It has been contended that psychological characteristics of the partner of the agoraphobic patient are important factors in the development and maintenance of the patient's symptoms. To examine this hypothesis, male partners of female agoraphobics were compared with those of non-phobic psychiatric patients and of normal controls on a total of 48 measures referring to several symptom complexes and traits, including defensiveness. The partners of agoraphobics as a group were not found to be more defensive or psychologically more disturbed than their control counterparts. Additional within-couple analyses across groups showed spouses in the control couples to be more comparable to each other than were agoraphobics and their partners—a finding which was attributed to the highly elevated scores of the agoraphobic patients.

The 1 mg dexamethasone suppression test (DST) was carried out in patients with a major depressive illness in order to establish whether the results of this test, given before antidepressant or ECT treatment, could predict eventual therapeutic outcome. No significant difference could be detected in overall therapeutic improvement between those patients with a normal or abnormal DST response respectively, based on the 50 ng/ml cortisol cut-off point. However, using 100 ng/ml as a cut-off point it was found that patients with an abnormal DST response (i.e. a post-DST plasma cortisol concentration ⩾ 100 ng/ml) responded significantly better than those who had a normal DST response. These observations were statistically significant for those patients receiving antidepressants and in the combined treatment groups of those patients receiving either antidepressants or ECT.

All X-rays requested by psychiatrists in-training during 1982 and performed by the Department of Radiology of a large mental hospital were analysed. Forty-five per cent of all requests were marked routine, and the majority of these were for chest X-rays; only 4% of these revealed significant abnormality and no patient under the age of 55 had a significant abnormality on routine chest X-ray. All routine skull X-rays were normal. One-third of the long-stay hospital population accounted for one-quarter of the overall workload of the department. It is recommended that: requests for routine skull X-rays be abandoned, and that routine chest X-rays for patients below the age of 55 be restricted to high-risk groups such as immigrants, those on steroids, etc. The financial implications of such a policy are discussed.

As part of the Leicester electroconvulsive therapy (ECT) study, the role of ECT in schizophrenia was investigated in a double-blind trial. The Present State Examination criteria for schizophrenia were fulfilled by 22 patients, of whom 19 gave consent and entered the trial. Neuroleptic medication was restricted during the trial period. Patients were randomly allocated to eight real ECT or eight simulated ECT. At the end of the four-week trial period, patients receiving real ECT showed a significantly greater improvement when measured on the Montgomery-Asberg Schizophrenia Scale (MASS), the visual analogue global psychopathology scale, and the depression scale. The differences on the MASS and visual analogue global psychopathology scale were not due to improvement in depressive symptoms. The superiority of real ECT was not demonstrated at the 12- and 28- week follow-up, when treatment was not controlled.

Post-dexamethasone cortisol and platelet monoamine oxidase (MAO) activity levels were examined in 50 depressed patients. The incidence of non-suppression was significantly greater in patients with high platelet MAO activity than in those with low activity. Similar results were obtained when males and females were analysed separately. The mean 4 p.m. post-dexamethasone cortisol level was significantly higher in those patients who had high MAO activity than in their low MAO counterparts. Moreover, a statistically significant positive correlation was observed between platelet MAO activity and 4 p.m. post-dexamethasone cortisol levels.

Renal function test results in 26 patients on neuroleptic treatment, who had never received lithium or antidepressants, were compared with those in a matched group, treated with lithium; also, their tubular response to DDAVP was compared with that of 25 control subjects. Measurements of serum creatinine, creatinine clearance, and urinary albumin excretion showed no abnormality attributable to either neuroleptics or lithium. The maximum urine concentrating ability after DDAVP was significantly lower in the neuroleptic group than in controls, but significantly higher than in the lithium-treated patients. There was a significant correlation between excretion of urinary ß2-microglobulin and duration of neuroleptic treatment, but mean excretion rates were the same in both treatment groups. The results suggest that neuroleptics as well as lithium impair urine concentrating ability.

