The medical school at Queen's University offers a 4-year M.D. degree course. Because the majority of graduating students consistently choose family medicine as a career, it was decided that the overall objective of the undergraduate course should be to provide the students with the skills and knowledge required to deal with the psychiatric disorders commonly found in general medical practice. The teaching of psychiatry is limited to the second, third and fourth medical years, and teachers are clinicians rather than nonpractising experts in particular fields related to medicine.

Problems in psychiatric and psychosocial education arise from the absence of agreement on curricular content, failure to emphasize observable skill development, and the ambivalent views on psychosocial material found in modern medicine. The curriculum for medical students presented here emphasizes an integrated approach to teaching psychiatry and psychosocial material. Great emphasis is placed on interviewing and history-taking as well as on problem-solving. Specific courses in development, psychiatry and ageing are prescribed. Preclinical education in psychiatry emphasizes a bio-psycho-social view of mental disorder.

The increasing role of psychiatry in the medical curriculum in Denmark is described. The general schedule of psychiatric teaching to medical students is outlined, emphasizing some of the special features of the Danish tradition. Roughly speaking, six per cent of all curriculum time is devoted to psychiatry. Clinical psychiatry, medical psychology and human sexuality are described separately. Interesting new possibilities for psychiatry in connection with a current curriculum reform, allotting more time to clerkships, elective periods and liaison teaching are pointed out.

I took up my present appointment at St. George's Hospital Medical School in 1967 and found myself with friendly colleagues and a tradition of undergraduate teaching of psychiatry extending back to the immediate post-war period. This tradition had also been expressed in the textbook Psychological Medicine, written and revised over successive years by Guttman, Curran and Partridge, and in more recent years by Peter Storey, currently a senior colleague here. The book is hallmarked by its clarity of expression and the richness of its clinical observation, and has for long been a favourite with both undergraduates and postgraduates.

Psychiatry is one of six major subjects examined in Finals, the others being medicine, surgery, obstetrics and gynaecology, paediatrics and community medicine. One of the main aims of our teaching is to help students to appreciate the importance of psychological factors in the diagnosis and treatment of all illness, and to realise that attention to a patient's psychological adjustment may be important even where physical illness is paramount.

The medical schools of origin were identified in 1229 psychiatrists who qualified in the United Kingdom in the years 1961–75. The group was defined operationally as those who had entered for the preliminary test of the membership examination of the Royal College of Psychiatrists. From 1966–75 only 4 per cent of doctors opted for a career in the specialty. There are wide discrepancies between medical schools in the proportion of their graduates who enter psychiatry. The most likely reasons for this have to do with differences in student selection, the models of psychiatry put forward, the enthusiasm of teachers and the career pull from other specialties, notably general practice. A number of suggestions which might help to improve recruitment to psychiatry are put forward.

Twenty compulsive gamblers were randomly allocated, half to receive aversion-relief therapy and half to receive imaginal desensitization; both groups were followed-up for one year. Compared with those who received aversion-relief, gamblers who received imaginal desensitization reported a significantly greater reduction of gambling urge and behaviour; they also showed a significant reduction in trait anxiety at one year and in state anxiety at one month and one year following treatment. A high level of state anxiety at one month following treatment predicted failure to respond to treatment at one year in the subjects who received imaginal desensitization, but not in those who received aversion-relief. The relationship between reduction in anxiety and in gambling urge in response to imaginal desensitization was predicted from the theory that compulsive gambling is driven by aversive tension.

Seventy-five autistic children, 52 males and 23 females, were admitted to the Iowa Autism Programme over a 3-year period. An overall male-female ratio of 2.26:1 was found, but in the patients with IQs less than 50, the ratio was 1.31:1. When IQ and receptive language functioning were considered together, significantly more females than males showed a more deviant form of autism. Autistic females were more seriously affected than autistic males; and more autistic females than males had IQs of less than 50 and evidence of cerebral dysfunction. However, when autistic males and females were closely matched in chronological age and receptive language functioning, the males and females were equally impaired in cognitive and perceptual-motor abilities. The findings suggest that the overall greater degree of morbidity in autistic females was accounted for by a significantly greater proportion of autistic males affected with a mild form of autism, whereas a significantly greater proportion of autistic females were affected with a more deviant form of autism. The findings were linked to the hypothesis of differential genetic loading in males and females.

