Rigorously collated information on 40 members of one kindred (not previously studied) and on their spouses and cohabitees, revealed that massive multiagency support had failed fully to ascertain and prevent extensive child abuse over at least three generations. Furthermore, five other large battering families have been closely associated (by cohabitation) with this kindred.

Severe behaviour disorder (starting with hyperactivity and uncontrollability) occurred in at least three-quarters of the children, and usually progressed to adult criminality. The second most common disorder was subnormal intelligence, which crucially incapacitated the rearing abilities of young mothers who were associating with antisocial cohabitees. Seven children died in infancy. The Welfare State has done little to help the plight of surviving children in this kindred.

Factors in the patient which have been commonly cited by therapists as relevant in assessment for psychotherapy are examined as well as the research done on them. These factors are discussed under four categories: (a) factors related to the illness, (b) personal factors related to the treatment, (c) personal factors not directly associated with the illness and (d) current life circumstances. Research on methods of assessing patient suitability is discussed together with an account of the reasons for the rather disappointing contribution of systematic research.

The types of problems of 49 patients referred to a psychiatrist in a terminal care unit are reported and their management reviewed. The findings suggest that a psychiatrist can play a useful role in such a unit, particularly in supervising medical and nursing staff in the psychological care of patients and in helping more directly in the management of psychiatrically complicated cases.

Twenty-four manic-depressive artists, in whom prophylactic lithium treatment had attenuated or prevented recurrences to a significant degree, were questioned about their creative power during the treatment. Twelve artists reported increased artistic productivity, six unaltered productivity, and six lowered productivity. The effect of lithium treatment on artistic productivity may depend on the severity and type of the illness, on individual sensitivity, and on habits of utilizing manic episodes productively.

Some of the clinical factors contributing to the currently unsatisfactory state of therapy for tardive dyskinesia are reviewed. Problems such as lack of clear syndrome delineation and phenomenological description, the lack of standardization in rating scales and the lack of attention to trial design have all probably contributed to a rather confusing picture. Controlled trials suggest that several pharmacological agents may be of therapeutic value but that clinical prediction of an individual's response is impossible. The strategy of acute drug challenge has emerged as perhaps the most promising approach to the definition of pharmacological subtypes and therefore the choice of optimal treatment.

Patients with premenstrual syndrome recorded their symptoms daily using menstrual distress questionnaires. These were analysed by a least mean square method of fitting sine waves. After recording an untreated cycle, patients were given progesterone 200 mg b.d. and placebo in a double-blind crossover manner; 75 per cent of patients were then given progesterone 400 mg b.d. and placebo in a similar manner. Treated cycles were rated by both daily menstrual distress questionnaires and retrospective self-assessment. Both rating methods showed there was no significant difference between progesterone and placebo in reducing symptoms of premenstrual syndrome, and in the majority of cases placebo was more effective, although never significantly so.

Patients consecutively referred for sterilization were examined at the time of referral, two months and one year after operation.

Twenty-five per cent of the sample were identified as psychiatric cases at the time of referral, and rates of disturbance were even higher in some subgroups of women. The rate of disturbance fell in all these groups by one year after operation.

New psychiatric disturbance following sterilization was similar in amount to that found in the community and was not related to any groups of women said in the literature to be at risk apart from those divorced or separated at the time of referral.

Many experienced improvement in their marital and sexual relationships and only 3 per cent expressed feelings of regret.

Systematic variation in aspects of the sleep-wakefulness cycle of a depressed woman showed that recovery occurred reliably after 19 to 20 hours sustained wakefulness, unrelated to diurnal rhythm. Depression returned during as little as 15 minutes sleep. The effect of sleep deprivation was a specific response, probably unrelated to REM sleep.

Seventeen schizophrenic patients with tardive dyskinesia (TD) and 33 schizophrenics without tardive dyskinesia were examined by psychological tests of intellectual function and EMI scans were performed. The group as a whole were found to be demented and 31 out of 45 had abnormalities on the scan. On a learning test the tardive dyskinesia group did significantly worse and using a measured parameter of the scan (the Ventricular Index) the tardive dyskinesia group had more abnormality. It is suggested that the higher incidence of pathology in the tardive dyskinesia group may be related to chronic neuroleptic toxicity.

The psychotherapeutic aspects of the care of the 49 terminally ill patients described in the preceding paper are discussed. Their differing ways of coping with the stress of dying and the range of psychotherapeutic strategies used in treatment are described. The work suggests that the therapist's use of psychological insights can improve his understanding of the emotional pain of terminal illness, and well-aimed psychotherapy can contribute to its relief.

The working of the Mental Health (Scotland) Act 1960 is examined by analysis of compulsory admissions both nationally and to one Glasgow hospital. Comparisons are drawn with England and Wales. Despite a six-fold increase in admissions since 1945 the use of compulsory powers has remained almost constant. It is suggested that an annual number of 45 compulsory admissions per 100,000 population may represent an inevitable basic level as foreseen by the Royal Commission in 1957. Section 31 (‘Emergency Recommendation’) secures 80 per cent of Part IV admissions, and Section 24 (‘Full Recommendation’) is employed in only 25 per cent. Part V accounts for only 300 admissions per annum, mostly remands for psychiatric report. Two suggestions are made for possible future amendments to the Act.

