In this study 368 patients were interviewed after they had attended the Bristol Royal Infirmary Accident and Emergency Department following a non-fatal act of deliberate self-harm. There were twice as many women (247) as men (121), and two thirds of the patients were in the 15–35 age group. Ninety-five per cent had taken a drug overdose, most commonly one or more of the tranquillizers, antidepressants, hypnotics or analgesics. Seventy-eight per cent had taken drugs prescribed by a doctor. Half the patients mentioned interpersonal conflict as a major precipitating factor in the episode. A psychiatric diagnosis was completed for all admitted patients, of whom 52 per cent were considered to be suffering from neurotic depression, 29 per cent from personality disorder, 12 per cent from functional psychosis and 10 per cent from alcohol addiction. Almost half had deliberately harmed themselves on a previous occasion. The series showed a greater than average incidence of unemployment, overcrowded living conditions, divorce and antisocial behaviour. The implications of these findings for the clinical management and prevention of non-fatal deliberate self-harm are discussed.

1. 1. Twenty-six out of 28 out-patients with agoraphobia and social phobias who had originally been treated with phenelzine or placebo in a double-blind clinical trial were followed up for a mean period of one year. During the follow-up period patients received further pharmacotherapy or behaviour therapy, except that those patients originally receiving placebo were not allowed therapy with monoamine oxidase inhibitors.

2. 2. Ratings of phobic and additional symptoms, social adjustment and degree of personality disorder were made after one year by one of the authors (D.S.) who had no prior knowledge of the treatment each patient had received.

3. 3. There were no significant differences in any of the ratings between the patients of the two groups, but those originally receiving placebo had more additional treatment in the follow-up period. Patients continuing to receive phenelzine frequently experienced a return of symptoms if the drug was withdrawn before six months treatment had elapsed.

4. 4. Degree of personality disorder showed a significant negative correlation (p = –0.6) with improvement in the phenelzine group but not in those receiving placebo originally.

5. 5. Improvement in social adjustment items was less than improvement in symptoms at follow-up. The implications of this are discussed.

6. 6. The results suggest that phenelzine is of comparable efficacy to other symptomatic treatments for agoraphobia and social phobias, but that it acts mainly by symptom suppression. Prolonged treatment in patients with personality disorders is not indicated, for improvement is less likely and the dangers of dependence are greater.

Although the semantic differential has been quite widely used with mental defectives, its usefulness (in its traditional form) with such a population has not been conclusively demonstrated.

The semantic differential was developed and shown to be valid as an index of representational mediation processes. However, there is also evidence of a mediational deficiency among retardates which, therefore, ought to be reflected in retardates' responses to the semantic differential. Thus, the present study was designed to test two hypotheses: (a) that mild grade retardates, in comparison with subjects of average intelligence, would show less discrimination in the use of the semantic differential, and (b) that such discriminative deficiencies would in turn predispose toward a polarized response bias among the retarded.

The results, which supported both hypotheses, are discussed in terms of their implications for the usefulness of an unmodified semantic differential with the mentally subnormal.

Twenty-five doctors and 50 nurses working in the medical wards of a general hospital were interviewed. They were asked to indicate typical motives for self-poisoning and were then shown brief accounts of four typical case histories. They were asked to choose from a list of motives those they considered applied to each case. They then rated each motive for acceptability and understandability, and each case for sympathy and readiness to help.

Motives were of two principal types—‘manipulative’ (i.e. aimed at eliciting a response from others) and ‘depressive’ (i.e. communicating despair and aimed at withdrawal, escape or death). ‘Depressive’ motives were more acceptable and evoked more sympathy or readiness to help in both doctors and nurses than ‘manipulative’ motives.

Doctors and nurses differed in various ways. Nurses were generally more accepting, more sympathetic and more likely to seek professional help as an alternative way of coping. Doctors distinguished more clearly between ‘suicidal’ motives, of which they were relatively accepting, and ‘manipulative’ motives, which they accepted less. Attitudes to the four cases differed, primarily in the motives attributed. Those differences may also reflect differing severity of problems, personal responsibility for problems, social class, sex or age.

In a recent letter to this Journal, Galdi (1974) stated, ‘Through what is … a genetic approach to classification, Winokur and associates … reported the isolation of two subtypes of unipolar depressive disorder differentiated by age of onset and contrasting family history pattern.’ These subtypes (Winokur, 1974) are termed depression spectrum disease (early-onset; most likely female; familial alcoholism and/or antisocial personality) and pure depressive disease (late onset; equally male or female; little familial alcoholism and/or antisocial personality).

