A method is described for the study of therapeutic factors in group therapy in which patients and their therapists prepare brief reports at regular intervals about those events in treatment which they regard as important; these reports are then assigned by independent judges to a classification of therapeutic factors which has been specifically devised for this purpose. The feasibility, validity and reliability of the method are discussed and its potential application to group therapy research and training briefly mentioned.

The introduction of anaesthesia and muscle relaxation has made ECT relatively safe. In a retrospective study of the case notes of 367 consecutive patients receiving ECT over a two year period, chest X-ray and full blood count added no significant information and were ineffective in predicting morbidity, in contrast to physical examination alone.

Since neither the unipolar nor the bipolar theories of manic-depressive psychosis explain all its features, an alternative model was tested. The hypotheses are that mixed affective psychoses represent a superimposition on hypomania of a second type of depression which can sometimes develop from the depressive phase of manic-depressive psychosis, and that schizophrenia occurring in the course of a manic-depressive illness is an alternative to mixed affective psychosis.

From an examination of the clinical histories of a random sample of people with bipolar manic-depressive psychosis, evidence was found to support both ideas.

Seventy agoraphobic out-patients were followed up prospectively for four years after treatment; the improvements manifested during treatment were found to be maintained and partly augmented. At the end of follow-up, 75 per cent of the patients had improved on the main phobia. No clear relationship was found between external control, social anxiety, depression and duration of the complaint at the beginning of treatment on the one hand and the results at follow-up on the other. The disorders remained phobic, no other neurotic symptoms having developed during the follow-up period.

Two representative samples of males first notified as addicts during 1969, one by hospitals and the other by penal establishments, were followed up for five years. It was found that 95 per cent of the hospital sample, but only 30 per cent of the penal sample, were addicted to opiates at some time during this follow-up, as judged by Home Office records. Notification may depend as much upon the setting and circumstances in which doctors see their patients as on their clinical judgement of a ‘notifiable’ case of addiction.

A follow-up study of patients diagnosed as suffering from presenile dementia has revealed a high incidence of erroneous diagnoses. Of 52 patients discharged from hospital with this diagnosis, information was obtained 5–15 years later on 51. Eighteen were alive and the diagnosis was rejected in 16 (31 per cent). Possible reasons for the mistaken diagnoses are discussed.

Pseudocholinesterase activities and phenotypes have been determined in 103 affectively ill patients, 168 schizophrenics and 73 Huntington's disease sufferers and compared with those of a sample of healthy controls. The distributions of phenotypes in the patient samples did not differ significantly from those of the controls.

When corrections were made for sex, age and E1 phenotypes, the Huntington's disease patients showed a reduced level of cholinesterase activity. Normal levels were found in affective disorders and schizophrenia.

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.

A suggestion that schizophrenic speech may be harder to understand than normal speech was tested by a technique of reconstruction. Ten schizophrenic and ten normal passages were typed onto cards, one sentence per card. Each passage was then presented with the sentences in random order, and students were asked to reconstruct what they believed was the original order. Fewer correct strings of three or more sentences were achieved for the schizophrenic material than the normal material. It is concluded that there is a detectable abnormality in the structure of schizophrenic speech, but that it stems from the relationship between sentences rather than the content of individual sentences.

The growth of speculative theories about response to physical illness has not been backed by quantitative information. The introduction of standardized measures of psychological and social adjustment has allowed description and analysis of disability for 100 patients and their spouses two and twelve months after a first myocardial infarction. (1) Global measures of social outcome were found to be inadequate and misleading and therefore work, leisure, marriage and family relationships, sex and compliance were separately examined. (2) There was considerable continuity in individual reactions throughout convalescence and it was possible (3) to identify factors in the premorbid psychosocial state predictive of outcome and (4) to describe characteristic patterns of coping. (5) Outcome for spouses can be similarly described and understood. The findings have clinical applications for diagnosis, prophylaxis, treatment and the evaluation of medical care. The conclusion also extend our understanding of the basic principles underlying response to physical illness.

