We interviewed 128 women regularly during pregnancy and the first postnatal year. Psychiatric interviews identified eight ‘cases' of psychiatric disorder (6 per cent) in early pregnancy and twenty ‘cases' (16 per cent) at six weeks after birth. Postnatal affective disorder, which accounted for 15 of these cases, was significantly associated with dissatisfaction with the marital relationship and also with previous psychiatric history. The implications of the term ‘postnatal depression’ are considered in terms of the course of the disorder in the 29 women (23 per cent) who had episodes of affective disorder at some time during pregnancy and the postnatal year. We found that the majority of episodes of affective disorder could be understood in terms of previous psychiatric history and/or reaction to life-events, including the stress of childbirth itself.

There have been reports that low doses of the dopamine-agonist apomorphine, which may inhibit dopamine neurotransmission, are of therapeutic benefit in schizophrenia. We conducted a placebo-controlled study of acute and chronic schizophrenics in which videotaped interviews were blindly rated. No specific therapeutic effect was demonstrated for apomorphine other than a reduction in anxiety in acute schizophrenics. Furthermore, there was no difference in the frequency of side-effects of apomorphine between schizophrenic patients and controls, and no specific effect of apomorphine on blink-rates. These findings emphasize the importance of placebo-controlled studies in schizophrenia research.

The clinical characteristics of 70 patients included in the Northwick Park ECT trial of real against simulated ECT were analysed to identify predictors of response to the two treatments. The initial agitated/deluded/retarded substratification, the initial assessment of delusions by PSE, the individual items and factors derived from the Hamilton depression scale were all evaluated, together with six scales previously held to predict response to ECT and the individual items of these scales. The limited size of the sample does not allow firm conclusions, but the most significant and only consistent predictor of response to real ECT appeared to be the presence of delusions. The features of ‘endogenous depression’ did not in themselves appear to predict response to real ECT. The findings are discussed in relation to the viewpoint that delusional depression may be a specific entity which is relatively resistant to tricyclic antidepressants but responsive to electroconvulsive shock.

The ‘conversational model’ of psychotherapy was investigated with a view to discovering which behaviours distinguish psychotherapists trained in this method from others, of equal clinical experience. A rating scheme designed to capture the theoretical aspects of the model, and 30 predictions were made concerning behaviours which were expected to distinguish the psychotherapists. Five psychotherapists were matched to five psychiatrists who had not been trained in this method; each doctor took on four patients for therapy, and each patient was seen on five occasions. All interviews were recorded, and excerpts from the recordings rated. Only ten of the 30 predictions were upheld. In ten further predictions, the psychotherapists displayed the appropriate behaviours, but the behaviours were not peculiar to the model, since eclectic psychiatrists also displayed them. Six model behaviours were not practised frequently by the psychotherapists, and four ‘non-model’ behaviours were equally common in either group. The research formed the basis for the preparation of materials to teach psychotherapeutic skills in a more efficient way.

It is common knowledge that the French school of psychiatry began with Pinel (1745–1826) at the end of the 18th century. Pinel is credited with having delivered the insane from their chains in the two hospitals of Paris where they were detained, Bicêtre and la Salpêtrière: his near contemporaries in the humanization of the treatment of the insane were Tuke in England, Chiarugi in Tuscany and Daquin in Savoy. Pinel's essential achievement was the creation of the 19th-century French tradition in psychiatry, encompassing the medical, clinical, descriptive and nosological fields. Pinel's breadth of outlook was shared by his pupil Esquirol (1772–1840), who dominated the so-called ‘classical’ school of the ‘Alienists of the Salpêtrière’ via his numerous disciples and his treatise, published in 1838, Des Maladies Mentales Considérées sous le Rapports Médical, Hygiénique et Médicol-légal.

The suicide rate in England and Wales has increased annually in the period 1975 to 1980. The increase has occurred in both sexes, but has been greater for males. There has been a decrease in suicide by poisoning with solid or liquid substances (including overdoses) and a marked increase in poisoning by vehicle exhaust gas. The rate of hanging, strangulation and suffocation has also increased substantially: taken together (ICD E953) these now form the most common method of suicide in males. Statistics for ‘undetermined’ and ‘accidental’ death have been examined, and indicate that the increase in the official suicide rate represents a real increase in suicides during this period.

