Handedness was assessed in 87 per cent (n = 116) of all known schizophrenics from a discrete geographical area, Nithsdale in Dumfries and Galloway Region. Seventy-three per cent were right-handed, a proportion greater than that found in a normal population. It was especially Feighner positive schizophrenics and non-in-patients who produced the excess of right-handers. Within the Feighner positive group, 68 per cent of mixed or lefthanders, but only 29 per cent of right-handers, had tardive dyskinesia.

Forty patients suffering from senile dementia who had been subjected to detailed clinical and psychological assessment and computed tomography (CT) were followed up for a mean period of 28.78 months. All but one were traced. The deceased (27) were compared with the survivors (12). All males had died at follow-up. The mean age was not statistically significant but the survivors differed significantly from the deceased in having performed better on a number of clinical and psychological tests, particularly those involving speech functions and constructoinal ability. Measures of ventricular size and cortical atrophy were not of predictive value, but a new technique of measuring radiological density showed that this was significantly lower in the right parietal region in the original CT scans of those who subsequently died. The study confirms that clinical involvement of the parietal lobes is an indication of poor prognosis and reports the first radiological support for this view. It also suggests that a more directly quantitative approach to computed tomography may yield results which are more useful than those obtained from visual reconstructions.

A 10 week double blind study of 24 agoraphobics and 16 social phobics all on clomipramine compared the effect of adding tryptophan or placebo. Tryptophan did not potentiate the beneficial effect of clomipramine on phobic avoidance, phobic fears or the incidence of panic attacks. Neither was the presence of depression a factor of outcome.

Segregation analysis was applied to blind family data concerning schizophrenia to decide if the transmission of schizophrenia could be explained by a single major gene. Our results showed that the Mendelian model was unacceptable. Therefore, the monogenic hypothesis could not account for the transmission of schizophrenia. Since the hypothesis of no parent-child transmission was also not accepted, there was an indication that some form of vertical transmission existed which could be psychosocial, or an interaction between genetic and psychosocial factors. Our results suggest genetic heterogeneity in schizophrenia. Currently available clinical criteria for defining subgroups must be improved in conjunction with detection of biological indicators so that segregation analysis of family data could be effectively used in determining modes of transmission in schizophrenia.

This study extends earlier work on the evaluation of depression by general physicians, and compares the results obtained with that group with those from a group of experienced psychiatrists. Differences within each group were larger than those between them. In neither group were individuals able to describe their own diagnostic processes with great accuracy, but psychiatrists were, as expected, somewhat more consistent than general physicians. They became even more so when allowed to select their own cues; of which, however, they made use of a smaller number. These tended to be of a specific rather than (as with the physicians) of a general nature.

In ten patients with presenile dementia of the Alzheimer type and in a control group the levels of the different immunoglobulins were determined in both serum and cerebrospinal fluid (CSF), and gel electrophoretic techniques used to determine possible oligoclonal bands in the gamma-globulin region. There is no indication that patients with Alzheimer disease produce immunoglobulins within the central nervous system.

The study at Graylingwell Hospital conducted by Roth (1955) has in part been replicated in order to study the changing patterns of mental illness in the elderly over a 25-year period. Important changes in the diagnostic distribution and outcome of cases admitted have occurred. Functional illness has given way to dementia, not as a proportion of patients admitted but in the number of beds employed for their care 6 and 24 months after their index admission. Discharge rates for all diagnostic groups except acute confusional states, have undergone considerable change and death rates have fallen. The study has concentrated on the residual in-patient population, paying particular attention to increasing demand for beds for the dementing group. These changes have been quantified and reflect a four-fold increase in bed requirements for cases of dementia at two years. Despite a striking reduction in requirement for functional cases, there is an overall increase in bed requirement of 38 per cent at the two-year mark.

Animal studies have suggested that the mechanism of the antidepressant action of ECT may be to increase monoaminergic post-synaptic receptor sensitivity. We have tested this hypothesis in 12 drug-free patients suffering from severe depression, 11 of whom had depressive delusions. The responses of growth hormone, prolactin and Cortisol to 0.75 mg subcutaneous apomorphine were examined before and after a successful course of ECT. There were no significant differences between hormonal measurements on the two occasions, with the exception that basal plasma Cortisol concentrations were significantly lower following ECT and recovery from depressive illness. These results do not support the hypothesis that ECT increases dopaminergic post-synaptic receptor sensitivity.

During two weeks' treatment of 11 manic patients with pimozide there was close correspondence between the timecourse of improvement in clinical ratings and the rise in plasma prolactin between the second and fourteenth day. There were no significant differences in growth hormone levels during the manic episodes compared to recovery. These findings are discussed in relation to the role of dopamine in the release of prolactin and growth hormone, and in the pathogenesis of mania.

The more recent large scale family investigations of schizophrenia are reviewed, particularly studies in which the authors have compared the rates in relatives of index cases with those of the general population. The risk of psychotic illness is increased four-fold in first-degree relatives and two-and-a-half-fold in second-degree relatives over that of the population at large. The possible genetic mechanisms are evaluated, with the conclusion that modified dominant transmission, based on a single major gene, is a plausible system.

We derived a discriminant function based on clinical features to classify patients with endogenous depression (‘melancholia’) and non-endogenous (‘neurotic’) depression. The difference between the groups was not one of overall severity of illness alone. Bipolar melancholic patients were classified less well than were unipolars, supporting previous findings of clinical differences between these groups.

The discriminant function (DF) was reduced to a discriminant index (DI) which classified a separate group of unipolar melancholic and non-endogenous patients with comparable accuracy. Approximately 80 per cent of all cases received a definite classification by the DI. The agreement between the 105 definite DI classifications and the clinical diagnoses was 90 per cent when results from the derivation and validation groups were combined.

