This paper reports the finding of one section of the third of a series of surveys on the training and background of a group of recently appointed consultant psychiatrists. The original survey was a postal enquiry primarily concerned with training, which was circulated to every consultant psychiatrist in the United Kingdom who had been appointed to a post in general psychiatry, with at least 6 N.H.S. sessions, between 1 October 1963 and 30 September 1966 (Royal Medico-Psychological Association, 1969). The second survey, using a different form of questionnaire, and enquiring more closely into background and motives for going into the specialty, was circulated to consultants appointed between the 1 October 1966 and 30 September 1969 (Brook, 1972; Brook, 1973).

Emotional illness in psychiatric post-graduate trainees has been the topic of several papers in recent years (1, 2, 3). In summary, these papers suggest that emotional illness in psychiatric training is common. Anxiety and depression characterize these illnesses and occur most frequently in the first year of training. But, as Halleck and Woods have stated, ‘Information as to the prevalence of anxiety states, depression, suicide, psychoses or serious acting out is unavailable’ (4).

In a previous paper, a preliminary report (Offord and Cross, 1971) found that adult schizophrenics differed in their school performance from both their siblings and their age mates. For instance, the pre-schizophrenics were significantly more likely than their siblings to have repeated at least one grade in elementary school and to have scored significantly lower on childhood IQ, tests than their siblings and age mates.

With large numbers of psychotic patients now living in the community, there is growing appreciation of the influence of family life on the long-term social outcome of chronic schizophrenia. From the work of Brown, Birley and Wing (1972) it appears that to achieve and maintain optimum clinical stability in ‘typical’ chronic schizophrenia, it is desirable that face-to-face contact between patients and emotional relatives should be held to a minimum and that phenothiazine drugs should be used to soften the impact on the patient of sudden and stressful life changes. Reviewing the many social problems which accrue from this general treatment approach, Stevens (1973) noted a distinct lack of evaluative study of psychotic patients who actually live in the community.

Many inheritance models of schizophrenia have been proposed, in view of its variable age at onset, variable familial occurrence and the relevant influence of a great number of environmental factors (Gottsman and Shields, 1967; Heston, 1970; Ödegård, 1972). However, the real genetic predisposition to schizophrenia has not yet been experimentally verified, and genetic markers have to be looked for, i.e. we need some character, genetically determined, whose transmission is associated with schizophrenia transmission: the more polymorphous the character, the greater will be the probability of finding such associations.

The poor prognosis of narcotic dependence is generally recognized, but this is a field in which it is specially difficult to make predictions about the outcome of treatment in the individual patient. Vaillant (1966a) noted that abstinence appears to depend more on the addict's ability to discover satisfying alternatives to his addiction than on methods of treatment. In an attempt to identify prognostic indicators in narcotic dependence a number of follow-up studies have examined the relationship between outcome and various social and psychological characteristics of the patients studied. While most follow-up studies are of male addicts or of samples containing only a small proportion of women, the present study is concerned with the outcome in a sample of 66 female narcotic addicts.

Some controversy exists regarding the notion that personality disturbance is specifically related to temporal-lobe epilepsy. A number of investigators have found no psychometric or psychiatric differences between psychomotor epileptics with a temporal-lobe focus and non-temporal epileptics with ‘centrencephalic’ or diffuse epilepsy or jacksonian sensorimotor epilepsy. But it is possible that the ‘negative’ findings in these studies may be explained by the reported acute psychoses caused by changes in anti-epileptic medication, or by the use of groups that were too heterogeneous or institutionalized and the use of less well-defined psychiatric and psychological variables. However, Janz (1969) has described a more primary, homogeneous, common and not serious form of grand-mal epilepsy, ‘Aufwach’ epilepsy, with psychiatric and Rorschach-test characteristics of a kind different from the corresponding characteristics of ‘Schlaf’ grand-mal epilepsy and psychomotor epilepsy. Furthermore, Meier and French (1965) obtained certain results with the MMPI test for a group of psychomotor epileptics with bilateral EEG temporal-lobe abnormalities. A separate analysis of this group showed that the presence of independent bitemporal EEG abnormalities was associated with the most and highest scale elevations.

A large part of the data gathered in psychiatric and clinical psychological research consists of ratings carried out by various members of the clinical team. A set of clinical ratings consists essentially of a questionnaire that is completed by someone who is familiar with the patient. Data of this kind provide information about the way in which members of the clinical team think about their patients; but not necessarily about the ways in which the patients themselves actually behave, feel and think. One would of course expect to find a relationship between the two kinds of data, and both are of psychological interest.

The aim of the investigation was to compare rating scales for syndromes as given by a psychological test, the Minnesota Multiphasic Personality Inventory (MMPI), with those derived from a standardized psychiatric history (CAPRICE System). The first is dependent on information supplied directly by the patient, who answers a check-list; the second is based on a psychiatric interview and the completing of a codified case-history. The computerized form of the MMPI was employed (Fowler and Miller, 1969), and the scales selected were those corresponding with manifest anxiety (At scale); depression (D scale); phobias, obsessions and compulsions (Pt scale); and schizophrenia (Sc scale). The nearly corresponding scales derived from the CAPRICE System (Valentine, 1973) are the scales for Anxiety, Depression, Obsessional-Compulsive Disorder, and Psychosis.