This paper represents part of an investigation designed to establish the validity of the Clifton Assessment Scale (a brief psychogeriatric assessment procedure) and the Stockton Geriatric Rating Schedule. One hundred consecutive admissions over the age of 60 were assessed soon after admission to the acute wards of a psychiatric hospital. The results indicated a close relationship between the scores and psychiatric diagnoses. Outcome was differentiated in terms of discharge home or of transfer to psychogeriatric and to other non-psychogeriatric wards, and significant differences were obtained between groups. The assessment procedure had predictive validity comparable with other reported procedures, with the advantages of brevity and test acceptability for an elderly population.

Previous studies have shown varying rates of discrepancy in drug administration in psychiatric hospitals, and the present survey attempted to elucidate this problem further, using two methods of investigation simultaneously.

Two wards in a psychiatric hospital and one ward in a mental subnormality hospital were studied. Urine specimens were tested for psychotropic drugs, and ward drug rounds were observed to detect discrepancies in administration.

Of the 266 instances of drug administration tested for in urine specimens, prescribed drugs were not detected in 7·9 per cent of cases and non-prescribed drugs were found in another 29 instances. Observation was made of 3,689 instances of drug administration, and in 1·7 per cent of these the drug was not given or taken as prescribed, whereas no instances of ingestion of non-prescribed drugs were observed. The reasons for the discrepancies and the different results obtained by the two methods are discussed.

Medical practitioners have begun to look for ways of helping the psycho-sexual problems of their patients with increasing awareness that it is impossible to ignore their sexual lives if they are to treat the whole patient. Sexual problems occurring in marriage have been treated in the past in two main ways, by some form of insight therapy or by behaviour therapy, and recently some adherents of both these schools have moved towards treating the disordered relationship rather than the individual patient. Dicks (1967) at the Tavistock Institute has pioneered the treatment of what he calls the ‘diad’ by two therapists, male and female, in a basically analytic framework, whilst Masters and Johnson (1970) in America have used an approach based largely on behaviour therapy techniques, also using two therapists.

A longitudinal study of a single case of manic-depressive psychosis investigated the relationship between psychiatric ratings, reaction time and two measures of autonomic activity. Measurements were made on 19 occasions over a five-month period. The number of slow responses on the reaction time task increased with increasing depression. Manic periods appeared not to be characterized by a slowing of responses, but rather by an increase in the number of premature responses, i.e. those made to the warning signal. A derived performance index discriminated over the complete range from severe depression to severe mania.

Increased depression was associated with lower heart rate resting levels, and increasing mania with increased skin conductance levels. An increased frequency of slow reaction times was significantly associated with lower resting heart rate. Skin conductance measures correlated significantly with the number of premature responses made on the reaction time tasks. Some differences in the relationships emerged when data obtained during the administration of lithium were included in the analysis.

The results are discussed in relation to both the bipolar and the continuum models of manic-depressive psychosis. The latter model is not supported by the present investigation, since manic episodes were not characterized by a more severe departure from normality than depressive episodes on either the number of slowed responses or autonomic measures.

National samples of case records of suicidal-type deaths from England and Wales and from Scotland were reassessed by officials in the other country. It emerged that similar criteria for suicide existed in both countries, and that there was no age-related tendency to misclassify cases. The lower official suicide rate amongst the old in Scotland was therefore considered not to result from ascertainment differences. It was also concluded that Scottish records were not so briefly documented as to prevent the conclusive ascertainment of cause by England and Wales coroners. Cases which were designated ‘undetermined’ in Scotland tended to be classified ‘accidental’ by coroners. Reasons for the lower incidence of suicide in Scotland are discussed.

T. S. Eliot, standing on his doorstep, with his Boston Evening Transcript in his hand, ‘turned wearily as he would turn to nod goodbye to Rochefoucauld if the street were time and he at the end of the street’. The same weary gaze characterizes the attitude of most psychiatrists towards important figures in the past history of their subject. A crude indication of this state of affairs is the total absence of any historical questions in most psychiatric examinations. For its jobbing practitioners, psychiatry might as well exist in a historical vacuum. And why not? History has its own snares and delusions. Henry Ford called it ‘bunk’. Alfred North Whitehead remarked that ‘a science which hesitates to forget its founders is lost’. And Karl Popper, who has done a thorough demolition job on the concept of ‘historicism’, has warned us that ‘if our civilization is to survive, we must break with the habit of deference to great men’. In contrast to psychiatrists, students of art study its history for at least a year. If we regarded psychiatry as an art, how does our history look then?

