Schizophreniform psychoses have long been associated with a wide variety of clinical conditions affecting the basal ganglia (Davison and Bagley, 1969); amongst such disorders have been post-encephalitic psychosis (Fairweather, 1947), hepato-lenticular degeneration (Beard, 1959) and Huntington's chorea (Heathfield, 1967). Kalamboukis and Molling (1962) reported calcification of the basal ganglia in a single male schizophrenic and paranoid hallucinatory psychoses have been noted in other cases of striopallidodentate calcification (Löwenthal and Bruyn, 1968); however, an association between familial basal ganglia calcification and schizophreniform symptomatology has not been recorded.

In a double-blind trial, female ‘drug-resistant’ chronic schizophrenic in-patients were given high dose or standard dose flupenthixol decanoate for 13 weeks. Plasma flupenthixol levels showed a five-fold interindividual variation, but were consistently higher with the high dose. Analysis of final scores showed no statistically significant differences between groups with regards to mental state, ward behaviour and extrapyramidal side-effects. When compared with pre-trial scores, the extrapyramidal side-effects worsened significantly in the high dose patients and social withdrawal decreased in the standard dose patients. The mental state of a sub-group of patients, possibly drug resistant for pharmacokinetic reasons, improved significantly on the high dose over the 13 weeks.

The clinical impression that phobic patients perceive their parents as being uncaring and overprotective was investigated in a controlled study of eighty-one phobic patients. Those assigned to a social phobic group scored both parents as less caring and as overprotective, while those assigned to an agoraphobic group differed from controls only in reporting less maternal care. Intensity of phobic symptoms in the pooled sample was examined in a separate analysis. Higher agoraphobic scores were associated with less maternal care and less maternal overprotection, while higher social phobic scores were associated with greater maternal care and greater maternal overprotection.

The revelation that opium-like substances are constitutional body elements is surely one of the major biological advances of the decade. The notion that the brain contains an inbuilt supply of opioid chemicals has been particularly seductive to the psychiatrist. It seems to offer a key to understanding, and therefore manipulating, the cerebral substrates for somatic pain, drug addiction and psychic discomfort. At a time when research effort in this area is increasing logarithmically, I present here a selective and personal view of certain aspects of endorphin research which have been claimed to be psychiatrically relevant. For detailed accounts of the background and breadth of endorphin research the reader is directed to other more extensive recent reviews (Kosterlitz and Hughes, 1977; Guillemin, 1978; Snyder, 1978; Watson et al, 1979; Hughes, 1979). The term endorphin will be used in the generic sense to include the specific Endorphins (such as β-Endorphin) and the enkephalins (Leu- and Met-)—see figure.

This is a study of the results of screening tests on all new psychiatric in-patients over a period of one year. Although none of the results indicated definite physical causes for the psychiatric illness, 10 per cent of the tests revealed abnormalities resulting from or co-incidental with the psychiatric illness. Of these abnormal results 61 per cent led to no further investigation or treatment, and the significance of this is discussed.

A case of addiction to tranylcypromine is described where tolerance occurred and a severe withdrawal illness followed discontinuation of the drug. Previous reports in the literature of similar cases are reviewed and comparisons made, and the implications for management are discussed.

It is ironic that one of the most difficult tasks confronting the psychiatrist is to assess a parasuicidal patient, while the conditions under which he is commonly obliged to do so may be the least favourable that can be imagined. Often he is asked to see the patient, who as likely as not is drunk and just getting over a stomach wash-out, in a crowded corner of a teeming Casualty Department; this is analogous to asking a surgeon to operate in the lavatory. Even if the patient has been admitted, he or she is likely to have been grudgingly lodged in an emergency ward with harassed staff whose hostility surfaces all too easily. It might be a valuable use of time to explore with medical colleagues how to provide the optimal environment for the patient and psychiatrist alike, and to review policy constantly. But the parasuicide violates all the rules of the medical game and rarely fits the culture of the general hospital. Attempts to change staff attitudes will probably have limited success if the social realities remain unaffected. A ward designed for patients with perforated ulcers and broken limbs generates its own values; mores reflect function as well as vice versa.

Seventy-one school phobic children seen at a child guidance clinic were followed up after they had passed school leaving age. Their record in work and further education was compared with the length of time they were off school, whether or not they returned to school, and the occurrence of further psychiatric treatment after discharge from the clinic. It was found that whether or not the child returned to school and the length of time he was off school had no relationship to future performance at work or in further education. A significantly larger number of children receiving further psychiatric treatment after discharge from the clinic failed to reach their potential in work or further education. Adequate treatment of the underlying conditions appears to be more important than returning the child to school.

Three groups of neurotic depressed patients were treated with amitriptyline, one group receiving the customary three daily doses, another a single dose in the morning, and the third a single dose at night. All three groups showed significant decrements of total scores on the Hamilton Scale for Depression and the Zung Self-Rating Depression Scale without significant differences. Patients taking the drug at night showed a lower incidence of side effects.

Seven out of twelve patients with malignancy and hypercalcaemia had associated psychiatric symptoms. The mental aberrations disappeared when the calcium levels returned to normal after treatment.

Of 102 alcoholics admitted to an alcoholism treatment unit one third (33) were clinically rated as having disabling agoraphobia and/or social phobia, and a further third (37) as having less disabling phobic symptoms of either or both kinds. Questionnaires and self-report symptom scales were used to validate the clinical ratings. Alcohol problem screening tests and consumption levels confirmed the severity of alcohol dependence. In a group of 44 phobic alcoholics who reported physical dependence, the onset of phobic symptoms preceded the onset of alcohol-telated problems and physical dependence significantly more frequently than the converse.

The prevalence of agoraphobia and social phobia in alcoholics is discussed in relation to prevalence data in affective and normal populations, together with their implications for the aetiology of phobias and alcohol dependence, and for screening and assessment of phobic alcoholics, preventative counselling, treatment approaches and prognosis.

There is evidence that ECT causes a breakdown of the blood-brain barrier through the rise of blood pressure it induces. Using the Benton test of cognitive function the day before and three hours after ECT treatment in 27 depressed patients, impairment of function was highly correlated with the maximum rise of systolic BP during the treatment.

Reading about therapeutic communities can be an exciting experience because of a sense of pioneering change and challenge in the face of establishment opposition. Survival is often difficult and administrative values of those who control the purse strings can threaten their very existence. There is also an aura of justice and freedom where injustice has prevailed. This air of excitement and enthusiasm permeates the writings of Martin (1962) in Adventure in Psychiatry and continues in Shoenberg's (1972) updating of the Claybury experience. It features in Wilmer's (1958) vivid account of practical achievements in the Oakland Naval Hospital Receiving Ward, Foudraine's (1974) conscientious efforts to change the social organization of a unit for schizophrenics receiving private treatment in a clinic in Virginia and Mandelbrote's (1958, 1964) descriptions of change in mental hospitals in Gloucester and Oxford. It also characterizes Maxwell Jones’ writings (1968) with their autobiographical flavour and ‘living learning experience’ and Clark's (1964, 1974) presentation of administrative and social therapy with its emphasis on patient freedom, activity and responsibility. Yet it is the very cult-like nature of the therapeutic community which can be its undoing, raising expectations and hampering the independence and difference which it aims to tolerate.