Using a classical click/flash paradigm the contingent negative variation (CNV) was recorded from 60 consecutive male admissions to Broadmoor Hospital. Clinical and psychometric Minnesota Multiphasic Personality Inventory (MMPI) assessments were made independently of the electroencephalography (EEG) data. A trend for higher amplitude CNV's to be recorded from patients with a clinical diagnosis of antisocial (psychopathic) personality was observed. Patients with a Mental Health Act diagnosis of psychopathic disorder had significantly higher voltage CNV's than those in the mental illness category. These CNV differences were only found in the primary (non-anxious, sociable) psychopaths. Secondary (neurotic, unsociable) psychopaths did not differ from staff controls. A positive association between CNV voltage and the personality factor of sociability(sociable-shy dimension) was observed. A weak, negative correlation between CNV amplitude and impulsivity (impulsive-controlled dimension) was also apparent. All subjects showed an habituation effect across trials. No difference in response variability between successive series of trials was apparent in any of the patient groups.

The historical development of official provision for the care and training of the mentally handicapped—both adults and children—is outlined, to show the changes between Local Authority and Government. Changes in emphasis between compulsory and voluntary admissions to institutions are discussed with particular reference to changes in the law and the administration of the services. Demographic changes due to longer survival, falling birth rate, and prevention, diagnosis and treatment of individual causes of mental handicap are discussed. Particular reference is made to Down's syndrome and to the fragile X syndrome.

The need for psychiatrists in mental handicap is mentioned along with the benefit of early intervention. The numbers of the mentally handicapped needing specialist care and training are not diminishing, but the manner of provision is changing, and partly reverting to ways tried long ago.

The clinical features of 35 patients with bulimia nervosa are described. All the patients came from the Oxford area and each fulfilled conservative operational diagnostic criteria. Standardised assessment procedures were used including a structured interview designed to assess the psychopathology characteristic of patients with eating disorders. It was confirmed that these patients have grossly disturbed eating habits accompanied by morbid beliefs and values concerning their shape and weight. Although the majority had a weight within the normal range, a history of weight disturbance was common. There was a high degree of psychiatric morbidity with depressive symptoms being particularly prominent. A quarter of the sample had previously fulfilled diagnostic criteria for anorexia nervosa, and this group closely resembled those patients with no such history.

A teaching package was produced to help trainees in psychiatry learn the techniques specific to a ‘conversational model’ of psychotherapy, prior to group supervision. This consisted of a booklet and three videotapes. The third tape used a micro-counselling approach to illustrate each key skill and was viewed together with a teacher. After this, trainees met in groups of three with a psychotherapist for eight weekly sessions. To evaluate this teaching, 12 trainees were asked to interview simulated patients before and after they used the package and after supervision. These interviews were recorded on videotape and rated. There were significant improvements on most of the key skills as a result of this training, and nine of the 12 trainees improved considerably. There was a strong negative correlation between improvement scores and a biological orientation to psychiatry. It is concluded that the teaching package is an economic but effective way of helping trainees learn the basics of a method of psychotherapy before they are given supervision.

The hormonal effects of apomorphine, a direct-acting dopamine receptor agonist, in schizophrenic patients are of interest in view of the therapeutic efficacy of dopamine receptor antagonists. In this study, apomorphine (0.75 mg s.c.) and placebo were administered to unmedicated acute and chronic schizophrenics and controls. Apomorphine-induced prolactin suppression did not discriminate between the groups. However, an inverse relationship between basal prolactin levels and the severity of positive symptoms was detected in the patients with acute schizophrenia, consistent with a role for dopamine in the genesis of these symptoms. Growth hormone increments after apomorphine administration were blunted in the chronic schizophrenic patients, particularly those with ‘negative’ symptoms. It is argued that this blunting is not due to previous neuroleptic therapy and may represent evidence of structural change in the hypothalamus in this group of patients.

This study considered the relationship between the personal networks of parents of schizophrenic patients and ratings of their level of expressed emotion towards the patient. Our initial hypothesis was that parents with high expressed emotion would be more isolated from an effective social support system. We found that the size of parental networks did correlate with the length of the patient's illness, with smaller networks associated with longer illnesses. There was no connection between overall ratings of parental expressed emotion and the size or quality of their social networks. However, the raw score of one component of expressed emotion, emotional over-involvement, did correlate with several network variables, indicating that parents who are over-involved with the patient are also more involved with their networks rather than being isolated.

