Despite over half a century of intensive research the essential nature of the schizophrenias still remains an enigma. Attempts to account for the disordered behaviour of the schizophrenic have ranged over the full spectrum of the biosocial sciences, explanations being sought both in the biochemistry of the organism and in the interpersonal relationships of the whole individual. Sitting somewhere between these two extremes is the psychophysiological view. As a conceptual and methodological approach to behaviour in general, psychophysiology concerns itself with the problem of integrating neurophysiological and psychological data, attempting to bridge the gap between these two disciplines. Of course, the potential value of describing behaviour at a different level of explanation, either more molecular or more molar, is not denied. However, the peculiar contribution of psychophysiology is its concentration on data gathered at the interface between the brain and behaviour. As such its techniques are chosen so as to allow guesses to be made about the functional systems in the brain that underly behaviour. They naturally include the study of E.E.G. and autonomic response but also extend to the measurement of various phenomena derived from conventional experimental psychology, such as perceptual thresholds and vigilance (Claridge, 1970b). The theoretical concepts of psychophysiology reflect its mongrel background and include such terms as ‘arousal’, a notion originating in academic psychology, but made respectable by neurophysiologists.

Torgerson (1968) has suggested that the most appropriate form of classification of functional mental illnesses may prove to be partly categorical and partly dimensional. Everitt, Gourlay and Kendell (1971) have tended to agree with this conclusion since their attempt at validating existing diagnostic categories by means of cluster analysis proved to be only partially successful. In the present paper the dimensional approach is considered in some detail and it is shown that it has limitations which are due in part to the distributional properties of the data which research psychiatrists record for their patients, and in part to the fact that some key symptoms occur only rarely. In the final paragraphs of the paper an attempt is made to clarify the dimensional and categorical roles in the description of functional illnesses. In doing so it becomes clear that some difficulties remain unresolved.

The psychiatric hospital can be viewed as a social system which is evolving slowly by attempting to improve. In order to systematically study and learn about itself the mental hospital and its care providers need continuous pertinent information. Yet, at present the psychiatric hospital is not organized in a way that readily allows isolation of problems or systematic learning from prior experience (8). In that sense, the hospital is a non-system which lacks an information system necessary for meaningful feedback to the decision-makers of the institution (7).

Little has been done to validate the so-called Newcastle scale for the differential diagnosis of endogenous and neurotic depression: neither are we aware of any validating work with the E.C.T. prediction scale or any investigation of the reliability of these indices (Carney, Roth and Garside, 1965). However, the diagnosis scale items, adapted for use with elderly patients (Post, 1970), and described as ‘highly relevant and clearly defined’, discriminated between deeply melancholic and more ‘neurotic’ patients; more recently Naylor and his associates (1971) found it to agree with clinical diagnosis in separating psychotic and neurotic depressives.

The literature on agreement between psychiatrists on the diagnostic assignment of cases has been extensively reviewed by Ley (1970). Percentage agreement figures ranged from 24 per cent and 28 per cent agreement for type of character disorder and type of neurosis respectively to 80 percent for type of organic illness. Taken at face value these findings suggested that psychiatric diagnosis may often be of little value.

A Consistency of Relationship score for comparing two grids was proposed by Bannister in 1960, revised slightly in 1962 and again, more substantially, in 1966. The theory behind it is that schizophrenic thought disorder results from repeated experiences of invalidation in construing. If a subject is repeatedly compelled to change his evaluation of an element in terms of a construct, that construct's relationship to the others composing his system may gradually become weakened—e.g. if his evaluations of an intimate acquaintance fluctuate repeatedly between loving and hating, the relationship between ‘loving’ and 'sincere’ or ‘reliable’ in his construct-system may tend to become looser. Progressive weakening and loss of stability in the system as a whole through repeated invalidation of parts of it is the mechanism which supposedly results in schizophrenic thought disorder.

Within a framework of Kelly's Personal Construct Theory (Kelly, 1955; Bannister, 1962a), Bannister (1960, 1962b) considers thought-process disorder (formal thought disorder) to be a loosening of the associations between the constructs of the patient's conceptual system, and an instability over time of whatever pattern of association remains. The disorder appears to be maximal in that construct subsystem which subsumes discriminations relating to psychological attributes (Bannister and Salmon, 1966; McPherson and Buckley, 1970).

