Forty-two subjects, 20 with and 22 without clinically diagnosed tardive dyskinesia (TD), were rated for TD on the scale of Simpson et al. They also performed a tongue protrusion test and had the presence of tongue movements within the buccal cavity observed. Fifty per cent of the severe or definite TD subjects as classified by rating scale were unable to maintain tongue protrusion for a minimum of 30 seconds, and 85 per cent of them had abnormal tongue movements. In 45 per cent of the possible TDs and in 9 per cent of the doubtful subjects, the movement test was also positive.

Women who had a psychiatric illness requiring hospital admission within 90 days of delivery were compared with a control group matched for age, Research Diagnostic Criteria diagnosis and year of admission. Those with a diagnosis of major depressive disorder differed significantly from non-puerperal controls in being more deluded or hallucinated, more labile and more disorientated. There was no difference between puerperal and control cases of major depressive or manic disorder with respect to treatment received, or responded to, or length of stay in hospital.

This study compared life events in three groups: hospitalized psychiatric, hospitalized paediatric, and non-patient non-hospitalized children, all aged 7–12 years. The most common life event in each group respectively was moving to a new school district, hospitalization for physical illnesses, and outstanding personal achievement. The hospitalized children had a significantly greater number of life events and mean score of life events than that of the general population. The authors conclude that the study of life events alone is insufficient to infer a causal relationship between life events, onset of illness and hospitalization in children.

Thirty Kenyan patients of black African origin undergoing treatment for clinical depression in Nairobi, and 40 matched non-psychiatrically disturbed controls in the community were studied for life events using the Brown-Harris model. It was found that the depressed group had significantly more life events (P <0.001 with Yates correction for continuity) in the twelve months preceding the onset of their depression than the controls in the same period. These results are similar to those obtained by several workers in Western settings. Their implication for the practice of psychiatry in an African context is examined, and some myths about psychiatry in Africa re-examined.

Three new cases of the syndrome of Capgras are presented. An unusual variant of the syndrome is recorded. It is contended that the definition of the syndrome should be widened to include impersonators who exhibit slight differences from the prototype, and that ambivalence and projection cannot explain all cases. The syndrome is critically reviewed.

A detailed record of the smoking habits of 83 patients treated in hospital for neurosis was compared with national statistics derived from the General Household Survey and Statistics of Smoking in the United Kingdom, and with a control group of patients admitted for treatment of varicose veins. Neurotic patients were more likely to be smokers. They started to smoke at a younger age, smoked more cigarettes and were more likely to inhale deeply. It is concluded that neurotic patients have a greater exposure to the potentially toxic effects of cigarette smoking than non-neurotic individuals.

Ten depressed elderly female patients in hospital (mean age 82 years) received a single oral dose of 50 mg nortriptyline prior to commencing treatment with this drug. The nortriptyline concentration in a plasma sample obtained 24 hours afterwards was used to predict the daily dose required to achieve a steady-state concentration within the range of 50–150 μg.l-1. The mean daily dose prescribed was 50 mg (range 20–100 mg). These dosage regimes provided a mean observed steady-state nortriptyline concentration of 104 μg.l-1, with a range of 76–180 μg.l-1 (S.D. 30 μg.l-1). Use of this prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success.

Jaspers' (1963) concept of delusions proper is founded on the fact that patients suffering from schizophrenic and paranoiac psychoses experience these mental events as ego alien and completely unlike previous modes of thinking, feeling and perceiving. This disruption in the continuity and quality of mental life has been taken to indicate that, in contrast to delusion-like ideas, delusions proper do not have psychological antecedents. Such a view has never been acceptable to psychiatrists who favour a developmental approach to mental pathology. According to Minkowski (1927), Katan (1954) and Ey (1969), whose writings are based on Jackson (1894), Freud (1911) and Ribot (1920), it is possible to understand and resolve this disturbance in the continuity of the content of the mental life of those who succumb to schizophrenic and paranoiac psychoses.

As part of an epidemiological survey of a rural community in the North of Spain we analysed the interaction between physical illness and neurotic morbidity using a two-phase cross-sectional analysis of a representative sample of the population over 15 years old. There was a very high prevalence of neurosis in the somatically ill (males—15.6 per cent, females—33.1 per cent) and much physical pathology in the group of neurotics (males—42.4 per cent, females—39 per cent). The personal characteristics of the sample, as well as some sociological factors like rural-urban way of life, educational level and social class, appear to influence the relationship between both types of illness. The neurotic morbidity of the somatic group comprised depressive, anxiety and hypochondriac types.

Personal construct theory and repertory grid methodology were applied to a study of psychological change experienced by a sample of ten neurotic depressives and their matched controls during short-term hospitalization. All subjects completed a repertory grid and the Zung depression scale on admission to hospital. Depressives were characterized by lower self-esteem, more negative social perception and higher scores on the Zung scale. Both measures were repeated at the time of discharge from hospital. Depressives showed a significant reduction in depressive mood, more positive social perception, and a change in the construing of the self; controls showed no changes. It is argued that the use of a quantitative assessment technique reinforced by a theoretical framework results in a more refined understanding of psychological change.

