A survey to determine the prevalence of diabetes in people with Down's syndrome was carried out at t raining centres in the West Riding of Yorkshire. Out of a total of 914 people known to the County Health Department as having this condition, 456 attended either junior or adult training centres and, of these, 404 provided urine specimens on two separate occasions. There were seven cases of diabetes among this group—a prevalence of 17 per thousand. Of more significance is the finding that the rate among children aged 0–14 years was 20·6 per thousand, which is considerably higher than expected in a population of this age group. It is postulated that there is an underlying defect of carbohydrate metabolism in people with Down's syndrome.

Plasma cortisol-binding capacity (CBC) was determined in 18 psychiatric patients, including 14 who had affective disorders, and 18 controls. Men with unipolar depressive illnesses had significantly lower CBC values than men with bipolar illnesses and male controls. No other significant differences in CBC values were found and it was concluded that elevated total plasma cortisol levels in affective disorder were probably associated with increased levels of unbound cortisol. The possibility that low CBC values may be a genetic marker for certain types of affective disorder requires further investigation. The effect of certain drugs on CBC was also investigated.

L-tryptophan 50 mg/kg was administered orally to patients suffering from either unipolar or bipolar affective illness, and the concentration of 5-hydroxyindol-acetic acid estimated in their cerebrospinal fluid eight hours later. There was no significant difference between the patient groups or between these and patients with neurological disease. These findings suggest a reduced neuronal activity in the 5-hydroxytryptaminergic system in some depressed patients rather than an absolute deficiency of tryptophan-5-hydroxylase. The synthesis of 5-HIAA in response to tryptophan varied with age.

Patients suffering from anorexia nervosa usually exhibit extreme concern over their physical size and weight. This tendency, noted by many observers, has been variously interpreted. However, few experimental studies of this phenomenon have been reported. In the present paper an objective technique for determining bodily perception is described, together with a series of studies involving investigation of bodily perception in anorexia nervosa. In the first study a group of anorexia nervosa patients was compared with a group of normal female controls, results showing that, unlike the controls, the patients exhibited marked overestimation of the width of their own body. Moreover, this tendency was found not to extend to perception of physical objects. The results of a second study showed that the overestimation of body width was less marked when the patients were required to gauge the size of a female model. In addition, they were found to be remarkably accurate in assessing physical height, both of themselves and of the model. A third study explored the effects of refeeding on the patients' tendency to see themselves as abnormally wide (and fat). The findings showed that this tendency decreased as patients put on weight. Moreover, the degree of overestimation of body width exhibited by patients was found to bear a relationship to their progress after discharge from hospital: when this persisted after weight gain, a subsequent relapse was more likely.

A theory is proposed which relates the learning theory concepts of reinforcement and incentive motivation to visceral afferent pathways in the central nervous System. Herrick's hypothesis of the functional significance of the difference between olfactory and gustatory connexions is used to demonstrate a parallel between olfactory and ‘drive inducing’ stimuli in their role in energizing and directing behaviour; and a somewhat similar parallel between the roles of gustatory and ‘reinforcing’ stimuli. This theory is used to explain recent evidence that there is a relationship between catecholamine-containing neurones and electrical self-stimulation behaviour. It is proposed that self-stimulation can be understood as resulting in most instances from activation of one or both of two ascending Systems: (1) a ‘reinforcement System’ (which may be phylogenetically related to gustation), arising from cell-bodies in the locus coeruleus and releasing noradrenaline as a neurohumour from terminals distributed to the neocortex; and (2) an ‘incentive motivational’ System (which may be a phylogenetic derivative of olfactory pathways), arising from cell bodies in the ventral mesencephalon and releasing dopamine from terminals distributed to the corpus striatum and related nuclei. Some implications of this theory for the action of certain psychotropic drugs and the ‘catecholamine hypothesis’ of affective disorders are discussed.

