With large numbers of psychotic patients now living in the community, there is growing appreciation of the influence of family life on the long-term social outcome of chronic schizophrenia. From the work of Brown, Birley and Wing (1972) it appears that to achieve and maintain optimum clinical stability in ‘typical’ chronic schizophrenia, it is desirable that face-to-face contact between patients and emotional relatives should be held to a minimum and that phenothiazine drugs should be used to soften the impact on the patient of sudden and stressful life changes. Reviewing the many social problems which accrue from this general treatment approach, Stevens (1973) noted a distinct lack of evaluative study of psychotic patients who actually live in the community.

Professor Penrose turned his attention to the subject of mongolism at a very early stage in his professional career and retained an undiminished interest in all facets of the problem for more than 40 years. His first publication in this sphere was in 1931 (1) and was entitled ‘The creases on the minimal digit in mongolism’. The observations he made in this publication are typical of some of his later ones. It reflected a mind alert to useful detail, in this case the fact that in some mongols there is only one flexion crease on the fifth digit instead of two. This peculiarity rarely occurs in the normal population and therefore provides an additional diagnostic criterion for mongolism. Particularly at a time when chromosomal examination could not be undertaken, this direct simple observation helped in the clinical delineation of a condition which is not always easily recognized.

While the beneficial effect of lysergic acid diethylamide (LSD) in the treatment of carefully selected patients as an adjunct to psychotherapy has been amply reported (Robinson et al., 1963), concern has been expressed regarding the damage to chromosomes in those taking the drug.

While there is general agreement that deafness, either congenital or acquired in early childhood, is psychologically damaging (Oléron, 1953; Furth, 1961; and Vernon, 1966), opinions are divided on the adverse effects that deafness beginning in adolescence or in adult life may have on mental health. For example, Furth (1966) has reported that the way of life of the adult deaf should not be all that different from people with normal hearing, although it has been generally held that deafness in adults predisposes to the development of irascibility and paranoid attitudes (Kraepelin, 1915; Slater et al., 1969). The relationship between deafness and paranoid illness has been investigated by Houston et al. (1964) and Kay et al. (1961).

Although there have been several reports of investigations of speech perception in schizophrenia (Laffal, 1961; Lawson, McGhie and Chapman, 1964) in all cases the assumption was made that the patients’ difficulties arose, not from an inability to perceive the individual words, but from a deficiency in perceiving the words in a meaningful relationship to each other, as part of an organized pattern. In this study, however, instead of examining the performance of schizophrenic patients on a task involving the perception of sentences, as these earlier workers had done, we have used individual words as stimuli in a series of tests of speech perception.

Many inheritance models of schizophrenia have been proposed, in view of its variable age at onset, variable familial occurrence and the relevant influence of a great number of environmental factors (Gottsman and Shields, 1967; Heston, 1970; Ödegård, 1972). However, the real genetic predisposition to schizophrenia has not yet been experimentally verified, and genetic markers have to be looked for, i.e. we need some character, genetically determined, whose transmission is associated with schizophrenia transmission: the more polymorphous the character, the greater will be the probability of finding such associations.

Surreptitious ingestion of anticoagulant drugs is a rare condition which presents as an obscure bleeding tendency associated with gross depletion of the vitamin K dependent factors (factors II, VII, IX and X). In all previously reported cases the patients have denied taking drugs but chemical analysis of the plasma has shown the presence of members of the coumarin or indanedione groups.

Beginning with the work of Cameron (1944), the concept of overinclusive thinking has been used to describe or account for the thought disorder observed in schizophrenic patients. This is usually defined as an inability to preserve conceptual boundaries, perhaps based on a cerebral input dysfunction which causes difficulty in filtering stimuli (Payne et al., 1959; McGhie, 1970; Epstein, 1953; Broadbent, 1958). This leads the schizophrenic to make remote associations and to overgeneralize or overabstract.

