Individual components of cognitive disability were assessed in the siblings of 41 autistic probands and compared with similar measures from a control group of siblings of Down's syndrome individuals. The results showed a significant familial clustering of cognitive disabilities in the siblings of autistic probands. These cognitive impairments included disturbances in expressive and receptive language, specific learning disabilities, and varying degrees of mental subnormality.

Electromyograms (EMGs) from the corrugator, zygomatic and splenius capitis muscle sites and Beck depression inventory scores were obtained from 21 depressed in-patients shortly after admission and after two weeks in hospital. Contrary to the result of a previous study by other investigators, significant covariation between depressive symptoms and corrugator EMG levels was not seen. However, consistent with a second finding of the previous study, initial corrugator EMG levels were shown to be significantly predictive of treatment outcome. Further, initial EMG from the zygomatic was also found to predict changes in depression. The explanation is unclear and further research is needed.

Using a standardized behavioural programme, nine in-patients with severe agoraphobia were treated by staff who had minimal training in the theory and practice of behaviour therapy. With one exception patients showed marked reduction in subjective fear and avoidance, both following treatment and at follow-up. The indications for such treatment are considered and compared with those for alternative behavioural approaches that have recently been advocated.

Pure erotomania was first described in 1920 by the French psychiatrist de Clérembault. It is a delusional condition, usually in a woman who believes that a man, unattainable because of his much higher social class or married state, is very much in love with her. The belief has a precise onset and occurs suddenly in a state of clear consciousness. Enoch and his colleagues (1967) claim that ‘some instances of this syndrome may be distinct from ordinary paranoid psychoses and deserve a separate place in psychiatric nosology’, while Arieti thinks that it is not a clinical entity but a symptom of paranoia or paranoid schizophrenia (Arieti and Meth, 1959).

All consultants in general psychiatry appointed in Britain between 1 October 1975 and 30 September 1978 were sent a questionnaire asking about their training and adequacy of experience before making a final decision. Over a quarter of the respondents were women, of whom a third had trained part-time. Family circumstances and availability of part-time posts were important determinants. Overseas graduates formed another quarter. For many psychiatry was not their first love but availability of posts and status were important factors in choice of career. Many consultants felt they lacked experience in the subspecialties within psychiatry.

Two self-report scales of mood and morale were administered to 45 elderly in-patient depressives and 45 non-patient controls, matched for age and sex. The responses of the two groups differed significantly in the predicted direction. When 18 patients from the depressive group were re-tested 6 to 8 weeks later, at discharge, significant declines in self-reported depression, and increases in ‘life-satisfaction’ were reported. Within the depressive group, there was a significant relationship between ‘overt’ depressive behaviour on the ward and self-reporting of greater depressive symptoms, and lower ‘life-satisfaction’. The importance of independent validation of self-report measures of mood and morale in elderly populations is discussed.

In an examination of the phenomenology of pain in 78 patients with schizophrenia, 29 had current pain complaints. Of these 13 had an appropriate physical cause, leaving 16 with pain of seemingly psychological origin. The head, leg and back were the commonest sites. Complaints were most often described in sensory terms.

Pain plausibly related to a specific delusion or hallucinatory process occurred only once, and no gross examples of insensitivity to noxious stimuli or to self-mutiliation were seen. Patients with schizophrenia may have less pain than those with anxiety or depression but certainly do experience pain both from physical and psychological causes. The influence of phenothiazines on pain experience is uncertain.

A double-blind comparison between benzodiazepines and neuroleptics was carried out for 1 ½ years on 30 schizophrenics who had hitherto continuously received neuroleptics and remained apparently in full remission for at least 3–5 years. The benzodiazepine-group had a significantly higher relapse rate than the neuroleptic-group, meaning that we cannot stop neuroleptics for these patients yet. Three possible reasons for this are (1) demand of the natural course of the illness, (2) the fact that the patients agreed to stay in therapy for so long may signify a need for therapy, (3) some of the relapses on stopping neuroleptics may be ‘withdrawal psychosis' after prolonged neuroleptic therapy. If withdrawal of neuroleptics is really needed, however, it may be considered for a subgroup of female patients whose illness started after the age of 40.

Delusions of altered personal identity were studied over a four-year period in 53 young schizophrenic in-patients divided into 13 with persistent delusions, 16 with fleeting delusions and 24 with no delusions of identity alteration at first examination. The three groups were clinically otherwise comparable. Follow-up showed that those with persistent delusions of altered identity had a poor prognosis and deteriorating course.

