We have observed a significantly higher growth hormone (GH) response to clonidine administration (150 μg i.v.) in 14 patients with a major depressive disorder who had never received antidepressant therapy than in 14 matched depressive patients who had not received tricyclic drugs for at least 15 days. Compared with a control group of eight subjects, untreated depressed patients, as a group, had a normal response, while matched patients had markedly blunted response. Results for the group of untreated depressed patients showed that some patients had a blunted response while others had a response in the normal range. The results suggest that studies on the GH response to clonidine in psychiatric patients need to take into account the confounding and long-lasting effects of tricyclics.

The present state of knowledge of the possible relationship between depressive illness and multiple sclerosis is described. Problems of the research methodology are identified and suggestions made for useful areas of inquiry.

When a psychiatric in-patient commits suicide by jumping out of the hospital building, the death is liable to attract Press attention and become public knowledge. In 1981, the psychiatric unit situated on the fifth floor of the Queen Elizabeth Hospital in Birmingham (UK) was closed by the Chairman of the District Health Authority on the advice of the coroner. This was a direct result of several in-patients committing suicide by jumping.

Fifty depressed in-patients at two psychiatric units, one in Italy the other in England, were treated with clomipramine, either orally, or intravenously and orally. A comparison of clinical response with plasma levels of clomipramine and its metabolite, desmethylclomipramine, showed clear relationships especially in the case of desmethylclomipramine. In the intravenously-treated group this was linear, in the orally-treated group it was curvilinear. Plasma levels of desmethylclomipramine and administered clomipramine correlate highly.

These findings, together with the fact that significant clinical improvement was observed in only 55 per cent of the patients, suggest that titration of the administered dose to obtain more effective plasma levels of the metabolite might improve the clinical response to the drug in some patients.

A study was made of platelet monoamine oxidase (MAO) activity in non-medicated, newly-admitted schizophrenics and institutionalized chronic schizophrenics both on and off medication. These patients were compared to two control groups: normal subjects and brain-damaged institutionalized patients. No relationship was found between platelet MAO activity and the severity or duration of illness, duration of psychotropic medication, presence of auditory hallucinations or institutionalization. Mean platelet MAO activity did not differ significantly between the schizophrenic subgroups and control groups. Thirty-one patients studied before and after treatment with phenothiazines showed no significant change in platelet MAO activity. The findings did not indicate a relationship between schizophrenia, its treatment or outcome and platelet MAO activity.

A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.

The study compares 72 female psychiatric patients who had a history of suicide attempt with 122 who had neither attempted nor contemplated suicide. Of these 194 women, 128 had experienced the death of their mothers before the age of 11, but the proportions of early bereaved and not early bereaved who were suicidal were similar. Not even the events which followed bereavement affected suicidal behaviour, but the suicidal patients tended to come from larger sibships. Poor quality of the marriage and, for the early bereaved only, having three or more children related significantly to suicidal behaviour. The suicidal women were significantly more often described as dependent. Suicidal behaviour was not differentiated on the endogenous/neurotic depressive dichotomy but it was significantly related to severity of depression.

An attempt is reported here to evaluate the results of a modified form of leucotomy. Subjects of the investigation were 64 consecutively operated patients, for all of whom the same technique of bimedial leucotomy was employed. This operation is similar to the full division of white matter (as described by Poppen, 1948) through a superior frontal approach, but the cut is limited to the medial 2 cm. (Greenblatt and Solomon, 1952). The operation is carried out under direct vision through two 4 cm. trephine openings placed immediately anterior to the coronal suture on either side of the midline. The plane of the cut is found with a brain needle and extends from the middle of the trephine opening (2 cm. in front of the coronal suture) to the line of the sphenoidal ridge. The white matter is cut with a metal sucker for a width of about 2 cm. subjacent to grey matter medially and inferiorly. The incision skirts the front of the lateral ventricles and divides the thalamo-frontal bundle, thereby isolating the cortex of the frontal pole and also interfering with the fibres to the remaining anterior prefrontal areas which lie in the midcentral segment of white matter. This cut does not necessarily extend sufficiently far back to interfere with all the fibres related to area 13, but is free from the disadvantages of misplacement into the septal area.

In a series of previous papers fairly detailed studies of an individual patient with a precisely timed forty-eight hour periodic psychosis have been presented. Jenner (1963), and Jenner, Gjessing, Cox, Davis-Jones, Hullin and Hanna (1967) have presented the clinical findings. Essentially, for thirteen years the patient regularly suffered from one day of depression alternating with one day of hypomania. The change of state occurred during sleep, usually between 02.00 and 03.00 hours. There were only eight major defects of the cycle in ten years. The timing of the cycle was however influenced by the environment; this was confirmed when the patient lived in an artificial environment in which a day and night totalled twenty-two hours instead of twenty-four. The psychotic cycle then became one of forty-four hours rather than forty-eight (Jenner, Goodwin, Sheridan, Tauber and Lobban (1968)).

Rating scales for negative symptoms, basic symptoms and other comparable psychopathological syndromes were not originally constructed in order to make psychiatric diagnoses. Moreover, these scales were intended to be applied principally to schizophrenic patients. From the point of view of psychological testing their application to non-schizophrenic patients could be rejected on methodological grounds. Nevertheless there are some considerations which may justify such an investigation.

We studied the functional neuroanatomy of social behaviour in velo-cardio-facial syndrome (VCFS) using a facial emotional processing task and functional magnetic resonance imaging in adults with this syndrome and controls matched for age and IQ. The VCFS group had less activation in the right insula and frontal brain regions and more activation in occipital regions. Genetically determined abnormalities in pathways including those involved in emotional processing may underlie deficits in social cognition in people with VCFS.

Estimation of lithium in 24 samples of serum and saliva show that there is a very high correlation between the lithium levels in serum and saliva (r= +0·88). The ratio found in our patients is very similar to that reported from North America. Estimation of lithium in saliva at different periods of time show there is a good degree of stability for saliva lithium levels. Thus saliva can be used as a substitute for serum for lithium monitoring. The practical advantages of this are discussed.

‘Koro’ has been described as a culture-bound syndrome with localised depersonalisation confined to the penis, occurring in the context of a panic state with fear of impending disaster (Yap 1965,1969). Because ghosts are not thought to possess genitals, penile shrinkage is believed to be potentially fatal, with the risk that the victim will himself turn into a ghost. Until recently the syndrome was thought to be restricted to Southern Chinese emigres in Hong Kong and South East Asia. We wish to report two such cases, one in a West Indian and the other in a Greek Cypriot, admitted to Friern Hospital.

In the absence of full understanding of the nature of anxiety neurosis, therapy must be, in part, symptomatic. Along with reassurance and efforts to comprehend the important aspects of the situation, most doctors are forced to use tranquillizing drugs. Careful clinical studies are, therefore, important.