A representative sample of 105 women were assessed by Goldberg's Standardised Psychiatric Interview (SPI) on two occasions during pregnancy and twice more in the puerperium. Total SPI scores increased significantly after childbirth. Thirteen out of the sample had a severe postnatal depression and a further 17 women had milder depression, which in 15 lasted at least four weeks. Marked deterioration of their marital relationships was reported by the depressed women but no other social or obstetric characteristics of postnatal depression were found. Women with severe postnatal blues were particularly at risk of developing persistent depressive symptoms subsequently. The only two women referred to a psychiatrist had personality disorders rather than depressive illnesses.

In a consecutive sample of 50 adolescents aged 13–18 admitted to hospital after taking overdoses, 90 per cent were girls. There were other clear differences between this sample and adolescents in general. Twenty-four per cent had visited their general practitioners in the previous week, and 50 per cent during the previous month. The most common difficulties preceding the overdoses were problems with parents, boy or girlfriends, and with school or work, including unemployment. A substantial proportion of the subjects had recent or current physical ill health. In the majority of cases the problems appeared to be transient so that one month later two-thirds of the adolescents had shown considerable general improvement. However, 14 per cent were referred to hospital for further self-poisoning or self-injury in the following year. The recent increase in the incidence of self-poisoning among adolescents suggests that more attention must be paid to this group in terms of both primary and secondary prevention.

A simple method of classifying adolescent self-poisoners into three sub-groups on the basis of the duration of their problems and the presence or absence of behavioural disturbance is described. The three groups differed markedly in terms of factors concerning their families, especially their relationships with their parents, and in their medical and psychiatric histories, the nature of their overdoses and the problems they were facing at the time. The treatment offered to members of the three groups also differed. The method of classification may offer a useful means of distinguishing between subjects in terms of outcome, including subsequent adjustment and repeat attempts.

One thousand and five patients referred to a psychiatrist were questioned, during a routine clinical interview, about current and previous suicidal ideas and previous suicide behaviour; they were also specifically asked what made life worth living for them at that time. In a four-year case-record follow-up 102 patients (10.1 per cent) were found subsequently to have attempted deliberately to harm themselves. Such deliberate self-harm (DSH) was significantly associated with female sex, with age below 35, and with evidence of suicidal ideation and/or behaviour at the time of and/or before the initial referral. To the question, “What makes life worth living for you at the present time?” a significant number of subsequent self-harmers had answered ‘Nothing’ or ‘Not much’ while a significant number of subsequent non-self-harmers had answered “Spouse and children” or “Family”.

The results suggest that the answers to questions about current and previous suicidal ideas and behaviour and perceptions of what makes life worth living may be useful in the prediction of deliberate self-harm.

Three of 39 first-admission schizophrenics committed suicide during the 10 to 15 year follow-up period of a retrospective, case-register based inquiry. Schizophrenic patients often talk about and attempt suicide. However, there is little reliable knowledge about the clinical characteristics of those who are likely to kill themselves.

The amount of intraneuronal lipofuscin in the parietal cortex and in the inferior olivary nucleus was measured in post-mortem tissue affected by Alzheimer dementia and in specimens from non-demented individuals. The results indicate that there is a linear relationship between the accumulation of cell body lipofuscin and advancing age, both in neuronal populations of the non-demented group, and in the olivary neurones of the demented group. However, in the demented group, the lipofuscin fluorescence intensity of the parietal neurones was not significantly correlated with age. The estimated amount of lipofuscin in the olivary neurones in the demented group was significantly higher than in the non-demented group, when age has been taken into account (P <0.01). The possible pathogenic role of lipofuscin accumulation in ageing and Alzheimer dementia is discussed.

Medically ill patients diagnosed at index admission as delirious, i.e., suffering cognitive decline and an altered state of consciousness, had higher fatality rates than demented, cognitively intact or depressed patients. At a one-year follow-up the death rate of those who had been delirious was still higher than that of demented patients. Delirious patients were more likely to have a diffusely slow EEG, tachycardia and hyperthermia and lower mean systolic and diastolic blood pressure. These results validate the distinction between delirium and dementia and the importance of alteration of consciousness as a defining characteristic of delirium.

The study at Graylingwell Hospital conducted by Roth (1955) has in part been replicated in order to study the changing patterns of mental illness in the elderly over a 25-year period. Important changes in the diagnostic distribution and outcome of cases admitted have occurred. Functional illness has given way to dementia, not as a proportion of patients admitted but in the number of beds employed for their care 6 and 24 months after their index admission. Discharge rates for all diagnostic groups except acute confusional states, have undergone considerable change and death rates have fallen. The study has concentrated on the residual in-patient population, paying particular attention to increasing demand for beds for the dementing group. These changes have been quantified and reflect a four-fold increase in bed requirements for cases of dementia at two years. Despite a striking reduction in requirement for functional cases, there is an overall increase in bed requirement of 38 per cent at the two-year mark.

