Increasing evidence suggests that the concentrations of cyclic guanosine 3′5′-monophosphate (cGMP) in the cerebrospinal fluid (CSF) may reflect central cholinergic activity. When the concentrations of this nucleotide in the CSF from 28 schizophrenic patients (13 without and 15 with neuroleptic treatment) and 16 psychiatrically healthy controls was determined the schizophrenics showed significantly lower CSF levels of cGMP as compared to controls.

As dopamine and homovanillic acid concentrations were not altered in these CSF samples, this finding of reduced cGMP suggests a cholinergic-dopaminergic imbalance in schizophrenia, with a reduction of the former and consequently a relative dominance of the latter.

This study was designed to replicate and extend earlier findings. Evoked potentials (EP) were recorded, using a task of varying complexity involving shape discrimination, with matched groups of obsessional and normal subjects. Results confirmed previous findings that obsessional patients are characterised by reduced amplitudes and decreased latencies of late EP components; divergencies between the groups were more marked for tasks of increased complexity.

Propranolol 40 mg was compared with a matched placebo tablet in its effect on the performance of anxious and non-anxious human volunteers. Subjects were required to give a brief speech, which was video-taped and later rated by trained observers for signs of anxiety; propranolol clearly reduced rated anxiety in the non-verbal behaviour of anxious subjects, as well as the anxiety observed in the speech of the anxious compared to the non-anxious. It also affected self-reported anxiety in the anxious, and reduced the pulse rate of anxious and non-anxious alike. Subjects were also prompted, by being given the first letter, to recall both difficult and easy words, drawn from selected verbal categories; propranolol impaired recall of difficult items in the memory of anxious subjects. Results were interpreted as showing a central as well as peripheral role for propranolol in blocking adrenergic receptors' activity in anxiety.

The prevalence of psychiatric morbidity (PM) was studied among general hospital out-patients in a rural and in a semi-urban area of Kenya. There were no significant differences in the demographic features of psychiatric patients from the two areas, so the results were pooled: this gave a PM prevalence rate of 29 per cent among 388 patients. Anxiety and depression were the most frequent diagnostic categories. Alcoholism was more common in the rural than in the semi-urban area. There was no sex difference in the prevalence of PM and possible reasons for this, which is in contrast to western findings, are discussed.

Psychiatric symptoms could be readily elicited when present. Patients showing them had been ill longer than non-PM patients.

The study suggests that clinic staff not psychiatrically trained should be able to identify and treat psychiatric morbidity, even when it is presented as somatic illness.

The addiction and conviction status of 60 male patients who presented to a London drug clinic in 1970 was re-examined 10 years later. Eleven of the patients had died. Three-quarters of the survivors had been abstinent for five years and one quarter were still addicted in this time. Ninety-seven per cent had received a court conviction by 1981 and 83 per cent were convicted during follow-up. Neither hospital treatment receipt of a clinic prescription nor imprisonment was associated with eventual abstinence. Poor outcome, in combined terms of continued addiction and re-conviction, related to early parental loss, poor academic achievement, conviction before drug use, longer imprisonment and a high conviction rate. Criminality emerges as the predominant and continuing expression of deviancy in these drug clinic patients.

An automated assessment interview was given by a microcomputer to 26 randomly selected patients, referred for treatment of phobias. The results were compared with those of conventional clinical assessment by experienced behaviour therapists. Ratings of overall severity and intensity of specific types of agoraphobia and social phobia were derived from the computer interview, and correlated very closely with global ratings by the clinician and also with an independent structured clinical assessment. The computer also elicited behavioural targets to serve as a basis for exposure treatment. Blind assessors rated these targets as highly as those arrived at by clinicians in respect of their practicability, precision and appropriateness for treatment. The automated technique is inexpensive, saves clinicians' time and can be made widely available for screening, assessment and progress monitoring. It may also provide a basis for automated exposure treatment.

Serum calcium concentration was estimated, via a multichannel analyser, in all patients admitted to a 25 bed psychogeriatric inpatient unit and associated day hospital. Case notes of 629 consecutive admissions over a 42 month period were studied, and the prevalence of hypercalcaemia found to be 0.7 per cent, close to that estimated for the general population. Cases of hypercalcaemia with psychiatric symptoms, undetected medically because of vague and non-specific physical symptoms, do not appear in excess in a psychogeriatric population.

