A series of 80 patients who had deliberately but not fatally harmed themselves and had been admitted to hospital was examined with special reference to their use of available services during the period of distress prior to the episode. They were followed up for 4 months and the ways in which they subsequently made use of helping agencies were also monitored.

Three broad groups of patient attitudes to help and its utilization are described. ‘General practitioner help-seekers’ (29) defaulted least often and appeared to have more positive attitudes towards seeking help for their problem. The ‘psychiatric help-seekers’ (17) appeared to be a chronically disorganized group who, though previously often in treatment, seemed unable to cooperate: they defaulted frequently and apparently gained little. ‘Non-help-seekers’ (34) had been reluctant to ask for help concerning psychological problems and subsequently defaulted just as frequently as did the ‘psychiatric help seekers’.

The need to take into account variation in patient attitude to help and its utilization in designing services for the primary prevention of non-fatal deliberate self-harm is emphasized.

Eight definitions of schizo-affective psychosis have been compared in a sample of psychotic first admissions. Their mutual concordance is very low (mean 0·19) showing that there is very poor agreement about the meaning of the term ‘schizo-affective’ at present. Ten patients (4·5 % of admissions and 8 % of psychotic admissions within the age group studied) satisfied 3 definitions, a figure which demonstrates the numerical importance of this group of unclassified mental disorders.

Emotional disturbance was assessed in a group of women in the first few days following childbirth and again 2 months and 1 year following childbirth; the clinical features are described. Variables such as social class, age and parity were not related to the level of emotional disturbance, but a history of marital problems, sexual difficulties, poor relationships with immediate family or disrupted family relationships in childhood were so related.

Twenty-four hour urinary excretion of cyclic AMP (adenosine 3' 5' cyclic monophosphate) was estimated in the same group of women on 2 occasions in the week following childbirth and again 2—3 months later in approximately one third of the original sample. Excretion of cyclic AMP in the few days following delivery was elevated compared with excretion 2—3 months later, and there was a significant rise in urinary excretion of cyclic AMP between the 1st and 2nd urine collections.

Those women showing most emotional disturbance on the 3rd day after delivery and women indicating most mood change in the direction of becoming elated had the highest levels of cyclic AMP in the 2nd urine collection.

Certain specificities of the human leukocyte antigen (HLA) system have been shown to be associated with particular diseases. A review of recent studies in schizophrenia shows inconsistent results for schizophrenia as a whole, although a significant increase in HLA A28 remains on combining the data. There are more consistent findings for disease subtypes. In particular, HLA A9 and HLA CW4 are increased in paranoid schizophrenics, while HLA Al and the A1–B8 haplotype are increased in nuclear forms. It is postulated that the relationship between the schizophrenias and certain HLA types could be due to an influence of the latter upon neuronal postsynaptic membrane sensitivity to central neurotransmitters such as dopamine.

Skin conductance responses to a series of tones were measured in 41 patients during an acute episode of schizophrenia before they received treatment and after 4 weeks of treatment with either α-flupenthixol, β-fiupenthixol or placebo. Patients who did not habituate to the tones prior to treatment tended to show no symptomatic improvement during the course of treatment. Patients who habituated and also showed an acute onset of their current symptoms (‘Feighner negative’ patients) showed a marked improvement even without active medication. Skin conductance responsivity did not change with improvement in symptoms alone, but decreased in patients on active medication (α-flupenthixol).

Non-habituation of skin conductance and insidious onset (i.e. fulfilment of the Feighner criteria) were found to be independent predictors of poor outcome. Taken together, these criteria may define a group of patients with particularly poor prognosis.

Self-poisoning patients admitted to hospital were studied for persistence of psychiatric symptoms over a 3-month period and evaluated at 3 points in time with the General Health Questionnaire and the Present State Examination. Symptoms were identified which had a high or low prevalence at 3-month follow-up. GHQ and PSE scores correlated at 0·8. The implications of the study are discussed, particularly the earlier need for out-patient help in those who had a moderate or high number of symptoms at initial interview.

In a study of 40 normal men it was found that self-ratings on variability of mood were positively correlated with self-ratings on hysterical traits. These results are similar to those found in normal women and lend support both to the validity of the concept of hysterical personality and to the idea that men and women experience fluctuations of mood in a similar way.

Platelet MAO activity was found to be elevated in primary depressive illness, and the severity to correlate positively with MAO activity. The reactive depression subgroup's mean platelet MAO activity was not significantly different from that of the controls. The endogenous group's unipolar and bipolar subgroups had significantly different platelet MAO activity, respectively high and low. The differences in MAO activity between unipolar and bipolar patients appeared to persist in the well state, but not after lithium carbonate therapy. These differences in MAO activity were apparent with the substrate tyramine but not with benzylamine. Altered MAO activity in patients with affective disorders may be determined through genetic mechanisms.

