The prevalence of subjective side-effects was studied in 258 control subjects, 65 drug-free depressive in-patients and 94 lithium-treated out-patients. It was shown that drug-free depressives reported more side-effects than both control subjects and lithium-treated patients. Side-effects were studied during amitriptyline therapy. Depressed patients on no medication complained of only slightly fewer side-effects than when they had received amitriptyline. There was a significant positive correlation of Hamilton depression scores and side-effects scores at baseline. Side-effects and affective morbidity over two years were investigated in 94 patients with recurrent affective disorders on long-term lithium therapy. Psychological variables were also investigated in 74 of these patients. Subjective side-effects reported by lithium-treated patients including those specific to lithium were related to their affective morbidity and personality variables. Patients on lithium complained significantly less of headache and unilateral headache than controls.

We have observed a lesser growth hormone response to intravenous clonidine administration in nine obsessive-compulsive disorder patients meeting research diagnostic criteria than in nine matched controls. The obsessive-compulsive disorder patients had higher plasma free 3-methoxy-4-hydroxyphenylglycol and plasma norepinephrine levels before clonidine than the controls. As blunted growth hormone responses to clonidine are also characteristic of affective disorder patients, these results support other observations of a psychobiologic affinity between these two groups and are also compatible with an association between increased presynaptic noradrenergic activity and decreased post-synaptic receptor responsiveness.

Are heterosexual pairings in which the male is dominant more satisfactory? Coital rates of couples in which husbands were younger than their wives were contrasted with those in which husbands were older, but there was no significant difference. However, the data were not controlled for duration of marriage, and for a constant spouse-age-sum, couples with the husband the younger marry later on average than do the others. So whether younger-husband couples have lower coital rates is undecided.

The authors were sent to Mwinilunga from Ndola to investigate what was reported to the local press as ‘mysterious madness'. The condition was actually an outbreak of epidemic hysteria which was triggerred off by a group of girls who were having educational and emotional problems prior to the epidemic.

A change in the administrative policy of rigidly segregating the sexes apparently prepared an emotionally charged background for the rapid spread of the illness. The salient features and management of the epidemic are discussed.

The characteristics in Hong Kong of 37 cases of child battering and their families compared to a control group matched for age of child and social class of family revealed that the families of battered children had significantly more problems, with a higher prevalence of psychiatric disorder among the parents. The victims were usually the product of unwanted pregnancy and had been separated from their parents in the first year of life. In Hong Kong older children rather than infants were at risk of being battered. The cultural factors in operation are discussed.

The binding of tritiated imipramine was significantly reduced in the hippocampus and occipital cortex from a series of patients with depressive illness compared with age-matched patients with no psychiatric disorder. In contrast there was no change in imipramine binding in established cases of senile dementia of Alzheimer-type. Scatchard analysis indicated normal binding affinity but a reduction in the number of imipramine binding sites in depression. These observations parallel previous findings of decreased binding sites in platelets from depressed patients and suggest there may be an abnormality in the uptake mechanism for serotonin in depression.

My association with the psychosurgical unit now carrying out over 80 per cent of these operations in Britain affords an unusual opportunity to assess the management of treatment-resistant affective disorders by a large number of psychiatrists from various parts of the country. The psychiatrists likely to refer patients for psychosurgery would be expected to be those more inclined to use psychotropic medication and physical treatments in general. Nonetheless, our experience is unequivocally of a widespread under-use of antidepressants. Most referral letters state that ‘… just about every antidepressant has been tried …’, but it is rare for the maximum dose of each drug used to be quoted. The letters suggest that with resistant illnesses the prescription of a series of drugs one after another at the usual doses is the therapeutic strategy, rather than giving one drug only in progressively increasing amounts to the limit of tolerance. Of course, the doses recommended by drug companies are understandably cautious and sometimes excessively so. For example, MIMS (November 1982) gives for “Anafranil” (Geigy); “More severe cases, 75 mg daily or more if necessary” and for “Surmontil” (M & B) “50–75 mg as single dose”.

A study of 20 manic patients, with patient and matched control comparisons, showed a two fold increase in life events during the 4 month period before admission to hospital. Life events, independent of affective illness and having significant objective negative impact (i.e. traumatic) were significantly more common. These findings are considered in relation to social relationships, family history of affective illness and the use of psychotropic medication.

Two patients are described with both anorexia nervosa and diabetes mellitus. In addition, both patients suffered from bulimic episodes. A third patient with bulimia is also described. All patients admitted to using their diabetes in a purposeful and direct way to pursue their morbid goal of weight loss. Management proved extremely difficult.

D. H. Myers et al (Journal, 1981, 139, 118–21) reported negative results of a double-blind investigation of propranolol (up to 1,920 mg per day for up to several months) as an adjunct to conventional neuroleptic treatment in 10 therapy-resistant chronic schizophrenics (compared with 10 control patients under placebo in addition to neuroleptic medication). They concluded with Gardos et al (1973) that the “failure to find propranolol effective in chronic schizophrenia does not cast doubt on its possible effectiveness in acute psychoses.” Our own experience of the short-term treatment of acute psychoses with propranolol and/or oxprenolol in high doses was unsuccessful in three schizophrenics and affected only the manic symptomatology in four out of six patients with schizoaffective psychoses (cf. von Zerssen, 1976; Table I). In two of these patients paranoid delusions even intensified during medication. In two separate drug trials there was a definite improvement in four out of six manic patients treated with propranolol (up to 2,300 mg/day). Therapeutic failures were restricted to incomplete trials (medication of less than 1 g/day or of less than one week's duration).

Two female psychiatric patient samples were examined—240 women, aged 20 or over, from North East Scotland; and 44, aged 40 to 49, from Chichester, West Sussex. There was also a Chichester community sample of 230 women of similar age-range.

The N.E. Scotland psychiatric patients with poor marriages broke down significantly earlier, and the delay between marriage and first breakdown was significantly shorter. This group also tended to have a neurotic rather than an endogenous type of depression.

The poor marriages of the Chichester psychiatric patients were, in the main, similar to those of the Chichester non-patients, but the patients demonstrated significantly more disturbance of sexual relationships, and their in-laws were significantly more disapproving.

316 psychiatric patients—predominantly out-patients—with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment.

One may read something about the psychiatry of old age by adhering to the College's reading list, supplementing it with more up to date papers from current journals or selections from the bibliographies and reference lists of reviews and textbooks. It would be profligate of a limited allowance for this article to repeat such lists or even to highlight choices from them. It is arguably as enlightening, perhaps more so, to read around the subject.

A psychiatric service was provided to the remote areas of Botswana by means of regular visits from psychiatrists and psychiatric nurses to the primary care facilities in those areas. The service was well used by the local health workers and general populations and encountered a substantial psychiatric morbidity. Studies in one region indicated that by using the primary care staff as case finders a substantial proportion of a total likely population of schizophrenic and epileptic patients could be bought into treatment. The specific conditions that enabled this service to become established are discussed.