In contrast to all previous reports of psychoses in genetically identical siblings, identical triplets aged 28 were discordant by major Kraepelinian type of psychosis. Two of them had been diagnosed schizophrenic while the third was diagnosed manic depressive. Re-evaluation of their illnesses using standardized methods and diagnosis by blind raters suggested that the discordance was not due to simple misdiagnosis or different diagnostic bias between psychiatrists. These triplets illustrate some of the shortcomings of a strictly applied Kraepelinian dichotomy and show that a genetic perspective is important in attempting to resolve the classificatory problems of atypical psychoses.

A characteristic withdrawal reaction following the cessation of long-term benzodiazepine treatment in seven patients was accompanied by a significant increase in output of urinary monoamine oxidase inhibitor. This finding provides further support for the concept that the urinary inhibitor excretion pattern may be related to stress or anxiety.

Forty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Measures of depression and obsessionality were made in patients with dysmorphophobia, psoriasis and control subjects. The depression score distinguished all three groups. Patients with dysmorphophobia had significantly higher scores compared to the patients with psoriasis, who in turn had significantly higher scores compared to a control group. Patients with dysmorphophobia and psoriasis had equally elevated obsessional symptom scores compared to controls. It is unlikely, therefore, that dysmorphophobic symptoms are due to an obsessional state. Depression, however, was found to be an important clinical feature of dysmorphophobia.

This is a one-year prospective study of one hundred and five 2 to 17 year old children of a consecutive sample of young widows and widowers in the community and of the children of controls. The children's reactions to the parental death were recorded at one month and thirteen months after the event in a structured interview with the surviving parent. The interview included items of general adaption to the death, school performance, behaviour problems, symptoms relevant to psychopathological manifestations (depression, anxiety, etc.) and general health. The results indicate a significant increase of dysphoria which disappears over time (P <0.0001), the persistance of a minor form of depression (P <0.03), an increase in bed wetting (P <0.03), and a significant degree of impairment in school performance (P <0.0001). There were no significant increases in behaviour problems and severe forms of depression. The children's general health was not affected. Those results are compared to currently available data on childhood bereavement and discussed in the light of conflicting reports relating parental loss to adult psychopathology.

This research assessed the rate of affective disorder in 124 mothers of preschool children, which was found to be lower than in earlier studies, i.e. twelve per cent during the child-rearing years, and eight per cent in the year before interview. In half of those mothers who had an affective episode during the child-rearing years, its onset had predated the birth of the first child. We investigated sociodemographic and social support variables in relation to clinical and subclinical disturbance and found only modest associations.

The apparent discrepancy between the present findings and those of previous research is discussed in relation to environmental and methodological factors.

The high incidence of psychiatric disorder in parents of disturbed children is usually explained in reactive terms implying a relationship in time. The records of children attending a child psychiatric service and the psychiatric records of their parents were examined and the time between episodes of illness in parent and child were calculated. Fathers' illnesses preceded those of their daughters, but in general, there was little evidence of any close relationship

In ten patients with presenile dementia of the Alzheimer type and in a control group the levels of the different immunoglobulins were determined in both serum and cerebrospinal fluid (CSF), and gel electrophoretic techniques used to determine possible oligoclonal bands in the gamma-globulin region. There is no indication that patients with Alzheimer disease produce immunoglobulins within the central nervous system.

A reliable and rapid way of assessing patient compliance is the use of a semi-quantitative drug determination in the urine. Almost all urines were positive to a microchromatographic test stick 2–6 hours after 25 or 100 mg nomifensine was taken orally by healthy normal volunteers. The test reliability between different observers varied between 76 and 100 per cent. False positive results were regularly observed with carbamazepine and triamterene, and false negatives or weakened reactions with lithium.

The test is reliable and highly ‘time-specific‘. Its applicability is, therefore, restricted to very specific questions.

The serum levels of lactoferrin, eosinophil cationic protein (ECP), lysozyme and β2-microglobulin have been measured in schizophrenic patients in an attempt to elucidate the activity and turnover of neutrophil and eosinophil granulocytes, macrophages/monocytes and lymphocytes, respectively. Serum-lactoferrin and serum-ECP levels were significantly (P <0.001) higher in the patient group as compared to healthy controls in contrast to blood cell counts and serum-lysozyme and serum-β2-microglobulin levels which all were within normal limits. The results were not affected by anti-psychotic therapy. A significant correlation was found between serum-ECP and serum-lactoferrin levels which may suggest a common underlying cause of the elevated levels. The findings suggest an increased eosinophil and neutrophil activity and/or turnover in schizophrenia and may have a bearing on the well-known altered inflammatory response associated with this syndrome.

Facial expressions provide crucial information about an individual's internal mood state, but are difficult to quantify. We report the development of a mathematical method for measuring facial expressions, using photographs and a specially designed computer programme.

A sample of placebo-controlled tricyclic antidepressant studies was examined retrospectively to determine whether there was any difference in the relative efficacy of the tricyclic when it was compared against an inert placebo as against an active (atropine) placebo with anticholinergic side effects. Fewer studies showed a significant difference between atropine placebo and drug than between inert placebo and drug. The possibilities that atropine has a specific antidepressant effect or that side effects amplify placebo responses are considered.

The terminology of sexual dysfunction is ugly enough in all conscience—erectile impotence, orgasmic dysfunction and so on—but it has served a useful purpose by bringing these problems into clear focus rather than burying them within the general vagueness of terms such as impotence and frigidity.

The last 15 years or so have witnessed a marked growth of interest in sexual problems paralleled by a growth of interest in marital and familial processes. The pioneering work of Masters and Johnson (Masters and Johnson, 1966 and 1970) has been a focus for this trend, but the increased interest shown in professional circles is in part a response to demands created by changes within society as a whole. In particular sexual attitudes have changed as have expectations of personal happiness, and these permissive attitudes have their casualties as well as being liberating in effect.

Modern psychodynamic formulations concerning the sexual dysfunctions stem directly from Freud's Three Essays on Sexuality (1905). Amplification and modification of psychoanalytical views since then have provided a further store of observation and clinical theory of personality development and the working of the unconscious mind, from which both behaviourally-, as well as psychoanalytically-orientated workers continue to draw. However, no single unified psychoanalytic theory of sexual dysfunction exists, nor should it at this stage of our understanding. Psychoanalysis continues to be the major source of psycho-dynamic principles in this field; there are three avenues down which progress is being made. The first, which forms the body of this contribution, is the application of psychoanalysis to the psychotherapeutic treatment of sexual dysfunctions. The second is the amalgamation of certain of the techniques and principles of psychoanalysis together with active behavioural practices based on the discoveries of Masters and Johnson and the behavioural therapists. [Singer (1974) in the USA; Robinson and Creed (1980) in the UK]. The third, no less interesting from a psychodynamic point of view is the way in which some modern behavioural learning theory psychologists are finding themselves facing psychodynamic complexities, such as transference, counter-transference, and a growing reliance on talking rather than manipulative procedures. Some behavioural sex-therapists see themselves as psychotherapists (Mackay, 1976). A knowledge of psychodynamics is therefore invaluable whatever one's final clinical approach.

The past 12 years have witnessed the establishment of behavioural methods of treating sexual problems based on the principles developed by Masters and Johnson (1970). Such methods, with some modifications, have proved to be well suited to the needs of our health service (Bancroft, 1975). It is an expedient time to take stock with regard to the current situation in this field, particularly the extent to which treatment facilities are meeting patients' needs, the type of methods being used, and how successful they are. In view of the rapid developments that have occurred in sex therapy it is also appropriate to consider what are now the oustanding clinical and research needs in this area.