Morning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.

The characteristics of patients and information-gathering processes in general practice consultations producing prescriptions for antibiotics and psychotropic drugs are discussed. The contribution of patients presenting symptoms and the exploration of these by the general practitioner in the prescribing of psychotropic drugs, is compred with that of diagnosis.

Enuresis is a disorder of micturition occurring in the absence of an organic urinary tract lesion. To understand its possible causation, the mechanisms controlling micturition are described together with the possible sites of action of various anti-enuretic agents, particularly imipramine. It is concluded that further research into the central control of micturition is required before the precise actions of centrally-acting anti-enuretic agents can be elucidated. Knowledge of these may give insight into the nature of the defect causing enuresis.

Food intake, appetite and a variety of feelings were measured pre- and post-operatively in obese patients undergoing jejuno—ileal bypass surgery. Decreased food intake correlated closely with the amount of weight loss at both 4 and 30 months after surgery. Malabsorption correlated with weight loss at 4 months but not 30 months post-operatively. The cause of the decreased food intake is unknown and cannot be completely explained by either depression, nausea, malabsorption, liver disease, an attempt to avert diarrhoea, or decreased appetite.

Non-esterified fatty acid and total and free tryptophan were determined in the plasma of psychiatric patients unselected with respect to psychiatric diagnosis and in the plasma of normal subjects before and after physiological and psychiatric tests. Retarded patients had significantly low total and free tryptophan values which correlated negatively with agitation. Total tryptophan fell significantly after testing in the non-retarded subjects. The only biochemical abnormality significantly associated with a diagnosis of primary depression was the rise of plasma non-esterified fatty acid after testing. Thus, tryptophan abnormalities were associated more with psychiatric rating scores than with diagnoses.

Twenty women with anorexia nervosa were investigated at varying stages during weight gain. Basal prolactin and TSH and prolactin responses to TRH were normal and unrelated to body weight. LH, FSH and 17β oestradiol were low in emaciated patients and rose with weight gain. There was no correlation between serum gonadotrophin and prolactin concentrations. T3 and T4 concentrations were low but T3 rose with weight gain during refeeding over 4–6 weeks, whereas T4 remained low. A positive correlation was found between the TSH response to TRH and body weight.

The abnormalities in the hypothalamic–pituitary–thyroid axis were similar to those seen in a variety of chronic illnesses and appear to be unrelated to the amenorrhoea. The failure of restoration of normal function at least after short-term refeeding requires further investigation.

It was concluded that the amenorrhoea in anorexia nervosa is not associated with changes in prolactin but is determined primarily by changes in the hypothalamic–pituitary–gonadal axis. These changes are induced largely by nutritional factors but psychological factors may also be involved.

Twenty-one patients on The Royal Free Hospital dialysis programme and 21 control subjects were examined using the Semantic Differential. Results were analysed by the method of check-style analysis and by a comparison of concept profiles for the 2 groups using a multivariate analysis program.

A highly significant difference (p < 0·001) was found between the check-styles of dialysis and control groups. The implications of this finding are discussed.

Three concepts were selected for particular study: ‘my self’, ‘my ideal self’ and ‘people’. There were significant differences in profiles between the 2 groups on all 3 concepts.

Subgroup analysis showed further differences for sex, age and length of time on dialysis.

Two earlier studies conducted in the vicinity of London (Heathrow) Airport compared the rate of admissions to a psychiatric hospital from areas exposed to different levels of aircraft noise. Their methods and results were not identical. A third study, reported here, examined standardized rates of admission to the same hospital for a longer period and for a larger area divided into 4 bands of aircraft noise. Statistically significant trends of decreasing admission with increasing noise levels were found. Comparisons between the investigations show how the contradictory results are related to the methods used and the accuracy of the data, and that caution should be exercised in formulating conclusions from exploratory research.

A study of attentional deficit in the relatives of schizophrenics and in a matched control group is reported, in which the relatives are found to have poorer scores on a vigilance test and on a choice reaction time test. It is concluded that this deficit points to one of the primary symptoms of schizophrenia, and suggestions for further research are made

Eighty-three chronic obstructive bronchitic patients were psychologically assessed before being randomly allocated to 1 of 3 management regimes. The following measures were taken: psychiatric disturbance, personality, social-desirability response set, vocabulary, expectations about treatment, attitudes and beliefs about bronchitis, effect of patient's bronchitis on the family, work, self, physical exercise, smoking, and general health. Outcome was assessed after one month and again one year later, and the measures included physiological tests of lung functioning, an exercise tolerance test, reported symptoms, time off work, drop-out, and death.

Contrary to expectations, it was found that psychological variables had some prognostic significance for outcome assessed by medical measures of illness severity. More important was the finding that, in bronchitics under retiring age, weeks off work during the year of the study could be predicted by psychological variables but not by physiological measures of illness severity.