A cluster analysis was done on items concerned with the onset and development (including life events) of depressive illness derived from standardised interviews on 70 in-patients with that diagnosis. The resulting groups were compared for symptoms derived from the Present State Examination (PSE) and outcome, five years later. New Groupings were sought, based on onset and development data, to test their predictive power, and to observe how closely they replicated existing binary classifications and whether or not suggestions emerged for narrowing the concept of depressive illness. The groups were clinically recognisable, and measures of five-year outcome differed significantly between the groups. They have been designated as forms of ‘Somatic depression’, type I ‘Slow onset—depression of middle age’; type II ‘Rapid onset—depression of middle age’; type III ‘Slow onset — depression of younger age’; type IV ‘Rapid onset — depression of younger age, and morbid distress. It is suggested that no simple binary classification is likely to prove as satisfactory for depression as a multi-axial method; the concept of ‘morbid distress' is advanced as a way of narrowing the over-extended rubric of depressive illness.

Seventy-one pairs of same-sexed biological adolescent siblings, discordant for antisocial behaviour and service contact, were compared using matched-pairs analyses along several dimensions which included developmental, family, psychiatric, educational, cognitive, pro- and antisocial behaviour. The antisocial youth had significantly more negative perceptions and experiences than their siblings, who experienced more protective influences. Earlier onset in the antisocial youth of activities such as smoking also significantly differentiated the pairs. The early temperament index alone correctly classified as proband and sibling 95% of the youth, using discriminant analysis procedures. The findings are relevant to the aetiology of antisocial behaviour and to possible treatment interventions.

To investigate the effectiveness of a new benzodiazepine, alprazolam, and to compare this with amitriptyline (AMT) and with placebo, a trial was undertaken in 65 patients in whom depression was considered to be the dominating feature but not considered to be the primary cause of their condition; it was designed to exclude endogenous depressions. A consistent pattern was found favouring alprazolam over AMT both in rate of response and in total response, as well as significant differences in favour of both alprazolam and AMT over placebo. A comparison of side effects showed a definite trend in favour of alprazolam and placebo over AMT.

This study describes a group treatment of bulimia using an adaptation of Fairburn's (1981) cognitive behavioural approach. Thirteen bulimic women with a self-reported average of 24 self-induced vomiting episodes per week were treated in two groups; each group met once a week for 16 weeks. The primary outcome measure was the number of self-reported vomiting episodes; pre- and post-treatment measures of eating attitudes, depression, assertiveness, and global level of psychological distress were also evaluated. Vomiting frequency decreased to an average 2.2 times per week (a 91% improvement) with seven patients abstinent by the end of treatment. Significant pre- to post-treatment changes were also demonstrated on measures of depression, eating attitudes, and assertiveness. Six-month follow-up data on 11 patients indicate a mean vomiting frequency of 3.8 per week; six patients maintained their progress. Although Fairburn had greater success using an individual cognitive behavioural approach, the results of the present study are promising for the development of a cost-effective treatment.

This study concerns 250 marriages of 40–49 year-old women from a psychiatric patient and general population series. Psychiatric patients' marriages involved less exchange of affection, were husband-dominated, and were of poor quality. In general population marriages, poor quality was related to wife domination. Affection given (AG) and affection received (AR) scores were significantly associated, being high in good marriages and low in bad ones. Zero or near-zero domination was associated with high AG and AR scores and with good quality marriages. Husband domination was linked with wives having high (MMPI) dependency scores. Terminated marriages, compared with bad but non-terminated marriages, had significantly lower AR scores.

Organic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxicmetabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.

A 20 year follow-up on 133 alcoholics was carried out. Tracing methods are outlined and the difficulties reviewed. A questionnaire was completed by 40 subjects concerning drinking outcome, aids to recovery and morbidity. Mortality data are outlined and discussed for the 53 subjects who died during the follow-up period.

