This preliminary study investigates the effect on patients' performance of a set time off, in the form of a short holiday, from a strict reinforcement (token economy) regime.

Assessment was by the patients' mean token earnings before and after the holiday and their self-care and work performance throughout. The results suggest that a holiday from a token economy has beneficial effects for patients.

The coroner's records of no accidental deaths resulting from poisoning, drowning and falling were examined for evidence of mental illness. Sixty per cent were classified as mentally ill before they died, depression, drug dependence and alcoholism accounting for over three-quarters of the diagnoses. Deaths given accident verdicts should be included in the study of the mortality of the mentally ill.

The difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation, method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.

A speculative hypothesis is presented which links the late development of modern concepts of schizophrenia with social and familial effects of industrialization. It is suggested that the social and family structures found historically in pre-industrial societies and currently in developing countries exert a comparatively benign effect upon patients with schizophrenia, and that these effects are lost during and after industrialization. Thus the severe and chronic forms of the illness became prominent and therefore recognized in the segregated institutions of Europe in the latter part of the nineteenth century.

Possible mechanisms are examined by which industrialization could influence the structure of communities and families and the development of individuals to produce the postulated changes in the individual's response to the schizophrenic illness. It is suggested that three major areas of interest for the identification of these mechanisms are (i) the rapid increase in size of towns and communities, (ii) changes in perinatal and infant mortality and morbidity, and (iii) changes in family structure. Some ways of testing the hypothesis and its implications are outlined.

From a sample of psychiatric referrals who had completed the MMPI the following three groups, matched for age and sex, were derived: 42 patients with a history of a serious suicide attempt, 42 patients with a history of a non-serious attempt, and 126 patients who had neither attempted nor contemplated suicide. Non-serious suicide attempters were shown to be the most deviant group and differed to a significant extent from each of the other two groups on the Dependency, Hostility and Unconventionality scales. Male non-serious attempters showed the most disturbed personality profile. This implies that there is, for males, a higher personality threshold for making a non-serious attempt, which may account for the fact that suicide attempts, most of which are non-serious, are commoner among females.

All new female indigenous Zambian patients (180) admitted to Chainama Hills Hospital from 1 June 1974 to 31 May 1975 were seen by the authors and given a firm diagnosis before they were started on treatment. The diagnostic classification of these patients was compared to that of a similar group of patients (163) admitted to the same hospital from 1 June 1973 to 31 May 1974. Forty-two per cent of the patients in 1974/75 were given a diagnosis of depression as compared to 26 per cent in 1973/74; 14 per cent of those in 1974/75 had a diagnosis of schizophrenia as compared to 21 per cent in 1973/74, and 3 per cent of the patients in 1974/75 fell into the group of ‘not yet diagnosed’ as opposed to 27 per cent in 1973/74. The ‘acute transient psychoses' were noted for their relative rarity in the two groups. A plea is made for all psychiatrists working in Africa to give diagnosis the importance it deserves.

The programme in an intensive rehabilitation unit in a large psychiatric hospital is described. Features include the use of non-medical staff as primary therapists, the use of a mini-bus to facilitate regular visits by patients to their home areas, the inclusion of the mini-bus driver on weekly staff conferences, the use of sociodrama, the re-organization of hospital money payments to patients, the promotion of relations with community-based facilities through occasional ‘teach-in’ days, and a special liaison social worker providing intensive follow-up after discharge. Rehabilitation was prolonged (average stay about one year) and about half of those selected for rehabilitation from the long-stay wards were discharged. Follow-up showed that these patients benefited from discharge, in spite of a relatively high incidence of psychopathology and of social problems. Those transferred back to long-stay wards showed increased institutionalization.

Correlations between the ratio of erythrocyte to plasma lithium (Le/Lp) and clinical status have been reported by some authors and disputed by others. Examination of the literature on Le/Lp and erythrocyte physiology suggests that Le/Lp is determined by peripheral pharmacokinetic parameters and has no direct relationship to central pathophysiology. Because of this, and because of inconsistencies between studies reporting correlations of the ratio with clinical status, such correlations probably cannot illuminate either the pathophysiology of affective illness or the mode of action of lithium.

A double-blind, cross-over trial of the effectiveness of piribedil, procyclidine and placebo in the control of parkinsonism induced by fluphenazine decanoate was conducted in sixteen cases of chronic schizophrenia. Procyclidine was shown to be more effective and piribedil less effective than the placebo. Piribedil produced a number of unpleasant effects, including headache, vomiting and malaise.

