The self-reported child-rearing practices of 214 parents of battered babies were characterized in a few but not all respects by demanding behaviour which exceeded that to be expected in relation to their social class and age. Inconsistency in child management was noted in the comparison between lack of demonstrativeness and emotional over-involvement, and between physical punishment and a tendency to be lax in the supervision of the child, and was reminiscent of parents of delinquents. Unhappiness and hostility in relationships with members of their families of origin, with unsupporting partners and with people in general were other important features. Generally, identified perpetrators were characterized by features significant for the sample as a whole.

Recent work has revealed that autistic children's predominating tendency to avoid social interactions is actually enhanced by the ‘friendly’ approaches of others. In this study it was recorded on video-tape how eight autistic children reacted to four styles of adult behaviour. The adult reacted to the child's looks at her by (i) smiling, (ii) gaze averting, (iii) gaze averting plus other ‘timid’ behaviours and (iv) doing nothing except continuing to look back. For this last condition—when the adult did not react—it was found that autistic children showed less avoidance behaviour after eye contact and spent more time within one metre of the adult. The implications for treatment are contrary to much modern practice and to what seems to be adults' ‘natural’ response. Reactivity by others appears to enhance the child's avoidance, and it is suggested that adults should be circumspect in the degree of sociability with which they respond to autistic children.

A pair of MZ male twins concordant for early infantile autism (E.I.A.) is presented. A distinction is drawn between E.I.A. and infantile psychosis (I.P.) with associated mental retardation as a guide to prognosis and the necessity to provide suitable social training and education. The relevance of aetiology is discussed, and the importance of abnormal ante-natal history and delivery status, even in cases with strong genetic predisposition, is noted.

Some conceptual problems in relation to the interaction of genetic influence and social disadvantagement are discussed, and some of the results of a study of 144 families with mentally handicapped children reported. The work of Heber and his associates in Milwaukee is briefly reviewed, and the Edinburgh data discussed in relation to the study in Aberdeen by Birch et al. (1970). Possible strategies for intervention are considered.

This study attempted to assess the applicability of the Clinical Interview Schedule (Goldberg et al., 1970) to mentally handicapped patients in a hospital. Twenty-seven patients were rated simultaneously by three raters. Of the 31 items assessed for reliability, 11 were completely satisfactory, 8 were satisfactory, 6 unsatisfactory and 6 ‘not proven’. Ratings made by all raters for overall severity of psychiatric illness correlated significantly with similar ratings made by the consultants responsible for the patients.

Definitions of mental handicap are imprecise in practice, and a wide spectrum of patients are provided for under this heading. There can be no question of specific treatment for ‘mental handicap’ as such. Many situations arising in institutions for the mentally handicapped derive from the nature of the institution and the regime. Drugs may be used ‘faute de mieux’ when environmental manipulation would be more appropriate. There is much overprescribing, and the choice of drugs is not always logical; monitoring of dose is seldom employed. A major source of behaviour disturbance in the mentally handicapped is lack of suitable occupation. Apart from a few specific indications, use of sedatives and tranquillizers for the mentally handicapped should be seen as a holding device, to enable a different system of management to be adopted or to disrupt an undesirable behaviour pattern.

Cannabis is easily available in Nepal, large numbers of persons using it regularly. I have studied its effects on 226 persons who had been using it for a long time and in considerable amount. As a control group I used an equal number of men of matching age and education.

Compared with the controls, the cannabis users had a poor work record, poor social and family relationships, a lack of interest in sex and a general loss of initiative and efficiency. However, there was no difference in crime rate between the groups.

Sixty-nine schizophrenic patients (52 men and 17 women) who were consecutive admissions to Shehar Psychiatric Hospital, Taif, Saudi Arabia, were investigated for the phenomenology and frequency of visual hallucinations. Of these patients 43 (62 per cent) were visually hallucinated. It is concluded that visual hallucinations in schizophrenia are of common occurrence in this country. The need for further investigation as to the part played by cultural and other factors is emphasized.

Comparative studies of first admission rates to psychiatric hospitals have revealed significant differences in the rates of diagnoses of functional psychoses between the United Kingdom and the United States of America.

The present study examined the diagnoses of indigenous patients born between 1921 and 1955 and first admitted to hospitals in New South Wales, Australia, and England and Wales. Admission rates for mania were in striking agreement. The rate in New South Wales for schizophrenia was slighdy higher and for psychotic depression considerably less than in England and Wales.

A similar trend in diagnostic dissonance would appear to exist between England and Wales and New South Wales as between England and Wales and the United States for schizophrenia and psychotic depression, but this is considerably less in degree.

In a factor-analytical study of depression across two cultures, African and European, certain similarities and important differences were found. Depression in African cultures presented principally as depressed mood, somatic symptoms and motor retardation. In European cultures depression presented with depressed mood, guilt, suicidal ideas, motor retardation or anxiety. Both groups lost interest in work and the environment.

