A survey of laboratory investigations in the management of 1007 non-geriatric admissions to a district general hospital adult psychiatric unit showed a wide variation in the number of tests performed, and in the abnormal proportion between test types. Despite a policy of screening on admission, 40% of admissions had no tests. Physical illness attributable to mental illness was common, but rarely serious and usually apparent clinically. Mental illness attributable to physical illness detected by laboratory tests was rare: five cases of thyroid disease in women with affective disorder, and two cases of chest infection with raised white cell count in sustained mania. The findings show that tests are frequently used in circumstances where the result is of no apparent value. Test use might be improved by restricting screening to thyroid function and laboratory urine analysis, each in women. There are particular indications for white cell count in sustained or unexplained relapse of mental illness, and for syphilis serology when disinhibition may have exposed the patient to infection.

The Copenhagen longitudinal high-risk study of offspring of 129 schizophrenic mothers commenced in 1962. At that time, the mothers were diagnosed according to contemporary Danish criteria. We have re-examined all of the hospital records of these mothers: 108 (84%) fulfil present-day DSM-III criteria for schizophrenia and 95 (74%) were diagnosed as paranoid schizophrenic according to ICD-8 criteria. In a follow-up at mean age 24, the offspring of the paranoid schizophrenic mothers were themselves found to be less frequently schizophrenic (5%) than were the offspring of non-paranoid schizophrenic mothers (29%).

Significant differences in handedness patterns between groups of psychiatric patients and normal controls were identified in two recent British studies, with substantial disagreement in some important findings. Most of the discrepancies were attributable to the different application of a simple classification of handedness data, and the remainder to differences in sample size. Diagnosis, sex and age were then found to have a similar effect on handedness in both studies. Neurotic patients were similar to controls regardless of classification, whereas mixed handedness in personality disorder depended on it. There was no overall excess of left-handedness among schizophrenics, but trends towards excess sinistrality in men and full dextrality in women approached significance.

There is growing conviction that childhood autism is a biologically based disorder. The evidence that has accrued in a variety of areas pertaining to biological abnormality in autism suggests that, with the possible exception of genetic factors, very few data are available that illuminate the autistic disorder specifically. Neurological models which might be useful in guiding further research are discussed and reasons for the slow progress in this important aspect of the study of autism are identified.

Eponymous lecturers are expected to make some reference to the person in whose name the lecture is being delivered. In this case my task has been facilitated by the fact that the first Mapother lecture was devoted to Edward Mapother himself. It was given by his successor, Sir Aubrey Lewis, who, as was his wont, furnished a comprehensive account of his subject, demonstrating how this remarkable man laid the foundations of the institution to which he devoted his professional life. Lewis's lecture, entitled “Edward Mapother and the Making of the Maudsley Hospital” (Lewis, 1969), provides a link with this one via the mention of the visit paid by Frederick Mott in 1909 to Emil Kraepelin's Forschungsanstalt in Munich, where he was so impressed by what he saw that he resolved to use Henry Maudsley's bequest to found a corresponding institution in this country. Edward Mapother was to assume a major responsibility for this large enterprise which he justified as follows:

Identification of 5-HT receptor subtypes — 5-HT1A, 5-HT1B, 5-HT1c, 5-HT1D, 5-HT2 (possibly A and B), 5-HT3 subtypes, and possibly 5-HT4 — has encouraged the manufacture of 5-HT receptor inhibitors with greater subtype specificity. However, it appears that the receptors interact, and drugs initially thought to be specific may have multiple actions. For some conditions such as anxiety/depression, almost all receptors are implicated. Clinical studies provide clear evidence that manipulation of the 5-HT system has a role in treating depression, anxiety, obsessional illness, migraine, and eating disorders. Interactions between the various receptor subtypes make it difficult to identify specific clinical functions. The 5-HT1A receptors may be involved in aggression, anorexia, and hypotension. The 5-HT1B receptors may be involved in aggression, while the 5-HT1C receptors may play a role in central aversion systems and anxiety/depression. The role of the 5-HT1D receptors remains speculative; 5-HT2 receptors appear to be involved in depression, anxiety, appetite, sleep, vasoconstriction, and hypertension. Many drugs that are effective in treating migraine are potent 5-HT2 antagonists. 5-HT3 antagonists at high doses are effective in treating nausea and at low doses in treating anxiety. Treatment of aggression, suicidal behaviour, addiction behaviour, memory impairment, dementia, and schizophrenia with 5-HT inhibitors requires further testing.

