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.

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.

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.

The well-developed community psychiatric services in the 13th Arrondissement use a large number of places in sheltered accommodation. Reasons for this are explored. It may be that there are areas in the U.K. where the need for such accommodation is greater than the Department of Health and Social Security has estimated.

This paper concerns a new clinical role for psychiatric nurses—as case managers for selected adult neurotics with behaviour problems. The role involves unusual autonomy. The selection and training procedures are unusually rigorous and focus on general case-management as much as behavioural skills. The number of service posts offered these therapists is rising. These developments have wide implications for other personnel, particularly in respect of authority and responsibility boundaries, selection and training procedures, and team structure.

Every article published in the British Journal of Psychiatry between 1945 and 1974 was reviewed that provided original information derived from the direct assessment of long-stay patients. The 225 articles were examined for details of assessment practice and characteristics of the patients studied. Most studies used a very restricted range of assessment methods, with rating scales, used most frequently. Many used wholly unstandardized methods, and the description of patient characteristics was inadequate. A number of improvements in assessment practice are suggested.

In the 12 months from July 1977 to June 1978, out of 168 papers in the British Journal of Psychiatry, 139 (83 per cent) presented numerical results. A total of 63 papers contained statistical errors and at least one drew unsupportable conclusions. In many cases the errors were not considered to be severe, but they were often sufficient to raise doubts about some inferences. It is suggested that more consultation of investigators with medical statisticians, a basic training in statistical methods in the preclinical years, and more extensive statistical refereeing are needed.

Cases of schizophrenia and schizophreniform attacks living in extended families have been compared to cases with similar diagnoses in nuclear families. Both diagnostic groups living in extended families presented earlier; they had lower rates of withdrawal symptoms and higher rates of behavioural disturbances and subjective suffering. Inter-generational conflict was a significantly more common precipitating factor in patients living in extended families; this was therapeutically utilized to induce family support. Patients from extended families had a lower tendency to deteriorate into withdrawn, affectively blunted residual states.

In an in-patient population in Sri Lanka, only those receiving a diagnosis of schizophrenia had Schneider's First Rank Symptoms. Among 65 males and 104 females, the prevalence of FRS was 25.4 per cent. Those patients with FRS in the first episode are likely to develop more during subsequent episodes. An attempt is made to explain the findings on a cultural basis.

Nineteen patients with acute psychoses, the majority schizophrenics, were studied in the course of chlorpromazine (CPZ) treatment. Plasma levels of the drug, plasma prolactin (PRL), extrapyramidal side-effects (EPS) and changes in mental state were monitored weekly, as in our earlier study. The results confirm some of our previous findings: (a) plasma CPZ levels vary widely among patients and correlate poorly with daily doses of CPZ; (b) increased plasma PRL is associated with higher plasma CPZ levels and is more common among the patients who develop EPS; and (c) none of these three variables differ between groups of patients with good and poor treatment outcome. However we did not confirm our previous finding of a significant association between EPS and higher plasma CPZ, nor did we find that the ratio of CPZ-sulphoxide to CPZ differed between the improved patients and the rest.

Schizophreniform psychoses have long been associated with a wide variety of clinical conditions affecting the basal ganglia (Davison and Bagley, 1969); amongst such disorders have been post-encephalitic psychosis (Fairweather, 1947), hepato-lenticular degeneration (Beard, 1959) and Huntington's chorea (Heathfield, 1967). Kalamboukis and Molling (1962) reported calcification of the basal ganglia in a single male schizophrenic and paranoid hallucinatory psychoses have been noted in other cases of striopallidodentate calcification (Löwenthal and Bruyn, 1968); however, an association between familial basal ganglia calcification and schizophreniform symptomatology has not been recorded.

Seven out of twelve patients with malignancy and hypercalcaemia had associated psychiatric symptoms. The mental aberrations disappeared when the calcium levels returned to normal after treatment.

Reading about therapeutic communities can be an exciting experience because of a sense of pioneering change and challenge in the face of establishment opposition. Survival is often difficult and administrative values of those who control the purse strings can threaten their very existence. There is also an aura of justice and freedom where injustice has prevailed. This air of excitement and enthusiasm permeates the writings of Martin (1962) in Adventure in Psychiatry and continues in Shoenberg's (1972) updating of the Claybury experience. It features in Wilmer's (1958) vivid account of practical achievements in the Oakland Naval Hospital Receiving Ward, Foudraine's (1974) conscientious efforts to change the social organization of a unit for schizophrenics receiving private treatment in a clinic in Virginia and Mandelbrote's (1958, 1964) descriptions of change in mental hospitals in Gloucester and Oxford. It also characterizes Maxwell Jones’ writings (1968) with their autobiographical flavour and ‘living learning experience’ and Clark's (1964, 1974) presentation of administrative and social therapy with its emphasis on patient freedom, activity and responsibility. Yet it is the very cult-like nature of the therapeutic community which can be its undoing, raising expectations and hampering the independence and difference which it aims to tolerate.