The tendency of adult and child psychiatrists to go their separate ways has led to neglect of the common ground which exists between the psychopathology of childhood and that of the psychoses of adult life. The purpose of this paper is to rekindle interest in what once was regarded as an important field for research into the psychoses. In this paper the phenomena which are to be found in children who suffer from neurotic disorders, ‘borderline’ states and psychoses will be compared with the signs and symptoms of adult psychoses and the significance of the similarities assessed. In both children and adults the data to be presented consists of the symptomatology observable at the onset of the illness and the phenomena which appear during the course of the illness and during psychotherapy.

For genetic characteristics controlled by a single locus which are such that the degree of dominance is not dependent on the environment, statistical methods of determining the mode of inheritance and the gene frequencies are now well understood in principle. If, however, there is incomplete penetrance, depending on the environment (taken in the wide sense), the problem becomes much more difficult, especially in human genetics. The situation is even worse if the character is dependent on several or many loci and such characteristics are often very dependent on environmental factors. This seems to occur in man in some psychiatric diseases and is certainly the case for intelligence. The genetical analysis of such phenomena is very difficult, and it is essential that the mathematical and statistical bases of such investigations be carefully understood by anyone who undertakes such work.

The incidence and prevalence of transsexualism are difficult to establish, as the syndrome is not sufficiently common to lend itself to the usual methods of epidemiological research.

The organization known as The Samaritans was established in 1953 in London by the Rev. Chad Varah as a suicide prevention service, but there is still an absence of data regarding the impact of this service on parasuicide (‘attempted suicide’). If it is hypothesized that the Samaritan organization does prevent parasuicide, it follows that an increase in Samaritan referrals would be associated with a decrease in parasuicide, other factors being equal. The recent B.B.C.1 programme based on the Samaritans afforded a natural experiment for testing this hypothesis.

The anti-psychotic properties of flupenthixol have been described by Gottfries (1971) and Gross and Kaltenback (1965), and its antidepressant action by Reiter (1969), Merskey (1971), and Hall and Coleman (1973). It is available in the form of its decanoate in oil (‘Depixol’) as a depot injection.

Of the many diverse treatments for impotence (Cooper, 1971) perhaps in some ways the most novel are the various mechanical devices which to date have never been adequately tested; although there are reasons to believe that they would be safer (even if no more effective) than many drugs in present use. A modern innovation of the penile splint (Lydston, 1908) is the Blakoe ‘Energiser’ Ring which is made of ebonite, with five small metal plates on opposite inner surfaces. It opens on a swivel so that the lower half can be placed high up under the scrotum and when the upper part is swung around, closing the ring, the penis, scrotum and testicles are enclosed within it, but hang freely below.

There have been many studies of the incidence with regard to marital status of admissions to mental hospital. Each has reported the same pattern of highest rates for the divorced, followed by the widowed and single and lowest rates for the married, the pattern being the same for both sexes (Adler, 1953; Brooke, 1963; Dayton, 1940; Frumkin, 1955; Malzberg, 1964; Norris, 1956; Ødegaard, 1946; Stevens, 1969; Thomas and Locke. 1963).

Older people in institutions are often disabled by physical disease (Wilson et al., 1962). Psychiatric patients, in general, have more somatic disorders than mentally healthy people (Westrin, 1961; Shepherd et al., 1964; Maguire and Granville-Grossman, 1968). In fact, most elderly long-term psychiatric patients in hospital suffer from one or more somatic disorders (Ask, 1962). Even a small improvement in the general health of these patients may be of importance for their daily life activities, and also reduce the requirements for assistance. An established regular somatic screening of these patients will help to detect disease which otherwise may be over-looked.

