The present paper compares a lenient and a strict operant conditioning programme in refeeding patients with anorexia nervosa. Sixty-five consecutive in-patients participated in the study. We found no significant difference in the rate of weight-gain between the two treatments. There were, however, a number of practical advantages in using the more lenient programme: it was more economical of nursing time, and patients were more accessible to psychotherapy. The programme was also more acceptable to the patients.

Two patients are described in whom diabetes mellitus and anorexia nervosa occurred together. The nature of the relationship between the two conditions is discussed. It is suggested that weight loss is not always the primary goal in such patients.

The authors have previously reported that a sub-group of schizophrenic-like patients respond favorably to lithium therapy: furthermore, psychotic patients who respond to lithium demonstrate appreciable improvement during the first seven days of treatment. The present study investigated which symptoms of schizophrenia improved quickly during lithium treatment. We found that patients who do respond to lithium show significant improvement in the core symptoms of psychosis—hallucinations, delusions and formal thought disorder—during the first seven days of treatment, thus allowing early identification of 88 per cent of schizophrenic patients who ultimately respond to lithium and 91 per cent of those who do not.

Recent clinical investigations have shown that long term treatment with the tricyclic antidepressants desipramine and amitriptyline reduces the sensitivity of the alpha-2 adrenergic autoreceptor. In order to determine whether the tetracyclic antidepressant mianserin also has this action, the effect of clonidine, an alpha-2 adrenergic receptor agonist, on plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenlethyleneglycol (MHPG), blood pressure, and patient-rated sedation were measured in fifteen depressed patients before and during mianserin treatment. Postsynaptic alpha-2 adrenergic receptor function was assessed by measuring the growth hormone response to clonidine before and during treatment. Mianserin had little or no effect on the ability of clonidine to lower plasma MHPG and blood pressure, and to increase sedation and growth hormone secretion. The findings of this investigation indicates that long term mianserin treatment does not produce significant subsensitivity of the alpha-2 adrenergic receptor and suggests that a reduction in alpha-2 adrenergic autoreceptor sensitivity is not a necessary action for all effective antidepressant treatments.

Cerebrospinal fluid was collected from 28 psychiatric (mostly schizophrenic) inpatients from Bombay, India. These included eight patients with tardive dyskinesia, five with spontaneous dyskinesia and 15 without dyskinesia. The samples were flown to the National Institute of Mental Health, Washington, D.C., where they were analyzed “blind” for concentrations of noradrenaline and several monoamine metabolites. Patients with tardive dyskinesia had significantly higher noradrenaline concentrations in the CSF as compared with the other two groups. Spontaneous dyskinesia group had significantly lower concentrations of homovanillic acid in the CSF. Our results support the hypothesis of noradrenergic hyperactivity, rather than postsynaptic dopamine receptor supersensitivity, in tardive dyskinesia.

We surveyed the psychotropic drug treatment of our hospital's 220 patients, and compared our findings with those of the only previous hospital survey in this country which showed much allegedly inappropriate prescribing. Using simple classifications of the patients' diagnoses and of the drugs prescribed, 30 per cent of our prescriptions appeared inappropriate in the absence of knowledge of the patients' symptoms. With such knowledge we show that only 2 of our 460 prescriptions were inappropriate.

Fifty-nine depressed inpatients who satisfied Feighner's criteria for depression were separated into two groups by the response of their plasma Cortisol (1600 hours) to a dose of 1 mg of dexamethasone given at 2100 hours. No statistically significant differences were found between suppressors and non-suppressors as regards severity of anxiety or depressive symptoms in the Leeds and the MADRS rating scales. No single item either in the Leeds or the MADRS scale was associated with a positive DST. The reason for this negative finding is discussed.

Serial post-ictal serum prolactin levels were obtained over a period of one hour after bilateral or unilateral electroconvulsive therapy (ECT) in six patients. Bilateral ECT yielded significantly higher mean post-ictal prolactin levels than unilateral ECT at the 15,20,30 and 60 minute sampling times. These findings demonstrate a greater hypothalamic-stimulating effect of bilateral than unilateral ECT, and may explain the reported therapeutic advantage of bilateral over unilateral ECT in the treatment of patients with melancholia.

We identified the population of schizophrenic patients under 65 in a geographically defined area. The number using psychiatric services based on a new District General Hospital unit in the course of one year was 364, a prevalence of 2.2 per 1000 adult population. Half the patients lived in supportive private households, most often with spouses or mothers. More women than men married and retained supporters. Patients and their primary supporters were interviewed separately. The PSE Catego programme classed 47 per cent of patients as psychotic. Supporters reported disturbed behaviour in 65 per cent of patients, and restricted social performance in 78 per cent. There was evidence of hardship (emotional and physical ill-health, problems with children) in 90 per cent of households. Supporters' subjective distress was directly related to the presence of psychosis and disturbed behaviour and inversely related to the duration of the illness. Drop-out and failure to take medication appeared to be causes of the relatively high prevalence of psychosis.

