As part of the study of alcoholism, we have investigated the possibility that early age of onset of alcoholism indicates a possible diagnosis of personality disorder while later age of onset does not.

Gilles de la Tourette's syndrome had been considered an organic, often hereditary illness for many years after it was first described in 1885 (1, 2), but when medicine became psychologically oriented, the syndrome was more frequently classified as a psychological illness (3), and patients have been said to be schizophrenic, psychotic, obsessive-compulsive, hysteric, to have inhibited aggression, and eventually to deteriorate intellectually and psychologically. However, no support for common psychopathological and dynamic factors was found in our previous study of 34 patients or in a review of the literature (4). Recently, as medicine has shifted back from a psychological orientation, and as case histories have accumulated, an organic aetiology has been more frequently postulated.

Weight change and sleep disturbance are well documented features of psychiatric illness. Complaint about difficulty in getting off to sleep is a common feature of neurotic illness, especially anxiety states. Early morning waking has for many years been regarded by some as a clinical feature—almost a diagnostic pointer—for ‘endogenous depression‘. Motor restlessness is also commonly described as a feature of this disorder. However, other clinicians have concluded that such depressive illness is merely one end of the spectrum of the depressive response. In particular, McGhie (1966) has shown that sleep disturbances of all kinds, as reported by the patients themselves, may occur in a variety of psychiatric illnesses. For instance he found that early morning waking was reported in 16 per cent of non-depressed psychiatric patients as distinct from 17 per cent of patients presenting with depression. Moreover, Hinton (1963) has shown that early morning waking when carefully measured does not specifically characterize those types of depressive illness described by others as ‘endogenous', but that it can occur in all types of depressive illness. He also reported his observation that sleep disturbance amongst depressed patients is mostly related to the phenomenon of agitation. Agitated patients lost more sleep, most apparent in the latter part of the night. On the other hand Carney et al. (1965), in their study of over 100 patients with depression, found that certain symptoms clustered into two groups reflecting the usual concepts of ‘endogenous' and ‘neurotic’ depression respectively. Early morning waking and weight loss were important characteristics of their group of patients designated ‘endogenous' depression, and were regarded as important indicators for them of the value of ECT. There was a positive inter-symptom correlation of 0.234 between weight loss (7 lb.+) and early waking. Most studies do not suggest a causal link between weight change and sleep disturbance, but by inference regard these features as being more integral aspects of an underlying biological factor which also promotes the disturbed mood.

The relationship between extreme temperament in infancy and clinical status at 4.7 years of age was studied in temperamentally different groups of infants matched for sex and SES, and subselected from a large birth cohort representative of the general population. The effects of certain dimensions of family functioning and of other risk factors were examined. By itself, extremely difficult temperament in infancy had no strong direct association with clinical outcome at four years of age, whereas temperament assessed at four, family attitudes to discipline, and stressful events did. However, extreme temperament in infancy might indirectly affect outcome through its association with temperament at four. The interplay between adverse temperament and parental attitudes of discipline previously observed in middle childhood might have antecedents in preschool years.

Nine elderly depressed patients were given ECT in courses which alternated unilateral and bilateral electrode placement; recovery times were measured. When compared with similar times for younger patients, recovery took on average five times as long from unilateral treatment and nine times as long from bilateral. Within the group, bilateral treatment took significantly longer for recovery than unilateral treatment and was significantly more sensitive to cumulative effect and interval effect.

Two common forms of alcoholism are described (World Health Organization, 1952; Kessel and Walton, 1965). The first is well recognized clinically, and has often been portrayed accurately by novelists and dramatists. So successfully has this more conspicuous form of alcohol addiction been publicized by Alcoholics Anonymous that Jellinek (1960) cautioned medical readers against overemphasis on it to the exclusion of the other clinical variety of the illness.

Three psychosocial variables were rated independently by two clinicians for 140 adolescent referrals to a psychiatric unit. Overall, intraclass correlations for DSM-III Axis IV, Axis V and a psychosocial adversity index (PSAI) were respectively 0.44, 0.58 and 0.68. The main source of unreliability is probably the operational definitions, rather than their application by clinicians; indices similar to the PSAI may be preferable.

