Thirty-two couples with the presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. Treatment involved a combination of drug therapy and counselling. Half the subjects received testosterone and half diazepam, half received weekly and half monthly counselling. They were assessed before treatment, at the end of treatment and at six months follow-up.

Those receiving testosterone did significantly better on a number of behavioural and attitudinal measures than the diazepam group. There were no notable differences in outcome between the two counselling regimes. There were no undesirable side-effects with the testosterone.

Further work is needed to establish the indications for testosterone therapy for unresponsive women.

The study relates to suicides occurring in Shropshire during 1965 to 1973 inclusive. Psychiatric patients who had committed suicide were compared with others, matched by sex and age who had not done so. The suicide group included a higher proportion of members who had behaved violently, experienced a broken marriage (through death, separation or divorce) or earlier had deliberately harmed themselves, often by dangerous means. Of the psychiatric patients who committed suicide 63 per cent had seen a doctor within a month beforehand, yet very few were receiving adequate physical treatment for depressive illness at the time of their death. Immigrants from eastern Europe were found to be particularly prone to suicide.

In Fijian, matiruku means literally ‘low tide in the morning’ and figuratively somebody periodically insane. In this study, the conceptual basis of matiruku was examined by means of a questionnaire completed by 24 Fijians which explored its occurrence, aetiology and precipitation, phenomenology, management and prognosis. It was concluded that matiruku corresponds to hypomania, which may have special features in Fiji: short duration, frequent recurrence and an intensification of symptoms in the morning.

The investigation to be reported in this paper was undertaken following a query concerning the relationship between road accidents and the use of psychotropic drugs. One aspect of this problem could be studied easily by using the file of linked records of the Oxford Record Linkage Study (Acheson, 1967; Baldwin, 1973). Statistical methods have been developed to estimate the degree of association between conditions occurring in time-ordered sequences (Baldwin et al, 1978). The existing file of linked hospital discharge and death records in the Oxford Record Linkage Study was therefore searched and relevant material analysed to test the hypothesis that admission to hospital for schizophrenia was followed by an increased risk of accident or injury. (The present data do not allow the more specific question of phenothiazine treatment to be investigated). The statistical procedures simultaneously provide data on the converse situation, namely where injury occurs prior to hospital admission with schizophrenia, and this was studied also.

Thirty-five people labelled as baa (crazy or insane) were studied in Laos—a country without psychiatrists or psychiatric institutions. Informant information was obtained for violence prior to becoming baa, violence during the course of their baa condition, and violence during the seven days prior to interview. Observation for violence was made for a one day period at the time of the interview. Use of restraints was also assessed.

Subjects were significantly more apt to have assaulted others, posed a risk to themselves, and been restrained (although not incarcerated) during their baa condition as compared to their previous state. Those in early stages of their condition (two years or less) manifested more violence than those later in their condition. ‘Folk’ use of restraints was applied only after dangerous or violent behaviour had occurred. Restraints were released as soon as practicable, but there was an ‘ascending’ use of certain restraint measures if violence persisted.

Teachers' comments in the childhood school records (grades K-12) of 143 psychiatric patients and their matched controls were coded along 23 bipolar dimensions. Two methods of grouping these scales were compared: rational clusters and factor analysis. Factor analysis yielded more numerous and narrowly defined behavioural groupings. Schizophrenics, personality disorder patients, neurotics, and depressives were compared to their matched controls on each of the cluster and factor scores. Both schizophrenics and personality disordered patients were significantly less agreeable in childhood than their respective controls. Pre-schizophrenics also were significantly more unstable. Depressives were more independent than their controls, while neurotics did not differ significantly in any respect from normals in childhood. The data suggest that schizophrenia may have specific developmental patterns of possible aetiological or early diagnostic significance.