Broadmoor Hospital is one of three Special Hospitals provided for the treatment of patients of ‘dangerous or violent propensities', under conditions of security. By definition, it caters for a unique and highly selected group of patients; patients who it is thought are too dangerous to be cared for in more conventional psychiatric facilities. Studies of such selected groups of patients may help us towards a better understanding of the relationship between dangerous behaviour and mental illness. Special groups of patients have been studied (Blackburn, 1970; Le Couteur, 1966; McGrath, 1958), but apart from a general paper by Gould (1957), and a recent research report by Black (1973) remarkably little is known either about the characteristics of those patients who go into hospitals, or about what happens to them after they leave the hospitals.

The study of the victims of violent criminal offences and the study of female criminality are both poorly documented areas which are currently attracting a larger share of attention. Investigations into the relationship between the victim and offender and descriptions of the victims of fatal offences have appeared intermittently over the years (East, 1936; von Hentig, 1948; Wolfgang, 1957; Morris and Blom-Cooper, 1964; Gibson and Klein, 1969), but in most of these cases the information is peripheral to the main interests of the researchers and the studies are confined to victims of homicide. This report describes the victims of mentally disordered violent female offenders who were patients in the Special Hospitals, and includes victims of murder, manslaughter, attempted murder and wounding.

In 1963–4 the Oxford University Penal Research Unit managed to collect information about 90 per cent of the offender-patients who were admitted to N.H.S. and Special Hospitals under hospital orders made by criminal courts: this cohort has been described in Crime and Insanity, Vol. II, by Walker and McCabe (1973). One of the by-products of the follow-up of these offender-patients was a rough and ready scoring system for predicting reconvictions (within a two-year follow-up) of 456 offender-patients who were allowed to leave hospital within a year of admission. A prediction system can be used to assist human decision-making (though it should not be a substitute for it)∗ and can also be used to assess the efficacy of measures—such as after-care—by seeing whether individuals with equal predicted reconviction-rates do better with than without the measure (Mannheim and Wilkins, 1955).

Recently, though the value of lithium salts has been supported by a number of careful studies (1–6), it has become increasingly evident that as a preventive of affective and schizoaffective psychoses the use of lithium is far from being universally effective and that it does not always lead to a complete disappearance of phases and attacks (7–8). The most generally held view (9–13) of lithium as a prophylactic drug is that it is of most value in preventing the recurrent affective attacks of patients with manic-depressive psychosis and cyclothymia.

Reports have been accumulating in the literature attesting to the failure of patients, particularly out-patients, to take medication as prescribed (Stewart and Cluff, 1972; Moulding et al., 1970). The incidence of these failures, which may include anything from missing occasional doses to taking no medication at all, has been reported to range from 25–59 Per cent. In addition, it has not been possible to identify those patients who will have the highest failure rates (Blackwell, 1972). While most of the studies have involved medical patients, it is probably legitimate to assume that schizophrenic patients are at least as unreliable in taking medication as the medical patients. Thus, in one study of 125 psychiatric patients, Willcox et al. (1965) found that 48 per cent took no medication at all.

Thiothixene and thioridazine, established anti-psychotic agents (5), have been reported to possess antidepressant (4, 7, 8, 9, 17) and anxiolytic (3, 15, 16) properties. The present study is primarily concerned with the latter claim. It was initiated to assess the role of both these major tranquillizers—thiothixene, a thioxanthene derivative, and thioridazine, a phenothiazine derivative—in the symptomatic treatment of anxious neurotic out-patients.

Anxiety is perhaps one of the commonest and most disabling symptoms in medicine, yet its satisfactory alleviation has been elusive.

Work by Kluver and Bucy (1939) suggested that the amygdala generated anxiety, the function of the hippocampus being to decrease it. The hypothalamus appears to organize the level of arousal through the amygdala.

Convulsions induced by mild pulse current (Cronholm and Ottosson, 1963; Ottosson, 1960) have been reported to be as beneficial as unilateral or bilateral sinusoidal ECT in depression while not associated with as many undesirable effects (Valentine et al., 1968). However, confirmatory work is needed, and the authors did not distinguish between response rates in neurotic and endogenous depression.

Systematic desensitization using bodily responses other than relaxation as the specific anxiety inhibitor has produced positive results in phobic states. Jones (1924) used feeding, Wolpe (1969) advocated motor activity using a conditioned motor response, Ventis (1973) described a case where induced laughter was effective and Orwin (1971) paired the respiratory relief obtained after maximum voluntary respiratory arrest with the anxiety evoking stimuli. A derivation of this latter technique utilized the autonomic excitation caused by the vigorous physical exertion of running, to compete with the anxiety response in the agoraphobic syndrome (Orwin, 1973). This brief report describes an unusual situational phobia treated by this latter method (‘the running treatment’), following previous experience with simple claustrophobia.