The first part of this study of female monozygous twins discordant for childbirth covered intrapair differences before pregnancy (Kaij and Malmquist, 1970). This part is focused on the influence of motherhood on health, presented as intrapair differences in gynaecological, other somatic, and psychiatric morbidity after pregnancy.

It is a common assumption in child psychiatry that the personality and attitudes of parents exert a fundamental influence on the developing child. This hypothesis merits careful examination. The authors were particularly interested in testing it in relation to aberrant personalities and undeniable psychiatric disorder in childhood. Theoretically there are two main methodological steps;

1. (i) The proving of a correlation between parental and childhood variables. The present paper concentrates on this step.

2. (ii) experimental or other studies to demon strate causal relationships between these variables.

Motor disorders occurring in association with phenothiazine therapy have been widely appreciated and investigated since the advent of these drugs in the early nineteen-fifties. Published works have indicated that between 20 and 40 per cent of patients treated with phenothiazines exhibit signs of extrapyramidal dysfunction (Denham, 1961; Ayd, 1961). However, the relationship between treatment variables and the frequency of these motor disorders is not a simple one. Many factors are likely to have aetiological significance, and it seems that their occurrence is more a reflection of personal idiosyncrasy than of chemical structure, dosage or duration of treatment (Lancet, 1964).

In recent years there has been a steady and alarming increase in the prevalence of attempted suicide (Aitken, Buglass and Kreitman, 1969). Though all cases of attempted suicide may be regarded as a distress signal, only a proportion of such cases are seriously mentally ill. The problem of their assessment and organization of appropriate treatment is becoming an increasing burden on the psychiatric services. The Hill Report (1968) recommended that all cases should be admitted to special poisoning treatment centres which have continuous psychiatric cover. In towns where there are medical schools this may be a feasible proposition, and such a centre has been in operation in Edinburgh for a number of years (Matthew, Proudfoot, Brown and Aitken, 1969). In the Aberdeen region all cases are treated in the city casualty department and are assessed by the staff of the Professorial Psychiatric Unit, which is less than a mile away. Seven day cover is provided by a duty rota, each doctor being on call for a period of twenty-four hours. In a non-university town with less staff available such an efficient service may not be possible, and Crammer (1969) has suggested that a questionary administered by the house officer in the casualty department might serve as a satisfactory screening procedure.

Recent clinical studies of families with schizophrenic offspring have reported a variety of abnormalities, some of which—such as abnormalities of individual development, family roles and cognitive processes—appear to relate to the development of schizophrenia in a given child. The precise nature and mechanism of these possible relationships, however, have not yet been definitively established. It is to this end that we have been studying a series of families with identical twins discordant for schizophrenia. Previous reports have described the sample, methodology, and findings with regard to life history differences between the schizophrenic and non-schizophrenic twins (Pollin et al., 1965, 1966), biological variables (Stabenau et al., 1968, 1969; Stabenau and Pollin, 1967b, 1968a), parental illness (Guggenheim et al., 1969), and the interaction of constitutional and psychological variables (Pollin and Stabenau, 1967, 1968, and Stabenau and Pollin, 1967a). This paper describes an attempt to further clarify the relationships among four variables in our sample of families: (a) psychopathology; (b) identification; (c) thinking and ‘cognitive’ style; and (d) dominance-submissiveness.

The elctrical resistance of the palmar skin, and the naturally-occurring difference in electrical potential between the palm and the dorsal surface of the forearm show simultaneous changes in response to sudden or emotionally-laden sensory stimuli (the ‘galvanic skin response’ or GSR). Spontaneous GSRs occur during wakefulness, especially in anxiety states, but they are reduced by general relaxation and it might be supposed that they would be absent during sleep of uniform EEG appearance. However, Oswald et al. (1959) reported that this was not so and that in sleep with very high voltage slow waves (today generally called Stage 4 sleep) there could be present random spontaneous GSR activity, measured by the potential difference technique. Since these electrical phenomena cannot be related to any known stimulus, to call them galvanic skin responses is inappropriate, and they may better be termed electrodermogram (EDG) activity.

Finney (1965) has defined drug monitoring as ‘any systematic collection and analysis of information pertaining to adverse effects or other idiosyncratic phenomena associated with the normal use of drugs'. The purpose of this study was to devise a method which could reliably detect and evaluate the frequency and nature of untoward events in a psychiatric population, examine selected factors which might influence the appearance of these events and finally study the inter-relationships between patient, drug and events. In a psychiatric unit where electroplexy is a common form of treatment and is often combined with drug therapy it is as essential to study the effects of electroplexy as it is to study the effects of drugs; in this paper, therefore, the word ‘drug’ is taken to include electroplexy. This paper describes the design, implementation and results of the monitor as a detection device, and looks at factors which were found to be associated with the occurrence of untoward drug events. No attempt, however, was made to examine the effects of other treatment measures, such as psychotherapy.

It has often been stated that there is a seasonal variation in suicidal deaths, with more occurring in the spring than at other times of the year. The analysis of this phenomenon has, however, remained at a relatively crude level. For example: (1) Recent data (Dublin, 1963) indicate that the pattern is not simple. There appears to be a subsidiary peak in suicidal deaths in the early winter in the U.S.A. (2) Investigators have not investigated whether the seasonal variation is found more strongly in some subgroups of the population than in others. (3) Investigators frequently omit to carry out statistical tests of significance on their data. The present study sought to investigate the seasonal variation in suicidal deaths, taking these considerations into account.

