This paper represents part of a study into what determines the action taken by individuals in distress. More specifically we were concerned to elucidate why some people attempt to find relief by seeking support and guidance from an appropriate agency, while others resort to self-aggressive behaviour. Two groups of subjects have been investigated, one consisting of certain clients seeking help from the Telephone Samaritans organization, while the other comprises patients who had engaged in acts generally described as ‘attempted suicide’ but better termed ‘parasuicide’ (Kreitman et al., 1969) or ‘deliberate self-poisoning or self-injury’ (Kessel, 1965).

This phase of the study was concerned only with the 93 parasuicides already described in Part I. It was designed to ascertain their knowledge of help-giving services, and to elucidate their attitudes towards help-seeking both in general and in the specific context of their parasuicidal behaviour.

Researchers agree that suicides are under-reported, although estimates of the extent vary. Dublin (1963) suggested that recorded figures were understated by one fourth to one third. Seager and Flood (1965) estimated that possible suicides among deaths reported as accidents, misadventure or open verdicts might be as many as 50 per cent of those actually returned as suicide. Important sources of under-reporting lie in the methods of ascertaining and recording suicide as well as in religious and social attitudes, which tend, in certain countries, to look upon suicide as a stigma and to avoid a verdict of suicide where possible.

Hospital-treated parasuicides∗ have been studied intensively in recent years, and on the basis of these hospital studies aetiological theory is advancing and expensive endeavours in prevention are being put into operation. Yet hospital studies can be misleading because cases selected for admission may not be representative. This prospective survey, based on general practice in Edinburgh, was carried out to study the prevalences of parasuicide uncontaminated by factors influencing hospital referral.

The present study was made within the framework of the Sams⊘-project, a psychiatric service and research project in the Danish island of Sams⊘, which had a population of 6,823 in 1957 when the project was started.

The unpleasant reaction to alcohol experienced by patients taking disulfiram was reported twenty-four years ago (Hald and Jacobsen, 1948; Martensen-Larsen, 1948). For as long as patients continue to take oral disulfiram they may be too afraid to drink. Unfortunately in practice they often discontinue the therapy, and drink with impunity a few days later. Thus a long-acting preparation of disulfiram would be desirable.

An association between alcohol use and violent behaviour has commonly been reported in the literature, both in the context of alcohol use at the time of the violent act (Wolfgang et al., 1956; McLintock, 1963) and in the context of the alcohol habit of men convicted of violent offences (Gibbens and Silberman, 1970). Similarly a high incidence of severe alcohol addiction has been found in men appearing before courts (Gath, 1969) and in prisons (Hensman, 1969).

Few studies have been published about psychiatric illness among relatives of patients with anorexia nervosa. Even less information is available concerning alcohol abuse in relatives of such patients. Theander (10) found a 2.5 per cent incidence of alcohol abuse among uncles and aunts of patients with anorexia nervosa. Six out of 94 fathers, 6.5 per cent, were alcohol abusers, whereas none of the 94 mothers so indulged. In a recent report of 13 male cases of anorexia nervosa Crisp and Toms (3) describe one father who was a severe alcoholic. Kay and Leigh (6), in a study of 38 patients with anorexia nervosa, noted alcoholism in four parents out of a total of 76 (5 per cent). Alcoholism in actual anorexia nervosa patients has been mentioned, but no incidence figures were given. Crisp (2) commented that ‘those chronic patients who have progressed to a state of overeating and vomiting not infrequently appear to become dominated by oral behaviour, and may sometimes present with alcoholism’. Toms and Crisp (11) hold that alcohol and drugs may be used as substitutes or diversions for the suppression of normal appetite.

There are many clinical reports on psychotherapy with depressed patients, and an enormous effort has been devoted to psychotherapy research (10, 23, 24, 27, 28). However, there is little quantitative description of the content of psychotherapy—what patients discuss during sessions and how much time is spent reflecting on problems. This situation is partially understandable given the technical difficulties in obtaining psychotherapy process data. Content analysis of transcribed tapes, process records, video-tapes and the coding of words have been among the methods used (7, 9, 12, 14). These methods are inclusive and precise but impracticable in lengthy psychotherapy or with large samples.