Cluster analytic procedures for classification were carried out on a sample of 236 suicide attempters. Rating variables concerned previous suicidal behaviour, details of the recent attempt and its motivation, mental state, and demographic characteristics. Results suggested the existence of three groups of attempters. The first comprised patients taking overdoses, on the whole showing less risk to life, less psychiatric disturbance, and more evidence of interpersonal rather than self-destructive motivation. The second group, fewer in number, made more severe attempts with more self-destructive motivation, by violent methods rather than overdose. The third and smallest group had a previous history of many attempts and gestures, made relatively mild attempts and were overtly hostile, engendering reciprocal hostility in the treating psychiatrist. These groups show some resemblance to those found in other studies.

Serum calcium and magnesium were studied in drug-free and neuroleptic-treated schizophrenic patients. Calcium and magnesium were not significantly different in 31 unmedicated schizophrenic patients compared with normal controls. Serum calcium was altered, however, in two subgroups: (1) Patients who remitted after neuroleptic withdrawal were significantly lower in calcium than those who did not remit; (2) catatonic schizophrenic patients appeared to have an increased calcium at the onset of catatonic stupor.

Patients treated with pimozide were found to have a significant decrease in both calcium and magnesium compared with their drug-free values. These same patients showed a similar decrease in both electrolytes during treatment with fluphenazine, a structurally different neuroleptic drug.

After a brief review of the characteristic somatic and psychotropic effects of benzodiazepines evidence is presented which supports a specific facilitatory action of these drugs on GABA ergic synapses within the mammalian central nervous system. Benzodiazepines enhance presynaptic inhibition in the spinal cord and dorsal column nuclei as well as postsynaptic inhibition in dorsal column nuclei, hippocampus, hypothalamus, cerebral cortex, cerebellar cortex, which are all examples of recurrent and collateral inhibition mediated by GABA ergic intrinsic neurones. In addition, the compounds also enhance the inhibitory effect of GABA ergic long projection neurones in the substantia nigra and the lateral vestibular nucleus of Deiters. Several problems remain to be solved, such as the exact site at which benzodiazepines initiate their action (pre-synaptically at GABA ergic nerve endings or postsynaptically at the target cells) and the possible existence of endogenous ligands for the benzodiazepine receptor. Some suspected implications which studies on benzodiazepine binding sites could have for a deeper understanding of the mode of action of these drugs are discussed.

A consecutive series of 110 undetermined deaths (U.D.) was compared with matched samples of suicides and accidents recorded in the same metropolitan Coroner's District. The hypothesis tested was that U.D. are mostly concealed suicides and will resemble known suicides more closely than accidents. The samples were compared on social and demographic variables, psychiatric and physical illness, evidence of suicide intent, information available to the Coroner and the circumstances of death. The results did not confirm the hypothesis. The study widens the investigation of the mortality of mental disorder from unnatural causes beyond the category of suicide.

The season of birth distribution of 1,039 sibs of Canadian schizophrenic patients was compared with that of births in the Canadian general population over the same time period. The excess of winter births observed among the schizophrenics was not found among their sibs.

In a retrospective study, there were clearly abnormal laboratory findings in 4.8 per cent of 4,994 adults who attended for psychiatric evaluation at a mental hygiene clinic. In particular high fasting blood sugars, abnormal blood counts, eosinophilia, VDRL and abnormalities of chest X-ray or urinalysis were found. Just under half of these abnormalities led to further medical follow-up. Old and young, schizophrenic and neurotic were equally likely to be followed up, but tests which were clinically not alarming might be ignored. The implications are discussed.

A weekly clinic was held for one year in a London probation office with 41 probation officers. Only 23 cases were referred but the clinic was found to be a valuable forum for discussion of problems with the officers, 10 per cent of whose clients were estimated to be receiving psychiatric treatment elsewhere. Suggestions are made to improve collaboration between psychiatrists and probation officers.

This paper is concerned with the use of multivariate statistical methods in relation to classification in psychiatry. There are two aspects of classification: the classification of symptoms to form syndromes and of patients into diagnostic groups. Critical papers are reviewed, and proposed severe limitations on the methods answered. The use of multivariate methods has increased objectivity and agreement between investigators, but differences remain, largely on issues in statistical logic, which must be resolved.