Many theoretical accounts of the affective disorders, in particular those by writers of the psychodynamic schools, have emphasized the central role of hostility and aggression. However, there have been very few objective studies of the expression of aggression in patients with affective disorders. Of these, two have used the Hostility and Direction of Hostility Questionnaire (HDHQ,) of Foulds (Foulds et al., 1960; Foulds, 1965). Mayo (1967) tested 24 depressed patients before and after treatment and found a significant decrease after recovery, both in their level of general punitiveness and in their level of intropunitiveness. The psychotically depressed patients scored significantly higher than the neurotic depressives. Philip (1971) tested depressed women, and found that extra-punitiveness did not change over time, but that improved patients were less intropunitive than those who showed no improvement. No studies have reported the hostility pattern of manic patients.

Like other mental disorders, mental deficiency presents great problems in diagnosis. These diagnostic problems derive ultimately from the fact that a medical diagnosis can be made only in exceptional cases. Mental retardation is not a disease in itself, but only a symptom which may be found in a number of different conditions. It is true that there are a great number of oligophrenia syndromes with known aetiology, but together they represent a numerically small group. When one considers, in addition, that no clear cut distinction between the normally intelligent and the mentally retarded can be made, since the difference is merely quantitative, the difficulties of diagnosis become manifest.

Various reports have suggested that the urinary excretion of adenosine cyclic 3'5’ monophosphate (cyclic AMP) is increased in mania and decreased in depression. However, our own serial studies from short-cycle bipolar manic-depressive patients showed no correlation between mood and cyclic AMP excretion (2). Jenner et al. (4) confirmed our findings, except in the case of a patient with a regular 48-hour mood cycle who did show a correlation between his mood changes and changes in cyclic AMP excretion. Paul et al. (5) also reported a general lack of correlation between these variables, but found a transient increase of urinary cyclic AMP during the rapid switch from depression to mania. We have investigated the situation in a bipolar patient who shows such a rapid switch in mood but have been unable to demonstrate any increase in cyclic AMP excretion during the switch period.

The poor prognosis of narcotic dependence is generally recognized, but this is a field in which it is specially difficult to make predictions about the outcome of treatment in the individual patient. Vaillant (1966a) noted that abstinence appears to depend more on the addict's ability to discover satisfying alternatives to his addiction than on methods of treatment. In an attempt to identify prognostic indicators in narcotic dependence a number of follow-up studies have examined the relationship between outcome and various social and psychological characteristics of the patients studied. While most follow-up studies are of male addicts or of samples containing only a small proportion of women, the present study is concerned with the outcome in a sample of 66 female narcotic addicts.

Historically, doctors have not always acknowledged that they have an obligation to prevent suicide, partly because they shared the prevalent idea that most suicides were caused by moral crises, no concern of theirs—and indeed suicide was a criminal matter until quite recently; but more, perhaps, because a fatalism has characterized their attitudes to its prevention, even where the suicide was clearly suffering from mental illness. Yet two recent American studies have shown more than 90 per cent of suicides to be mentally ill before their death (17, 8); this finding and the familiar clinical observation that suicidal thoughts disappear when the illness is successfully treated provide a strong case for a medical policy of prevention.

Disturbance of attention has been frequently suggested as one of the mechanisms underlying schizophrenic thought disorder (Weckowicz and Blewett, 1959; Chapman, 1961; Payne, 1966). Much effort has, therefore, been directed toward studying this variable in schizophrenia (McGhie, 1971; Neale and Cromwell, 1972). The approach undertaken has been determined by the psychophysiological and theoretical constructs presumed to be involved. To enumerate a few, disordered attention has been studied with indices of arousal (Venables, 1960; Venables and Wing, 1962), vigilance tasks (Mackworth, 1970), reaction time (Shakow, 1962), size constancy (Weckowicz and Blewett, 1959; Silverman, 1964a), tachistoscopic detection (Kornetsky, 1972), the WAIS Digit Span subtest (Blum et al., 1969), and immediate recall (McGhie et al., 1965). The lack of correspondence between these various procedures has become increasingly apparent (Neale and Cromwell, 1972). In one recent study, for example, the intercorrelations of five purported measures of attention ranged from –.23 to +.31 (Kopfstein and Neale, 1972).