The case notes of 24 children diagnosed as elective mutes were compared with those of 24 matched controls with diagnosed emotional disorders. One-third of the elective mutes (but none of the controls) had experienced delayed development of speech or difficulties in articulation. All the elective mutes lived in two-parent families, but marital discord was noted in half the families in both groups. Compared with the controls, the mute children were more often described as ‘anxious', ‘depressed’ and ‘manipulative’, and their mothers were characterised as ‘over-protective’, and tending to ‘spoil’ their children. Three unusual cases, of mutism at home, are described in detail. It is proposed that elective mutism is associated with particular personal and family characteristics and represents a condition different from any recognised emotional disorder.

This study investigated the validity of the Fould & Bedford hierarchical model of psychiatric illness, as compared to hierarchical models based upon prevalence and severity of disorder. The DSSI was administered to 52 American psychiatric in-patients with severe disturbances. The reports of symptoms in this sample conformed to the Foulds hierarchy in 90% of cases, while 94% of cases conformed to a model based upon prevalence. When a cross-method validation was investigated, the Foulds & Bedford classification demonstrated good discriminative capacity, while models based upon prevalence and severity failed to achieve significance. These results suggest that the Foulds & Bedford model is a useful taxonomy of symptomatology in psychiatric illness.

A point-prevalence study in South-west Scotland found that 0.77 per 1,000 of the total population were receiving lithium. Almost one quarter had done so for more than ten years. At the time of lithium commencement, only 68% had always been diagnosed as having an affective illness; 59% of the patients were also receiving antidepressants, major tranquillisers, or both. Though this might be due in part to unnecessary administration of supplementary drugs, 19% of non-inpatients had moderate depressive symptoms, significant depressive illness, or manic symptoms. Lithium side-effects were prominent: 30% of the sample complained of weight gain, thirst or excessive micturition; 42% had noticed hair changes; and 7% had diminished thyroid activity, but most patients believed they had benefited considerably from lithium therapy.

Sixty nine patients took part in a double-blind study to investigate the efficacy of bilateral, unilateral, and simulated ECT in the treatment of depressive illness. The findings suggest that both bilateral and unilateral ECT are highly effective treatments for depression and are significantly superior to simulated ECT. There was also evidence that patients receiving bilateral ECT recovered more rapidly than those receiving unilateral ECT and required significantly fewer treatments. The relevance of these findings to clinical practice is discussed.

We administered an extensive battery of primarily non-memory neuropsychological tasks to 37 patients with endogenous depression, randomly assigned to either bilateral (B/ECT) or unilateral (U/ECT) electroconvulsive therapy. Testing was done prior to therapy and again shortly after the sixth induced seizure. The two groups did not significantly differ in cognitive impairment, either before or after treatment, and within-group cognitive changes following treatment were small. We conclude that neither B/ECT nor U/ECT substantially worsen non-memory cognitive performance in depressed patients, yet both result in significant clinical improvement.

The efficacy of intramuscular pipothiazine palmitate (PP) in the management of aggressive mentally handicapped patients was examined in a double-blind, placebo-controlled, cross-over study, in which 30 patients received each treatment for 13 weeks. A target symptom scale of aggressiveness (TSA) and a clinical global impression scale of efficacy were rated at monthly intervals, and an extra-pyramidal side-effects scale weekly. The patients showed marked improvement during treatment with PP, which was assessed as superior to placebo. Individual and total TSA scores were also reduced compared to placebo.

In a longitudinal study in South-west Scotland of patients suffering mainly from affective illness, the introduction of lithium as prophylactic therapy was associated with a significant reduction in the number and length of hospital in-patient admissions, as well as in the number of courses and total number of electro-convulsive treatments. However, there was no significant reduction in the length of time patients received either antidepressants or major tranquillisers. A rating of individual patients suggested that a bare majority (52%) had improved considerably following the introduction of lithium.