Two types of crude synaptic membranes have been prepared which differ in their kinetic properties to bind 3H-GABA in a Na+-free medium. One type (B) has one type of receptor (affinity or KD about 0.2 μM), the other type (A) has two populations of receptors which have a high (0.16 μM) and a low (.02 μM) KD for GABA binding. This difference is due to the presence of a selective endogenous inhibitor of the high affinity receptor for GABA, a thermostable protein of about 15,000 molecular weight. Inhibitor action is counteracted by diazepam (7 x 10-7M), competitively. Clonazepam is more active but chlordiazepoxide is less active than diazepam. Two enantiomers of a benzodiazepine were studied. One of them is endowed with anxiolytic activity and nullifies the action of the endogenous inhibitor on high affinity GABA binding, the other is devoid of anxiolytic activity and is inactive against the inhibitor. The endogenous protein inhibitor also competitively blocks the high affinity binding of 3H-diazepam to Type A membranes. It is concluded that the endogenous inhibitor and diazepam act on the same receptor; and suggested that the endogenous inhibitor may be the natural ligand for the brain receptors that bind benzodiazepines with high affinity.

The effects of videotape feedback on patients' self-perception were assessed in a study which was a partial replication of an investigation reported by Griffiths and Hinkson (1973). Subjects were randomly allocated to one of three groups. After a semi-structured interview, they were either (1) shown a videotape of the interview, or (2) shown a videotape of another person being interviewed, or (3) engaged in other activities not involving videotape. Patients' self-ratings indicated that videotape feedback has immediate effects on self-assessments of social ease and physical attractiveness. Feedback produced changes in ratings of social ease, but individuals differed in the direction of the change (i.e. whether social ease was ‘better’ or ‘worse’). The direction of the change was predicted by a questionnaire measure of response style. Feedback also tended to make patients rate themselves as less attractive in the eyes of other people. All changes were, however, temporary and had disappeared at a two-week follow-up.

The results are generally consistent with those reported by Griffiths and Hinkson in that they indicate temporary and specific changes in response to videotape feedback. The implications of the results are discussed.

A prospective study was undertaken on 374 out-patients receiving depot fluphenazine or depot flupenthixol to determine the incidence of tardive dyskinesia. In three years the percentage showing the bucco-linguo-masticatory syndrome rose from 8 per cent to 22 per cent, though patients had received various neuroleptics for a mean of 13 years previously. Fluphenazine and flupenthixol were equally involved though 75 per cent of affected patients had the condition in mild degree. Six additional cases of generalized chorea were all receiving flupenthixol. Reduction of dose or the substitution of pimozide produced marked improvement, but results suggest that it is unlikely that this will be permanent. Substitution of depot fluspirilene also produced favourable results. Careful monitoring, minimal neuroleptic dosage, and periods of neuroleptic abstinence are recommended.

An analysis of the distribution of ancestral secondary cases of affective illness in families of patients with bipolar manic-depressive disorder was undertaken. Twenty probands with at least two affectively ill second degree relatives were available for study. Probands with both parents affected were excluded. The distribution of unilateral to bilateral pairs of all affected relatives, both excluding and including parents, of probands showed no significant differences from that expected in polygenic inheritance. However, separation into bipolar family history, positive or negative, showed significant differences from the expected ratio of unilateral to bilateral pairs in a bipolar family history positive group consistent with a single dominant gene inheritance.

American women awaiting trial were administered the Eysenck Personality Questionnaire. Compared to a heterogeneous control group, these women scored significantly higher on the neuroticism and psychoticism scales and on Burgess's ‘hedonism’ variable, though they did not differ with respect to extraversion or lie scale scores. Women awaiting trial were more likely to fall in the neurotic-extravert quadrant (a trend more marked for non-white women). In general, the results support Eysenck's theory of criminality and the usefulness of Burgess's ‘hedonism’ variable.

The bond between human and pet depends on their commonality as animals and their mutual need for attachment. Under abnormal circumstances of developmental frustration a human may displace an overdetermined need for attachment to the pet. The attachment relationship is pathological because of its defensive purpose, and its interruption can create enduring psychiatric reactions. The paper details the developmental determinants for this interaction.