The relationship between criminality and the outcome of treatment was investigated in opiate addicts attending a drug dependence clinic. A comparison was made between the criminal records of 33 male and 7 female patients who came off drugs and a control group of 29 male and 10 female patients who remained addicted. In male patients, the extent of criminal involvement (as measured by the number of previous convictions on entering treatment) failed to discriminate between those who subsequently achieved abstinence and those who remained addicted. In the small sample of female patients the control group more often had a criminal record and had more previous convictions. These results were in keeping with a previous study of female addicts.

The findings suggest that there is a sex difference in the relationship between criminality and the prognosis for addiction. In male addicts criminal involvement has no significant influence on the outcome of treatment and previous convictions are not a helpful guide to prognosis, whereas in female addicts a criminal record is of more adverse significance.

The training experiences of 35 academic psychiatrists first appointed in the years 1966–72, obtained by a postal questionnaire, are reported and compared with those of N.H.S. consultant psychiatrists appointed in the same period. The academic group reported less satisfactory training in a number of important areas, including psychogeriatrics and work in the community. Academics also differ from consultants in their fathers' socio-economic status and educational background.

A case of schizophrenia in a 47,XYY male diagnosed according to strict phenomenologicai criteria is presented. The authors suggest that the 47,XYY chromosome anomaly should be added to the list of possible causes of symptomatic schizophrenia, and express the hope that future investigations of the effects of an extra Y chromosome on brain function will yield clues as to the aetiology of idiopathic schizophrenia.

This is a study of one mode of inception into psychiatric care in Birmingham, Mentally disturbed people coming to the attention of the police are referred to a mental welfare officer and assessed by him, usually in a police station. The mental welfare officer may then refer for a psychiatric decision with regard to further management, and the patient is examined by the doctor in the police station.

The annual frequency of use of this referral system was studied from 1962–73 inclusive. It is shown that there was an increase in referral over the years and that such referral from the police became an increasing proportion of new referrals to the Mental Health Department (Social Services Department).

The sample of referrals from the police for 12 months is studied in greater detail (252 cases), surveying social characteristics of individual patients, the relationships between such police intervention and areas of the city, the nature of situation requiring intervention and the management and treatment which these patients received. The referrals were traced from contact with the mental welfare officer to hospital where the case notes of those admitted were studied for details of legal status and mental state on admission, diagnosis, duration of stay and disposal. The effectiveness of this method of entering treatment is discussed and some recommendations are made.

The implementation of a policy of ‘community care’ is seen to involve a number of assumptions, some of which are rarely examined. These can be roughly categorized as involving the nature of mental illness, the nature of community, the course and treatment of mental illness, the proper scope of psychiatry, the burden on the community and the efficacy of social work. Data bearing on these assumptions are reviewed, and the conclusion is offered that they are far from being uncontentious.

It is suggested that the movement toward community care has many of the attributes of a moral enterprise which, unless substantiated by benefits to the patient or his family, may be the latest diversion of the psychiatric conscience from the care and treatment of the chronic mentally ill.

The details of 98 women sterilized over a three-year period are presented. They show that female sterilization is a safe procedure which has a satisfactory result in many cases and confers many secondary benefits. However, some regret is common and is associated with a high incidence of psychiatric and marital morbidity, and this is shown to be related to pre-operative factors. A method of pre-operative assessment is outlined which should minimize the risk of a poor outcome following female sterilization.

The present study has been made with the purpose of studying the frequency of chromosome aberrations in a male psychiatric hospital population, especially in order to look for possible associations between minor chromosome aberrations such as variations in short arms or satellites in D or G chromosomes as well as in Y length on the one hand and mental illness and criminality on the other.

Treatment under conditions of gnotobiotic isolation can augment the stress of adaptation to a diagnosis of leukaemia. Identification of the psychological problems experienced in isolator treatment can contribute to the effective maintenance of therapy. Individual patterns of adjustment to treatment relate to the psychological defence mechanisms employed to contend with the dependent position enforced by isolation. Psychiatric assessment can assist both patients and nursing staff with the management of their separate difficulties in this unfamiliar treatment situation. Psychological features of isolator treatment in ten patients with acute leukaemia are described and suggestions proposed for psychological management of patients under isolator conditions.