Previous research has resulted in inconsistent findings regarding the predictability of schizophrenic speech samples. It was hypothesized that the predictability of schizophrenic speech varies as a function of clinically manifest thought disorder. In an experiment based on the Cloze procedure, raters were asked to predict ten passages of schizophrenic speech and eight passages of normal speech under conditions of fourth- and fifth-word deletion. Differences emerged between the samples only for the fifth-word deletion procedure. When the schizophrenic samples were grouped according to the presence of thought disorder, thought-disordered speech was significantly less predictable than normal and non-thought disordered schizophrenic speech. Furthermore, non-thought-disordered schizophrenic speech was no less predictable than normal speech. It is concluded that schizophrenia should be more carefully defined and that thought disorder should be routinely assessed in future investigations.

Monoamine oxidase (MAO) levels in plasma, platelets, lymphocytes and granulocytes have been compared in schizophrenics and controls using three substrates. No significant difference was found between MAO levels in controls and the schizophrenic group as a whole, but platelets and lymphocytes of the latter (tyramine or benzylamine substrate) showed greater variation and in some cases higher values than controls, irrespective of treatment. Schizophrenics who experienced auditory hallucinations had significantly lower MAO levels in lymphocytes and platelets than those who did not.

A system for monitoring drug use was based on the data from annual surveys of two contrasting population groups, a general cross-section of young people and a cross-section of antisocial deviants. Correlation of deviancy and drug use established that drug use, both licit and illicit, was more extensive among those who suffered parental deprivation, whose parents were divorced or separated, who had psychiatric illness and particularly those who had committed antisocial acts. The degree of antisocial deviancy correlated with the extent of drug use.

Approximately two thirds of a group of bipolar patients attending the routine lithium clinic suffered side effects. These patients tended to have a lower plasma and erythrocyte lithium concentration and a lower erythrocyte/plasma lithium ratio than those who had no side effects. Explanations of this unexpected finding are discussed.

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.

In two series of psychiatric patients (numbering about 6,000 and 2,000 respectively), the mean age of the mothers at the time of the patients' birth was found to be very significantly above expectation from the general population, and this was so for each of the major diagnostic groups. In the second series, the age of the fathers was also found to be very significantly above that expected from a sample survey of the general population, and this was so for each diagnostic group. Fathers' age was raised more than mothers', and was highest for schizophrenia. The raised parental age could not be explained in terms of the patient's year of birth or his father's social class. The raised mothers' age could largely be accounted for by regression on the raised fathers' age. The present findings, and those of previous studies, seem best explained on the hypothesis of a constitutional parental trait leading to delayed marriage.

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.

The relationship between mental status and community adjustment has been examined in 100 outpatient chronic schizophrenics. Sixty-six per cent presented at least one of the signs of Schneiderian First Rank Symptoms, which, however, failed to discriminate the diagnostic subgroups. Total adjustment correlated with total mental status and appeared to differentiate the diagnostic subclassifications of schizophrenia. From the major components of mental status, anxiety and depression appear to be significantly correlated with the functioning and stress of the individual in community adjustment while primary symptoms are only peripherally correlated with adjustment.

A study was made of platelet monoamine oxidase (MAO) activity in non-medicated, newly-admitted schizophrenics and institutionalized chronic schizophrenics both on and off medication. These patients were compared to two control groups: normal subjects and brain-damaged institutionalized patients. No relationship was found between platelet MAO activity and the severity or duration of illness, duration of psychotropic medication, presence of auditory hallucinations or institutionalization. Mean platelet MAO activity did not differ significantly between the schizophrenic subgroups and control groups. Thirty-one patients studied before and after treatment with phenothiazines showed no significant change in platelet MAO activity. The findings did not indicate a relationship between schizophrenia, its treatment or outcome and platelet MAO activity.

Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequency was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.