Using routine data from the Mental Health Enquiry, the work of two district general hospital (DGH) units and a mental hospital was examined. There was a marked difference in the way the two DGH units operated and between the way the mental hospital worked as support hospital or as independent complete in-patient service. The operational policy practised by psychiatrists is more important than the structure of the system. It is important to establish sensitive policies for a wide variety of organizational structures.

Significant differences in handedness patterns between groups of psychiatric patients and normal controls were identified in two recent British studies, with substantial disagreement in some important findings. Most of the discrepancies were attributable to the different application of a simple classification of handedness data, and the remainder to differences in sample size. Diagnosis, sex and age were then found to have a similar effect on handedness in both studies. Neurotic patients were similar to controls regardless of classification, whereas mixed handedness in personality disorder depended on it. There was no overall excess of left-handedness among schizophrenics, but trends towards excess sinistrality in men and full dextrality in women approached significance.

The 60-item GHQ was validated in a community population by comparison with the CIS. The GHQ failed to identify nearly half of the psychiatric ‘cases' in this population. Those missed were similar to those detected except for greater chronicity of illness and more frequent social and interpersonal problems. The GHQ appears to be unsuitable as a screening instrument for mental illness in the community and the possible reasons are discussed. Principal components analysis resulted in a 15-item GHQ factor which, when used with Likert scoring, resulted in considerable improvement and failed to identify only 4 per cent of ‘cases'. It is suggested that this may provide a more satisfactory screening instrument.

Six depressed patients were treated routinely with desipramine, a relatively selective noradrenergic uptake blocking drug. After 0, 1 and 3 weeks' treatment pupillary responses to tyramine, phenylephrine and pilocarpine were measured using a photographic technique. Both 1 and 3 weeks' treatment significantly inhibited tyramine and phenylephrine-induced mydriasis, but did not inhibit pilocarpine-induced miosis; in fact the longer treatment enhanced miosis due to pilocarpine. Resting pupil size was significantly increased after 1 and 3 weeks' treatment.

The findings can be explained by the known ability of desipramine to block noradrenaline uptake and α adrenoceptors: they provide no evidence of muscarinic receptor blockade or of a slowly developing adaptation at a adrenoceptors.

The effect of long-term lithium treatment on the kidneys has generated concern among psychiatrists, and proposals have been made that routine determinations of serum lithium and serum TSH should be supplemented with control of the kidney function through regular determinations of serum creatinine, glomerular filtration rate, and renal concentrating ability, as well as through kidney biopsy in certain circumstances.

The Visual Analogue Mood Scale (VAMS) was completed for 30 consecutive days by 124 psychiatric patients and 36 non-patient control subjects. The 65 euthymic manic-depressive patients on chronic lithium therapy had similar mean mood ratings to the non-patient controls, but had lower mood variability as measured either by standard deviation of the mood rating or by a measure of the mean successive differences between consecutive mood ratings (delta squared). This unusual mood stability appears to be an effect of lithium therapy. This study thus offers some empirical support for the ‘mood stabilizer’ psychological model of lithium's effects in patients. It is also noted that this effect may be perceived in well patients as an undesirable effect of lithium treatment.

Platelet monoamine oxidase (MAO) activity was studied in 33 in-patients with bipolar and schizoaffective disorder who were treated with lithium. Platelet MAO activity was found to increase following 10–41 days of lithium treatment compared to a prior drug free period, and the increase was positively correlated with the duration of lithium treatment. The increase in platelet MAO activity was not correlated with clinical improvement as measured by the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment Scale (GAS). The number of platelets per unit of blood was also significantly correlated with the number of days of lithium treatment. However, the increase in the number of platelets in lithium-treated patients was not correlated with the increase in MAO activity and thus appears not to account for it. These results indicate that studies relating platelet MAO activity to psychiatric diagnosis should be interpreted cautiously if patients are receiving lithium carbonate.

A distinction is made (British Medical Journal, 1978; Munro, 1980) between an excessive preoccupation with minor bodily defect, dysmorphophobia, and monosymptomatic psychosis in which a delusion of bodily change may be the sole symptom of an underlying schizophrenic or depressive illness. Hay (1981) has argued for careful distinction between the over-valued idea of dysmorphophobia and the delusion of depressive or schizophrenic illness. But in the absence of any features suggesting psychosis, scrutiny of the abnormal belief in isolation may fail to detect which sort it is. Riding and Munro (1975) hold the distinction to depend upon assessment of the abnormal belief as being of ‘neurotic’ versus ‘delusional’ intensity and of the degree of personality involvement. Andreasen and Bardach (1977) have proposed formal diagnostic criteria incorporating similar features: the dysmorphophobic symptom of excessive concern with appearance, the desire for surgery or underlying presence of personality disorder, and the absence of psychotic symptomatology. However, judgements of ‘neurotic’ versus ‘delusional’ intensity, of absence of psychotic symptomatology and of personality involvement may be particularly difficult against a background of developing personality and in adolescence the problem may be further compounded by the cumulative and recursive effects upon personality development of psychological disturbance.