In order to investigate the validity of Foulds' hierarchical model of psychiatric illness a cross-cultural study was carried out. The DSSI, a self-report symptom inventory, was administered to 100 English psychiatric patients and a translated version was administered to 100 Turkish psychiatric patients. The report of symptoms in both nationality groups conformed to Foulds' hierarchy principles in 93 per cent and 87 per cent of cases respectively.

When the reporting of symptoms within classes was investigated, nationality effects were observed to influence the self-reporting of ‘hysterical’ neurotic symptoms, irrespective of diagnostic class. Nationality was also observed to influence the reporting of ‘delusional’ symptoms, but in non-psychotic patients.

These results suggest that Foulds' model is a useful one in cross-cultural psychiatry, because it indicates both the universal features of hierarchical ordering of symptoms and the cultural influence on those symptoms which do not define the diagnostic class of the patient.

This study surveys the discharge register of a large London teaching hospital over 20 years and presents data on its 48 cases of clinical sexual fetishism. An attempt was made to answer two questions: (1) What are the clinical problems these patients present? They have more to do with the perception of fetishes as personally or socially unacceptable than with ‘objective’ restrictions placed on sexual activity. (2) What is the classification used to describe? The data have not enabled any conclusions to be drawn about the existence of particular fetishist syndromes. Certainly, a fifth or more of the sample had fetishes for clothes or rubber or rubber items, or wore or stole a fetish or fetishes; but this information is insufficient to allow one to assume that these patients had something significant in common, and leaves open the question of what more precisely each individual was attracted to.

A five-year follow-up of 25 children who attended a psychiatric day centre for pre-school children is described. This group was compared at eight years of age with two matched control groups who had not received intensive treatment. There were few differences between the treated and untreated groups. Possible reasons for the findings are discussed and some methodological issues involved in carrying out evaluation studies are raised.

Seventy severely depressed patients randomly assigned to receive 8 real or sham ECT were further subdivided on the basis of degree of recovery from depression afterwards. In comparison to a non-depressed control group the depressed patients were impaired on a wide range of tests of memory and concentration prior to treatment, but afterwards performance on most of the tests had improved. Real ECT induced impairments of concentration, short-term memory and learning, but significantly facilitated access to remote memories. At 6 month follow-up all differences between real and sham ECT groups had disappeared. On the majority of tests the previously depressed patients now performed at the same level as the control group. There was some evidence that a subgroup of treatment-resistant patients (poor outcome after real ECT) were significantly more likely to complain of memory problems 6 months later.

Eighty-seven people with the symptom of social phobia were compared with 57 people with the symptom of agoraphobia to determine whether these symptoms were part of distinct syndromes. Comparisons were made on demographic, clinical and questionnaire data. Significant differences were found on important variables. The social phobics were younger and more often male, unmarried, and from social classes I and II. The pattern of phobic situations was different in the two groups and so was the pattern of autonomic symptoms experienced in these situations. Symptoms visible to others were more frequent among social phobics. Fainting was more frequent among the agoraphobics.

The relationships between patients speaking out and measured outcome were investigated over 18 months in an out-patient group. The parameters of therapeutic progress were derived from the Symptom Check List and individualized repertory grid rating scales. Each patient's verbal participation was compared to that of other group members and to his own participation over other measurement phases. Speaking out phases were associated with more chance of change and improvement, while silent phases were associated with less chance of change and an increased likelihood of negative change. This study demonstrates the use of a relatively non-disruptive measurement model in testing clinical hypotheses in single psychotherapy groups.

2,3-butanediol appears in the blood of some alcoholics following ethanol ingestion. Whether it be a genetic trait or a phenomenon of induction remains to be determined. It may be associated in some way with depression.

Two women who both experienced a psychotic illness after each of three consecutive pregnancies are described. Subjects who are at high risk for post-partum psychotic breakdown offer an almost unique opportunity for prospective tests of hypotheses about the aetiology of severe mental illness.

