A large part of medical practice is complicated by two problems; the degree to which treatments are specific (the placebo problem) and the extent to which they are implemented (the adherence problem). Depending on setting and circumstance, up to half of the benefits of treatment are either non-specific or never obtained. This review considers the problem of adherence in the context of use of medication in psychiatry.

A comparison was made of the social and domestic background, prepsychotic personality and symptomatology of deaf (‘hard of hearing’) and non-deaf patients aged 50 or over with paranoid or affective psychoses. The deaf patients were found to be a very heterogeneous group in respect of age of onset, duration, severity and pathological basis of their deafness, but there was a substantial subgroup of paranoid patients with deafness beginning before the age of 45 in whom the personality appeared to have been less deviating than in the remainder. It was thought that the deafness in this subgroup had possibly played a relatively specific role in causing the psychosis. Some problems in identifying deafness and assessing its significance are discussed.

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls.

The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.

As the first phase of a project designed to institute controlled drinking as a therapeutic goal for alcoholics, it was decided to recruit volunteers who were dissatisfied with their present mode of drinking but who had not previously sought help. This was done by requesting them to phone a private number. When these volunteers had been recruited it was proposed to modify their drinking habits to their own requirements, using non-averse training, drinking practice and ongoing group psychotherapy. This project however has not been implemented because of a paucity of volunteers. The methods of recruitment are listed and those drinkers who volunteered are described. The reasons for the low rate of response are discussed.

The chemical structure of a neuroleptic does not reliably predict the exact profile of its therapeutic action. We considered the question whether the biochemical action of a neuroleptic, and specifically the ratio between DA-receptor block and NA-receptor block, might have a higher predictive value in this respect. In this context we carried out a double-blind study of the therapeutic value of clozapine and perphenazine in acute psychoses of varying symptomatology and aetiology. There are strong indications that clozapine has only a slight inhibitory effect on transmission in central DA-ergic neurons, but markedly inhibits transmission in central NA-ergic neurons, and that the reverse applies to perphenazine. In view of these data we expected perphenazine to be a stronger antipsychotic and a weaker sedative than clozapine, and vice versa. The plausibility of this hypothesis was demonstrated. Partly also on the basis of earlier research, we concluded that the biochemical action of a neuroleptic is a more faithful predictor of its therapeutic action profile than the chemical structure.

In four studies homosexual patients were randomly allocated to receive either different forms of aversive therapy; or aversive therapy or a positive conditioning procedure. Before and after therapy the patients' sexual orientation was determined by measuring their penile volume responses to moving pictures of nude men and women.

The aversive therapies produced reduction in homosexual feelings and behaviour. In the fourth study the reduction was significantly greater following the aversive compared with the positive conditioning procedure. No significant change in measured sexual orientation occurred in the patients who received aversive therapy compared with those who received positive conditioning. The measured sexual orientation of the homosexual patients after treatment differed significantly from that of heterosexual patients who received aversive therapy for sexual anomalies.

A sample of 471 enlisted men 183 cm or taller serving in the US Navy, Coast Guard, and Marine Corps was screened for Y-chromosome aneuploidy by use of quinacrine fluorescence of peripheral blood smears. Two 47, XYY males were detected, resulting in a prevalence of .00425 or approximately 1 in 236. The prevalence of 47, XYY males (.00331) in a number of samples of tall, non-institutionalized males is significantly higher than the incidence in newborn males (.00091), indicating that 47, XYY males are disproportionately represented in tall male populations. The 47, XYY males had significantly higher scores than 46, XY males on the Schizophrenia, Schizophrenia + 1K, and Prejudice scales of the Minnesota Multiphasic Personality Inventory and significantly lower scores on the Dominance scale. Since the probability that a randomly selected pair of subjects in the sample had four or more scale scores significantly different from the remainder of the group was greater than .05, it is possible that the differences between the 47, XYY and 46, XY males occurred by chance. On the other hand, one or more of these scales may measure personality dimensions on which non-institutionalized 47, XYY males may, in fact, differ from 46, XY males.

The topic of psychiatric classification has generated more interest and controversy in the last decade than for a long time. Several trends have coalesced to foster its resurgence as a subject of debate. First, a sociological perspective on psychopathology has gained widespread attention (Becker, 1963; Matza, 1969; Scheff, 1966). The exponents of this perspective have focused on the effects of ‘labelling.’ Their writings have stimulated mental health professionals to examine the consequences of applying classificatory systems in psychiatry. Second, the rapid development of behaviour modification has been a source of numerous polemical attacks on the ‘medical model’ and on the classification system derived from the notion that psychological disturbances constitute a finite number of varieties of mental illness (e.g., Ullmann and Krasner, 1975). Third, criticisms have been voiced of the unsatisfactory reliability of the standard/accepted national and international psychiatric classification schemes (e.g., Scharfetter, 1971; Spitzer and Wilson, 1974). Such criticisms have sparked the development of new classificatory systems notable for the specificity and explicitness of rules of diagnostic assignment (Feighner et al, 1972; Spitzer, Endicott, and Robins, 1974).

Associative intrusions in the thought of short-term and long-term schizophrenic, non-schizophrenic, and non-psychiatric in-patients were measured using Rattan and Chapman's multiple-choice vocabulary test. This test consists of two subtests, one with associative distractors and the other without distractors, which are matched on discriminating power and thus permit the assessment of differential specific performance deficit uncontaminated by the generalized deficit characteristic of many patient groups.

Results indicated that some susceptibility to associative intrusions characterizes all groups of long-term patients regardless of diagnosis. Short-term patients (with the possible exception of schizophrenic) did not show such heightened susceptibility.

Lengthy illness and/or stay in hospital are apparently implicated in at least this form of thought disorder, which has been often considered to be a uniquely schizophrenic phenomenon.

A sample of ‘automatic speech’ (counting from 1 to 10) was tape-recorded and the times taken up by phonation and pauses measured. In four healthy volunteers, both phonation times and pause times remained constant over a period of two months. In four moderately depressed patients, with no history of manic illness and with no obvious clinical signs of motor retardation, the pause times were significantly elongated while the patients were depressed compared to pause times measured after recovery. The phonation times were constant throughout the period of observation (4–6 months). Other tests for motor retardation (tapping time; Nurses' rating scale; Hamilton Retardation Scores) did not give consistent results. It is concluded that the simple test described here may reveal a degree of motor retardation in cases where other tests fail to do so.

The UCLS questionnaire, in a form modified to include a measure of syllabus-boundness, and a questionnaire to measure psychiatric symptomatology (the MHQ) were administered to two groups of students, one seeking help for emotional problems, the other a control group. Groups were compared on tests, test findings were inter-correlated, and scores were related to academic success. The UCLSQ is confirmed as a reliable research instrument. Principal component analysis again indicates a separation of psychoneurotic and motivational components of study difficulty. Syllabus-boundness (‘Sylbism’) emerges as a relatively independent trait, with a significant negative relationship to work satisfaction in both groups. MHQ, scores again show a positive correlation between phobic anxiety and academic attainment for patients.