The prevalence of psychiatric morbidity (PM) was studied among general hospital out-patients in a rural and in a semi-urban area of Kenya. There were no significant differences in the demographic features of psychiatric patients from the two areas, so the results were pooled: this gave a PM prevalence rate of 29 per cent among 388 patients. Anxiety and depression were the most frequent diagnostic categories. Alcoholism was more common in the rural than in the semi-urban area. There was no sex difference in the prevalence of PM and possible reasons for this, which is in contrast to western findings, are discussed.

Psychiatric symptoms could be readily elicited when present. Patients showing them had been ill longer than non-PM patients.

The study suggests that clinic staff not psychiatrically trained should be able to identify and treat psychiatric morbidity, even when it is presented as somatic illness.

Serum calcium concentration was estimated, via a multichannel analyser, in all patients admitted to a 25 bed psychogeriatric inpatient unit and associated day hospital. Case notes of 629 consecutive admissions over a 42 month period were studied, and the prevalence of hypercalcaemia found to be 0.7 per cent, close to that estimated for the general population. Cases of hypercalcaemia with psychiatric symptoms, undetected medically because of vague and non-specific physical symptoms, do not appear in excess in a psychogeriatric population.

2,3-butanediol appears in the blood of some alcoholics following ethanol ingestion. Whether it be a genetic trait or a phenomenon of induction remains to be determined. It may be associated in some way with depression.

The prevalence of subjective side-effects was studied in 258 control subjects, 65 drug-free depressive in-patients and 94 lithium-treated out-patients. It was shown that drug-free depressives reported more side-effects than both control subjects and lithium-treated patients. Side-effects were studied during amitriptyline therapy. Depressed patients on no medication complained of only slightly fewer side-effects than when they had received amitriptyline. There was a significant positive correlation of Hamilton depression scores and side-effects scores at baseline. Side-effects and affective morbidity over two years were investigated in 94 patients with recurrent affective disorders on long-term lithium therapy. Psychological variables were also investigated in 74 of these patients. Subjective side-effects reported by lithium-treated patients including those specific to lithium were related to their affective morbidity and personality variables. Patients on lithium complained significantly less of headache and unilateral headache than controls.

A study of 20 manic patients, with patient and matched control comparisons, showed a two fold increase in life events during the 4 month period before admission to hospital. Life events, independent of affective illness and having significant objective negative impact (i.e. traumatic) were significantly more common. These findings are considered in relation to social relationships, family history of affective illness and the use of psychotropic medication.

316 psychiatric patients—predominantly out-patients—with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment.

This study compares the diagnostic terminology used for 592 consecutive discharges from a psychiatric unit before and after teaching psychiatric trainees the use of the ICD-9 classificatory system. The results show a marked increase in specificity of diagnostic labels, with a decrease of diagnoses with the term ‘not otherwise specified’, and an increase in the diagnoses of organic psychoses, paranoid and hebephrenic schizophrenia and depressive neurosis. The implications of this for training about diagnosis, clinical practice and recording of data for national statistics are discussed.

At the turn of the century Kraepelin brought together the disparate syndromes of hebephrenia, dementia paranoides, and catatonia under the rubric of dementia praecox. At the same time he crystallized the concept of manic-depressive illness as an entity discrete and separate from the former syndrome. In the years since Kraepelin's classification first came to be adopted, the definitions and descriptions of these two major disorders have undergone many changes. In an attempt to comprehend the meaning and the mechanism of the psychoses, Bleuler was drawn by the emergent theories of psychoanalysis to extend Kraepelin's clinical observations into the realm of psychology. He renamed dementia praecox the schizophrenias, thus emphasizing his idea that the splitting of associative processes was a fundamental feature of the syndrome; and he added the subcategory of simple schizophrenia. American psychiatry, dominated until recently by psychoanalytic concepts, has been influenced more by Bleulerian than Kraepelinian contributions. However, it has not restricted itself to Bleulerian notions. As Kety (1980) remarked in his Maudsley Lecture, great liberties have been taken with the syndrome of schizophrenia; the essential features have been altered, primarily by an expansion of its boundaries.

The shortcomings of the DSM-II classification of organic brain syndrome are described, including the limitation of the concept to the global brain disorders; the idiosyncratic use of the terms acute and chronic; and the unsatisfactory categories psychotic and nonpsychotic. Organic brain syndrome is defined according to DSM-III and the 10 separate brain syndrome categories are outlined. The diagnostic criteria for each category are listed and the general principles underlying the criteria are described. Finally, the goals of the authors' of DSM-III to enhance diagnostic reliability and validity are discussed and the impact of the new nomenclature is assessed.