The therapeutic benefit of combining propranolol with diazepam over either of these drugs given alone was tested in a placebo-controlled crossover study with twenty-four chronically anxious out-patients. The combination was generally more effective than diazepam. Diazepam was more effective than placebo or propranolol. A reduction in the resting pulse rate by propranolol of more than 7.5 beats per minute resulted in a greater therapeutic response to this drug, alone and in combination. Lesser degrees of pathology responded better to treatment. Psychological factors in treatment showed themselves to be important in moderating pharmacological response. Chronically anxious patients generally derived little benefit from continued anti-anxiety treatment.

A medical, psychiatric and social assessment was conducted on 272 residents admitted consecutively to local authority residential care for the elderly in Nottingham in the year ending 31st January 1978. A high level of medical and psychiatric pathology was discovered, in spite of frequent general practitioner contact in the community and recent hospital admissions. Few of the staff in the old people's homes were sufficiently qualified to deal with the medical and psychiatric conditions of the residents only a third of whom had been examined by a general practitioner during the month after admission. The social service provision in the community showed an uneven pattern and did not appear to have a direct relationship with the residents' requirements, 12 per cent of whom could have remained in the community had there been adequate social assessment and support. Only just over half were appropriately placed, and a further third should have been in the care of the hospital services.

Recommendations for change are directed towards the provision of routine medical, psychiatric and social assessment of all potential residents by geriatricians and psychogeriatricians in close collaboration with social services in special local authority assessment homes.

The paper reports a controlled study of the impact of social skills training within a longer treatment approach to patients with anorexia nervosa. Under these circumstances social skills training was not found to be a very powerful form of intervention. Possible reasons for this are touched on.

A review of studies which used standardized interviews as a means of data collection indicated that the issue of reliability was frequently neglected in the psychiatric literature. It is suggested that this may be due to a misinterpretation of the concept of reliability which is apparently perceived as a permanent feature of an interview instrument. The importance of reliability is discussed, and recommendations are made as to how a methodologically adequate assessment of reliability might be undertaken.

Following the method of Brown and Harris 30 Kenyan patients suffering from depression and 40 community non-psychiatrically-disturbed controls were studied for contextual and reported threat due to short-term and long-term life events. It was found that the patients did not over-rate threat due to events (in ‘search for the meaning’) nor did the controls under-rate the threat of life events. Some theoretical issues on the ‘contextual threat’ of life events are raised.

Four experimental interview styles, designed to differ in the extent of their use of active fact-oriented and active feeling-oriented techniques, were compared in relation to their use in the initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. All four styles proved to be effective in eliciting emotions and feelings, but the findings suggested that each was effective for different reasons. It appeared that emotional expression could be encouraged by the interviewer's response to emotional cues, by a reflective style with little factual cross-questioning, by the use of direct requests for self-disclosures, by the optimal (but not necessarily maximal) use of interpretations and expressions of sympathy, and by direct requests for feelings.

The extent to which anxiety, irritability and depression were differentiated as separate entities associated with characteristic patterns of somatic and cognitive symptoms by field dependent (FD) and field independent (Fl) normal female subjects was studied with the Hidden Figures Test and Unpleasant Emotions Questionnaire. In the Fl group the correlations between the three emotions were low and non-significant, reflecting a clear-cut differentiation in symptom configuration, as shown by psychiatrists. In the FD group the inter-correlations were significant and positive, corresponding to relatively poor symptom differentiation, comparable to that of a psychiatric patient group. This suggests that the cognitive style variable of field dependence may underly differences in symptom differentiation associated with psychiatrist/patient differences and, more generally, with social class and sex differences.

The Middlesex Hospital Questionnaire (MHQ) was used as a screening test for psychiatric disorder in 169 new outpatients. The profile obtained on the six subscales of the MHQ was strikingly similar in this American sample compared to four previous British reports. The MHQ significantly differentiated between diagnostic groups, most particularly between neuroses and personality disorders. Moreover, 75 per cent of the patients could be correctly classified as either neurosis or personality disorder on the basis of their MHQ total and subscale scores. The MHQ appears to be particularly useful in identifying phobic disorders, and the phobia subscale consistently discriminated between anxiety-phobic states and other diagnostic groups.

Juvenile court histories were investigated of male and female juvenile drug offenders and of control groups of juvenile delinquents never charged with drug-related offences. On most of the parameters of drug-related and of other criminal offences, criminal involvement was greatest among opiate abusers, followed by those abusing sedatives, and then by cannabis abusers. However, this difference was less marked among females than among males. Involvement with crime not related to drugs was greater among delinquents abusing opiates and sedatives than among delinquent controls, while the criminality of delinquents abusing cannabis was less than that of the controls. There were significant differences between the patterns of offences of the four groups, which did not support the economic necessity hypothesis of crime among (at least juvenile) drug abusers. The findings were consistent with progression from soft to hard drugs, and with the view that where juvenile delinquency and drug abuse co-exist, the former tends to precede the latter. The association between juvenile drug abuse and delinquency seems to be accounted for by a common denominator of a sociopathic character development, rather than by some form of causal relationship between these two phenomena.

This paper examines the capital costs and accommodation provided in three different types of residential facility for mentally handicapped people—a large campus hospital, a small campus hospital and a network of individually-sited hospital units. The findings do not indicate any economy arising from increased size, or from centralization of facilities on a single site. These findings, together with the other research cited, have implications for the design of future residential services.