Temporal stability of symptom patterns was examined in 33 depressives studied initially at the height of illness and again some months later in a relapse following earlier recovery. Relapse symptoms were significantly less severe at the time of rating, and initial and relapse severity were not significantly related. Nevertheless there were significant correlations between initial and relapse scores on two factors orthogonal to severity. One of these reflected symptom patterns important to the endogenous-neurotic distinction, the other a contrast between depression and anxiety. These findings indicate some consistency in symptom patterns in successive episodes of depression, and thereby support the value of clinical classifications depending on symptom patterns.

The purpose of the study was to clarify the attitude of patients with schizophrenia and paranoid psychoses towards hospital personnel and treatment procedures during the two pre-suicidal months. The study was carried out on subjects from south Finland who had committed suicide during a three-year period and had been treated under these diagnoses. The controls included suicides who had received psychiatric treatment for other reasons. A questionnaire was issued to ascertain the opinions of the doctor last in charge of the patient and other personnel. Both groups answered independently, and the opinions given were almost the same. Both groups stated that during the last pre-suicidal months the patients with schizophrenia and paranoid psychoses had shown a more negative or indifferent attitude towards personnel than the controls, and their attitude towards medication had been clearly more negative. Among them there were considerably more patients who had ceased to request support or attention. Thus these patients had developed a degree of despair which manifested itself in a negative attitude towards personnel and treatment.

The uses of chlormethiazole (Heminevrin) are briefly mentioned. Differing views of its potential for producing dependence are discussed. The consensus opinion is taken to be that a risk of psychological dependence does exist, but only one case has appeared in the medical literature to date of physiological dependence on chlormethiazole, with withdrawal symptoms. This case is re-examined. A second case is described in which the features of increasing dosage and withdrawal were followed by confusion, disorientation, delusions, hallucinations and muscular spasm and coarse jerking. This is taken as confirmation of the potential of chlormethiazole to produce physiological dependence. Some personal opinions of the author regarding indications for use and incidence of abuse are briefly mentioned.

The proportion of persons with neurotic personalities in flats was not significantly greater than that in houses. Extraversion was not correlated with psychiatric illness or with the tendency to consult a doctor. Flat dwelling, but not house dwelling, was sufficient stress for neurotic personalities to cause, among them, an increase in clinical psychiatric illness. The resulting increase in the overall level of psychiatric illness of all flat dwellers was too small to be significantly greater than that of all house dwellers.

Four mentally defective patients who were suffering from short-cycle manic-depressive psychosis were each studied under metabolic ward conditions for about six months. Weekly estimations of erythrocyte Na-K ATPase activity, ouabain sensitive potassium influx, sodium concentration, whole blood cell ATP concentration and blood haematocrit were made. The findings in each patient differed, but the erythrocyte Na-K ATPase activity, sodium and ATP concentration appeared to show cyclic changes related to, though out of phase with, the clinical state.

Thirty-six patients who had had infectious mononucleosis (IM) were followed up a year later and assessed by the Middlesex Hospital Questionnaire and by interview or (in five cases) by postal questionnaire. The results support the view that IM leads to depression in a considerable number of cases, but in this series only women were so affected.

Work has been a highly valued feature of psychiatric rehabilitation programmes. The performance of patients has often been the object of scrutiny and assessment, but the jobs performed by these patients have not been so assessed. This paper describes the development and use of a job rating scale which parallels the use of patient assessment instruments.

Frequent references have been made to the similarities between highly creative and psychotic thinking. This study attempts to test the hypothesis that one explanation for such a correspondence lies in the fact that individuals in both these populations habitually employ common attentional strategies which cause them to sample an unusually wide range of available environmental stimuli.

A group of highly creative adults and a group of equally intelligent but low creative adults were compared with a group of acute non-paranoid schizophrenic adults on three tests designed to assess attentional and other cognitive styles.

The results offer support to the view that both highly creative and schizophrenic individuals habitually sample a wider range of available environmental input than do less creative individuals. In the case of the schizophrenic this involuntary widening of attention tends to have a deleterious effect on performance, while, in contrast, the highly creative individual is more able to successfully process the greater input without this incurring a performance deficit.

Among twenty patients with narcolepsy intelligence was normal and no characteristic personality or psychopathology was found. A family history of psychiatric disorder was present in five and a past personal history in ten. Eight had a current psychiatric disorder and twelve either a current or past psychiatric disorder. Chronic sexual disorder was present in eleven. Arousal appeared to be the mechanism by which emotions precipitated symptoms. Ten patients were found to have had difficulties at work, in marriage or in social life.

Twenty-two female patients with anorexia nervosa were assessed by means of objective personality testing. The EPI, Leyton Obsessional Inventory, Cattell's 16 PF and Raven's Matrices were used for this purpose. The personality profile that emerged was of a highly neurotic and introverted person with moderately severe obsessional features and average intelligence.

A psychiatric condition disabling to persons in the fifth and sixth decades is described. Approximately 51 per cent of nearly 1,000 Social Security Disability applicants sampled presented a wide variety of somatic and psychological complaints, but no severe psychiatric disorder. This group is characterized by inability to continue gainful employment. Commencement of full-time employment before age 16 years (59 per cent) and level of education were the only significant differences between this group and psychotic applicants; another 33 per cent began full-time work before age 20 years. 88.5 per cent of the families of these persons remained intact until after they began work. Apparently, being thrust into the responsibilities of adulthood earlier than their peers contributed to the early disability.

