Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all.

Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets.

The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.

The hypothesis has been tested that three types of suicide (‘old and handicapped’, ‘sociopathic’ and ‘depressed’) will vary in prevalence across ecologically defined urban areas. The hypothesis is supported with respect to ‘old and handicapped’ suicide, which predominates in middleclass areas with established residents of middle-class status; and with respect to ‘sociopathic’ suicide, which predominates in central areas with high rates of social pathology of all kinds, and poor housing conditions.

The results of surveys and inquiries to identify autistic children, carried out in England and Wales, the U.S.A. and Denmark, are compared. Three studies, in each of which either a total population of children or a wide range of handicapped children was screened, using case-note inspection and interviews, all estimated the prevalence of the autistic syndrome to be between four and five children per 10,000 aged under 15 years. Inquiries that counted diagnosed cases only or that relied upon local authority records produced much lower prevalence rates for the autistic syndrome. The reasons for this are examined, and the implications for prevalence studies of handicapping conditions are discussed.

N1-Methylnicotinamide urinary output is examined in 38 healthy volunteers, 52 patients with secondary affective disorders (SAD), 55 patients with primary affective disorders (PAD) and 46 healthy first-degree relatives of PAD patients. The results indicate (1) that in PAD patients and their first-degree relatives the frequency of low Nl-MN excretion was significantly higher (p < 0001) than in healthy controls and in patients with secondary affective disorders, and (2) that PAD patients have a consistently low N1-MN output, at all times constant and independent of the clinical phases of the disease. These findings provide evidence that the low N1-MN levels may represent an index of a biological background linked to a high morbidity risk for primary affective disorders. The theoretical implications deriving from these data are briefly discussed.

Several so-called ‘non-specific’ or ‘non-drug’ factors are known to interfere with the response to psychotropic drug administration. Animal emotionality has been reported to change the outcome of psychoactive drug administration, so that the response to a stimulant or depressant drug may considerably change according to the baseline state of activity of the central nervous system. Prolonged socio-environmental deprivation or isolation has been shown to produce in rats three different types of abnormal behaviour which have been tentatively defined as ‘friendly’, ‘indifferent’ and ‘muricide’. Such unusual changes in rat behaviour are assumed to reflect a series of different emotional changes. The present experiments show that psychoactive drugs can exert a different effect in relation to the different kinds of animal behaviour used in the experiments. The investigation of the properties of psychoactive compounds, as performed in experimental animals showing behavioural alterations, is then suggested as being more fruitful in providing much information closer to the clinical results than that achieved with the experiments performed in normal laboratory animals.

Four hundred ‘new’ long-stay patients were studied and assessments of their needs for treatment and accommodation were made. About one third appeared to need further care in hospital. A further third could possibly be discharged if suitable accommodation in the community were available: most of this group were more handicapped than present residents in hostels. The remaining third had diverse needs; many were multiply handicapped – for example, by physical disability or mental retardation in addition to psychiatric disorder. At the moment the psychiatric hospital is virtually the only agency to accept the care of such people.

An investigation into the extent and nature of social inadequacy among outpatients diagnosed as neuroses and personality disorders was undertaken on patients aged 18–49 attending one clinic over a six-month period. A feature of this survey was that each patient took part in a standard social interaction test, and their performance was assessed by two psychologists. A relatively high proportion of patients, one in six on the most conservative estimate, and probably over one in four, were judged by psychologists and psychiatrists to be socially inadequate, and the results showed a clear pattern of behavioural, social and personality factors associated with these judgements. Implications for assessment and treatment are discussed.

A post mortem enquiry has been made into the social family and clinical circumstances of 50 individuals who, according to a coroner's verdict, killed themselves in Brighton. A dimensional analysis of the 123 variables thus collected suggested the possibility of three distinct types of suicide: ‘depressive suicide’, ‘sociopathic suicide’ and ‘physical illness suicide’. The reliability of this typology has been checked by the analysis of 55 selected variables for a total of 193 cases considered by the same coroner. A cluster analysis has confirmed that the data contain at least three independent types of suicide. Some implications for the prevention of suicide are discussed.

A one-year cohort of parasuicide patients (n = 822) was divided into three age groups, subdivided by sex where indicated. Systematic comparisons of the groups were made, and significant discrepancies validated using a second cohort of patients. A number of social, demographic and clinical differences were found, as well as some unexpected similarities. The rates for subsequent (completed) suicide were conspicuously different in the six age-sex subgroups.

There is evidence that changes in the concentrations of the monoamine neurotransmitters within the brain are associated with changes in mental processes, with disorders of control of movement and with certain neuropsychiatric diseases. These neurotransmitters are synthesized in the brain from aromatic amino acid precursors that have to be obtained from the circulating blood. In this study some factors which alter the rates of entry of four amino acids (the important neurotransmitter precursors L-tyrosine and L-tryptophan, as well as L-phenylalanine and L-histidine) into the brain have been studied and the findings considered in relation to conditions in which the quantities of one or more of the monoamine neurotransmitters formed within the cerebral cells may be either too large or too small. Thus too little neurotransmitter will be formed if competition between amino acids for the carriers transporting them into the cerebral cells causes the exclusion of a large proportion of any of the aromatic amino acid precursors from the brain. For example, L-tryptophan is partially excluded from the brain if a raised level of any one of several other amino acids is maintained in the circulation. Of these, L-phenylalanine inhibits the transport of L-tryptophan into the brain most effectively, while aromatic amino acids in general exclude L-tryptophan more effectively than do other neutral amino acids.