It is widely agreed that the MAO inhibitor group of drugs are less effective anti-depressants than the tricyclics in severe depressions, specially those of endogenous type (Medical Research Council, 1965), but a role for them is still claimed, for example, in the treatment of milder depressions or of depressive symptoms. According to Pöldinger (1967) they are ‘thermagasics', i.e. psychic energizers or disinhibitors, and their mood elevating effect is relatively slight. Dally (1965) maintained that MAO inhibitors were most useful in atypical depressions, with tension and anxiety, but were ineffective in patients with inadequate personalities. Kelly et al. (1970) found that these drugs relieved depressive symptoms in phobic anxiety states. In this paper we have attempted to reexamine this question in a double-blind trial of phenelzine and amitriptyline in depressed out-patients.

The advantages of a new sustained release form of amitriptyline (Lentizol) which can be given in a single dose for the treatment of depressive illness have recently been described by Sims (1972) and Haider (1972). This paper reports a similar double blind cross-over trial in the treatment of depressive illness (ICD 296) of the same substance compared against conventional amitriptyline at an overall higher dosage level.

Electroconvulsive therapy with unilateral electrode placement has been tried most often in depressive disorders (Abrams and de Vito, 1969; Cannicott, 1962; Cannicott and Waggoner, 1967; Costello et al., 1970; d'Elia, 1970; Fleminger et al., 1970; Levy, 1968; Martin et al., 1965; Strain et al., 1968; Valentine et al., 1968; Zinkin and Birtchnell, 1968; Lancaster et al., 1958), although Lancaster (op. cit.) noted that it was as effective as bilateral ECT in relieving certain other psychotic symptoms, such as catatonia, stupor and hallucinations. This paper reports the comparative results in schizophrenia of bilaterally administered ECT and of ECT administered unilaterally to either the dominant or the non-dominant hemisphere.

A nine-month-old baby was admitted to hospital following attacks by his father. The baby had been choked, then injured by prolonged banging against furniture; finally, he had been picked up by one leg and thrown across the room. The child had also been attacked previously.

It has been shown in a record study (Welner, Liss, Robins and Richardson, 1972), and confirmed in a follow-up study using a blind structured interview (liss, Welner, and Robins, 1972), that most of those in-patients in our studies who were discharged without a diagnosis met the criteria for a psychiatric diagnosis when rigorous criteria were used (Feighner, Robins, Guze, Woodruff, Winokur and Munoz, 1972). However, using methods and evidence from these studies, out of the 109 patients who were followed-up for a mean period of 39 months, 25 patients were conspicuous in that even after initial or repeated admissions to hospital, after their records were reviewed, and after a follow-up study, they still remained undiagnosable. It was the purpose of this study to describe and evaluate in detail this group of 25 patients with particular reference to the possible reasons why they remained undiagnosed and therefore were defined by us as ‘undiagnosable’.

The association between renal papillary necrosis and prolonged ingestion of compound analgesics containing aspirin and phenacetin, has been widely reported (5, 6, 11, 13, 17, 19, 20, 24, 42). Although formerly thought to occur mainly in Switzerland, Scandinavia and Australia, analgesic nephropathy is now being increasingly reported in Britain (3, 26, 36), and in particular in Western Scotland (33). In the past seven years over 100 cases have been seen in the renal unit of the Western Infirmary, Glasgow, and, of these 42 have died in uraemia.

Reports on adrenocortical function in mental illness have been conflicting, and there has been a failure to replicate results, especially with plasma Cortisol measurements (Gibbons, 1968; Segraves, 1970; and Franzen, 1971). Also, the study of particular diagnostic categories of patients appears to introduce a sampling bias, whilst isolated measurements usually fail to assess hypothalamo-pituitaryadrenal function. We have therefore undertaken a blind assessment study of the nyctohemeral rhythm of plasma Cortisol in Nigerian inmates of the Aro Neuropsychiatric Hospital and Lantoro Institution in Abeokuta, which operate respectively as open and closed treatment centres (Asuni, 1967).

In attempting to resolve the issue of the relative importance of environmental and genetic factors in mental illness migration studies have been inconclusive (Dohrenwend and Dohrenwend, 1969). Among West Indian immigrants an increased incidence of mental disorder as compared to the native population and the population at home has been suggested (Hemsi, 1967). Other workers have attached great importance to environmental factors in explaining the atypical picture of West Indian mental illness (Gordon, 1965; Tewfik and Okasha, 1965).