A 3½ month old baby boy was admitted to the children's ward with subdural and subarachnoid haemorrhages which had impaired his hearing and vision, with permanent damage to the brain. Further investigations confirmed the child as a battered baby (Generation VI No. 2 on Fig. 1., No. 12 on Fig. 2).

A conspicuous deficiency of practically all birth order studies is the absence of a general population control group. Instead, a number of statistical methods of estimating the expected number of subjects in each sibling position have been used. These are based upon the assumption that for any given size of sibship there should be equal numbers of subjects in each birth rank. As Price and Hare (1969) have pointed out, there are a number of reasons why such as assumption is incorrect, and therefore why the conclusions based upon it are unreliable. Because, in most studies, only relatively small numbers of patients are available various methods of combining sibships of different sizes are adopted and the sexes of the siblings are ignored. To consider a sibling position irrespective of the size and composition of the sibship in which it occurs is unjustifiable. As birth order effects are relatively slight, large numbers of subjects are required to detect them. Unless a patient sample of several thousand is used the numbers in any sibship size are too small to permit analysis by birth rank. As sibship size is itself a possible variable, and as within each sibship the sexes of the siblings can be distributed in a variety of ways, birth order studies should ideally consider one sibship size at a time and should investigate sibling position by sex of sibling. Unfortunately, in sibships of four or more the numbers of combinations become so great as to render this approach impracticable.

Public controversy surrounds the workings of the Abortion Act and will no doubt continue to do so, probably until such time as surgical operation is replaced by other methods. Recently the report has been published of the enquiry by the Royal College of Obstetricians and Gynaecologists which emphasises the difficulties involved in interpretation of the Act and the variations encountered in practice. There is a substantial body of psychiatric literature on the subject, e.g., Ekblad, 1955; Arkle, 1957; Kummer, 1963; Sim, 1963; Höök, 1963; Baird, 1967; Clark et al., 1968 and Kenyon, 1969, but results obtained in other countries and in this country some years ago are not necessarily applicable to this country now, since changes in public attitudes are likely to influence them. Little has been published by psychiatrists about their experience with cases since the Act came into operation. The recent follow-up series of Pare and Raven deals with cases seen in the years 1962 to 1968, i.e., mainly before the implementation of the Act.

Arson has long been a subject of interest to the psychiatrist. In the early nineteenth century, continental psychiatrists in particular maintained that pyromania was a form of insanity, and laws were enacted in the German States and in France to protect such persons from the death penalty. The underlying sexual roots of arson have been stressed (e.g. Stekel, 1924), and although Reiss (1909) suggested that it might represent any form of displaced emotional reaction to tension, and McKerracher and Dacre (1966) that it might represent displaced aggression, the view of a sexual basis for arson is still commonly held.

Most chromosome studies of criminal males have been made on groups selected on account of tall stature with the main purpose of finding the frequency of patients with extra Y or X chromosomes.

A diagnosis of Turner's Syndrome is given to female patients who have small stature, primary amenorrhoea and a number of other variable stigmata. The ovaries are absent and the genital ducts and external genitalia do not develop spontaneously beyond the pre-pubertal stage. Chromosome analysis shows that the majority have a 45, X karyotype, in which one of the pair of sex chromosomes is missing. Others have a structural abnormality of one of the two X chromosomes resulting in loss of short-arm material.

Although the suicide rate in England and Wales is declining (Fox, 1970), the rate of parasuicide is increasing rapidly (Aitken et al., 1969; Stanley, 1969; Bagley, 1970). There is an obvious clinical interest in knowing the extent to which medical and other agencies can prevent such behaviour, or its repetition, and in being able to predict high risk individuals. Progress in the evaluation of the prevention agencies has been reviewed by Bagley (1971), and in the field of prediction a number of studies have been published using British material. These studies usually take the form of an examination of the traits and characteristics of a group of completed or attempted suicides, and follow-up studies are less common (W.H.O. 1968). The present study, so far as we can discover, is the first follow-up study which includes patients who were not seen by a psychiatrist at the time of their key attempt.

A review of studies relating suicide to the menstrual cycle (Wetzel et al., in preparation) showed that an increased proportion of female suicides and attempted suicides probably occur during the luteal (from ovulation to onset of menses) and menstrual phases of the cycle. Mandell and Mandell (1967), in a study of women calling the Los Angeles Suicide Prevention Center, found an increased number calling in the late luteal and menstrual phase of their cycle. This study assessed the relationship between phase of the cycle at the time of call and self-judged lethality.

