The insanity defence is considered in terms of the operation of incommensurable scientific and legal discourses, a dualism which in turn is held to reflect individualist values. This analysis is used to explain both the recurring nature of medico-legal controversy and the historical results of the defence in Victorian England.

Attempts to underpin the classification of psychiatric drugs in biological and clinical terms are discussed with reference to their value and limitations. The current need for a multiplative, heuristic taxonomy is suggested.

Neuroendocrine tests are now available for studying monoamine function in the brains of patients with mental illness. Great care is required in the selection of drugs which act upon specific monoamine receptors to produce specific hormonal responses. Equal care is required in the control of biological variables which may influence hormonal release.

Recently reported neuroendocrine studies of depressive illness are assessed in these terms. The results of these studies support the hypothesis that there is defective noradrenergic function in the brains of some patients with depressive illness.

The mechanisms responsible for the production of major extrapyramidal side-effects (parkinsonism, akathisia, acute dystonic reactions, chronic tardive dyskinesias) are reviewed in the light of the complex effects of these drugs on cerebral dopamine systems.

A study of 32 patients meeting criteria for ‘schizomanic’ psychosis is described. These psychoses account for about 1 % of hospital admissions. Very few first-degree relatives had either schizophrenia or mania. Lithium seemed an effective treatment. Twenty-four patients made a full recovery, and the series as a whole was closer to manic depressive psychosis than schizophrenia on all outcome measures. Some diagnostic clues are suggested to help the clinician to recognize the patients with a poor prognosis.

These findings are in line with other studies, and suggest that most of these patients should be regarded as manic. This conclusion should lead to some revision of present ideas on the incidence and diagnosis of mania.

Twenty-two boys with schizoid personality were followed-up some 10 years later and compared with a matched control group with other diagnoses who had been referred to the same child psychiatry department. The diagnostic category is shown to have predictive validity. A start has been made towards an operational definition of the syndrome.

Psychiatric epidemiology has advanced considerably since early studies of hospital populations. The direction of this advance has been away from the study of populations of hospital psychiatric patients towards the study of psychiatric disorder in general practice and the community as a whole. Just as the populations under study have different defining characteristics, so have the individuals who comprise them. Psychosis becomes less and less common at greater distances from the hospital patient, and in the community the epidemiologist is faced with large numbers of respondents who present with fewer, minor and non-specific symptoms.

In this review, we present evidence to indicate that concepts of case definition and case identification are insufficiently advanced so far, and are still rooted in ideas derived from hospital psychiatry. Foremost among these is an exclusive preoccupation with diagnosis and symptoms. We suggest that this may be inadequate for the study of non-psychotic disturbance in the community, and discuss other models of case definition, encompassing personality and social functioning as well as psychiatric symptomatology.

A systematic evaluation was made of the reliability, validity and psychometric properties of the Symptom Rating Test Langner 22-Item Scale in the order to determine whether they are suitable for use in community surveys of psychiatric epidemiology. On the basis of studies on several samples (total N = 846), both scales were shown to be suitable for this purpose. Although the subscale structure of the Symptom Rating Test was not confirmed, it appeared superior in most respects to the Langner Scale

Two psychiatric screening instruments, the Mini-Mental State (MMS), a test for cognitive disturbance, and the General Health Questionnaire (GHQ), were administered to 197 neurological in-patients. The results suggest a high rate of psychiatric disturbance. The highest rate of cognitive disturbance detected by the MMS was found in patients with Parkinson's disease. The highest rates of emotional disturbance indicated by GHQ scores were found in patients with myasthenia gravis and multiple sclerosis. MMS scores but not GHQ scores were related to standardtests of cognition, the diagnosis of cerebral pathology, and CAT scan abnormality. The results also demonstrate that the GHQ does not adequately detect patients with cognitive impairment. It is concluded that in populations at high risk for cognitive impairment a tandem screening procedure utilizing tests for both cognitive and emotional disorders is needed.