Guilt and suicidal ideas and acts are uncommon in African sample, and appear to be culturally determined.

In this study 368 patients were interviewed after they had attended the Bristol Royal Infirmary Accident and Emergency Department following a non-fatal act of deliberate self-harm. There were twice as many women (247) as men (121), and two thirds of the patients were in the 15–35 age group. Ninety-five per cent had taken a drug overdose, most commonly one or more of the tranquillizers, antidepressants, hypnotics or analgesics. Seventy-eight per cent had taken drugs prescribed by a doctor. Half the patients mentioned interpersonal conflict as a major precipitating factor in the episode. A psychiatric diagnosis was completed for all admitted patients, of whom 52 per cent were considered to be suffering from neurotic depression, 29 per cent from personality disorder, 12 per cent from functional psychosis and 10 per cent from alcohol addiction. Almost half had deliberately harmed themselves on a previous occasion. The series showed a greater than average incidence of unemployment, overcrowded living conditions, divorce and antisocial behaviour. The implications of these findings for the clinical management and prevention of non-fatal deliberate self-harm are discussed.

National samples of case records of suicidal-type deaths from England and Wales and from Scotland were reassessed by officials in the other country. It emerged that similar criteria for suicide existed in both countries, and that there was no age-related tendency to misclassify cases. The lower official suicide rate amongst the old in Scotland was therefore considered not to result from ascertainment differences. It was also concluded that Scottish records were not so briefly documented as to prevent the conclusive ascertainment of cause by England and Wales coroners. Cases which were designated ‘undetermined’ in Scotland tended to be classified ‘accidental’ by coroners. Reasons for the lower incidence of suicide in Scotland are discussed.

The details of 98 women sterilized over a three-year period are presented. They show that female sterilization is a safe procedure which has a satisfactory result in many cases and confers many secondary benefits. However, some regret is common and is associated with a high incidence of psychiatric and marital morbidity, and this is shown to be related to pre-operative factors. A method of pre-operative assessment is outlined which should minimize the risk of a poor outcome following female sterilization.

Treatment under conditions of gnotobiotic isolation can augment the stress of adaptation to a diagnosis of leukaemia. Identification of the psychological problems experienced in isolator treatment can contribute to the effective maintenance of therapy. Individual patterns of adjustment to treatment relate to the psychological defence mechanisms employed to contend with the dependent position enforced by isolation. Psychiatric assessment can assist both patients and nursing staff with the management of their separate difficulties in this unfamiliar treatment situation. Psychological features of isolator treatment in ten patients with acute leukaemia are described and suggestions proposed for psychological management of patients under isolator conditions.

Adenosine diphosphate (ADP) stimulates the synthesis of prostaglandin E1 (PGE1) in lysed platelets from normal subjects, patients with affective illness but not in platelets from cases of schizophrenia. The stimulation is concentration-dependent and follows a curve which is mildly sigmoid in the normal, markedly sigmoid in depression and hyperbolic in mania.

Plasma and erythrocyte lithium levels have been determined repeatedly in twelve patients taking lithium carbonate for affective disorders. In any individual the plot of the plasma lithium level against erythrocyte/plasma ratio is linear, but the ratio can either increase or decrease with increasing plasma lithium concentration. Erythrocyte/plasma ratio is an unsound basis for comparing individual responses to lithium.

A method of reviewing a series of clinical trials by extracting the basic data in the form of 2 × 2 tables and analysing these by Fisher's two-tailed Exact Test is described, and illustrated by published imipramine-placebo trials.

The results suggest that the benefit of this drug in patients with endogenous depression who have not become institutionalized is indisputable, and that further drug-placebo trials in this condition are not justified.

Two of the three trials of imipramine in neurotic depression gave results showing significant improvement.

Possible explanations of the apparent failure of this drug in groups of patients with undifferentiated depression are discussed.

Forty depressed in-patients for whom electro-convulsive therapy had been prescribed were rated before treatment on depression and anxiety scales. Side effects, post-operative agitation and retrograde memory impairment were assessed in each patient after each of several treatments. Results were compared when no tranquillizer was given and when either diazepam or haloperidol was administered intravenously immediately before the anaesthetic. It was found than when ECT was given without tranquillization, the incidence and severity of post-operative agitation and of side effects were significantly greater in those patients with a high level of anxiety before treatment. Both diazepam and haloperidol were found to be effective in subduing agitation and side effects in anxious, depressed patients, but with diazepam recovery time was longer.

The incidence of side-effects present 24 hours after electroconvulsive therapy was studied in 96 patients who between them received 500 treatments in a consecutive series. None of the side-effects occurred frequently: headache was experienced after 2·6 per cent and subjective memory impairment after 3 per cent of treatments. None of the unwanted effects held any serious physical threat. The aspect of ECT most disliked by the patients in this study, and mentioned by 16 per cent of them, was the fear of permanent memory upset.