The psychiatric status of 70 homeless women from two direct-access hostels in inner-London was assessed. Detailed sociodemographic, psychiatric and physical illness data were also collected, and where possible, verified from psychiatric and general hospital sources. Forty-five women met DSM–III–R criteria for schizophrenia, but few were in contact with the psychiatric services or in receipt of any treatment.

The different classifications of homicide used make comparative studies difficult. For our purposes we will sub-divide homicide as follows: (i) ‘Abnormal homicide’, comprising (a) ‘murder-suicide’ in which the murder suspect commits suicide, and (b) ‘abnormal murder’, comprising cases where (i) the murder suspect is mentally ill, or (ii) the court returns a verdict of manslaughter by reason of diminished responsibility. (2) ‘Normal homicide’, a term we will use synonymously with ‘normal murder’, i.e. murder committed by the mentally normal.

The physical examination on admission, as recorded in the psychiatric case notes, was assessed for 100 consecutive admissions under the age of 65. Assessment was made on the presence or absence of reference to 43 items of examination and the recording of the examinations was found to be uniformly poor. One of the authors re-examined 50 patients within 48 h of admission and the findings were then compared with the initial recorded examination. Significant unrecorded positive findings were most frequent in the neurological and locomotor systems.

In this presentation of two cases it is suggested that many Münchausen syndrome patients present with psychiatric symptoms. This syndrome, however, should be differentiated from other clinical psychiatric conditions.

The present paper continues our study of the parents of children of primary school age, in a sample taken from one of the authors' N.H.S. list. The details of the selection of this population, the methods of data collection, and the absence of any relationship between various social factors and neuroticism, were described in a previous paper (Pond et al., 1963) and are not repeated here. In this paper we report upon the marital history and adjustment of the parents of these 100 families, and investigate the relationship between neuroticism and these factors.

Cross, Harrington and Mayer-Gross (1957), in a survey of the long-stay population of a Birmingham mental hospital, came to the conclusion that “only very small proportions required constant vigilance and about two-thirds required routine care only…. The large majority of patients were ambulant the whole day” but almost one-third had physical diseases of some kind. The major problem was the “large number of passive, indolent and harmless chronic schizophrenics”. The authors specifically made the point that, “to avoid chronicity and utilize every sign of improved behaviour and better adaptation which may lead to discharge, well-trained nursing staff and specialized knowledge is as much needed as in the treatment of earlier patients”.

Definition of Medical Rehabilitation

A full definition of medical rehabilitation should contain three parts. The first is a statement of aim: ideally, to settle or resettle an individual in his normal domestic setting, and in work appropriate to his talents. Most patients and doctors can measure their success against these two practical indices, although what is regarded as socially desirable varies widely and some individuals prefer a highly idiosyncratic way of life.

A double blind, placebo controlled trial was carried out to examine the contribution of propranolol as an adjunct to neuroleptic medication in the treatment of chronic schizophrenic patients whose florid symptoms had not remitted with neuroleptic medication alone. Propranolol was shown to have a more beneficial effect than placebo, but the results were much less dramatic than those which have been described in previous studies. Recent work has shown that there may be a pharmacokinetic interaction between propranolol and neuroleptics, and this should be considered as one possible explanation of our findings.

The cheese reaction following use of the irreversible monoamine oxidase inhibitors (MAOIs) began to be reported in the UK with increasing frequency from about 1961. By 1965, the underlying mechanism (tyramine-provoked hypertension) had been essentially elucidated. Thereafter, this potentially severe side-effect could have been largely avoided by the use of fairly simple dietary precautions. Unfortunately, suspicion and fear burgeoned, and both the seriousness and the frequency of risk were dramatically inflated. This was a major factor in the subsequent general disuse of the irreversible MAOIs. Second-generation MAOIs which are selective for monoamine oxidase-A and B are now being synthesised and may eliminate the eventuality of hypertension without special dietary precautions.

Twenty-two anorgasmic women received 20 sessions of a multiple-technique behavioural therapy. The design included blind ratings by two independent assessors, multiple assessment instruments, and a waiting list control group.

