When no endopathological abnormalities are available to serve as classifying criteria, symptom clusters are generally used as substitutes. They then form the core of particular functional diseases, especially in psychiatry. The selection of symptom clusters on the basis of clinical impression is the predominant procedure, but it is subjective and arbitrary. To remedy this shortcoming, cluster-searching methods of a sophisticated statistical nature have been introduced, though they have not so far been conspicuously successful. In some functional psychiatric diseases, such as phobic neurosis, depressive neurosis, war neurosis, and compensation neurosis, exopathological environmental, but normal, events form the classifying criteria. They are presumed to activate idiosyncratic endopathological predispositions. The classification of organic diseases relies on endopathological and inherited exopathological abnormalities as classifying criteria. As an illustration of the establishment of an inherited exopathological disease, the discovery of phenylketonuria as a clinical sign and the gradual elucidation of its pathogenesis are described.

As part of a survey of the need for rehabilitation services in Camberwell, a representative group of 56 unemployed psychiatric patients were selected from the Camberwell Register during 1968; most of these were chronic schizophrenics, and 29, or just over half of them, were living with their parents or siblings. This paper describes a special analysis made by a medical sociologist into the problems of these 29 patients as perceived by their relatives. Assessment of the patient's handicaps and the burden felt by the family showed a dependence on parents of pensionable age which is an obstacle to rehabilitation. Patients were content, but relatives were dissatisfied and experienced considerable financial burden and symptoms of reactive anxiety and depression. The need for special services is emphasized to help the patient towards a more independent existence when the relative dies.

The Leyton Obsessional Inventory, together with 46 questions taken from Sections M–R of the Cornell Medical Index and the short version of the Maudsley Personality Inventory were administered to a group of orthopaedic patients made up of Irish, English, and Irish immigrants. The results indicated that the Irish subjects had more obsessional symptoms and traits and also that they appeared to be more disturbed by the possession of such attributes than did the English. Among the various cultural factors considered, the bachelor state, in the case of the Irish males, and rural dwelling, in the case of Irish females, were associated with the highest obsessional scores. Ways in which the cultural background may be related to the development of obsessional symptoms and traits are discussed and suggestions are made as to the further epidemiological implications of these findings.

The investigation described in this paper considers the influence of social class and the infant's birth order on maternal care, and then, in the light of these findings, examines the association between quality of maternal care and infant development. The study population comprised 89% of all births during an 18-month period in a defined administrative area in Glamorganshire. Possible explanations for the findings are discussed.

A study is reported of a random sample of 170 normal men and 192 normal women who were given a 110-item questionnaire incorporating items intended to measure personality variables P (psychoticism), N (neuroticism), E (extraversion), and L (a lie and dissimulation scale). Factor analysis of the intercorrelations between items disclosed a clear-cut psychoticism factor, relatively independent of the others. The rationale and the psychiatric importance of this factor are discussed.

The concentration of cortisol (F) has been found to decrease only to a limited extent in intact brain tissue maintained at ambient temperature after death, and the decrease is mainly accounted for as 20-dihydrocortisols (DHF). The sum of F and DHF has therefore been estimated in samples of frontal cortex removed from human cadaver brains collected at necropsy, and taken as a measure of the concentration of cortisol at death. Corticosterone concentration was also estimated. The concentration of cortisol in the cerebral cortex of physically healthy individuals who had committed suicide was consistently as low or lower than in the cortex of control patients who had died suddenly without antecedent severe illness. It is concluded therefore that neither the presumed severe emotional stress preceding suicide nor depressive illness itself is associated with high levels of cortisol in the cerebral cortex. On the other hand, it was found that the cerebral cortical concentration of cortisol in patients who had died from stressful somatic diseases was raised and that the increase was roughly related to the likely degree and duration of the physical stress endured by the patients. There was some indication that the ratio of cortisol (F+DHF) to corticosterone may be lower in the cerebral cortex of suicides than in that of controls.

During 20 separate illnesses 17 severely disturbed manic patients were given either methysergide or thioridazine in a 21 day double-blind controlled trial. For most of the trial patients received either 9 mg methysergide or 450 mg thioridazine daily; during one 24-hour period 12 mg methysergide or 600 mg thioridazine was administered. Daily clinical assessments were made. Methysergide proved significantly less effective than the phenothiazine.

A male patient is described whose loss of sexual interest and activity was due to gonadal failure, presumably the result partly of Klinefelter's syndrome and partly of orchitis, though the latter was unilateral. He showed no change during a placebo control period, but within a few days of starting replacement treatment with testosterone he reported a return of sexual interest and showed a response to sexually arousing stimuli; sexual attitudes also improved. This case is of interest because of the specific and rapid psychological response to the correction of an androgen deficiency.

Based on the available research evidence, several rating and self-rating methods are recommended which appear to be suitable for the measurement of changes in distress in drug trials with neurotic patients.

Daily measurements of MHPG in urine have been carried out in two patients with manic-depressive psychosis. In both cases, levels in mania were elevated and in depression lowered with interval levels which were intermediate and within the normal range. The results lend some support to the suggestion that there might be an increase in brain noradrenaline metabolism in mania and a decrease in depression.

The Medical Research Council Social Psychiatry Unit was set up at the Institute of Psychiatry in 1948 by Professor Sir Aubrey Lewis, who remained its honorary director until March 1965. The origins of the unit were described by Dr. Neil O'Connor in an introduction to Studies in Psychiatry (Shepherd and Davies, 1968). This book in honour of Professor Lewis contains six chapters by former unit members summarizing the scientific programme up to that date. A new unit, with the same name, was then set up at the Institute of Psychiatry under the directorship of Professor J. K. Wing, with the aim of investigating social and clinical factors which influence the development of chronic disablement in psychiatric patients and of devising and evaluating techniques of treatment and prevention.