It is ironic but not unexpected that, at a time when psychiatry is moving out of isolation and into closer proximity with other disciplines in general hospitals, the relationship of psychiatry with medicine should be called into question. The anti-medical critique of psychiatry represents one approach within a wider movement which has assumed international proportions and adopts a critical or derogatory stance towards psychiatry's methods, aims and social role; it is anti-medical, anti-therapeutic, anti-institutional, and anti-scientific, either by expressed aim or implicitly through the dogmatic, hortatory, diffuse and inconsistent character of its utterances.

Weight change and sleep disturbance are well documented features of psychiatric illness. Complaint about difficulty in getting off to sleep is a common feature of neurotic illness, especially anxiety states. Early morning waking has for many years been regarded by some as a clinical feature—almost a diagnostic pointer—for ‘endogenous depression‘. Motor restlessness is also commonly described as a feature of this disorder. However, other clinicians have concluded that such depressive illness is merely one end of the spectrum of the depressive response. In particular, McGhie (1966) has shown that sleep disturbances of all kinds, as reported by the patients themselves, may occur in a variety of psychiatric illnesses. For instance he found that early morning waking was reported in 16 per cent of non-depressed psychiatric patients as distinct from 17 per cent of patients presenting with depression. Moreover, Hinton (1963) has shown that early morning waking when carefully measured does not specifically characterize those types of depressive illness described by others as ‘endogenous', but that it can occur in all types of depressive illness. He also reported his observation that sleep disturbance amongst depressed patients is mostly related to the phenomenon of agitation. Agitated patients lost more sleep, most apparent in the latter part of the night. On the other hand Carney et al. (1965), in their study of over 100 patients with depression, found that certain symptoms clustered into two groups reflecting the usual concepts of ‘endogenous' and ‘neurotic’ depression respectively. Early morning waking and weight loss were important characteristics of their group of patients designated ‘endogenous' depression, and were regarded as important indicators for them of the value of ECT. There was a positive inter-symptom correlation of 0.234 between weight loss (7 lb.+) and early waking. Most studies do not suggest a causal link between weight change and sleep disturbance, but by inference regard these features as being more integral aspects of an underlying biological factor which also promotes the disturbed mood.

The first three cases of tardive dyskinesia were described in a brief communication by Schonecker (1957), and in the following ten years some 600 new cases were reported in 37 papers. Since the literature up to 1967 has been reviewed by Ayd (1967a) and myself (1968a), this communication will deal mainly with the publications of the last five years. I will also report a few personal observations of the last two years, hitherto unpublished.

It is a common clinical observation that schizophrenic subjects often exhibit abnormalities of verbal behaviour in both the spoken and the written modes. Such abnormalities may range from minor idiosyncrasy to gross linguistic deviance. Where the linguistic deviance is very obvious, this of itself may carry considerable diagnostic weight in the overall schizophrenic symptomatology. In general, two main questions have been asked concerning this phenomenon: (a) why do schizophrenics produce abnormal language?; (b) what precisely is the linguistic characteristic of the abnormality? For mainly historical reasons it has been the first question which until relatively recently has received the most attention. The past twenty years or so have seen a remarkable advance in linguistics and its vigorous hybrid, psycholinguistics, without which present attempts to analyse and quantify language deviance would have been impossible. All of this is relevant to question (b). Since the beginning of this century, however, psychodynamic models and theories have afforded sufficient frameworks for speculation over question (a).

It has been demonstrated that experience with alcohol leads to a decrease in its behavioural effects (Jellinek, 1960). There is also evidence that personality factors affect tolerance for alcohol; for example, psychological adjustment (Vogel, 1958), extraversion (Drew, Colquhoun and Long, 1958) and field dependence (Smith and Carpenter, 1966) have been reported to be associated with alcohol effects.

Intravenous diazepam is widely used both in general medicine and in psychiatry. It is used to produce sedation in psychiatric emergencies and to enhance systematic desensitization; it is also employed in the treatment of drug-induced dystonic reactions, status epilepticus and tetanus, and as an anaesthetic agent. Its property of relieving severe muscle spasm has been utilized to treat patients suffering from ‘stiff-man syndrome‘.

Mild alterations in serum magnesium are said to be symptomless (D. N. S. Kerr in Cecil and Loeb, 1971). Cade (1964) reported high levels in depression but Frizel et al. (1969) found low values restored to normal with clinical recovery. Raised serum magnesium concentrations have been reported in manic patients (Nielson, 1964; Goodwin, Murphy and Bunney, 1968) and schizophrenics (Cade, 1964). These results suggested that serum magnesium had predictive value in the treatment of psychiatric patients, so we estimated pre- and post-treatment serum magnesium concentrations in a number of patients and investigated their relationships with diagnosis and clinical course.

Transitory depression and tearfulness occurring on one or two days during the early Puerperium (commonly known as ‘mother's' or ‘maternity blues', ‘third, fourth, or tenth-day blues', or ‘the transitory syndrome’) is often mentioned as a normal finding after from 15 per cent (Oppenheim, 1962) to nearly 80 per cent (Robin, 1962) of deliveries. Physical discomfort and psychological difficulty at the onset of lactation, ‘narcissistic loss' before discovery of the child (Sclare, 1955), perineal soreness and hormonal changes (Railton, 1961) have all been invoked as causes.