In recent years an increasing number of workers investigating schizophrenic behaviour have concluded that many of the symptoms found in schizophrenia are related to a disturbance in the selective and inhibitory functions of attention. One of the earliest statements of this argument is found in Norman Cameron's (1938, 1939, 1944) concept of “over-inclusion”, which he used to describe the schizophrenic patient's tendency to include many elements irrelevant to the central idea in his thinking. Shakow (1962) reached the following conclusions in summarizing his own psychological studies of schizophrenia—“It is as if, in the scanning process which takes place before the response to stimulus is made, the schizophrenic is unable to select out the material relevant for optimal response. He apparently cannot free himself from the irrelevant among the numerous possibilities available for choice.” Weckowicz and Blewett (1959), in their studies of alterations in perceptual constancy in schizophrenic patients, interpreted their findings as suggesting that the patient's basic difficulty was that of “an inability to attend selectively or to select relevant information“. Venables and his colleagues (1959, 1962, 1963), in a series of studies on the arousal level of schizophrenic patients, also concluded that many of the behavioural abnormalities demonstrated were due to variations in the range of attention. In a series of investigations carried out by Payne and his colleagues (1960, 1961, 1963) to develop Cameron's concept of over-inclusive thinking in schizophrenia, the authors utilized Broad-bent's (1958) model of selective attention to postulate that this form of thought disorder is basically due “to a defect in some hypothetical central filter mechanism, the function of which

is to screen out irrelevant data both internal … and external … to allow for the most efficient processing of incoming information”.

A two-stage screening strategy was used to study psychiatric morbidity and social problems in a consecutive series of out-patients with insulin-dependent diabetes mellitus. The prevalence of psychiatric morbidity was 18%, and consisted of depression, anxiety, and attendant symptoms. Patients reporting major social problems had significantly higher levels of psychiatric symptoms. Psychiatric morbidity was not associated with the presence of complications of diabetes.

The ongoing experience of panic disorder was assessed in 20 female subjects, to determine psychological precursors to panic attacks. Measures of anxiety, threat, control, prediction of panic, and symptoms were assessed at hourly intervals during waking hours for one week. Measures were taken using a portable computerised diary which prompted for and stored responses. Patients' ratings of the prediction of panic attacks were the only significant precursors to panic attacks. This supports recent research that expectancy is important in panic onset. The data also suggested that anxiety levels follow a circadian pattern.

The augmentation of serotonin (5-HT) neurotransmission attenuates alcohol consumption, whereas depletion enhances use. A number of serotonin-specific pharmacological probes appear to be effective in reducing the voluntary consumption of alcohol. The 5-HT1A receptor agonist buspirone is an anxiolytic which has been shown to diminish the desire to consume alcohol in anxious alcoholic patients. Thus, serotonin may represent a common denominator for a spectrum of behavioural disorders including anxiety and alcoholism. Novel serotonin drugs, such as the azapirones, may usefully supplement conventional treatment strategies for substance abuse.

This paper reviews and reports on the frequencies of qualitative dermatoglyphic characters in schizophrenia. Dermatoglyphics is the name given by Cummins and Midlo (1943) to the study of the ridged skin found on the fingers, palms and soles. The biological value of dermatoglyphic investigation lies in the morphological constancy, from the time of formation until death, of the dermal ridge arrangements. The dermal ridges are fully formed by the fourteenth week of foetal development, therefore only genetic and prenatal environmental factors can influence ridge formation.

Results from a 15–20-year follow-up study of 35 7–12–year-old children with school refusal and 35 age- and sex-matched comparison children are reported. The school refusal cases had applied for out-patient adult psychiatric care more often than comparison children. Also they had fewer children of their own. In respect of overall social adjustment and severe psychiatric disorders requiring in-patient treatment, there were no important differences.

A new type of hostel ward is described in which domestic activities take the place of attendance at a day centre or industrial workshop. Residents no longer depend on the institution for meals, cleaning, or social activities. The programme is resident-orientated, and individual treatment plans are designed and effected using a points system. The emphasis of group activities is on communication and living skills. The hostel ward is able to care for our most disabled patients who are thought to need 24-hour nursing care.