The DI classification was then validated against an objective biological marker, the dexamethasone suppression test (DST). The diagnostic discriminant index predicted the DST result with the same accuracy as the clinical diagnoses. The discriminant index can serve as an operational definition of the patients diagnosed as endogenous or nonendogenous unipolar depression in future studies by ourselves and other groups of investigators.

Using routine data from the Mental Health Enquiry, the work of two district general hospital (DGH) units and a mental hospital was examined. There was a marked difference in the way the two DGH units operated and between the way the mental hospital worked as support hospital or as independent complete in-patient service. The operational policy practised by psychiatrists is more important than the structure of the system. It is important to establish sensitive policies for a wide variety of organizational structures.

A reliable and rapid way of assessing patient compliance is the use of a semi-quantitative drug determination in the urine. Almost all urines were positive to a microchromatographic test stick 2–6 hours after 25 or 100 mg nomifensine was taken orally by healthy normal volunteers. The test reliability between different observers varied between 76 and 100 per cent. False positive results were regularly observed with carbamazepine and triamterene, and false negatives or weakened reactions with lithium.

The test is reliable and highly ‘time-specific‘. Its applicability is, therefore, restricted to very specific questions.

In an in-patient psychiatric unit attached to a teaching general hospital in Hong Kong, community meetings went through doctor-directed and nurse-directed forms to develop into a non-directive one. The therapeutic value of these different forms was tested by retrospective and prospective studies. In the retrospective study the rates of ward incidents and discharge rates of inpatients before and during the three stages were compared. In the prospective study an ABA design was used with ten-week blocks of regular non-directive meetings, cessation of meetings and then resumption; ward incidents, discharge rates and ward atmosphere during these blocks were compared. Both the non-directive and nurse-directed forms were equally associated with a reduction in ward incidents, aggressive incidents showing the greatest tendency to change; ward atmosphere and patient discharge rates did not change with community meetings.

Significant differences in handedness patterns between groups of psychiatric patients and normal controls were identified in two recent British studies, with substantial disagreement in some important findings. Most of the discrepancies were attributable to the different application of a simple classification of handedness data, and the remainder to differences in sample size. Diagnosis, sex and age were then found to have a similar effect on handedness in both studies. Neurotic patients were similar to controls regardless of classification, whereas mixed handedness in personality disorder depended on it. There was no overall excess of left-handedness among schizophrenics, but trends towards excess sinistrality in men and full dextrality in women approached significance.

First rank symptoms have assumed an important role in the assessment of schizophrenia. Only recently, however, have there been empirical studies of their reliability and validity. In this study, we examined the relationship between first rank and other psychiatric symptoms in 100 schizophrenic patients. The results are consistent with other research reports suggesting that first rank symptoms do not represent a homogeneous group of symptoms within an individual patient.

The factor structure of the General Health Questionnaire (GHQ) was investigated in a non-clinical sample in relation to the role of field dependence (assessed by the Hidden Figures Test) in influencing the extent to which different aspects of psychoneurotic disturbance are differentiated. Greater differentiation was achieved by the field independent (FI) group than by the field dependent (FD) group, as shown by: (i) the proportion of variance accounted for by the general factor in the principal components analysis of the 60-item GHQ data was lower (17 per cent) in the FI group than in the FD group (33 per cent); (ii) the factor loadings in the FI group, but not the FD group, corresponded closely with the four subscales of the 28-item scaled GHQ; (iii) the interscale correlations were significantly lower in the FI group than in the FD group. The implications of these findings are discussed, particularly their relevance to ‘unitary’ and ‘distinct-syndrome’ models of minor anxiety and depressive disorders, and the greater probability of occurrence of mixed states in field dependent subjects.

The serum levels of lactoferrin, eosinophil cationic protein (ECP), lysozyme and β2-microglobulin have been measured in schizophrenic patients in an attempt to elucidate the activity and turnover of neutrophil and eosinophil granulocytes, macrophages/monocytes and lymphocytes, respectively. Serum-lactoferrin and serum-ECP levels were significantly (P <0.001) higher in the patient group as compared to healthy controls in contrast to blood cell counts and serum-lysozyme and serum-β2-microglobulin levels which all were within normal limits. The results were not affected by anti-psychotic therapy. A significant correlation was found between serum-ECP and serum-lactoferrin levels which may suggest a common underlying cause of the elevated levels. The findings suggest an increased eosinophil and neutrophil activity and/or turnover in schizophrenia and may have a bearing on the well-known altered inflammatory response associated with this syndrome.

In a double blind trial, 28 male chronic schizophrenic in-patients received either pimozide, given once weekly, or fluphenazine decanoate, given mostly once fortnightly. There was no difference in relapse rates over nine months. However, three-quarters of the patients on pimozide who completed the trial developed at least mild tardive dyskinesia. All patients on pimozide lost weight, the average loss being 5.4 kg (12 lbs). Plasma pimozide levels suggested satisfactory drug compliance. Plasma prolactin levels confirmed that in the pimozide group there was fluctuating dopamine receptor antagonism, while in the fluphenazine group average plasma prolactin levels throughout most of the interval between injections were at the upper limit of normal.

The HLA antigens distribution was studied in 56 chronic schizophrenic in-patients with or without brain atrophy determined by CAT examination, and compared with that of 200 controls. There was no difference in the incidence of HLA-A2 in the whole sample, and an increase in those without brain atrophy (by comparison with normal controls) failed to reach statistical significance. A decrease of Bw35 in the whole sample, more prominent in those without brain atrophy, again failed to be significant after multiplying the probability by the number of antigens studied.