Liaison psychiatry has been recognised in many countries as a special interest or sub-speciality of psychiatry concerned with the management of general hospital patients with psychological problems. However, despite increasing awareness of the emotional and behavioural aspects of illness, it has yet to achieve substantial influence within psychiatry and, more importantly, has had only modest effects on the delivery of medical care by physicians and other specialists. Recognition of its potential by planners and commissioners has been disappointing. Regrettably, in the UK and elsewhere, recent changes in the organisation of health care could hinder its development. This paper argues that in order to make substantial progress there is a compelling need to solve a fundamental obstacle – the separation between psychiatric and general medical care. This requires:

(a) convincing the psychiatric profession that consultation-liaison is a distinct sub-speciality;

(b) continuing efforts by liaison psychiatrists to define their special expertise and to demonstrate that their services are effective and acceptable to medical colleagues and to patients;

(c) persuading those who organise health care that liaison psychiatry services need to be provided and administered as an integral component of comprehensive medical care.

Geographically, Iran is for the most part a plateau at an average altitude of about a thousand metres; the terrain—the near-jungle conditions of the Caspian littoral excepted—is arid semi-desert and the typical landscape one of limestone mountain ranges between which lie flat plains. It is bordered by Iraq, Turkey, the U.S.S.R., the Caspian Sea, Afghanistan, Pakistan and the Persian Gulf. Except during spring the vegetation in most areas is sun-shrivelled on the bare treeless earth; after five months of burning heat the winter rainfall washes off the topsoil, and river-beds, dry throughout the summer, overflow with muddy torrents. Although the soil is dry and powdery there are abundant watercourses below the surface and with irrigation the land is very productive. The country has great mineral resources; apart from the oil-fields they are un-exploited due to lack of coal and road and rail communications. The people are mainly feudal villagers or nomadic tribesfolk but Tehran is a modern city of a million population and the provincial capitals are also semi-Westernized.

A 12-year-old Chinese boy had a diagnosis of infantile autism at infancy that was finally confirmed as classic phenylketonuria at adolescence. This treatable inborn metabolic disease should be investigated in cases of apparent autism, especially where mass neonatal screening of inborn metabolic diseases has not been established.

The theory underlying medical classification is not always given sufficient regard. Here systematic methods developed in biology are summarised and compared with parallel developments in nosology. The classification of the functional psychoses is discussed as an example of a methodological problem in medicine. We consider that cladism could have a useful application in nosology, and could lead to classifications based on the concept of interrelationships of disease.

This study examined characteristics of 296 alcohol and/or drug abuse clients assigned to either (1) in-patient programmes, (2) out-patient programmes, or (3) a lower cost primary care alternative. Multivariate analysis indicated that clients admitted for in-patient care reported greater alcohol consumption and associated problems, fewer community supports and more severe symptoms such as depression and anxiety. They tended to be more frank about their problems while defence mechanisms were more apparent in clients admitted to out-patient and primary care programmes. In general, out-patients ahd more favourable prognostic indicators, such as higher social stability and lower level of alcoholic involvement. The differences among treatment programmes were along quantitative dimensions of problem severity. In particular, the alcohol dependence syndrome was a major discriminating dimension.

The clinical concept of the negative therapeutic reaction has been included in this series for a number of reasons. It is a concept of particular importance in the history of psychoanalysis, for it represents the clinical phenomenon chosen by Freud (1923) to illustrate the workings of an ‘unconscious sense of guilt’ and to indicate the existence of what he conceived of as a special mental agency—the superego. Moreover, it is a concept widely used in clinical psychoanalysis, although little has been written on the subject since Freud's original formulation of it. Unlike such concepts as transference (Sandler, Dare and Holder, 1970) and acting out (Sandler, Holder and Dare, 1970a) it has not been extensively applied outside clinical psychoanalysis. This may be regarded as surprising in view of the fact that it would seem to be readily capable of application without alteration to a wide variety of clinical situations.