Brain monoamine concentrations were determined post mortem in 19 patients with dementia of Alzheimer type. Samples were taken from 10 parts of the brain and compared with an age-matched control group.

There were lower mean concentrations of dopamine in the demented group of patients in seven regions of the brain, and two of these were at a significant level. There were also significantly lower concentrations of homovanillic acid in the nucleus caudatus and in the putamen. The means of the concentrations of noradrenaline were also lower, and in the putamen and the cortex gyrus frontalis significant differences were observed. The 5-hydroxytryptamine concentrations were slightly lower in the demented group but the differences did not reach significance. The degree of intellectual deterioration was negatively correlated with the noradrenaline concentrations in the hypothalamus and the cortex gyrus cinguli.

The study aimed to identify those patients referred to a psychiatric out-patient clinic who had sexual or marital difficulties and who could be offered help with these problems, although none of the patients had been referred primarily for sexual or marital therapy. The methods of assessment formed a series of filtering devices for screening the sample, and possible reasons for discrepancies in the results are discussed. Twelve per cent of the sample had sexual or marital problems and were offered treatment, and it is suggested that this proportion may be an underestimate of the ‘true’ frequency of such problems in the sample. Implications of this finding for the provision of treatment resources in the psychiatric out-patient setting are considered.

Patients' view of psychiatric care and its implications is a neglected area of inquiry, partly due to ideological factors as well as structural aspects of the National Health Service. It is acknowledged that patient satisfaction per se cannot be the major goal of the Health Services, but the path to improved welfare and treatment may be facilitated by patient satisfaction or at least by an awareness of patient opinion. Further exploration of this area is recommended.

Psychiatric disorder was studied in 62 patients with temporal lobe epilepsy (study group) and 70 patients with grand mal epilepsy (control group), both diagnosed electroencephalographically. The two groups were similar as regards age, sex, socio-economic status, duration and frequency of fits, family history and premorbid personality.

A significantly greater number of temporal lobe epileptics had emotional disturbances in childhood and psychiatric abnormalities at the time of study. Neuroses, schizophrenia and behaviour disorder occurred more commonly in the study group, while epileptic personality and confusional psychosis were seen more frequently in the controls.

The findings of the study are discussed in the light of relevant literature.

The effect of single intravenous doses of metoclopramide (10 mg, 20 mg and 40 mg) and haloperidol (5 mg and 10 mg) have been compared to placebo (saline) in a double blind randomised study in 8 patients with tardive dyskinesia secondary to neuroleptic therapy. Tardive dyskinesia rating scores were improved significantly (P <0.01) 6 hours after dosing by metoclopramide 40 mg, and haloperidol 5 mg and 10 mg, when compared to placebo. Single doses of dopamine receptor blocking agents improve tardive dyskinesia. The dose of metoclopramide required to show a beneficial effect was high, and this therefore suggests that it is unlikely to be of therapeutic value as the incidence of adverse reactions would be greatly increased. By monitoring the effects of single doses of dopamine receptor blocking drugs in patients with tardive dyskinesia it is possible to compare the relative potencies of these drugs on dopaminergic systems in vivo in man.

The case notes of all 67 manic patients admitted to the psychiatric wing of a District General Hospital over a period of two years were screened for evidence of independent life events during a four week period prior to admission. The nature of such events and of the underlying stresses was examined and the data obtained were compared with data from a control group of acute surgical admissions. Four times as many manic patients had an independent life event closely preceding their admission. It is concluded that stress in the form of loss or threat is a common precipitant of mania. Some surprising findings are focused upon and discussed.

Ten of 114 psychiatric patients undergoing combined lithium-neuroleptic treatment exhibited somnambulistic-like episodes. These episodes are differentiated from nocturnal wanderings and epileptic attacks during sleep; they occurred within two to three hours after sleep onset and were characterized by the patients appearing confused and walking about in a quiet, detached and clumsy manner. Generally, there was amnesia for the event. Since sleepwalking occurs out of slow wave sleep, the increase in slow wave sleep induced by lithium and certain neuroleptics may represent a neurophysiological mechanism responsible for these patients’ somnambulistic behaviour. The occurrence of grand mal seizures in two patients was probably unrelated to the somnambulistic-like episodes. However, persistence of the latter appears to be associated with drug-induced EEG irregularity.

The association between lateralized hemispheric dysfunction and psychiatric diagnosis was investigated with a measure of summation of dichotic clicks and with a dichotic competing message task. Ear asymmetries of affective psychotic patients were similar to those of right temporal lesioned controls and differed from those of schizophrenic patients and normal controls. In contrast, schizophrenic patients did not display abnormal auditory perceptual asymmetries.