The Present State Examination was administered to 539 patients who attended a casualty department after an act of self-poisoning during the course of a year. Computer analysis by means of the Catego program showed that 30% of the patients had insufficient symptoms to be considered as psychiatric ‘cases’. Fewer than 4% had symptoms of functional psychosis. About 60% of the patients were classed as depressed: on several indices this group was less severely ill than a group of depressives receiving psychiatric treatment. It is suggested that psychiatric treatment is essential for only a small proportion of self-poisoning patients. The effectiveness of psychiatric treatment for the large group of patients with depressive disorders of minor severity and probably short duration has still to be evaluated.

It is suggested that, if depressed patients have deficient noradrenergic function at central α-adrenergic receptors, then they will also have impaired corticosteroid responses to methylamphetamine but unaltered growth hormone responses. This prediction has been confirmed when the responses of a group of patients with endogenous depression were compared with the responses of a group of patients with other functional psychoses, a group of patients with reactive depression, and a group of patients with other psychiatric diagnoses. These findings support the hypothesis that there is a functional deficiency of noradrenaline at some central α-adrenergic receptors.

Depressed affect as a cause of associated somatic problems is explored by means of data on affect, appetite, energy, and sleep collected from a community sample and from subsamples contacted after each of several time lags. The analysis of the data indicates that depressed affect is a cause of the major somatic problems associated with it. It is suspected that depressed affect involves continuing high density neural firing which, over a period of months, causes a reduction of post- synaptic biogenic amine receptor cell sensitivity in the brainstem, with the diencephalon as the major site. This results in a functional impairment responsible for the somatic problems.

The Leyton Obsessional Inventory was administered to 73 obsessive-compulsive neurotics, and their responses compared with those of 100 normal subjects. The ratio of the mean patient to normal scores ranged from 2·4: 1 for obsessional traits and 3·2: 1 for symptoms to 6·2: 1 for resistance and 12·5: 1 for interference with other activities. A principal components analysis on the patients' replies produced 3 unitary components (household order, personal contamination, and doubting) plus 2 bipolar components (checking/parsimony and desire for closure/unpleasant ruminations). These appeared to be more definitive representations of components identified from a similar analysis on normal subjects, suggesting that obsessional neurotics differ from normal subjects quantitatively rather than qualitatively. A cluster analysis on the patients' responses produced 3 subgroups. Thirty-two patients were predominantly hesitant and indecisive (‘doubters’), 30 were concerned with bodily and clothing contamination (‘contaminators’), and 7 were preoccupied with checking (‘checkers’).

Thirty-nine male and 90 female patients aged 40 and over, who had been given a primary diagnosis of depression, were followed up for 2⅓;13–4 years. During this period 9 male and 9 female patients died. Five male patients and 1 female died from cancer that had not been diagnosed at the time of their psychiatric admissions. The male cancer deaths are significantly higher than expected. The possible relationships of malignant neoplasm to affective disorder are discussed.

Multicompartmental studies of tyrosine in patients suffering from affective disorders and controls gave estimates of 2 major pools of amino acid, together with the associated fractional clearance rates and fluxes. The 2 pools were considered provisionally to represent extracellular and intracellular tyrosine.

Temporal ordering of core items in the alcohol dependence syndrome was investigated in 38 men admitted to an alcoholism treatment unit. An analysis of rank sums yielded a modal sequence which resembled classical descriptions of alcoholism, though ‘loss of control’ appeared very early.

An entire population of 32 patients on regular dialysis treatment (RDT) in their own homes were ranked according to their present mental state as assessed by a standardized semi-structured interview. The point-prevalence of psychiatric morbidity was 31 % which compares closely with that of patients attending a general practitioner's surgery who were assessed by the same method. The 10 patients who were psychiatrically ill had more organic symptoms and their spouses were less able to tolerate RDT in the home.

The multiaxial diagnostic model, consisting in the systematic formulation of a patient's condition according to separate clinical variables or aspects, is receiving increasing attention in several parts of the world. This innovative model promises to improve diagnostic reliability and validity and involves many methodological challenges. This paper reviews patterns and issues in the conceptualization of axial content, number and organization of axes, dimensional versus categorical scaling, and evaluation and further development of multiaxial systems.

Fifty-four patients suffering from primary depressive illness were rated on the Newcastle diagnostic scale while taking part in a pharmacokinetic study of amitriptyline therapy, and their clinical response was assessed by the Hamilton Rating Scale for depression. Patients with a Newcastle score of 4−8 showed the best response to amitriptyline. Patients with low Newcastle scores, representing the non-endogenous or neurotic group, responded poorly. Patients with high scores on the Newcastle scale, representing those with marked endogenous features, also responded poorly.

Foulds' short psychiatric screening questionnaire and personality measures were administered to a representative Greek sample. The results were significantly different from British norms, highlighting the importance of the interaction between states and traits in population morbidity and the need for local norms.

An entire group of 32 home dialysis patients from one hospital renal unit was assessed for psychiatric morbidity on a standardized interview of proven reliability. A rating of physical symptomatology and an enquiry into the childhood and psychosocial background were made at the same time. Psychiatric morbidity, physical symptomatology and a history of good relationships with both natural parents in childhood were inter-related. They were all related to survival on haemodialysis 3½ years later. Survival was also associated with a coping spouse and full-time employment or housework by the patient. These findings are discussed in the light of current concepts of the psychosocial setting for physical illness.