Over-production of one or more of the monoamine neurotransmitters is likely to occur when there is too much of one of the aromatic amino acid precursors in the brain cells as a result of abnormally high uptake from the blood, or as a result of their release by an excessive breakdown of the protein within these cells. Underproduction of neurotransmitters may occur in certain disease states, such as some aminoacidurias or Parkinsonism. We have listed some conditions associated with altered mental states or motor disability in which over- or under-production of monoamine neurotransmitters may occur and have tried to relate the findings in human disease with our experimental results.

Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes. The patients were divided into 2 groups. The first group consisted of subjects who had become emaciated solely because of dieting, food refusal and excessive exercising (‘dieters’); the second of those who had used additional means to bring about weight loss such, as habitual vomiting and the abuse of purgatives (‘vomiters and purgers’).

Most ‘dieters’ were intense, introverted, socially withdrawn individuals whose anorexic behaviour had started in response to psychological stress. They had become completely preoccupied with thoughts of food, eating and losing weight. Several did well in treatment, and recovered fully from their anorexic symptoms. ‘Vomiters and purgers’, on the other hand, were more outgoing in respect to personality. Most had previously been obese and, as they had been unable to keep themselves thin by simply abstaining from food, they had learnt to use other means to control their weight. These latter patients did less well in treatment. They continued to experience difficulty in controlling their weight, and the majority persisted with their abnormal behaviour.

A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.

Emotional symptomatology data on 78 obese females treated for 3 weeks with fenfluramine, dextroamphetamine, or placebo were evaluated. These obese females were shown to be considerably less emotionally disturbed than neurotic females, and similar in emotional symptomatology to other females seeing physicians for nonpsychiatric complaints. Even within these marginally symptomatic patients, fenfluramine and dextroamphetamine were significantly more effective than placebo in reducing anxious, depressive, and anxious-depressive symptomatology. Fenfluramine was particularly effective in alleviating anxiety in patients who were initially higher in anxiety. Most important, fenfluramine produced significantly greater weight loss than dextroamphetamine in patients with higher levels of anxiety and depression, while dextroamphetamine was an especially effective anorexic in low anxious patients. Differences in initial anxiety and depression, even within relatively normal patients, may well affect results obtained with fenfluramine and dextroamphetamine in the short-term treatment of obesity.

Eleven children with phenylketonuria (PKU) taken off diet after the age of six showed significant decreases in rate of mental development compared with 26 control children of comparable IQ and with 17 PKU children of comparable IQ who remained on the diet. Changes in rate of mental development were significantly and inversely correlated with plasma phenylalanine levels in treated PKU.

One hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of ageing may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.

Previous research by the author (Slade, 1972, 1973) and others has suggested that psychological stress plays an important role in triggering off the experience of auditory hallucinations. Clearly, however, predispositional factors are involved as well. The present study is an attempt to investigate some of the psychological factors which may predispose the individual to such experiences. A battery of tests involving cognitive, personality and mental imagery variables and the verbal transformation effect was administered to two small groups of psychotic patients differing only in respect of a history of auditory hallucinations and a normal control group. The main conclusion was that the results lend direct support to the proposition of Mintz & Alpert (1972) that a combination of vivid mental imagery and poor reality-testing in the auditory modality provides the basic predisposition for the experience of auditory hallucinations.

The Leyton Obsessional Inventory (LOI), together with 46 questions taken from Sections M–R of the Cornell Medical Index, were administered to 30 inpatients suffering from duodenal ulcer and to 30 patients admitted for ulcerative colitis to test the hypothesis that the latter have more obsessional traits than the former. The results indicated that although the two groups did not differ much in their obsessive personality traits, the ulcerative colitis patients were significantly more worried and concerned about them. None of the socio-cultural factors measured, which are known from other studies to influence these obsessive scores, was associated with the differences found. An analysis of the individual LOI items between the two groups showed that the ulcerative colitis patients were more indecisive, and also more morose, more rigid and more punctual than the duodenal ulcer patients, i.e. traits traditionally associated with obsessional personality types. The two groups did not differ on the Cornell score.

The Camberwell Psychiatric Register was searched for contacts by the 2257 women resident in the register catchment area who were known to have had a child in 1970. Of these, 99 women (and 39 of their husbands) were found to have had a ‘new episode’ of psychiatric illness in the two years before or the two years after the birth of their child. The distribution of these ‘new episodes’ relative to the time of childbirth was then studied. In the women, both functional psychoses and depressive illnesses showed a sharp rise in the new episode rate in the three months immediately after delivery. There was also a suggestion of a secondary rise, less dramatic but more sustained, from the 10th to the 24th month after delivery. There was no comparable rise in the husbands. Women whose children were illegitimate had high new episode rates throughout the four-year study period, but not particularly so in the puerperium itself.

Their own accounts of their use of drugs, together with a detailed description of psychiatric history and present mental state, were obtained from a sample of institutionalized delinquents, Subjects reporting extensive involvement in drug abuse were found to be disturbed on a number of psychiatric variables; however, those reporting some limited abuse were less disturbed than subjects reporting no experience of drug taking. The results and their implications are discussed.

The concept of psychopathic personality is currently being called into question. Grendon prison has been established for the treatment of psychopaths. A recent study of Grendon prisoners enabled an examination of some characteristics commonly attributed to psychopaths to be carried out. It proved difficult to obtain good agreement in rating such phenomena as ‘conscientiousness’, ‘sexual deviation’, ‘impulsiveness’. Of ten reliable variables including ‘personal relationships’, ‘lying’, ‘alcohol problem’, only five bore a significant relationship one to another. It was concluded that whilst the term ‘psychopathic disorder’ may be appropriate for a small handful of individuals the term is probably now used too widely and too loosely.