Data on the development of a 40-item measure of the symptoms in anorexia nervosa are reported. The scale (EAT) is presented in a 6-point, forced choice, self-report format which is easily administered and scored. The EAT was validated using 2 groups of female anorexia nervosa patients (N = 32 and 33) and female control subjects (N = 34 and 59). Total EAT score was significantly correlated with criterion group membership(r = 0·87, P < 0·001), suggesting a high level of concurrent validity. There was very little overlap in the frequency distributions of the 2 groups and only 7% of the normal controls scored as high as the lowest anorexic patient. Female obese and male subjects also scored significantly lower on the EAT than anorexics. Recovered anorexic patients scored in the normal range on the test, suggesting that the EAT is sensitive to clinical remission.

Perception of body size, subjective experience of body image distortions and differentiation of body concept in the human figure drawing were assessed in adolescent anorexia nervosa patients and controls shortly after hospital admission, and again 6 months later during the recuperative phase. Size estimation was not found to be a distinguishing variable, as both groups exhibited overestimation tendencies of comparable magnitude at both time periods. By contrast, experiences denoting estrangement from the body, insensitivity to body sensations, and weakness of body boundaries were more prevalent in anorexics, and persisted at high levels after frank symptoms of weight and eating disorder had subsided. Anorexics were also shown to depict the human figure with less differentiation relative to controls. Within the anorexic sample the presence of vomiting was linked to greater subjective experience of body image distortion, and such phenomena appear to be a more enduring feature in this subgroup. Overall, the results were viewed as lending support to the argument that defects in body image formation render the anorexic vulnerable to their manifest pathology, which is itself activated by maturational conflicts unique to adolescence.

Between 1968 and 1975 there was a marked, non-artefactual rise in the numbers of young female parasuicides admitted to the Regional Poisoning Treatment Centre in Edinburgh. The greatest increase in rates occurred among girls aged 15–19 (for events, persons and ‘first-ever’ episodes). Among teenagers the most marked increase occurred for those who were married: this group also reported a greater increase than did the non-married in the frequency of physical violence and Serious debt. ‘Marginal’ social-sexual roles have also become progressively more common in this age group. The 20- to 24-year group showed a more modest increase in rates, similar for the married and the non-married. In this age group there was no consistent pattern of change for reported violence or debt over the study period, nor were changes in these variables related to marital status. An increase in consumption of alcohol before parasuicide was noted for both age groups.

Patients with anorexia nervosa have previously been shown to display disturbances in visual self-perception and interoception. In the present investigation we wished to determine the stability of these disturbances and the effects of weight gain on them. We studied 29 females, 16 patients with primary anorexia nervosa and 13 controls, who had also been studied one year previously. Each subject took part in investigations of body image, using a distorting photograph technique, and interoception, using a satiety aversion to sucrose test. We found that some anorexic subjects tend to overestimate body size and have an absence of aversion to repeated sucrose tastes. Moreover, these disturbances were stable over the year and were not affected by weight change.

It has recently been suggested that the bilateral asymmetry of electrodermal activity (EDA) reported in schizophrenia may be related to unilateral temporal lobe dysfunction. To test this hypothesis, 3 aspects of EDA – skin conductance level (SCL), number of spontaneous fluctuations (SF), and skin conductance response (SCR) – were measured bilaterally in 10 patients who had undergone unilateral temporal lobectomy. No differences could be detected between the operated and non-operated sides within the patient group, nor between the patient and control groups. The implications of these findings are discussed.

The concept of psychophysiologic disorders and the major theories invented to account for such disorders are critically reviewed. The Irritable Bowel Syndrome (IBS) serves to illustrate the application of each theory and provides a vehicle for their appraisal. The tendency to think of ‘physical’ and ‘psychological’ as separate entities rather than separate languages has led to attempts to make a categorical distinction between disorders caused by ‘psychological’ factors and those caused by ‘physical’ factors. Some of the theories developed to account for psychophysiologic disorders are unscientific and none can adequately account for all the features of IBS. It is concluded that the concept of psychophysiologic or psychosomatic disorder is outmoded.

The origins of present misconceptions of pathological intoxication are reviewed, and the main symptoms examined in relation to possible aetiological factors. The diagnosis is infrequently made in clinical practice, and has little use in court in cases of alcohol-related violence. It is suggested that ‘pathological drunkenness’ (lCD 291.4) should be removed from the International Classification of Diseases.

Eleven behaviourally abnormal XYY males who had been treated in a structured combined programme of antiandrogen medication and counselling were followed up 1 year after cessation of the programme. Behavioural ratings were made in each of 5 categories: assault against people, destructiveness against things, threatening behaviour, stealing, and self-harming. On examining the follow-up findings, therapeutic success appeared questionable.

A review of psychological contributions to cancer research is presented and a theoretical framework of heuristic value for such investigations is suggested. The author's study of women with breast cancer is described and methodological limitations are considered. There is evidence that psychological and psychobiological studies can make a useful contribution to cancer research, providing they are based on rigorous scientific methods.

In Sheffield 544 consecutive cases of attempted suicide (parasuicide) were seen at 2 large hospitals over a 12-month period, and allocated in sequence to the junior and senior psychiatric staff, of British and foreign origin. During the follow-up period of 12 months, 31 patients had a further episode of parasuicide and 5 patients committed suicide.

The outcome (as measured by repeat parasuicide or suicide) was not significantly affected by the country of origin of the psychiatrist, nor his length of training in psychiatry