The concentration of 3-methoxy-4-hydroxyphenylglycol (MHPG) in the cerebrospinal fluid of patients suffering from unipolar depressive illness did not differ significantly from the concentration in a neurological control group. After recovery there was a small but significant decrease in the concentration of MHPG and there was positive correlation between the concentration of MHPG and severity of depression as measured by the Beck Inventory. There was no correlation between urinary excretion of MHPG and the concentration of MHPG in cerebrospinal fluid. In contrast with the findings in cerebrospinal fluid there was a significant increase in the urinary excretion of MHPG after recovery.

All patients with anorexia nervosa were extracted from three psychiatric case registers— North-East Scotland, Camberwell, and Monroe County. The average incidence varied from 0·37 per 100,000 population per year in Monroe County to 1·6 per 100,000 in North-East Scotland, in all three areas the number of cases reported per year was increasing, and in Camberwell, but not in Monroe County or North-East Scotland, there was a significant excess of patients from middle-class backgrounds.

A rating scale for depression, intended for international studies of drug treatment, is presented. The reliability between raters differing in training and language was 0·86 (Swedish and English raters) and 0·92 (Swedish and Danish raters); the reliability between two Swedish raters was 0·97. There was a strong correlation between severity of depression as measured on this scale and on a nurses' rating scale (0·87). The correlation with patients' self-ratings of depression was weaker (0·63) but still significant.

A principal components analysis has been carried out on the Leyton Obsessional Inventory replies of 302 normal subjects, divided into subgroups by sex and nationality (Irish and English). Three distinct components were found in all the analyses, which have been called ‘clean and tidy’, ‘incompleteness’, and ‘checking’. Other less distinct components are described, and the differences and similarities between the analyses of the subgroups are discussed.

Two different types of hypothyroidism can occur during lithium administration, one with evidence of underlying thyroiditis, the other without. Two cases are reported, one of type 1, the other of type 2, and 17 other cases of lithium-induced hypothyroidism in the literature are reviewed. The literature on the occurrence of goitre during lithium treatment, and that on the alteration of thyroid function tests are also reviewed. Possible mechanisms for the disturbance of thyroid function are discussed and recommendations for managing this complication of lithium therapy are made.

The paper focuses on recent criticisms of the study of the role of life-events in the onset of psychiatric conditions and suggests that measurement error and bias can be reasonably well controlled by various methodological procedures. Failure to comply with these may be expected, however, to increase rather than decrease the chances of establishing a ‘positive’ resuit. Three further factors to do with the design of studies and the analysis of data are discussed which are likely to mask real differences between patient and comparison group, and which therefore might explain the ‘negative’ results reported in the literature. They concern: (1) the choice of an appropriate comparison group; (2) specification of the length of the period between event and onset; and (3) specification of the event in terms of some measure of severity. Results from two London studies of schizophrenic and depressive patients are presented to illustrate the argument. The studies suggest that life-events do play an important causal role in bringing about both disorders.

Two scales are described which have been found useful in the measurement of relevant behaviour characteristics of mentally handicapped people in large scale surveys. One scale rates according to levels of continence, ambulance, and the presence of specified disruptive behaviours, while the other reflects speech, self-help, and literacy abilities. This information has been found useful in the planning and implementation of services for the mentally handicapped.

Depressed patients were rated at a psychiatric interview and completed a self-report symptom inventory. Concordance between the two measures was modest. Patients with psychotic depression and those with obsessional personalities were found to rate themselves low on self-report relative to interview assessments. Younger patients, and those showing neuroticism, hysterical, and oral dependent personalities rated themselves as more severely ill than did the clinician. These systematic discrepancies appeared to reflect a self-report response set to exaggerate or minimize psychiatric symptoms together with rater set regarding certain types of patients.

Results of studies with various versions of the Symptom Rating Test are described. The test was designed to measure changes in the symptoms of neurotic patients participating in experiments in therapeutics such as drug trials. In all studies the test scores discriminated significantly between psychiatric patients and normals. In drug trials the test was found to be effective in discriminating between the responses to psychotropic drugs and to placebo. The findings suggest that the test is a valid and reliable measure of distress.