At a child psychiatry clinic 122 boys were scored on scales of aggressiveness, noncompliance and antisocial behaviour. Their biological fathers were scored on aggressiveness and antisocial behaviour. The fathers' scores were modestly but significantly correlated with those of their sons. The correlations were also computed separately for the 64 boys whose biological fathers were no longer in the home and for the 58 whose fathers had stayed. Father–son resemblances for the latter group were considerably higher than those observed in the whole sample, and for the father-absent group were insignificant.

Of 15 patients with writer's cramp (4 females, 11 males, mean age 36, range 23–50, mean duration 3.6 years), 13 entered a behavioural treatment. Nine received a multimodal treatment, and four EMG feedback alone. Four patients dropped out during the treatment phase. Nine patients were considered as improved at a follow-up between 1 and 9 months. A stress-coping model is put forward to account for the therapeutic effectiveness, and to explain the drop-outs. Writer's cramp seems to be related to stressful situations at work. The existence of personality and biological factors remains to be demonstrated.

Changes in sexual behaviour in patients with Parkinson's disease treated with levodopa are well recognized. Barbeau (1969) was the first to draw attention to “a clear-cut visually evident increase in libido” occurring in at least four out of 62 male parkinsonian patients treated with levodopa. Hyyppa et al (1970) reported that among 41 treated patients 10 experienced an increase of libido. De Ajuriaguerra et al (1972) reported that 29 out of 202 treated patients spontaneously told the authors of their satisfaction in respect of sexual behaviour. They commented “despite a few complaints from their spouses we do not believe there are any grounds to support the hypothesis of hypersexuality, but rather a more or less complete return to normal”. Similarly, Duvoisin and Yahr (1972) found that 8 per cent of a total of 283 patients reported an increase in sexual activity that “generally appeared to represent a partial return towards normalcy”. However, hypersexuality during levodopa therapy in parkinsonian patients was seen in senile dements, or as a feature of a more generalized disturbance, e.g. hypomanic behaviour. The subsequent experience of other authors (Bowers et al, 1971; Shapiro, 1973; Ballivet et al, 1973) has left no doubt that frankly hypersexual behaviour, albeit uncommon, may be provoked by levodopa treatment. Goodwin (1971) reviewed the literature on 908 patients and found an incidence of 0.9 per cent and Shapiro (1973) concurred, with an incidence in the region of 1 per cent of treated patients. Bowers et al (1971) reported 7 out of 19 patients on levodopa who indicated an activation of sexual behaviour on a combined scale of feeling and performance at some time during levodopa therapy. They divided the subjects into three groups: firstly patients who showed increased sexual drive apparently independent of motor improvement, secondly others whose sexual drive increased proportionately with their mobility, and thirdly those who developed hypersexual behaviour as part of an acute brain syndrome with an agitated and confused state.

The phenomenon of post-treatment depression in schizophrenia has become the subject of considerable controversy regarding its causality (Ananth and Chadirian, 1980; McGlashan and Carpenter, 1976a). But as the recent commentary by Hirsch (1982) emphasizes, the most controversial issue is focused on whether this depression is neuroleptic-induced. Hirsch himself refutes neuroleptic-induction on the basis of various uncontrolled data which seem ostensibly incompatible with this causality. Results indicating that pretreatment depressions appear in a high proportion of recently hospitalized schizophrenics, occur in drug-free patients, and frequently remit or decrease following neuroleptic therapy are cited as evidence contradicting neuroleptic-induction. Hirsch therefore proposes an alternative view: that this post-treatment depression is an integral, “revealed” aspect of the schizophrenia syndrome which arises from the same pathophysiological process (cf. McGlashan and Carpenter, 1976b).

A postal survey of male and female university students is reported, using the Eating Attitude Test (EAT) and the Crown Crisp Experiential Index (CCEI). Eleven per cent of the 156 female respondents but none of 120 males scored above 30 on the EAT, thereby declaring eating attitudes comparable to anorexic subjects. Of those interviewed, none fulfilled diagnostic criteria for anorexia nervosa, but half showed eating disorder of clinical severity. There was a clear association between high EAT scores and higher scores on all the subscales of the CCEI except the phobic scale. The results are discussed in relation to ideas about the possible origins of clinical eating disorders.