Fifty-four patients suffering from a variety of psychotic states were graded by their degree of psychomotor activity. Serum creatine Phosphokinase (CPK) levels were found to be related to the degree of psychomotor activity, irrespective of the diagnostic category. Retarded and withdrawn patients had normal serum CPK, but on their return to normal psychomotor activity the CPK levels tended to rise transiently. It appears that unphysiological motor activity has a more direct relationship to the rise of serum CPK than motor activity per se.

This investigation is an attempt to test the common supposition that postpartum emotional disturbance is related to hormone changes. A group of 27 normal pregnant women were assessed three times before delivery and sixteen times in the six weeks following delivery. During the first two interviews baseline data on personality and other personal variables were obtained. On each occasion blood was taken and three measures of clinical status and mood were completed. Plasma LH, FSH, total oestrogen and progesterone results are presented in detail and the results of prolactin assays mentioned more briefly. An attempt to correlate hormone findings and clinical findings is described. This failed to produce any strong evidence that hormones are related to mood at this time, although hormone changes were correlated weakly with a few specific symptoms. Some of the unexpected clinical findings and technical difficulties of the study are discussed, with special reference to possible further research in this area.

Better Services for the Mentally Handicapped (1971) forecasts a diminution in the number of beds in hospitals for mental handicap. It can be achieved only by the admission of fewer new long-stay patients. This paper considers 50 new long-stay cases admitted to a hospital for mentally handicapped in the five years 1970 to 1974. Of these admissions 42 per cent were children, and of all the admissions 54 per cent had Wechsler intelligence quotients under 25. Further, 62 per cent of the admissions were for behaviour problems and 38 per cent were for physical infirmity and helplessness. It is concluded that there are some mentally handicapped people who have problems with which only a hospital can cope. The high nursing dependency and the profound mental retardation of a majority of the new long-stay patients present a formidable challenge.

The efficacy and side effects of 10 mg of nitrazepam and 25 mg of thioridazine as sleeping aids were measured in 20 psychogeriatric in-patients during the 14th night and morning of drug administration. The trial used a double blind, cross-over design. The effect of nitrazepam was slightly faster than that of thioridazine. After thioridazine, but not after nitrazepam, the patients slept significantly longer than after placebo. Nitrazepam, but not thioridazine, significantly impaired patients' abilities to move and to conduct everyday activities. It is concluded that thioridazine is a suitable sleeping aid for psychogeriatric patients, but that nitrazepam should be avoided.

Catechol O-methyltransferase of lysed human red blood cells was assayed under optimal conditions, using saturating concentrations of the substrates, S-adenosyl-L-methionine and 3,4-dihydroxybenzoic acid. The mean enzyme activity found in 24 normal subjects was 29.2 nmol/hr/ml RBC. The mean activity in blood of 33 female unipolar depressives was not significantly different from normal. However, higher enzyme activities were observed in the blood of 11 schizophrenic patients (38.9 nmol/hr/ml RBC). Partially purified enzyme preparations from blood of normal and schizophrenic individuals were indistinguishable with respect to substrate specificities, isoelectric pH values, and ratios of the two O-methylated products. Therefore it is unlikely that any defect in O-methylation which may occur in schizophrenia can be attributed to a change in the intrinsic properties of erythrocyte catechol O-methyltransferase.

Two cases are presented in which treatment with lithium was complicated by thyrotoxicosis. The underlying physiological mechanisms are discussed.

Lithium suppresses thyroid function, so the early stages of thyrotoxicosis may be clinically undetectable. The symptoms and signs of thyrotoxicosis may be confused with the side effects of lithium, and if lithium is withdrawn severe rebound thyrotoxicity may occur. Furthermore, some of the side effects of lithium may be aggravated by thyrotoxicity.

These cases provide further evidence of the importance of routine screening of thyroid function before starting treatment with lithium.

Three-hundred-and-thirty cases of unnatural death, leading to 110 open verdicts, 110 verdicts of suicide and 11o of accident, from the Inner West London Coroner's District have been examined to see if particular coroner's officers or pathologists were associated with disproportionate numbers of suicide verdicts. No significant deviations from the expected numbers were found. Coroner's officers probably share common ideas about the features defining suicide, and so do pathologists.

We studied the relationship between side effects, clinical outcome and the drug plasma levels in 28 female depressed patients treated with protriptyline. After 3½ weeks treatment, patients with plasma levels within a median range (630 to 900 nmol/1) showed better responses to the drug than patients with plasma levels outside this range.

There were no statistically significant correlations between plasma levels and side effect scores or ‘corrected’ side effect scores (scores after subtracting pre-treatment values) for the group at any time after starting the treatment. But we found positive correlations between plasma levels and ‘corrected’ side effect scores for the neurotic subgroup after 14 and 21 days of treatment. Other correlations between plasma levels and side effect scores were non-significant.

A retrospective study of the records of 17,571 psychiatric patients who attended the out-patients department of Eginition Hospital in Athens during three two-year periods (1948–50, 1958–60 and 1969–71) revealed a statistically significant decrease in the frequency of patients diagnosed as suffering from hysteria, a statistically significant decrease in the relative frequency of patients with hysterical fits and with mental conversion symptoms, and a statistically significant increase in the relative frequency of patients with mixed conversion symptoms. The findings confirm the notion that hysteria is still a ‘woman's disease’, although a statistically significant increase in male participation was noted. The significance of the above findings for the understanding of certain aspects of hysteria is discussed.