Two studies have been made of the relationship between premenstrual tension and phase of the menstrual cycle at the time of suicide attempt. Tonks et al. (1968) reported a negative relationship. Women without premenstrual symptoms accounted for the premenstrual increase in suicide attempts. Zacco et al. (1960) reported a significant positive relationship, women with the premenstrual syndrome being more likely to attempt premenstrually.

The premenstrual occurrence or exacerbation of affective symptoms has been noted (Dalton, 1964). This symptom exacerbation may be sufficient to require hospitalization (Dalton, 1959; Janowsky et al., 1966). Data presented by Coppen (1965) indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual symptoms. However, we are aware of no previous report that would suggest any relationship between premenstrual symptoms and bipolar affective disorder.

Longitudinal clinical studies have provided evidence for years to support the value of classifying psychiatrically ill patients according to well-described syndromes whenever possible. Using such classification as a base, knowledge has been accumulated concerning aetiology, prognosis, and treatment of such diverse disorders as general paresis, schizophrenia, manic-depressive illness, antisocial personality, and others. Our understanding of the essential nature, causes, and treatment of psychiatric disorders is far from complete, and what we do know has been learned more through systematic studies of syndromes than through analyses of intrapsychic and interpersonal processes, however important those may be. In order to treat a psychiatrically ill patient it is at least as important to understand the syndrome from which he suffers as to understand the nature of his personal problems. The physician can attend to the former without neglecting the latter.

Recently, Mitchell (1969) treated 16 migraine subjects using a combination of three specific behaviour therapy techniques namely, applied relaxation training, desensitization and assertive therapy. Migraine episodes for the treatment subjects decreased by an average of 89.5 per cent when compared with their pre-treatment base rate; no change was reported by six control subjects. The present investigation reports the comparative effectiveness of the three behaviour therapy techniques used previously. The specific therapeutic effectiveness of applied relaxation training was compared with that of combined desensitization (relaxation application, desensitization and assertive therapy). This comparison follows the conclusion by Cautela (1969), ‘… that relaxation can be considered a self-control technique in its own right: first, when it is used to reduce the overall anxiety level, and second, as a means of decreasing anxiety or tension whenever the patient is either involved in a readily identifiable anxiety-provoking situation, or is experiencing anxiety without being able to discern the antecedent conditions (p. 328.)’ It was predicted that combined desensitization would be more effective than the single-model procedure of applied relaxation training.

The clinical research reported here has two thrusts or purposes: one theoretical and one practical. The theoretical question can be stated: Is psychotherapy in general, and group psychotherapy in particular, a lawful, directive, and predictable process that can be understood from a behavioural or learning point of view? The second question and the more practical and down-to-earth one, is whether analyzing group therapy from a learning point of view can suggest and direct our attention to practical improvements in the technical work that we carry out as group therapists, whatever our theoretical persuasions.

There is a widespread belief among clinicians that trifluoperazine (Tr) is more effective than chlorpromazine (Ch) in activating retarded schizophrenic patients. We examined the effect of these two drugs on the motor activity of three groups of inactive patients: A, very inactive; B, moderately inactive and C, mildly inactive. All these patients were under 60, with at least 10 years duration of illness. We excluded those with subnormality or physical illness and those who had a leucotomy. They were all sufficiently inactive to fall below the mid-point on the Venables scale (Venables, 1957), so that an increase in activity constituted an improvement. The same supervisors and raters were used throughout and attempts were made to maintain the work environment as constant as possible. The raters did not have access to their earlier scores.

Flupenthixol is the latest addition to the thioxanthene series (Møller Nielsen, 1967). Clinical investigations have shown that it is principally indicated in conditions of prolonged psychosis without severe anxiety (Gross and Kaltenbäck, 1965; Knutsen, 1965, Noreik and Rimestad, 1965; Gottfries, 1967). An antidepressant effect and an effect on neurosis have also been reported, (Ravn and Rud, 1965; Sonne, 1966), and there have been tests with the preparation as a depot-neuroleptic (Enerheim et al., 1970).

Many years ago Eugen Bleuler postulated a correlation between alcoholic hallucinosis and schizophrenia. In his textbook, he stated his belief that ‘alcholic hallucinosis could … be a mere syndrome of schizophrenia induced by alcohol (1)’.