Some patterns of deranged function—epilepsy, schizophrenia—have been enshrined as diseases; others, such as depersonalization, have, by and large, escaped this fetter. This is perhaps why there has been no difficulty in accepting that depersonalization, being a pattern of disordered function, can occur in conditions of very different aetiology. It is seen in temporal lobe epilepsy (12), temporal lobe migrane (22), depression (8), LSD intoxication (20), schizophrenia (1), phobic anxiety states (15), sleep deprivation (2) and the hypnagogic state. Shorvon (21) reported cases of depersonalization occurring in the apparent absence of other psychiatric disorder, and Davison (4) investigated in detail seven such cases. Finally the occurrence of depersonalization in people not attending psychiatric or neurological clinics is now well attested (13, 5, 18, 6).

Scientific studies of the families of depressed patients have shown that the risk of development of similar illnesses for close relatives is greater when the illness of the index case began relatively early in life than when it began later. These studies have included both manic-depressive and single episode endogeneous depressions, and no account has been taken of the mode of precipitation of the illnesses. It has been postulated that (a) the penetrance of the gene may be lower in those families with late onset of depression, and (b) that depressive illness may be of diverse aetiology, so that genetically determined forms appear earlier in life and those which are not genetically determined occur later (Hopkinson and Ley 1969).

The Child Psychiatric Clinic of the Paediatric Department at St. Thomas' Hospital has had a relatively large number of referrals of disturbed children under 5 years of age, because of the existence of a day hospital where they and their families can be offered treatment together (Frommer, 1967). As there are few reports on psychiatric disturbance in this age-group, we thought it worthwhile to report on some aspects of their problems as we have seen them. Clinical experience led us to the supposition that we would find recurring patterns of family disturbance and symptoms accompanying the main behavioural disturbances for which they were brought. For this reason, we undertook an analysis of the presenting features, symptoms, behaviour, and family circumstances of all pre-school children who were referred to this Clinic during six years from August, 1962, when the day hospital first opened as a part-time pilot venture, to August 1968. The following is an account of some of our findings.

Acute dystonic reactions, including oculogyric crises, were once thought to be pathognomonic of encephalitis lethargica, but the clinical use of the phenothiazines has led to the recognition that similar symptoms can be produced by these drugs. Some phenothiazines, such as trifluoperazine, fluphenazine, prochlorperazine and perphenazine (Ayd, 1960; Christian and Paulson, 1958; Hollister, 1957; Waugh and Metts, 1960), are thought to cause these effects more frequently, especially when given parenterally. Other non-phenothiazine tranquillizers, for example haloperidol, also produce these reactions. not un-commonly. Certain patients, particularly the young and perhaps the genetically predisposed, are more likely to be affected.

Erythropoietic Protoporphyria (E.P.P.) may be classified along with the other erythropoietic syndromes of porphyria. It is inherited as an autosomal dominant (Taddeini and Watson, 1968). The condition was first clearly delineated by Magnus, Jarrett, Prankerd and Rimington (1961). They recorded a case with the presenting symptom of solar urticaria in whom faecal excretion of coproporphyrin and protoporphyrin was greatly increased while urinary porphyrins were normal. The red cells contained grossly abnormal amounts of protoporphyrin and coproporphyrin, the plasma increased levels of protoporphyrin. The absence of uroporphyrin distinguished this condition from congenital porphyria (Gunther's Disease).

Over 70 years ago, Sibbald (1900) commented that the official statistics on suicide showed Scotland to have lower rates than England and Wales. It seems that Scotland has always been regarded as one of the countries with relatively few suicides. A recent World Health Organization publication (1968) commented on the official suicide rates in a sample of 20 different nations; among these Scotland ranked nineteenth in 1952–4. However, this picture appears to have been gradually changing over the last two decades, and the same W.H.O. publication, citing official statistics for the period 1961–3, quotes a value for Scotland which raises it to fifteenth in the list of 20 countries. Moreover, the Scottish rates and those for England and Wales have gradually come closer together over the last 20 years.

The aim of this paper is to examine the trends in Scottish statistics for the last two decades and to compare the current suicide rates with those of the rest of the United Kingdom. All the data quoted are based on the publications of the Registrars General for Scotland and for England and Wales.

Indecent exposure is the second commonest sexual offence in England and Wales. The offenders responsible usually fall into the clinical group known as exhibitionists. Exhibitionism is one of the less well understood sexual disorders, and is virtually confined to males. It is characterized by the urge to expose the genitals to members of the opposite sex in a more or less public situation.