were predicted by earlier assessments of motivation, self-confidence, and patients' view of the presence and extent of handicap; outcome was not predicted by the initial assessments of work level, length of unemployment, intellectual level, and the realism of attitudes.

In 1960, the National Institute of Mental Health of the U.S.A. provided research support to Professor H. O. Schild of the Department of Pharmacology, University College London (U.C.L.) and to Dr. (now Professor) Michael Shepherd of the Department of Psychiatry, Institute of Psychiatry, University of London, for studies in human psychopharmacology. The research assistants initially employed were Dr. Lorna Wing, Dr. J. D. Montagu, and Dr. Malcolm Lader and work was carried out at U.C.L., the Institute of Psychiatry, and Runwell Hospital, Essex. In 1966, the Medical Research Council assumed responsibility by appointing Dr. Lader to their External Scientific Staff. Other support has come from the Bethlem Research Fund and from the pharmaceutical industry, in particular Roche (U.K.) Ltd. and May and Baker, Ltd. A group of six to eight workers has thus been built up based mainly in the Institute of Psychiatry but with continuing links to U.C.L. At present our team comprises pharmacologists, psychiatrists, psychologists, a physiologist, a chemist, and a mathematician. Several workers from abroad on British Council or Commonwealth Fellowships have been attached to the team at various times, and students for higher degrees such as PhD and MD have been welcomed.

The difficulties of developing a classification of the non-psychotic disorders of early childhood are discussed. A cluster analysis technique is described for determining whether the pattern of behavioural items in 3 year olds could be used as a basis for such a classification. Among the clusters found were two suggesting conduct and neurotic disorders. Two pieces of evidence suggest that the clusters produced are clinically meaningful and have prognostic significance: (1) a group of children with a high risk for later psychiatrie disorder (children in local authority care) are over-represented in the ‘pathological’ clusters, and (2) the mothers of the children in these latter ‘clusters’ have significantly higher scores than mothers of children in the remaining clusters on an index of mental health one year later. It is suggested that evidence for the psychiatrie syndromes of early life is sufficiently strong to warrant further investigation.

A method is described for comparing the speed of recall of pleasant and unpleasant experiences. Pleasant experiences have proved to be recalled significantly more quickly than unpleasant experiences in healthy volunteer subjects, and especially in those scoring low on neuroticism or high on extraversion as measured by the Eysenck Personality Inventory. The overall pleasant/unpleasant differential was found to persist on re-testing some months later with an alternative form of the test. The technique appears to be a valid and simple means for exploring hedonic selectivity in memory.

Five emaciated patients suffering from anorexia nervosa were studied. Mean plasma prolactin levels, as measured by radioimmunoassay, were within the normal range, although mean plasma levels of luteinizing hormone were depressed. This association is of interest as it suggests that basal levels of circulating prolactin are not affected by the hypothalamic disorder found in patients with anorexia nervosa.

A structured interview was developed to assess the drive, realism, self-confidence, and self-rated disablement of psychiatric patients in relation to work. The clinical and research value of the interview was demonstrated by (1) studies of rater consistency, temporal stability, and parallel form reliability, and (2) by an investigation of its predictive validity.

The incidence of past school phobia was surveyed by questionnaire in 786 women under 60 years of age who were members of an agoraphobia correspondence club. Twenty-two per cent admitted to previous school phobia, a proportion similar to that found in 57 non-agoraphobic neurotic controls. Past school phobia predicted an earlier onset of subsequent agoraphobia and a more severe psychiatric state as far as symptoms not specifically agoraphobic were concerned. Adolescent agoraphobic difficulties were more associated with school phobia than with agoraphobia in adult life. It was concluded that school phobia leads to agoraphobia in only a small proportion of cases. Although school phobia may predispose to later agoraphobia, it seems more likely that both conditions reflect a lasting tendency to neurotic illness.

Plasma tryptophan concentrations were determined in serial blood samples from a short cycle (two to three day) manic-depressive patient and four manic-depressive patients with longer (60 day) affective cycles. Tryptophan levels varied significantly with affective state in the short cycle patient and one of the longer cycle patients. Correlation in the short cycle patient was better with blood samples taken at 3 p.m. than at 9 a.m.

A comparison is made between two forms of treatment for patients with interpersonal difficulties—one, an established treatment in the form of brief psychotherapy, and the other, social skills training, a form of behaviour modification designed to provide or improve the social skills necessary for successful social interaction. In a pilot study using social skills training, six out of seven patients showed marked clinical and social improvement. In the controlled trial, there was evidence that both types of treatment improved behaviour, but that social skills training tended to maintain its effect for longer, even though psychotherapy patients had more than twice the number of therapy hours.

Plasma amitriptyline and nortriptyline concentrations were measured in a group of five adult subjects who each received two different dosage regimes of amitriptyline (Tryptizol) for 14 day periods—namely, 25 mg three times daily and 75 mg once nightly. Mean steady-state plasma concentrations during the two dosage regimes were in close accord. The daily variation in drugplasma concentrations were only minimal during the thrice daily dosage regime but during the once nightly dosage regime there was an average decline in total drug plasma concentrations (amitriptyline plus nortriptyline) of about 30%. It was concluded that antidepressant medication with amitriptyline using a single nightly dose schedule might be more reliably taken by patients without there being any significant reduction in therapeutic efficacy.

Depressives and matched first admission schizophrenics were compared with respect to life events experienced in the six months before the onset of illness. Depressives reported more events than schizophrenics, but this excess involved only certain types of events. Depressives reported more exits from the social field, and a variety of undesirable events, particularly those involving interpersonal arguments. They reported no more events in some other classes. These findings support previous work involving life events, particularly exits and undesirable events in the genesis of depression, and indicate that qualitative implications of events influence their effects.

This paper reports the relationship between mood, as measured by the Visual Analogue Mood Scale, and digit-symbol performance within individual hospitalized patients in a consecutive series of admissions with functional psychiatric disorders. It confirms the earlier finding of Folstein and Luria that a significant mood-digit-symbol relationship distinguishes clear cases of affective psychoses from clear non-affective disorders. Furthermore, it shows that, among patients who do not present with classical affective syndromes, those who manifest a significant mood-digit-symbol relationship tend to receive specific treatments for mood disturbances, have a positive family history of depression or mania, and improve significantly at discharge.