In Autumn, 1971, the Director of the Office of Health Economics stated that ‘the majority of the population regard homosexuality as an abnormality justifying medical treatment‘.

Much has been said and written about the logical status of diagnoses; their reliability and validity have often been measured and questioned; and several mathematical models of the diagnostic process have been developed for use in computers. But surprisingly little interest has been taken in the practical aspects of diagnosis as a decision-making process. A large and undistinguished literature on ‘psycho-diagnostics' was generated by clinical psychologists in the 1950s, but this was largely concerned with diagnoses derived from cognitive and projective test results and so has little relevance to diagnosis by the traditional medical method of asking the patient about his symptoms. More recently a few people, like Gauron and Dickinson in Iowa and Sandifer in North Carolina, have studied the diagnostic activity of psychiatrists in specially designed experimental situations, and their findings have been both interesting and instructive. But we are still uncertain at what stage in a diagnostic interview a provisional diagnosis is usually arrived at, or how often this initial impression is correct, or is changed later on. Nor do we know the relative importance of the patient's behaviour and the factual information he provides in reply to questions, or what differences exist between psychiatrists in the means by which they reach a diagnosis, or in the speed and confidence with which they do so. The studies described here were designed with the aim of shedding some light on these matters.

Various inevitably indirect attempts to quantify mood states have recently been reviewed by Aitken and Zealley (1970). In the present study, the results of administering two depression rating scales to the same group of patients were compared and their usefulness appraised.

The use of a token-economy system to condition ward-wide behaviours in psychiatric in-patients, is gaining acceptance as a definite therapeutic modality (Franks, 1969).

Because of the empirical nature of the treatment procedure, many investigators have sought predictors of clinical response to ECT (Abrams, 1972). Three studies (Hobson, 1953; Carney et al., 1965; and Mendels, 1967) provide well-defined methods for calculating an index for prediction of response to ECT. Each assigns individual weights to specific features of the clinical state and the history of the illness, as determined during a pre-treatment interview. The predictive accuracy reported for these indices ranges from 79–87 per cent. Three attempts have been made to replicate Hobson's (1953) results—two were successful (Roberts, 1959; and Mendels, 1965), and one was not (Hamilton and White, 1960). We have found no reports attempting to test the prognostic accuracy of the indices of Carney et al. (1965) or Mendels (1967).

It is generally accepted that psychological factors are of importance in determining the effects of drugs—beneficial or adverse (Green, 1964; Wilson, 1966; Boszormenyi, 1969). Placebo studies have suggested that one such psychological factor may be prior knowledge of side-effects (Wolf, 1950; M.R.C., 1950; Coleman, 1969). In a controlled trial of amitriptyline in general practice (Blashki et al., 1971) the patients were asked to record their experience of side-effects on a prepared list, and it was thought that this might have ‘involved the risk of suggesting side-effects to the patients'. In a controlled trial of Imipramine in general practice (Porter, 1970) the data suggested that side-effects were an important cause for patients abandoning treatment. Doctors may be chary of detailing side-effects, thinking that imparting such knowledge to patients may in a proportion of them induce the side-effects to appear and lead to discontinuance of therapy.

The frequency and intensity of various alcohol post-intoxication symptoms and their regression was studied during a three week double-blind treatment period. During the first two weeks daily doses of 60–120 mg. chlorprothixen and 120–240 mg. oxazepam respectively were given. During the third week a dose reduction was generally made, and during the fourth week placebo treatment was given. As an alternative treatment placebo alone was given during four weeks. No other medication than the coded substance was allowed during the observation period. The dose-response technique was used for ethical and practical reasons. The results have been registered by means of psychometric tests as well as assessments made by the patients, the personnel and the psychiatrist (the author) (Fig.). Some of these results have already been accounted for (Bliding, 1970) and will consequently not be mentioned here.

A recent examination paper for the Membership of the Royal College of Psychiatrists contained a compulsory question on pseudo-hallucinations. As is proper in a higher examination, the question was difficult, and at least one examiner (the present writer) had no idea what the answer should have been. While it is probably true that an examiner does not need to know a great deal about a question in order to assess a candidate's worth, yet if he is conscientious he will feel that he ought to know something about it. A rapid search through several textbooks proved curiously unhelpful; so this particular examiner awarded marks as best he could, and as soon as time permitted set out to discover what he should have known about pseudo-hallucinations. The present communication reports his findings and reflections. The findings are in no sense an exhaustive enquiry into the subject; they are the outcome of a search through those current textbooks and journals which may be taken to constitute as broad and as authoritative a background of study as can reasonably be expected of an examination candidate faced with a compulsory question.

Hare, Price and Slater (1971) plotted the age distribution of first admissions to hospital of patients suffering from schizophrenia and neurosis. (I.C.D. 7th Revision, Nos. 300, 303, 310–318). They found a close correspondence between the curves, and contrasted this with the deviation shown by similar age distribution curves plotted for mania, depression and personality disorder (I.C.D. 7th Revision, Nos. 301.0, 301.1, 301.2, 302, 320 and 321). Hare et al. argued from these curves that the environmental factors precipitating an attack are the same for schizophrenia as for neurosis.