Psychotropic drug use was investigated using a two-stage survey of a random sample of persons aged 17 and over from a rural Spanish community. It was found that 6.9%, 11.8% and 25.1% of the population were consuming psychotropic, analgesic and somatic medicines respectively. Women presented a higher rate of psychotropic use than men (prevalence for women 10.7%, for men 2.6%). This female predominance was found to be significantly related to sociodemographic and medical factors. Psychotropic use was also associated with the physical health of the respondent. The coexistence of physical and mental illness generated an increase of consumption, whereas the absence of both types of illness was associated with a very low rate. The rates for physical and for mental illness alone were intermediate and were almost equal.

Payne and Hewlett (1960) found that the schizophrenics having the highest factor scores on their dimension of overinclusion were diagnosed paranoid schizophrenic. Payne (1966) has suggested that if overinclusive thinking is construed as an inability to disregard irrelevant stimulation it is conceivable that overinclusive thought-disordered schizophrenics will come to hold delusions of reference and persecution as a consequence of their giving these irrelevances personal significance. In this way the paranoid schizophrenic's thought disorder is seen as the basis of his delusional symptomatology. A number of studies have lent support to this contention (Payne, Caird and Laverty, 1964; Lloyd, 1967). On the other hand several studies have failed to find the predicted relationship between overinclusive test performance and delusional symptomatology (Hawks, 1964; Chapman and McGhie, 1962).

Most clinical and genetic evidence suggests that puerperal psychosis is closely related to bipolar affective disorder. During a linkage study of bipolar disorder we ascertained a British family in which puerperal psychosis was associated with consanguinity in three sisters. All three subjects had lifetime RDC diagnoses of bipolar I or manic disorder. An inbred brother also had bipolar I disorder. The only female member of the sibship to escape puerperal psychosis was outbred. These findings are consistent with several genetic models for bipolar disorder in this family. The most interesting possibility is a single major susceptibility locus of recessive effect. Under this assumption, the family could be used for homozygosity mapping to help localise the putative recessive locus. If other inbred families can be found in which the same putative recessive locus is operating, the power to localise the gene by homozygosity mapping would be greatly increased.

This study reports the demography, weight, and alcohol and psychiatric histories of the sexual partners of 112 consecutive patients with bulimia nervosa, all from an urban catchment area. Seventy-three patients (65%) had a current sexual partner. The partners were of similar social background, but slightly older. On average, partners were overweight (110% of MMPW) and over 27% reported having an eating or weight problem. A quarter of the partners had been treated for a psychiatric or emotional disorder. Nearly 40% drank more than 36 units of alcohol a week, and 14% had received treatment or consulted a doctor for alcohol-related problems. Heavy-drinking partners and multi-impulsive bulimics sought out each other. A quarter of partners had themselves been raised in a nuclear family in which a member had received psychiatric treatment; 12% had had a mother or sister with an eating disorder. Thirty-seven per cent of patients used a ‘safe man’, their fear of being hurt stemming from low self-esteem and a general sense of ‘failure’, and for 11% the relationship was abusive.

In most mental hospitals some attempt is made to effect change among long-stay patients. This problem in rehabilitation has been approached in several ways, but irrespective of individual approach it is desirable to have some assessment of the degree of change accomplished. Social aspects of behaviour, rather than symptoms, are the target of such rehabilitative efforts, and nurses play an important part both in pursuing the goals of treatment and in assessing change in individual patients. The NOSIE (Honigfeld and Klett, 1965; Honigfeld, Gillis and Klett, 1966) is a particularly well-developed rating scale whose content has been tailored to the task of assessing change in long-stay patients and has been successfully used for this purpose in the United States. In its present form it comprises 30 items which form 6 scales: namely, Social Competence, Social Interest, Personal Neatness, Irritability, Manifest Psychosis and Retardation. This note is concerned with three questions which the British user should ask before using the scale; does it do what it claims to do, does it do it accurately, and what range of scores could be expected in a British hospital population.

In order to try to overcome the common clinical experience of patients who do not take the drugs prescribed for them (Wilcox et al., 1965) a sustained release form of amitriptyline (Lentizol) has recently been made available. This trial was undertaken to test the efficacy of this formulation given once daily at night compared to standard amitriptyline given thrice daily.

Assessment of cognitive and behavioural disability on 100 elderly psychiatric admissions was carried out by means of the Clifton Assessment Schedule and the Shortened Stockton Geriatric Rating Scale. The results provided useful predictive indices, confirming the relationship between cognitive impairment and unfavourable outcome at two-year follow up.

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.