The sensitivity in detecting a click was measured separately for the right and left ear of psychiatric patients and non-patient controls using a three-interval forced-choice staircase procedure. Patients with affective disorders showed reduced right ear sensitivity, while schizophrenic patients did not show reduced sensitivity. Lower sensitivity correlated with higher structured-interview ratings of speech retardation.

In an attempt to replicate findings reported by Slade (1976), 12 hallucinating and 12 non-hallucinating schizophrenic subjects were compared on tests of verbal ability, personality and mental imagery variables and the Verbal Transformation Effect. No significant difference between the groups was demonstrated. When the data from both groups of schizophrenics were combined, a significant correlation was found between 2 measures of the Verbal Transformation Effect and the P-score of the Eysenck Personality Questionnaire.

The natural course of anxiety before and after surgery was examined using the State– Trait Anxiety Inventory in 4 studies involving 136 surgical patients. The results suggested that high levels of anxiety were experienced before admission to hospital, between admission and surgery and following surgery, and were not restricted to the immediate pre-operative period. Only a small percentage of patients reached their maximum level of anxiety on the morning of surgery.

These results have implications for those planning interventions to alleviate anxiety associated with surgery and for those studying surgical stress as a model for other naturally occurring stresses.

Forty patients on chronic haemodialysis were studied in order to gather information about the relationship of locus of control and adjustment. Negative correlations of high statistical significance were found between locus of control and compliance with the diet, and locus of control and vocational rehabilitation, as well as between locus of control and acceptance of disability. All the findings indicate that patients with internal locus of control adjust and adapt better than those with external locus of control. The number of years on dialysis did not correlate with locus of control. It might be suggested that the shift from internal to external locus of control occurs prior to dialysis in the stage of chronic kidney disease.

This study had 3 aims: to determine whether rheumatoid arthritics had certain personality traits; to examine the relationship between psychological factors and the presence of rheumatoid factor in blood serum; and to explore the prognostic significance of psychological factors in the management of rheumatoid arthritis. Within a few days of discharge, 129 in-patient rheumatoid arthritics were clinically and psychologically assessed and allocated at random to 1 of 3 forms of follow-up care. The psychological assessment included measures of personality, non-psychotic psychiatric disturbance, and attitudes and beliefs. A year later all patients were reassessed. It was found that rheumatoid arthritics were more neurotic in personality, more likely to give socially desirable responses, and more prone to psychiatric disturbance, than the general population. Seropositive patients were less susceptible to psychiatric disturbance than seronegative patients. None of the psychological variables predicted disease activity, but those patients who rated themselves as ‘slow, dependent, and weak’ lost more time off work in the subsequent year.

Two groups of medical students answered a modified version of the Leyton Obsessional Inventory twice, with 8 weeks between tests. On one occasion it was administered in its original card-sorting (postbox) form; on the other, it was given as a written questionnaire. Fifty students answered the postbox form first, 50 the questionnaire first. Correlation between the 2 tests was reasonably good (r = 0·73–0·77). Scores on the first occasion of testing were significantly higher than on the second, but differences between scores on the 2 forms were not significant. Mean scores of male and female students were similar.

Awareness of pulse rate was tested in 60 psychiatric out-patients with anxiety, phobic or hypochondriacal neuroses by asking them to record how fast their hearts were beating during exposure to short film sequences. Correlations between subjective and objective heart rate (ECG) were significantly higher in anxious and hypochondriacal patients than in phobic ones. The results suggest that somatic symptoms in hypochondriacal and anxiety neurosis reflect increased awareness of bodily function.

Over the past few years, a new WHO mental health programme has been formulated through a process of consultations within WHO, with other UN bodies, with governments, the scientific community and various non-governmental organizations (Sartorius, 1978; WHO, 1978 a, b). This report will attempt to give an outline of research activities that are being initiated, co-ordinated and supported by the programme at country, regional and global level.