A series of recent papers (Creak, 1961, 1963; Rutter, 1966; Brown, 1963; Lotter, 1967; Schain and Yannet, 1960) have provided evidence of degrees of cerebral dysfunction in infantile autism (Kanner, 1943) and other infantile psychoses. They have demonstrated that groups of cases of infantile psychoses satisfying broadly similar diagnostic criteria have in their backgrounds a variable frequency of cerebral insult and abnormal discharge in the EEC The diagnostic criteria in such series are of crucial importance. Imprecision and vagueness hamper comparisons between series. In childhood psychoses some investigators have excluded those cases in which there was any history or clinical evidence of organic features in an attempt to obtain a ‘pure’ group. This technique, while valid in delineating a syndrome, is handicapping to subsequent etiological study. For these reasons the present authors have used only age of onset and behavioural features as their ascertainment criteria it was a behavioural rather than an aetiological diagnosis.

In Personal Construct Theory (Kelly, 1955), a person is considered to describe and predict his perception of the world by using bi-polar constructs which form an integrated system. In clinical practice it is possible to elicit from a patient not only a description of his environment in his own constructs but also an account of how he uses his construct system to predict future events. The following study shows how an assessment of the patient's construct system is useful in evaluating the outcome by therapy.

This is the sixth and final paper of a series studying various symptomatic, physical and social aspects of a sample of 47 cases of infantile psychosis (I.P.) and 33 cases of late onset psychosis (L.O.P.). They were seen at the Park Hospital for Children, Oxford, and the Newcastle Child Psychiatry Unit.

It is still generally believed that it is dangerous to combine the tricyclic antidepressants with any of the M.A.O. inhibitors, and the Federal Drug Administration, the Witts Committee and the drug manufacturers caution against so doing. Several current texts reiterate these warnings. (Beck, 1967; Malitz, 1966: Shepherd et al., 1968).

Dibenzepin hydrochloride is a new tricyclic antidepressant drug with pharmacological properties midway between those of imipramine and amitriptyline. In a double-blind comparative trial, J. M. Fielding (Med. J. Australia, 1969, 1, 614) found no significant difference in the speed of the effect of the two drugs in depressed patients. He reported that side-effects rated subjectively by patients were maximal before starting on the drugs and tended to decrease with time. The following trial was accordingly staged.

The difficulty of examining separately the genetic and environmental factors responsible for mental illness has resulted in different approaches to surmount this obstacle.

A marked reduction of distress scores following attendance at a clinic even before placebo was given has been reported by Goldstein (5) and Frank, et al. (3). Various therapeutic and diagnostic procedures are believed to have a placebo effect and lead to a further reduction of distress (11).

This paper examines the differences in diagnostic practice and rating behaviour between groups of psychiatrists trained in different centres in the British Isles, using their observations on three video-taped psychiatric interviews. The findings are also briefly compared with similar data obtained in the United States.

Child psychiatrists are much exercised at the present time about the classification of clinical syndromes occurring in children (Rutter et al., 1969). Perhaps surprisingly, there is less difficulty in the case of such relatively rare conditions as childhood psychoses, the psychoneuroses or even the syndromes associated with neurological dysfunction than there is in the categorization of the common behaviour disorders.

The philosophy behind subnormality care is clearly to prevent subnormal functioning. This involves eugenic aspects, adequate obstetric and pre-natal care, paediatric diagnosis, and remedying inherited and acquired handicaps. It is common knowledge that much of the functional subnormality once seen among adults can be avoided with good community facilities. A recent team of American experts touring the U.S.S.R. reluctantly concluded that, by means of good obstetric and child care facilities, the U.S.S.R. probably avoided the hospitalization of some half the number of those who in the U.S. were found to need residential care (Kety, 1965). Craft and Miles reviewed Welsh facilities in the 1960's, and found that some of the areas reviewed apparently labelled three times as many persons ‘subnormal’ as others, thereby producing a residential hospital solution to many difficult social problems.

Previous papers in this series have concentrated on concepts which relate to the communications brought by the patient and to the factors, in both patient and therapist, which either facilitate or hinder the free flow and understanding of these communications. However, in the discussion of working through (Sandler, Dare and Holder, 1970a) reference was made to those interventions of the analyst which aim at bringing about enduring changes in the patient, and to the need for continual elaboration and reinforcement of the analyst's interventions. Whilst the term ‘interpretation’ is often used in a general sense to refer to these interventions (at least, to the extent that they are verbal) it seems appropriate to examine the concept in some detail.

Despite the popularity of group psychotherapy in its many different forms over several decades, we seem to be little nearer to an understanding of how it works and how effective it is. This lack in our understanding stems largely from deficiencies in research in this field. Bennis (1960) found that research on group psychotherapy was more often based on descriptions, anecdotes and clinical observations than on systematic collection and analysis of data. Slavson (1962) found that many of the papers which he dealt with as the editor of International Journal of Group Psychotherapy ‘lacked in scientific discipline, and often drew conclusions from inadequate evidence’. Luchins (1947) felt that there was ‘a decided deficiency in the use of objective methods of establishing outcome of group psychotherapy programmes', and Burchard et at. (1948), in their comparative evaluation of fifteen reported programmes of group psychotherapy, concluded that failure to consider pertinent variables, the lack of operational definitions, and the absence of any frame of reference, made comparison of methods or evaluation of outcome almost impossible.