It is now ten years since the Drug Clinics were set up. In the early 1960's a long established equilibrium broke down, and the number of narcotic addicts known to the Home Office began to rise steeply. The new addicts were predominantly in their early 20's, and drugs were being obtained either from the over-generous prescribing of a handful of doctors or from the spill-over of this prescribing to the black market (Bewley, 1965 (1), 1966 (2)). Heroin was the essential agent of this epidemic, with cocaine as the major ancillary.

455 male and 120 female opiate addicts were treated at two London drug dependence clinics between 1968 and 1975. The delinquency pattern of 117 female addicts and of a systematic sample of 119 male addicts was analysed in relation to stages of their addiction career and outcome. Treatment had no effect on overall crime rate but there was a significant increase in the proportion of drug offences during the treatment stage. Comparisons between the sexes showed that the outcome of treatment was worse in women. In male addicts a history of delinquency had no prognostic significance, but in females convictions for non-drug offences before entering treatment might predict poor response to treatment of drug dependence.

Records of 186 suicides among male prisoners in England between 1958 and 1971 emphasize the differences between the prison population and the population at large. The suicide rate may well be three times greater. The records show that sentence of more than 18 months' duration, whether anticipated or actually received, is associated with a greater risk of suicide than shorter sentence, and that suicide is most likely to be committed during the first few weeks in custody.

Forty-five patients with acute schizophrenic illnesses (defined by PSE criteria) were assessed in clinical, cognitive and social terms before being entered in a four week study of the isomers of flupenthixol and placebo. At the end of one year they were re-assessed in the same terms. The clinical and psychological features of the acute illness and the drug treatment given did not predict outcome. Poor outcome in social terms was significantly related to severe social isolation in the initial assessment and to the presence of nuclear symptoms and negative schizophrenic features at follow-up.

The files of a cohort of schizophrenic patients who were admitted to hospital for the first time in their lives in 1963, and who were representative of cases in a large unselected population, were examined, first by exclusion criteria, and then by the diagnostic criteria of Schneider's first-rank symptoms, Feighner et al's criteria, and the New Haven Schizophrenia Index (NHSI). Forty-three such cases were found who were schizophrenic on at least two sets of criteria, and who were followed up in 1977. Examination of the outcome showed no relationship with FRS presence or absence or number of first-rank symptoms, nor with the NHSI score, but did show a relationship to the Feighner et al criteria and an even stronger relationship to a simple score derived from these criteria.

The possible failure of a notional sensory filter in schizophrenia was studied by means of habituation of the orienting response. Non-paranoid schizophrenics failed to habituate, but paranoids habituated normally. Paranoids, however, showed a different impairment: they responded to a dishabituating tone as if the novel stimulus were somewhat familiar.

The failure of habituation in non-paranoids could not be explained in terms of arousal when the index was the rate of skin conductance fluctuation. Neurotic controls showed considerably higher levels than either group of schizophrenics.

Non-paranoid schizophrenics had lost the normal inverse relationship between habituation and level of arousal as manifested in the rate of spontaneous skin conductance fluctuation.

The need for a focus for brief interpretive psychotherapy is considered and a new approach is suggested. In this method, the ways in which the patient's construction of himself and his relationships are related to his problems are identified and expressed in the form of dilemmas, traps and snags. It is suggested that these formulations represent an appropriate level of abstraction, allowing patient and therapist to share provisional hypotheses about the goals of therapy and offering the basis for a method of measuring how far these goals are achieved.

In three collaborating hospitals, 81 anorexia nervosa patients were randomly assigned to behaviour modification or its absence and followed over 35 days. There was no overall significant difference in weight gain in the two groups except in a subset of patients: those with no prior out-patient treatments.

Body image distortion in 79 female anorexia nervosa patients were examined on a visual-size estimation apparatus during the emaciated stage of illness. Both they and an age-matched female control group overestimated their body widths, so this overestimation cannot be considered unique to anorexia nervosa. Among anorexia patients the degree of overestimation was associated with less weight gain during treatment, greater denial of illness, and several other pretreatment characteristics indicative of poor outcome.

In three hospitals 81 female patients satisfying rigorous diagnostic criteria for anorexia nervosa were randomly allocated to one of four treatment combinations of cyproheptadine and placebo with behaviour therapy and no behaviour therapy. Cyproheptadine was found to be effective in inducing weight gain in a subgroup of anorexia nervosa patients who (a) had a history of birth delivery complications, (b) had lost 41–52 per cent weight from norm and (c) had a history of prior outpatient treatment failure. This subgroup may represent a more severe form of anorexia nervosa.

The relationship of selected pretreatment characteristics to weight gain during treatment was examined in 81 anorexia nervosa patients. Good prognostic indicators correlating positively with weight gain were: no previous hospitalizations for anorexia nervosa, a great amount of overactivity before treatment, less denial of illness, less psychosexual immaturity and the admission to feeling hunger. A perinatal history of delivery complications was associated with the poor outcome predictor of prior hospitalizations.

A group of normal women and a group of women in hospital for treatment of a neurosis but without a disorder of eating were compared with a group of anorexic patients in terms of their attitudes to weight. All subjects completed a rank order form of repertory grid. Differences in construct patterning between the anorexic patients and the other female groups could not be accounted for by social class, age or neurotic disorder. The most psychologically significant finding was a positive correlation between the constructs self at normal weight and ideal weight instead of a negative correlation which clinical experience would lead one to expect. Four explanations are proposed to account for this finding.

Testing hypotheses on classification could be made more precise by using only clinical symptoms and signs as its basis. Analyses based on a mixture of clinical, aetiological and background variables give ambiguous results since they incorporate the assumption that aetiological and symptomatological patterns are related in a one-to-one manner. A set of simplified models of possible relationships between aetiology and symptomatology is used to discuss these problems of interpretation. The clinical variables to be used for discriminant analyses may be chosen by testing for the existence of lower-order and higher-order differences between groups.

A series of discriminant function analyses based only on clinical symptomatology suggests that psychotic and neurotic depressives do not differ globally but at a fairly specific level and that the principal, if not only, clinical difference between the groups is one of severity. This interpretation is reinforced by the fact that there are few symptoms more common in the neurotic group. There is suggestive evidence that symptoms generally thought to characterize neurotic depression may conduce to referral to psychiatric services. The neurotic depressive syndrome as classically conceived may therefore be an artificial one, created by selective factors bringing patients with particular symptoms into hospital populations.

Forty-five in-patients, with primary diagnoses of neurosis or personality disorder, completed the test cards and booklet versions of the Symptom Rating Test—Day (SRT). In order to facilitate retroactive interference the Manifest Anxiety Scale (MAS) and the Maudsley Personality Inventory (MPI) were administered between the two forms of the SRT. On the next day the patients were given the SRT (Week). The initial SRT, MAS and MPI testing was repeated one week later.

On the assumption that positional set is an important consideration predictions were made as to the expected differences between the test cards and booklet modes of SRT administration.

The results add support to the practical use of the SRT in its more recent standardized format.

The use of cerebral electrotherapy (CET) in methadone detoxification was studied in 28 patients. Fourteen patients received active CET; the other 14 acted as controls and received either simulated CET or only methadone detoxification therapy. One patient dropped out of the study. The Taylor Manifest Anxiety Scale and the Hamilton Anxiety Scale were administered before and after the study period. Nine of the patients receiving active CET were drug-free by the end of 8 to 10 days, and all experienced a marked reduction of their symptoms; the control group did not show significant changes. CET was clearly beneficial in the treatment of patients undergoing methadone withdrawal.