The reliability and validity of the Visual Analogue Mood Scale (VAMS) has been demonstrated in both a military and a private psychiatric hospital, inpatient population. The repeated and concurrent administration of the VAMS and the Digit-Symbol test identifies a mood-performance correlation which distinguishes patients with affective disorders, of manic or depressed type, from other psychiatric patients.

In an experiment to investigate the relationship of exercise response to the personality dimensions of introversion-extraversion and neuroticism, 30 subjects filled in an Eysenck Personality Inventory and were later given a standard amount of exercise on a bicycle ergometer, with blood samples being taken before and afterwards to be analysed for lactate and glucose. A highly significant positive correlation was found between neuroticism and the change in blood glucose and a highly significant curvilinear relationship between neuroticism and the increase in blood lactate, with the largest increases in lactate occurring at the extremes of the neuroticism scale. No significant relationship was found between introversion-extraversion and either of the biochemical variables. Hypotheses are put forward to account for the relationship between neuroticism and the change in blood glucose in terms of the action of adrenaline in releasing glucose from the liver, and to account for the relationship between neuroticism and the increase in blood lactate in terms of differing rates of pulmonary ventilation during and after exercise.

A five-year sample of suicide deaths in 82 county boroughs in England and Wales has been examined according to the age and sex of the victims. A number of demographic and other factors were chosen to test out the hypothesis that male suicides were more likely to be associated with other forms of violent death in the community and that female suicides would correlate with a number of variables measuring aspects of sociosexual life. In old age it was postulated that mental and physical illness would outweigh any environmental factors—apart from social isolation—as contributory causes to suicide by both sexes. The fmdings give limited support to the original hypothesis which needs to be checked by a sociomedical investigation of as many suicides as possible in a large number of towns.

Within minutes of leaving the consulting room, patients are frequently unable to recall what their doctor has told them. This paper describes a simple, practical method for increasing recall by the organization of medical information into ‘labelled’ categories. The success of this technique was demonstrated first in a laboratory experiment with volunteer subjects, and then in a naturalistic setting with general practice patients.

Three videotapes of diagnostic interviews were rated by psychiatrists at several different centres in the British Isles. Audiences were asked to use a number of rating schedules including a list of 116 technical psychiatric terms. They were also asked to make a provisional diagnosis. The influence of the psychiatrists' concepts of normality and the type of training and other factors such as age on the perception and quantitative assessment of psychiatric symptoms and the use of technical terms is discussed. Maudsley-trained raters tended to see fewer symptoms of all kinds in all three patients, while Glasgow psychiatrists made more ratings of affective symptoms–both manic and depressive—on two of the three tapes. Dublin raters use more ‘dynamic’ terms in their daily routine than do raters from the United Kingdom. Raters over 40 years of age tended to use ‘dynamic’ terms more often than raters under 40 years. Raters trained in university departments differed only slightly in the terms they used from those trained in area mental hospitals. This study points to the problems of psychiatric communication within one culture.

Visual and auditory evoked potentials were recorded from the scalp under conditions of uncertainty versus certainty, correctness versus incorrectness of pretrial guess, and shift versus repetition of the sensory modality of the stimulus. Schizophrenic patients, psychotic depressive patients, and normal controls were matched for age, sex, race, and socioeconomic status and educational level. The two patient groups were matched for medication (chlorpromazine) dosage level. Under all conditions normals exhibited the largest N1-P3 evoked potential amplitudes, while depressives exhibited the next largest and schizophrenics the smallest. All three groups had larger Ni-Pa amplitudes in the uncertain condition than in the certain condition. However, the effect of uncertainty was greatest in the normal group and least in the schizophrenic group. There were no significant interactions between group membership and guessing correctly and incorrectly. On the other hand, there was a significant interaction between group membership and modality shift. Depressives and normals tended to have larger N1-P3 amplitudes in the crossmodal condition, while schizophrenics tended to have larger amplitudes in the ipsimodal condition.