Three hypotheses are abstracted from Laing's writings on the interrelationships between self-consciousness, anxiety, and self-evaluation. Indicators of self-consciousness are obtained from an open-ended instrument which requires the respondent to provide twenty answers to the question (asked of himself): ‘Who am I ?’ Statements indicative of self-consciousness are those on which the respondent inserts a self-reference into the statement made about himself and are distinguished from statements in which no explicit self-reference is found. The data indicate that the mark of the self-conscious person is anxiety and that anxiety is largely restricted to those statements devoid of self-consciousness. The structure of a system likely to produce this configuration is considered by drawing upon Kierkegaard's conjectures on the joint emergence of consciousness and anxiety. Equating self-consciousness with ‘reflection’, it is suggested that while reflection brings about anxiety in a system as a whole, the act of reflection deters the emergence of anxiety at the particular points within the system upon which it is deployed. Thus the function of reflection is two-fold, creating anxiety at the same time (but not at the same place) as anxiety is reduced.

Evidence suggests that anomalies of functional organization in the brain may be present in some psychiatric disorders and that EEG differences between psychiatric patients and appropriate control groups may depend on them. It is therefore of practical importance to develop further ways of examining the association between the EEG and such organization. The change in inter-hemisphere coherence (a measure of EEG synchronicity) in the alpha frequency band when carrying out a task is shown to discriminate a group of 11 right from 11 left preferent normal individuals. Since right and left preference is associated with differences in cerebral functional organization, the coherence measure may be a useful way of studying this feature of psychiatric illness.

In the present study dermatoglyphic features were studied in schizophrenics with and without positive family history of schizophrenia. It was found that the difference between normals and schizophrenics was further exaggerated in those schizophrenics with a positive family history for schizophrenia. The implications of the findings and the need for further work are highlighted.

During the Arab-Israeli war of 1973 measures had to be taken by the kibbutz civilian population in Israel to cope with the stresses of war. The measures adopted, and the specific characteristics of an organized cohesive group, appear to have succeeded in reducing the severity of the reactions to stress and in lowering the incidence of psychiatric casualties among children and adult members of the kibbutzim.

Among 18 patients receiving prophylactic, long-term lithium treatment for manic-depressive psychosis, a high incidence of increased thirst and frequency of micturition (60–70 per cent) was noted on direct questioning. Symptoms arose at varying times after the start of lithium therapy; in no patient did symptoms antedate the use of the drug.

Plasma levels of antidiuretic hormone were found, on average, to be higher than in normal control subjects for a given level of plasma osmolality, although the scatter of results was wide. It is suggested that elevation of antidiuretic hormone occurs as a compensatory mechanism for the polyuria which is a common feature of long-term lithium treatment. The more florid form of nephrogenic diabetes insipidus occasionally seen in lithium takers seems likely to be due to a different mechanism from the more common mild polyuria.

A behavioural technique is described suitable for the treatment of patients with high levels of guilt who attempt to relieve their depression by risk-taking activities which reflect their individual wishes and fears, or who suffer anxiety due to unacceptable past behaviour. It is recommended as an alternative brief method of treatment to psychoanalysis and is based on the application of behaviour therapy to a patient's psychopathology. Three case histories are described to illustrate the principles of the technique.

Nineteen volunteers completed a Moos Menstrual Distress Questionnaire daily for a period exceeding one menstrual cycle. The data were analysed, using a least mean square method of fitting sine waves. The fact that the results obtained on this group are essentially those found by other workers looking at the menstrual cycle suggests that this may be a useful method for assessing menstrual distress.

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.

One hundred and nine out of one hundred and twenty-two cases of endogenous depression were followed-up after their index diagnosis 3–13 years earlier. No recurrence occurred in 28 cases. Forty-two cases turned out to be bipolar and 21 remained unipolar. Manic episodes outnumbered the depressive ones. The change of polarity from depression to mania occurred within three years after the initial depression, though in others the shift occurred between three years and twelve years. The number of episodes of depression before the onset of mania varied from 1 to 3. While the onset of depression before the age of 40 years predisposed to recurrences, there was risk of chronicity in those patients who developed the illness after 40.

The birth records of 78 subjects born to psychotic parents and 72 subjects born to normal parents were studied.

No significant differences in the rates of pregnancy and birth complications (PBCs) were found between the offspring of psychotic parents and normal control parents. There were no differences between offspring born to psychotic mothers compared to psychotic fathers. Neither the onset of the parent's illness, nor the mother's age at delivery, nor the sex of the offspring seemed to influence the rate of PBCs. The offspring of chronic schizophrenic mothers and manic-depressive fathers had lower PBC rates than the offspring of parents of other diagnostic categories. The parents of these two groups, which were of a limited size, did not differ on any variable of significance, excepting the time of their first psychiatric hospital admission.

Eye movements while watching an oscillating pendulum were recorded in 24 chronic schizophrenics and 24 matched normal controls. As others have reported previously, abnormal tracking movements were significantly commoner in the schizophrenics. However, in a series of experiments with normal subjects it was found that conditions designed to distract attention, or to produce declining arousal and attention, produced abnormal tracking movements indistinguishable from those observed in schizophrenics. As chronic schizophrenics are known to perform badly on a variety of psychomotor tasks and there is evidence that this is due to impaired attention or heightened distractibility, it seems likely that these same factors are responsible for their poor eye-tracking performance.