The experience and perception of effective sources of help of 101 schizophrenic patients were studied. A combination of professional help, social support, and self-coping efforts was listed as helpful. The more experiences patients had with the various sources of help, the better were their outcomes. Premorbid adjustment, exposure to the magnitude and nature of helpful sources, as well as the patients' own ability and motivation to make use of available helpful sources were thought to be important mediating variables for a better outcome. Apart from psychotropic medications, over half of the patients were not using any one of the sources of help mentioned. It remains an important research question whether or not schizophrenic patients may benefit from direct coaching in self-help skills in conjunction with making optimal use of professional and environmental supports.

The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.

This is an account of a model psychosis (6) produced by eating the seed of a tropical American plant which is known in Mexico as ololiuqui. It is only quite recently that Schultes (16) has made order from chaos in the matter of the identity of a climbing vine called Rivea corymbosa. I was introduced to ololiuqui by Mr. Leslie LeCron during a visit to Los Angeles in which he showed me Taylor's (22) article where he compares it with the peyote. Mr. LeCron discovered that seeds of Rivea corymbosa could be obtained from Dr. I. D. Clement, Director of the Atkins Gardens and Research Laboratory of Harvard University. I am indebted to Dr. Clement for sending me a supply of the seeds which would otherwise have been very difficult to obtain. It is reassuring for the investigator to know that the substances with which he is experimenting have been collected by skilled scientists who exercise meticulous care, for medical and pharmacological investigators have very often suffered from improper or imperfect botanical determination.

Jaspers (1946) has pointed out that in the history of psychiatry one can distinguish two main types of psychiatrist. On the one hand there is the describer who depicts a lively clear clinical picture and communicates it to the reader in everyday speech. On the other hand there is the analyst who dissects the clinical picture and tries to obtain clear concepts about the abnormal phenomena. The describer is always popular because little effort is required to understand his views and appreciate his clinical descriptions. However it is much more difficult to understand the analyst as this requires time-consuming preparatory work and an attempt to apply the analyst's views in practice. Thus anyone who wishes to understand the views of Kleist and Leonhard, who are the modern representatives of the great clinical analyst Carl Wernicke, has a difficult task. If therefore this present communication appears to disagree with other work recently published by the author (Fish, 1957b, 1958) then all that can be said in extenuation is that the analysis of clinical pictures is difficult and one can only achieve accuracy in this field by learning from mistakes.

Of 51 long-term female in-patients receiving psychotropic drugs, 62% were overweight or obese, and 73% were centrally obese to a degree which could be dangerous to their health. The patients also had waist: hip ratios which were significantly higher than expected for their age and obesity (P < 0.01).

Fluoxetine, a selective serotonin uptake inhibitor (mean dose 73 mg each morning) was compared with amitriptyline (mean dose 122 mg at night) in a double-blind study of 64 depressed out-patients. Fifty patients completed the 6-week trial. The drugs did not differ with respect to psychiatrists' ratings, but amitriptyline was slightly superior with respect to patients' ratings. The amitriptyline-treated group had complaints of dry mouth and dizziness on standing; the fluoxetine-treated group of sleep disturbances, nausea, and headaches.

It is well recognized that bouts of uncontrolled and excessive eating (binges) occur in both a small proportion of patients who are overweight and in about 50 per cent of patients with anorexia nervosa. However, it has only recently been appreciated that many people who fall into neither category also have an eating disorder which is principally characterized by episodes of binge-eating. These people experience a profound and distressing loss of control over eating which results in a grossly disturbed eating pattern. Despite this, their body weight tends to lie within the normal range. The disorder has attracted various names including ‘the dietary chaos syndrome’ (Palmer, 1979), ‘the abnormal normal weight control syndrome’ (Crisp, 1979), ‘bulimia nervosa’ (Russell, 1979), and simply ‘bulimia’ (DSM III, 1980). The term bulimia nervosa is probably the most satisfactory since it conveys the links with anorexia nervosa and emphasises the central role of binge-eating. Russell (1979) proposed the following diagnostic criteria for this syndrome:

Only Scandinavian investigators have reported on demographic aspects of reactive psychoses. Data from the National Health Service, Denmark, for age at first admission, sex, and length of stay in hospital in reactive, manic-depressive and schizophrenic psychoses are analysed. Differences in sex incidence ratios, age at first admission and length of stay are evident between the three psychoses. The differences noted are considered to provide indirect evidence supporting the separate diagnostic categories.