Thirty-four forensic specialists from the Prison Service and elsewhere rated 22 alleged signs of psychopathy in order of importance. Only two respondents did not view psychopathy as a clinical entity. The remainder recognized a large number of diagnostic signs, though with much disagreement about the exact importance of each.

Young women who had attempted suicide did not score in a more hysterical manner than women in a comparison group when assessed by the Hysteroid-Obsessoid Questionnaire. Those who made suicide attempts resulting in little physical harm more often demonstrated hysterical traits than those whose attempt involved a serious threat to life. However, even in those subjects the majority did not score in an hysteroid manner, and they certainly scored in a less hysteroid manner than subjects of the comparison group.

These results are in accord with the small literature using standardised assessments, and do not support the clinical view that young women who attempt suicide exhibit marked hysterical traits.

Psychiatry in traditional Chinese medicine had a long evolution, but is now under re-evaluation. Modern psychiatry in China is based on Western psychiatry, and has a history of less than one hundred years since the first lunatic asylum was set up in Guangzhou (Canton) in 1898 (1, 2, 3) and the first generation of Chinese psychiatrists was trained by an American psychiatrist, Dr Lyman, in Peking Union Medical College, in the 1930s. The present paper is a brief introduction to psychiatry in traditional Chinese medicine.

Psychiatric disorders in a sample of spouses of probands with recurrent Primary Affective Disorders (PAD) and in their first degree relatives were evaluated and compared with those in the spouses of control subjects without psychiatric illnesses. No differences were found in the risk for PAD, but spouses of PAD patients and their respective first degree relatives manifested a greater incidence of affective spectrum disorders.

Neurophysiological studies of experimental pain were carried out on two severely depressed patients who complained of an inability to experience emotion. They had normal thresholds for stimulus appreciation but markedly increased thresholds for pain. These abnormal pain thresholds normalized with clinical recovery.

The frequency of HLA-A2 was examined in 32 black and 22 white schizophrenic patients separated into two groups according to whether they had normal or reversed cerebral hemispheric asymmetries as determined by computed tomography. The black patients with reversed asymmetry had a significantly greater frequency of HLA-A2 as compared to black patients with normal asymmetry and a black normal control group. There were no significant differences for any other A, B or C antigens. These findings also held when only the 22 black patients without evidence of brain atrophy were studied. The results for the white patients were in the same direction but did not reach statistical significance. These findings suggest that, at least for black schizophrenic patients, reversed cerebral asymmetry is associated with an increased frequency of HLA-A2.

HLA antigens were typed among 136 Japanese schizophrenics. Increased frequencies were seen in A9 (Aw24), A10 (A26) and Bw54, and decreased frequency in B40 antigens when compared to 187 Japanese controls. It is suggested that there may be an association between A9 (Aw24) and schizophrenia with a chronic-progressive course and also an association between A10 (A26) and hebephrenia.

Disturbed and non-disturbed subjects were compared on a Repertory Grid measure of the differentiation of values, emotions and behaviours. The disturbed subjects tended to show either excessively tightened or excessively loosened relationships between values, feelings and behaviours. Tight relationships denoted a close correspondence between a subject's assessment of these three items; loose relationships denoted a poor correspondence. Non-disturbed subjects showed more moderate relationships. Among the disturbed patients, loosened relationships were found in schizophrenics rather than neurotics or personality disorders and tightened relationships in neurotics and personality disorders rather than schizophrenics.

Measurements of spontaneous fluctuations in skin conductance in 20 acutely ill schizophrenic patients were made in a video-tape studio. Recordings were made initially with the patient talking to an interviewer, then during a video-taped interview conducted with the patient's key relative. The Expressed Emotion (EE) of the patient's key relative had been measured previously. Significant differences in the type of spontaneous fluctuation activity between patients who had low EE and high EE relatives were demonstrated when the relative was present, but not when the relative was absent. The findings were not related to phenothiazine medication.

This paper describes the construction of a semi-structured interview schedule to assess the burden placed on families of psychiatric patients living in the community. The Indian population studied found their sick relatives most burdensome in respect of the effect of the illness on family finances, the disruption of normal family activities and the production of stress symptoms in family members other than the patient. The inter-investigator reliability of the interview schedule proved to be high.