The possible psychiatric diagnostic utility of certain quantitative EEG measures was evaluated by further analysis of previously reported data from 242 unmedicated patients and 94 non-patients. Time series of amplitude, frequency and wave symmetry measures for 12-lead EEGs (eyes closed and open) were factor analyzed across leads. Factor scores meeting specified criteria in multivariate analyses were entered into discriminant analyses comparing pairs of the following groups: non-patients, neurotics, personality disorders, overt schizophrenics, latent schizophrenics, major depressives and manics. The following discriminations were obtained with at least 50 per cent sensitivity, and diagnostic confidence rates from 69 to 92 per cent: (a) non-psychotic patients (neuroses, personality disorders) from overt schizophrenics, latent schizophrenics or manics; (b) major depressives from latent schizophrenics or manics; (c) non-patients from schizophrenics (overt and latent), depressives or manics. Most discriminations were replicable in split-half analyses. Possible utility of EEG measures in differential diagnosis is supported.

This clinical research report identified 4 subcategories of the hospitalized borderline personality disorder: developmental, affective disorder, attentional deficit/learning disabled, and organic. Developmental and affective disorder subcategories are predominantly composed of females, while males are overly represented in the attentional deficit/learning disabilities subcategory. Comparison of the borderline patients with schizophrenic and affective disorder control groups supports the hypothesis that the borderline personality disorder is a diagnostic entity distinct from schizophrenia, but perhaps not from affective disorders.

Previous work on the inter-relationships among depression, hopelessness and suicidal intent in parasuicide is reviewed. Our own study of 120 hospital-referred parasuicides confirms previous findings that, while both depression and hopelessness correlate with the degree of suicidal intent as measured on a Suicide Intent Scale, the relationship between depression and suicidal intent is dependent on that between hopelessness and suicidal intent. Some practical and theoretical implications are discussed.

This study was undertaken in a society without psychiatric services to assess the economic losses associated there with major mental disorder. Such data are important in assessing the cost/benefit of services for major mental disorders.

A survey was conducted in 27 representative villages of Laos, each containing about 200–300 people; 35 mentally ill subjects were identified. Data were obtained on expenditure for treatment, loss of productivity, and other economic losses (eg., destruction of property); demographic data and clinical rating scales were also obtained, and compared with economic variables.

The data show wide variability in expenditures for treatment, but losses of productivity were consistently high; acute losses, while impressive due to their suddeness and obvious wastefulness, were comparatively small relative to others. Demographic data were not associated with loss in productivity. Certain psychopathological parameters, ie., more psychopathology, less productivity, were inversely correlated with productivity. Psychosocial function scales were strongly and directly correlated with productivity.

The experience of 82 demented female patients, admitted to Crichton Royal in the period 1957–59, is compared with 107 similar female patients from 1974–76. All finally died in the hospital, or at the closure of the study in November 1981 were long-stay patients there. Results show that on average, each patient in the more recent group spent 24 per cent longer in hospital; the results, however, were only statistically significant in the very elderly—over 85. Further study of the 1970s failed to demonstrate that day care and intermittent holiday admissions had any effect on the length of time the patient spent in hospital on final admission. Using the study data, models of future needs are worked out on the basis of bed requirements for patients admitted without prospect of discharge.

We are conducting a two year longitudinal study of mood disorders in a group of 103 stroke patients. During the first six month period following the stroke the prevalence of symptoms of major depression increased from 23 per cent to 34 per cent while the frequency of symptoms of dysthymic depression increased from 20 per cent to 26 per cent. In addition, 10 of 13 patients who had major depresssive symptoms during the initial evaluation continued to have these symptoms at six months follow-up and 4 of 9 patients who had minor depression in hospital developed major depression, while 5 of 9 continued to have minor depressive symptoms. Thus, the duration of depression following stroke is more than six months and the prevalence of major depressive symptoms increases steadily for the first half year after a cerebral hemorrhage or ischemic lesion.

Suicide is rare under 14 years but thereafter increases with increasing age, with males predominating. The suicide rate for 15–19 year olds in England and Wales has increased since the nineteen fifties for both males and females, with a recent substantial rise in males. There has also been an increase in the small number of female suicides aged 10–14 years between 1941–50 and 1971–80. In younger age groups there is a higher proportion of undetermined deaths compared with officially recorded suicides, and this category has recently increased disproportionately in the young. The number of deaths by poisoning with solids or liquids recorded as suicide, accidental poisoning or undetermined poisoning has increased markedly in young people, and the relationship between the three groups might repay investigation.