Psychiatrists, psychologists, and nursing staff are increasingly making direct observations and ratings of ward behaviour. Characteristically, a nurse may be asked to complete a multi-item rating scale on a group of patients during the course of a drug trial. Several factors are involved in the choice of an appropriate scale for a particular purpose. Among these factors are the number of points per item, which defines the sensitivity to change of the item, and the total number of items in the scale, which affects the time taken to complete the scale and hence the frequency of rating that can be permitted in an assessment schedule.

The analysis of family data in the hope of detecting a recognizable pattern in the distribution of disease may be of value in respect of cause and of prevention. The recognition of classical Mendelian ratios, for instance, is both a partial explanation and an opportunity for genetic counselling which may lead relatives to take eugenic measures. In mentally subnormal populations, however, the occurrence of disease in families often shows more complicated distributions. From knowledge of the relationship between cause and distribution models may be constructed with which empirical data may be compared, for instance, in maternal-foetal incompatibility in respect of some antigen, or in polygenically determined diseases showing threshold effects in liability to disease.

Lionel Penrose's work was essentially concerned with medical genetics and, as this audience is well aware, especially with mental defect. He very seldom published in an anthropological journal, and on the few occasions when he mentioned anthropologists in his writings his remarks were not very complimentary. However, those of us who are in the business can take comfort from the fact that these remarks were generally aimed at an earlier generation of anthropologists who had failed to benefit from what human genetics already had to offer in the years before World War II.

In Orthomolecular Psychiatry; Treatment of Schizophrenia, edited by David Hawkins and Linus Pauling (1973), Beebe and Wendel (pp. 278–302) report a high correlation coefficient of r = 0.99 (which we calculate gives N = 42, p very much lower than 0.001) between whole blood glucose and adenosine triphosphate (ATP). This relationship they claim is no longer maintained in schizophrenics with anxiety, r = 0.16 (N = 62, p > 0.1). Erban and Hanzlicek (1966), Hansen (1972) and Hansen and Dimitrakoudi (1974) have suggested a possible significance of whole blood ATP in psychoses, and Naylor, Dick, Dick, Le Poidevin and Whyte (1973) have implicated red cell Na/K ATPases. The mechanisms involved in controlling blood ATP seemed therefore worthy of study especially if they are so dependent on glucose.

Some controversy exists regarding the notion that personality disturbance is specifically related to temporal-lobe epilepsy. A number of investigators have found no psychometric or psychiatric differences between psychomotor epileptics with a temporal-lobe focus and non-temporal epileptics with ‘centrencephalic’ or diffuse epilepsy or jacksonian sensorimotor epilepsy. But it is possible that the ‘negative’ findings in these studies may be explained by the reported acute psychoses caused by changes in anti-epileptic medication, or by the use of groups that were too heterogeneous or institutionalized and the use of less well-defined psychiatric and psychological variables. However, Janz (1969) has described a more primary, homogeneous, common and not serious form of grand-mal epilepsy, ‘Aufwach’ epilepsy, with psychiatric and Rorschach-test characteristics of a kind different from the corresponding characteristics of ‘Schlaf’ grand-mal epilepsy and psychomotor epilepsy. Furthermore, Meier and French (1965) obtained certain results with the MMPI test for a group of psychomotor epileptics with bilateral EEG temporal-lobe abnormalities. A separate analysis of this group showed that the presence of independent bitemporal EEG abnormalities was associated with the most and highest scale elevations.

The aim of the present study is to investigate probable socio-cultural determinants in the epidemiology of attempted suicide in Trinidad and Tobago. In an earlier paper the author described the clinical features which were noted among those patients who attempted suicide and were admitted to the only psychiatric unit in these islands (Burke, 1974). During the period before this unit was in full operation other workers had noted a tendency for suicide attempts to be made more frequently by women of East Indian origin, who most often reside in rural areas, than among the more urban African ones (Haynes, 1966; Roberts and Russell, 1969). Since those studies a suicide prevention service has been established which admits all patients who attempt suicide. The present study was intended to re-investigate the ethnic sub-cultural findings which occur in the new service. It was hypothesized that there was no difference in the distribution of attempted suicide, between the two sub-cultural groups.