The theory that some male homosexuals might have female chromosomal constitution (Lang, 1940) became untenable when techniques for studying sex chromosomes were developed. Amongst others the work of Pare (1956) and Raboch and Nedoma (1958) showed that male homosexuals had normal male chromosomes. The latter authors in the same study also reported on 36 male patients with a female type of sex chromatin (i.e. chromatin positive) and could not detect any homosexual orientation: 32 were definitely heterosexual and the remaining 4 were considered ‘infantile’, They assumed that the finding of a chromatin-positive homosexual would be coincidental and that there was no causal relationship between this sex chromosome abnormality and homosexuality. Money and Pollitt (1964) searched for a genotypical abnormality in a related psychosexual disorder, namely transsexualism, but although they collected six cases in the literature where Klinefelter's syndrome and transsexualism occurred together, the correlation was not statistically significant. In fact, it would now appear to be established that there is no specific correlation between sex chromosome abnormality and psychosexual disorders (Slater and Cowie, 1971).

In his review of psychotherapeutic practice today, Marks (1971) has pointed out that there is a decreasing tendency to make dogmatic assertions of universal applicability of one or other form of psychotherapy to all neurotic states. There is an increasing readiness among psychotherapists of different schools to recognize that genuine therapeutic potential may be found in a variety of techniques with widely differing underlying assumptions about the nature of neurosis. It seems increasingly probable that psychotherapists of the future will need to be conversant with many techniques and the clinical indications for each, for it is becoming unrealistic to expect all neurotic problems to be solved by one technique alone.

When a doctor sees a patient it is important that he should have an accurate account of that patient's previous drug treatment. An earlier study (Ballinger and Stewart, 1971) showed that there were inconsistencies in the various reports of a patient's drug treatment immediately before admission to a psychiatric hospital. It seemed very likely that this problem was not limited to this one situation, and general practitioners have often criticized the quality of the information received after a patient has been discharged from hospital. The present survey attempted to assess the quality of the information about drug treatment sent to general practitioners at the time of discharge.

The presumed carcinogenic and chromosome-breaking potential of d-lysergic acid diethylamide (d-LSD 25) in human somatic cells has been reviewed by Fernandez et al. (1973). Reports concerning its teratogenic effect in experimental animals and man have been either contradictory or inconclusive. The following possible teratogenic mechanisms may be considered: (1) A direct effect on organogenesis of LSD ingested by the mother during early pregnancy; (2) A similar disturbance of organogenesis by a persistent metabolite of LSD ingested by the mother at some time prior to the pregnancy; (3) Chromosome damage or point mutations in parental germ cells exposed to LSD before initiation of a pregnancy.

The sedative effects of single doses of hypnotic drugs in normals are still detectable on behavioural tests 13 hours after administration, and on the electroencephalogram (EEG) at 18 hours (Malpas et al., 1970), and similar results have been noted by other workers (Lader and Walters, 1971). Using measures of driving skill, Betts et al. (1972) have also found that normal subjects may be impaired after five doses of amylobarbitone sodium taken over the preceding 36 hours. However, the relevance of all these results to the prediction of effects in patients for whom the drugs are prescribed is uncertain, as our preliminary report indicated (Legg et al., 1973). Here we present the more detailed results of a study carried out on anxious out-patients, using behavioural and EEG measures to determine whether or not persistent effects were present following a course of 7 days treatment with hypnotic drugs.

As the staff in a psychiatric adolescent service become more experienced, they invariably develop hunches and hypotheses about the young people referred to them. These ideas, which are essentially clinical in origin, can often be tested if relevant information is systematically collected; previously unsuspected associations may also be found in such a body of data. For these reasons, the Young People's Unit adopted the routine use of a pre-coded assessment form.

The possibility of understanding self and others through the use of drugs has entertained and intrigued the imagination of man for centuries. The accidental discovery of d-lysergic acid diethylamide-25 (LSD) by Hofman in 1943 brought this possibility closer to realization than ever before.

Between 1962 and 1970, the male parasuicide (attempted suicide) rate in Edinburgh has doubled, and the rate for women shows a 70 per cent increase (Kreitman, 1972). Of those who are admitted following a parasuicidal act a substantial proportion are readmitted—approximately 15 per cent within 12 months and 25 per cent within three years. Parasuicide is a sign of severe distress, and repetition indicates that the distress has not been adequately alleviated. A means of early identification of the potential repeaters would be valuable.

The success of an in-patient therapeutic programme depends, in many instances, on the willingness of the patient to co-operate with medical and nursing staff, and to react positively to the permissive regime characteristic of the modern psychiatric hospital.