In a consecutive series of 127 chronic schizophrenics admitted to hospital, 70 (55.1 per cent) had attempted suicide. When compared with the chronic schizophrenics who had not attempted suicide, significantly more of the attempters had had a major depressive episode (45.7 per cent) and had received antidepressant medication (65.7 per cent). They also had histories of significantly more psychiatric admissions (a mean of 5.4 compared with 3.6). These findings are discussed.

Thirty alcoholic patients were investigated for evidence of impaired hepatic function and deficits in cognitive functioning, to see if there was any significant relationship between these two complications of alcoholism. Forty-seven per cent had abnormal γ-glutamyl transpeptidase levels, and 63 per cent had abnormal results on the Category test. Only one significant correlation coefficient was found, between one parameter of hepatic function and one of cognitive function. Possible explanations for this (negative) correlation are discussed, and the value of further study is suggested.

The growth hormone and hypotensive responses to clonidine have been measured in six drug free severely depressed patients before, and at two weeks after, the surgical procedure of stereotactic sub-caudate tractotomy. The responses were unaltered two weeks after operation, by which time a small clinical improvement was evident. These findings are discussed in relation to central a adrenoceptor functions in depression, and the effect upon this of antidepressant treatment.

Brain-type creatine phosphokinase isoenzyme (CPK BB) was measured by radioimmunoassay in the serum of 31 depressed patients undergoing bilateral ECT. Samples were taken shortly before and at one hour, two hours, and six hours following ECT. ECT did not cause a significant alteration in serum CPK BB concentration during the six hours following the treatment. Similarly, there was no difference in mean pre-ECT concentration of serum CPK BB between patients receiving the first ECT of their current admission and those receiving subsequent treatments. These findings do not support suggestions that ECT causes alteration in permeability of the blood-brain barrier, nor that it causes detectable brain injury.

In order to explore the possibility that prolactinomas may be caused by prolonged under-inhibition of prolactin-secreting cells we examined the pituitary fossa in 69 patients on long-term phenothiazine treatment. The average duration of treatment was 12.5 years and 55 (80 per cent) of the patients had persistently raised serum prolactin levels. The incidence of radiologically detectable pituitary fossa abnormalities was not significantly different to that in control populations. In 62 per cent of patients the skull x-rays from an earlier admission were available. Comparison of these with earlier films did not show a higher incidence of pituitary fossa abnormalities after prolonged exposure to phenothiazines.

Twenty-five patients with obsessive-compulsive neurosis and matched controls had their life event scores (Paykel's Life Event Schedule) rated for the year prior to the onset of illness and the date of interview, respectively. The Standard Assessment of Personality Schedule, whose high inter-temporal and inter-informant reliability was confirmed, was used to rate the patients' premorbid personality.

The obsessive-compulsive patients' mean life event score was significantly higher than the control subjects; and this excess spanned the six months prior to the onset of illness. Patients with abnormal personality traits (obsessional, anxious and self-conscious) experienced significantly fewer life events than those without such traits.

Life histories and interview descriptions of 23 young men diagnosed as schizoid in middle childhood and adult life and of 20 control subjects not given this diagnosis were presented for diagnostic rating to two independent general psychiatrists. Agreement about the presence or absence of schizoid personality was good. It is concluded that, in the case of boys, the syndrome of schizoid personality in childhood (Asperger's syndrome) corresponds to or is subsumed by the more general clinical picture psychiatrists have of schizoid personality in adult life, and that our original use of this diagnostic label for the youngsters we described was not idiosyncratic.

Current psychiatric classifications of anxiety are examined critically. In the European literature a specific cluster of symptoms is diagnostic of anxiety neurosis and their subsidiary classification is based on precipitating factors and duration of symptoms. In the American literature, exemplified by DSM-III, greater emphasis is placed on symptomatic classification and panic is given separate diagnostic status, both alone and in conjunction with agoraphobia. In both classifications generalized anxiety is at the bottom of a diagnostic hierarchy so that all other symptoms take precedence. It is argued that neither classification properly identifies a discrete syndrome of pathological anxiety that is recognizable in clinical practice.

Eighty opiate takers attending a Scottish drug dependence clinic were studied on a number of characteristics. The more recent attenders since 1981 were younger but otherwise not different from longer-term attenders. Recent young heroin abusers may not be seeking treatment from the drug clinic.

A syndrome is described in three elderly women who all suffered from cerebral arteriosclerosis, and who in their dependent condition were looked after by their daughters. These women accepted their daughters as their daughters when carrying out directly caring tasks related to them, but spoke of them and addressed them as different women, with the same forenames as their daughters, when their daughters were engaged in other duties. This syndrome is compared with the syndromes of Capgras and similar conditions. It is likely to be detected with increasing frequency as psychiatrists become involved in the community aspects of the speciality.

A case of obsessional disorder is described in which a combination of tranylcypromine and thought stopping was effective in markedly reducing obsessional ruminations. Thought stopping appears to have had a major role in preventing relapse on withdrawal of the tranylcypromine. Isberg (1981) and Jenike (1981) have reviewed the literature regarding the response of obsessive compulsive disorders to monoamine oxidase inhibitors, the results of such treatment may be quite dramatic but there is a tendency to report positive results and not to report treatment failures.