The generally accepted (Waelsch and Weil-Malherbe, 1964) reduction in the rate of glucose utilization in cases of severe depression could not be confirmed with specifically determined blood glucose in patients given diets high in carbohydrate for three or four days before testing (Herzberg, Coppen and Marks, 1968; Hansen, 1969). Nevertheless, in numerical agreement with previous findings with older methods for blood sugar determination (Henneman, Altschule and Gonz, 1954; Balter and Efron, 1965), depression as a symptom in psychosis correlated highly with elevation of non-glucose carbohydrate concentrations as determined by the colorimetric anthrone method. It was found that elevated whole blood uridine diphosphate glucose (UDPG), enzymatically determined, correlated with depression in psychosis (Hansen, 1969).

Increased serum creatine phosphokinase (C.P.K.) levels have been shown in acutely psychotic patients on admission to hospital (Meltzer, 1968). Little is known about C.P.K. activity in non-psychotic (e.g. neurotic) patients admitted under similar conditions. Psychotic patients have not been compared with non-psychotic patients over a period of time following admission. Examination of a single serum sample for C.P.K. activity in non-psychotic patients at the time of admission has shown no abnormality (Meltzer et al., 1969).

Excessive alcohol consumption over a prolonged period of time may result in a variety of neuropsychiatric complications (Victor and Adams, 1953). The most frequent of these is alcoholic tremulousness which may be complicated in 25 per cent of cases by perceptual disturbances ranging from transitory misinterpretations of familiar objects to visual and auditory hallucinations (Victor and Adams, 1953). Closely related to this condition are delirium tremens (Victor and Adams, 1953; Lundquist, 1961; Nielsen, 1965), and acute or chronic auditory hallucinosis (Benedetti, 1952; Victor and Hope, 1958). In clinical practice intermediate or atypical forms of these syndromes are seen (Sabot, Gross and Halpert, 1968).

The XYY constitution has achieved some measure of clinical definition, having been found in association with tallness, asocial personality, dilution of intelligence (Griffiths, 1971) and a tendency to psychopathic disorder (Griffiths, Richards, Zaremba, Abramowicz and Stewart, 1970). In addition, neurological, endocrinological, skeletal and other abnormalities have been reviewed (Griffiths, 1971), and the condition, like mongolism, has come to be regarded as affecting many systems of the body to a greater or lesser extent. Biochemical investigations, hitherto largely concerned with sex hormones, especially testosterone, have in general revealed no significant difference from matched controls. Some authors have, however, reported increased plasma testosterone levels both in 46 XY and 47 XYY patients of maximum security hospitals as compared to patients in other psychiatric hospitals and to the general population (Ismail, Harkness, Kirkham, Loraine, Whatmore and Brittain, 1968; Rudd, Galal and Casey, 1968; Price and Van de Molen, 1970). The pre-eminent desirability of rigorously selected controls has been remarked on in these investigations.

The County Borough of Brighton is a seaside town with a population at the 1971 census of 166,081. This population has fluctuated only slightly. In 1951, the total population was 156,486; in 1961 it was 163,159; in 1966 it was 159,510. Brighton's population contains a large percentage of elderly people; in 1966 there were 25 · 7 per cent of the population over the age of 60, and 18 · 8 per cent were over 65 years old, compared with 18 per cent over 60, and 12 per cent over 65 for England and Wales.

The incidence of deliberate self-injury without fatal outcome (‘attempted suicide’), and with consequent referral to casualty departments and wards of general hospitals, is a constant and growing concern for the medical and social professions. The situation may be described as a steady, never-ending epidemic, with no ready remedy capable of halting it. Indeed, for many hospitals all over the country the epidemic seems likely to overwhelm existing facilities for the treatment of psychiatric, and even non-psychiatric conditions.

The aim of the present investigation is to consider the dynamics and the effects of suicidal attempts in 100 female patients admitted to Holywell Hospital in two consecutive years, 1962 and 1963. (Holywell is a psychiatric hospital of 750 beds situated in the town of Antrim, 17 miles north-west of Belfast. It serves County Antrim, which has a population of about 330,000.)

Affective disorder is a serious and disabling illness which has a high suicide rate. Suicide is estimated as the eventual cause of death in 15 per cent of those given this diagnosis (4). Lithium carbonate has been convincingly shown to be an effective prophylactic against further attacks of depression (1, 3). Because suicide is such a common end in those with depressive illness, and per contra depressive illness is found in at least half of those dying by suicide (5, 2), the suicide rate may well go down once lithium is in general use. The reduction will depend on how many cases of suicide are recurrent depressives who might respond to lithium.