Treatment was significantly better than no treatment in terms of: (1) the percentage of patients experiencing orgasm during at least 50 per cent of sexual relations; (2) the percentage of women reporting satisfactory sexual relations at least 50 per cent of the time; (3) patients' ratings of positive reactions to various sexual behaviours; and (4) assessors' global clinical ratings.

Significant improvement was also noted on the MMPI, IPAT, and Symptom Check List. Improvement was maintained at a follow-up average 9 months later. These results support the impression that a behavioural approach offers much promise in treating female orgasmic dysfunction.

The sedative effects of single doses of hypnotic drugs in normals are still detectable on behavioural tests 13 hours after administration, and on the electroencephalogram (EEG) at 18 hours (Malpas et al., 1970), and similar results have been noted by other workers (Lader and Walters, 1971). Using measures of driving skill, Betts et al. (1972) have also found that normal subjects may be impaired after five doses of amylobarbitone sodium taken over the preceding 36 hours. However, the relevance of all these results to the prediction of effects in patients for whom the drugs are prescribed is uncertain, as our preliminary report indicated (Legg et al., 1973). Here we present the more detailed results of a study carried out on anxious out-patients, using behavioural and EEG measures to determine whether or not persistent effects were present following a course of 7 days treatment with hypnotic drugs.

Clinical reports have suggested that antidepressant medication may contribute to the sexual dysfunction experienced by some depressed patients. A double-blind trial in a non-psychiatric male population compared amitriptyline (tricyclic), mianserin (tetracyclic) and placebo for their effects on nocturnal sexual arousal. In a three-way crossover design active drug or placebo were taken for two weeks preceding measurement of the frequency, amplitude and duration of nocturnal penile tumescence and synchronous sleep indices. Both active compounds significantly decreased the amplitude and the total duration of nocturnal erections. The effects on sleep indices were as previously reported. Few differences were found between the tricyclic and tetracyclic drugs. Some implications of these findings are considered.

Few with relevant experience would dispute the common observation that a striking change for the better has taken place in the behaviour of long-stay patients in British psychiatric hospitals over the past fifteen years.

Many psychiatric symptoms have been described in pernicious anaemia, including depression, manic excitement, paranoid states, confusional episodes, and dementia. Although vitamin B12 deficiency is known to produce neurological symptoms there is much less certainty about its role in producing mental symptoms. Despite this uncertainty, it has been asserted that carrying out vitamin B12 assays on psychiatric patients will enable doctors to cure for good severe disabling disease which otherwise may end in chronicity (Edwin et al., 1966). Routine examinations to exclude pernicious anaemia have been advocated for all psychiatric patients (Strachan and Henderson, 1965; Hunter and Matthews, 1965). A prudent preliminary is a critical evaluation of the causal relationship between vitamin B12 deficiency and individual psychiatric syndromes.

The present study examined responses on the Fear Questionnaire (FQ) of 68 patients suffering panic disorder with agoraphobia, 50 social phobics, 75 subjects with ‘non-clinical’ panic attacks, and 188 non-panicking controls. The FQ agoraphobia and social subscales had satisfactory internal consistency and were accurate (82%) in correctly differentiating the patients. In general, the patient and control groups differed as expected. The highest level of social fear was reported by social phobics and the highest level of agoraphobic fear was reported by patients with panic disorder and agoraphobia. Five items from these two subscales significantly differentiated social phobia from panic disorder with agoraphobia. The results support the reliability and validity of the FQ.

The season of birth of the siblings of psychiatric patients was studied to test the hypothesis that an unusual seasonal pattern of maternal conception is the cause of the excess of births in the early months of the year which has been found in national studies of psychotic patients. Information on the month of birth of the siblings was obtained from interviews with psychiatric in-patients born in Britain. The quarterly distribution of births of 670 mentally well siblings of psychotic patients (schizophrenia and manic-depression) was significantly different from that of 1,513 siblings of other psychiatric patients and also from that of all births in England and Wales. The results lend qualified support to the hypothesis, but they were not clear-cut and there was some evidence that the information on birth dates was biased.