The value of measuring changes in symptoms in a single patient has been discussed by a number of authors. (1, 3, 4.) The “self-controlled trial” (1) or the “multiple cross-over method”, i.e. the measurement of responses to repeated and systematic changes in treatment, appears to have advantages over the simple cross-over trial, but the method would be extremely time-consuming in group research with psychiatric patients if the ratings had to be carried out by research workers. The use of valid self-rating scales would make the multiple cross-over method feasible in drug trials with groups of psychiatric patients.

The offence of attempted infanticide has hitherto been unknown in English Law. A case is here described in which a woman was convicted of infanticide, and attempted infanticide, having been charged with murder and attempted murder. The relevance of this is discussed, together with an aspect of infanticide previously unreported in the English literature, i.e. repetition of the offence.

Symptoms attributed to dysfunction of the ductless glands have long been noticed in the group of mental disorders formerly known as dementia praecox, now included in the wider designation schizophrenia. A variety of such abnormalities has been described, but without sufficient consistency or clarity to help in formulating a pathology of the disorder. From the first, the usual onset in adolescence or early adulthood, and the symptomatology, prompted investigation of the gonads. Papers have been published by Fränkel (1919), Mott (1919), Pézard (1920), Tiffany (1921), Lewis (1923), Morse (1923), Geller (1923), Münzer (1926), McCartney (1929), in which histological changes in the testis in schizophrenia are cited and discussed. The contributions of Mott, Lewis and Morse are the most important, for their material and histology are more accurately controlled and described. It appeared as if the very extensive work done by Mott had succeeded in establishing a direct relationship between gonadal failure and dementia praecox. Subsequently his findings were heavily criticised and the conclusions to a great extent rejected, for, like others, he had obtained material at post mortem, mostly from patients who had died of tuberculosis or other diseases liable to produce the very changes he regarded as specific; very few were young adults in the early phases of the mental disease. These objections constituted an apparently insuperable difficulty, and the whole question has remained virtually in abeyance ever since.

The outcome for a group of outpatients treated daily for 12 weeks in a dynamic group psychotherapy programme, was evaluated on both objective and subjective parameters. In the post-therapy year, the majority (82%) reduced their dependence on psychiatric services and showed considerable change in self-satisfaction, as assessed by an attitude test. Those available for follow-up three years later had maintained the change. There was a sub-group of patients (17%) who demonstrated an increase in service use in the post-therapy year.

Emotional illness in psychiatric post-graduate trainees has been the topic of several papers in recent years (1, 2, 3). In summary, these papers suggest that emotional illness in psychiatric training is common. Anxiety and depression characterize these illnesses and occur most frequently in the first year of training. But, as Halleck and Woods have stated, ‘Information as to the prevalence of anxiety states, depression, suicide, psychoses or serious acting out is unavailable’ (4).

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.

A relatively normal 16-year-old Chinese woman with a six-month history of compulsive water drinking resulting in a comatose state is reported. The drinking was perpetuated by an enjoyable altered state of consciousness after ingestion of an average of 20 litres of water per day. Treatment by fluid restriction and, later, simple education was successful. The subjective dimension of an altered state of consciousness may provide an important explanation for the obscure aetiology.

Complementarity of roles is chiefly responsible for the degree of harmony and stability obtaining in interpersonal relationships (Spiegel, 1957). Collins et al. (1971) compared decision-making in the marriages of a group of male neurotics and in a control group. They found that patient marriages were more often categorized as ‘segregated’ (where distinct areas of responsibility were demarcated for each spouse) or ‘husband-dominated’ (where most of the decisions were made by the husband). Conflict over decision-making was also commoner in the patient marriages. By contrast, the control marriages were more often co-operative (both partners collaborated equally in a co-operative manner). The authors suggested that the severity of the husband's neurosis led to the adoption of certain patterns of decision-making which in turn led to conflict. They proposed that these patterns of behaviour might partly explain the development of psychiatric symptoms in the patient's spouse. In a series of normal families in Australia, Herbst (1954) noted that as the percentage of separate decisions increased tension rose. The ‘syncratic’ family structure (comparable to the co-operative pattern) was below average in tension, while the ‘autocratic’ (comparable to the segregated pattern) carried the highest tension.

The primary aim of the long-term treatment of patients with schizophrenia is to prevent relapse, which is costly both in psychological and economic terms. Although with conventional antipsychotic drugs relapse may occur despite compliance with maintenance regimens, the rate of relapse is reduced in compliant patients. However, this benefit is achieved at the cost of side-effects and the risk of developing tardive dyskinesia, even among patients who have taken these drugs for only a year or two. To provide the therapeutic benefits of maintenance medication without its drawbacks, intermittent dosing and long-term therapy with reduced doses of conventional medications have been explored. The atypical antipsychotic agent, olanzapine, has been shown to be effective maintenance medication and has an improved safety profile.

This paper confirms previous findings that the incidence of suicide in England and Wales is greater than that in Eire, but shows that the incidence in 1968–70 was only twice as high, and not four times as stated in the official statistics.

N-acetyl-β-glucosaminadase (NAG) is a renal enzyme which is an early, sensitive and reliable indicator of renal damage. NAG assays of midstream spot urines were not significantly different in a group of controls when compared to patients starting lithium for the first time, or to a group of patients who had been taking lithium for more than one year. However, a small number of lithium-treated patients may have evidence of renal damage, identifiable by NAG assay.

Obsessional neurosis, inasfar as it comes to the attention of the psychiatrist, is a comparatively rare disorder, comprising not more than about 3 per cent of all cases of neurosis. Its rarity is reflected in the fact that the largest series so far described, that of Pollitt (1957), consisted of only 150 cases, though a limited amount of information has been available from the somewhat larger series of the Bethlem-Maudsley Hospital (Blacker and Gore, 1955) and of the Registrar General (1964).

Major depressive episodes are common in bipolar disorder, which consequently may be misdiagnosed as major depressive disorder. Improved detection of bipolar disorder rests upon better ascertainment of a history of hypomania. Antidepressants are of dubious benefit in bipolar disorder and more accurate diagnosis of depression would promote better treatment.

Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.