Since the long-term results of the treatment of elderly depressives admitted to the writer's care between 1949 and 1951 were communicated (1962), further experiences (e.g. Colwell and Post, 1959; Post, 1968) have confirmed that affective illnesses in late life are associated with much subsequent mental invalidism and needs for further treatment. It was hoped that these needs might be met by increased use of out-patient and community care as well as by the introduction of thymoleptic drugs. A follow-up investigation of a further consecutive series of depressives over the age of 60 receiving inpatient treatment from the same psychiatrist in the same hospital during the years 1966–67 was undertaken with the following aims in view:

Firstly, it was intended to test the proposition that the less reluctant use of electro-convulsive therapy in old persons, as well as the introduction of antidepressant drugs and of more active after-care measures, had improved the long term outlook in the affective illnesses of late life. It was realized that a comparison of two series of patients separated from one another by some 15 years might be vitiated by differences between the samples other than those due to changed methods of treatment. It would, however, have been unethical to withhold the new forms of management from a control group.

Over a hundred years ago Griesinger (1861) identified hypochondriasis with melancholia; and quite recently, Kenyon (1964) in a study of 512 patients with a diagnosis of hypochondriasis concluded that it was always part of another syndrome, most commonly a depressive or anxiety state. Many patients with a depressive illness experience localized somatic symptoms. The question arises why, during an episode of depression, some patients have localized somatic symptoms, sometimes consistently in the same site in recurrent episodes, whilst others have none. The head, chest and abdomen have been reported as the most common sites (Schneider, 1959; Gittleson, 1962). Jaspers (1913–46) pointed out that ‘we should distinguish between phenomenological description of actual bodily experiences and any discussion of the significance for the individual of his own body in terms of the effective meaningful connections where there are hypochondriacal narcissistic or symbol-forming tendencies influencing the self-awareness'. The present study is concerned with the possible meaningful connections related to the localization of symptoms to the chest in depression, and follows a descriptive account of respiratory symptoms in depression (Burns, 1971). These symptoms include sighing respiration, hyperventilation, ‘vital feelings' on the chest and depressive delusions directed towards the chest.

In previous papers (Pilowsky, Levine and Boulton, 1969; Pilowsky and Boulton, 1970; Pilowsky and McGrath, 1970) we have described the development of a depression questionnaire and its use in the classification and identification of depressed patients. In order to increase the flexibility of the questionnaire as a research tool we have derived a depression scale from the items in it and have investigated its validity as a measure of the depth of depression. The purpose of this paper is to describe the development of the depression scale and report the results of validation studies.

The Netherne Resettlement Unit, established in 1957, has been described in detailed publications including those by Bennett et al. (1) and Folkard (15, 16). These authors stressed the Unit's dual function of assessment and preparation of disabled patients for resettlement, and described results of its first two years in terms of discharge, readmission and employment. The basic Unit aims of resettlement in optimum employment and accommodation have remained unchanged since that time. The programme has been geared towards minimizing the patients' handicaps by improving their coping abilities (24) so that they can manage in less protected situations, by utilizing the pooled experience of a multidisciplinary rehabilitation team (18) and by mobilizing community resources (36). Hospital living and working conditions are repeatedly scrutinized so that factors which might provoke, increase or reactivate the patients' symptoms (10) are reduced. The Unit's policies, therefore, remain dependent on the forward-looking hospital administration which has encouraged democratization, effective communication and clear definition of function (33).

The difficulties in providing adequate psychotherapy facilities in the N.H.S. are well known, and various psychotherapeutic techniques have been used to try to cope with them. Of these the most important have been variants of group and brief psychotherapy, and it is with the latter that this paper is concerned. The technique I have used in this series is to offer patients once-weekly psychotherapy for a maximum period of 6 months and then to terminate no matter what progress has been made, the patient having been informed of these conditions from the start. In this paper I shall consider the criteria used in the selection of patients, the technique and probable mode of action, a brief account of the cases with the therapeutic results obtained, and the follow-up on these cases.

The sexual asphyxias have, in the past, often been described by forensic pathologists after an apparently accidental death has brought the condition to light. The following case is exceptional in that it came to light before a fatality occurred and suggests that intense self-punitive tendencies may play a part in some cases.

The production of a catatonic-like state in animals by phenothiazines and related compounds (‘experimental catatonia’) is an important laboratory test in the assessment of neuroleptics (Joyce, 1968). This response is, however, uncommon in humans who are receiving therapeutic doses of this type of drug. Such a case is described, and some of the literature concerning this subject is reviewed.