The increasing interest in the treatment of phobias underlines the need for clarifying their definition and classification. A brief historical note highlights some of the difficulties which have been, and still are, encountered.

Fifty patients attending a neurological outpatient clinic for Parkinson's disease were assessed by standardized methods for both physical and psychiatric symptoms. The patients then received treatment with L-dopa, L-dopa with carbidopa or anticholinergic drugs and/or amantadine. During the following six-month period the subjects were assessed at intervals, both physically and psychiatrically. Forty patients were followed up for the full six-month period. The severity of physical signs and affective symptoms was shown to be significantly related at several stages of the investigation. Initially, the patients showed a high psychiatric morbidity. During treatment, 22 patients developed a depressive disorder, 12 of which had a history of previous depressive episodes. By contrast, of the 11 patients who showed very few affective symptoms during follow-up, none had a history of depression. Of the 22 patients with a depressive disorder, only two were in the anticholinergic/amantadine group, compared with nine and 11 in the other groups. L-dopa was not an effective antidepressant agent. The probable relevance of the findings of the study to the management of patients with Parkinson's disease is outlined.

It has been proposed that p-hydroxynorephedrine, a metabolite of amphetamine, is responsible for the tolerance that occurs to this drug. To test this idea, the development of tolerance to amphetamine has been examined in two species, the rat and the guinea pig, the former of which produces p-hydroxynorephedrine from amphetamine while the latter does not. In both species, tolerance develops to the anorectic and hyperthermic actions of amphetamine, and similar changes in the pattern of behavioural stimulation are seen.

Urinary free Cortisol (UFC) excretion was determined in 60 depressed inpatients and in 35 psychiatric inpatients with other disorders. The depressed patients had high daily UFC values, while the other patients excreted normal amounts. Over 40% of the depressed patients had UFC excretions in the range seen in Cushing's disease, while only 6% of the other patients excreted such high amounts of Cortisol. Age and sex differences did not account for the results. Among the depressed patients those with depressive neuroses excreted less than unipolar or bipolar depressives. Following treatment, more normal UFC excretion was found in depressed patients. The estimation of UFC and its clinical utility are discussed in detail. UFC determination is a simple and informative indicator of adrenal cortical activation and its application to psychoendocrine studies is recommended.

The plasma lithium levels of 18 subjects receiving one standard and two slow-release preparations of lithium carbonate were measured at frequent intervals during the 24 hours following oral ingestion of a single dose of the drug. Although the slow-release tablets showed slow-release in vitro, this was not so in vivo. One slow-release preparation, in particular, was ineffectively absorbed by some subjects. There was no difference in the rate of absorption and excretion between the other slow-release product and the standard BP preparation. The implications of the results are discussed.

An inverse factor analysis of 880 depressed inpatients on 33 endogenous–neurotic variables yielded four patient types. Type 3 resembled the endogenous depressions and Type 2 the neurotic depressions. Type 3 patients responded well to both imipramine and chlorpromazine and did poorly on a placebo. Type 2 patients showed the greatest overall improvement at three weeks irrespective of treatment received, including a placebo.

Fifty-seven chronic agoraphobic outpatients were treated by 12 hours of exposure in vivo on four days over two weeks to check the effects of oral diazepam versus placebo during group exposure, group versus individual exposure, and high versus medium anxiety arousal during individual exposure. The controlled parallel design allowed comparative evaluation of each treatment condition to six months follow-up. Assessment was blind with respect to drug and psychological treatment. Patients in all treatment conditions improved significantly in phobias and in related life areas.

Outcome to group exposure on phobias and other measures was similar in all three drug conditions (placebo, waning diazepam, peak diazepam) with no significant differences between them. Diazepam patients had significantly less discomfort than placebo patients during group exposure treatment. Group exposure patients improved slightly but significantly more than individual exposure patients on non-phobic measures, though group exposure was accompanied by more panics during treatment yet was easier to run by the therapist. Individual exposure under high anxiety arousal was no more therapeutic than with lower anxiety. Diazepam is a mild palliative during group exposure but does not facilitate outcome to treatment. Group exposure in vivo is mildly facilitatory for outcome compared with individual exposure. Anxiety evocation during treatment was not therapeutically helpful.

The results of surveys and inquiries to identify autistic children, carried out in England and Wales, the U.S.A. and Denmark, are compared. Three studies, in each of which either a total population of children or a wide range of handicapped children was screened, using case-note inspection and interviews, all estimated the prevalence of the autistic syndrome to be between four and five children per 10,000 aged under 15 years. Inquiries that counted diagnosed cases only or that relied upon local authority records produced much lower prevalence rates for the autistic syndrome. The reasons for this are examined, and the implications for prevalence studies of handicapping conditions are discussed.

An investigation into the extent and nature of social inadequacy among outpatients diagnosed as neuroses and personality disorders was undertaken on patients aged 18–49 attending one clinic over a six-month period. A feature of this survey was that each patient took part in a standard social interaction test, and their performance was assessed by two psychologists. A relatively high proportion of patients, one in six on the most conservative estimate, and probably over one in four, were judged by psychologists and psychiatrists to be socially inadequate, and the results showed a clear pattern of behavioural, social and personality factors associated with these judgements. Implications for assessment and treatment are discussed.

A one-year cohort of parasuicide patients (n = 822) was divided into three age groups, subdivided by sex where indicated. Systematic comparisons of the groups were made, and significant discrepancies validated using a second cohort of patients. A number of social, demographic and clinical differences were found, as well as some unexpected similarities. The rates for subsequent (completed) suicide were conspicuously different in the six age-sex subgroups.

Previous research by the author (Slade, 1972, 1973) and others has suggested that psychological stress plays an important role in triggering off the experience of auditory hallucinations. Clearly, however, predispositional factors are involved as well. The present study is an attempt to investigate some of the psychological factors which may predispose the individual to such experiences. A battery of tests involving cognitive, personality and mental imagery variables and the verbal transformation effect was administered to two small groups of psychotic patients differing only in respect of a history of auditory hallucinations and a normal control group. The main conclusion was that the results lend direct support to the proposition of Mintz & Alpert (1972) that a combination of vivid mental imagery and poor reality-testing in the auditory modality provides the basic predisposition for the experience of auditory hallucinations.

Their own accounts of their use of drugs, together with a detailed description of psychiatric history and present mental state, were obtained from a sample of institutionalized delinquents, Subjects reporting extensive involvement in drug abuse were found to be disturbed on a number of psychiatric variables; however, those reporting some limited abuse were less disturbed than subjects reporting no experience of drug taking. The results and their implications are discussed.

Prisoners' attitudes to their drinking behaviour, although largely accurate, minimize problems in terms of other assessments made at interview. Semantic differences are apparent in the use of the terms ‘heavy’ and ‘problem’ as descriptions of drinking behaviour; thus men who admit heavy but deny problem drinking are often reported to be problem drinkers by their family and myself. There is close agreement between the family's reported attitude to a man's drinking and the assessment made in a structured psychiatric interview.

In psychiatry the relationship between treatment and punishment is variable and ambiguous. It has always been possible to employ physical methods of treatment for punitive ends, against which the introduction of liberal policies is no complete safeguard. Indulging one's personal animosities towards a difficult or violent patient has always been condemned, but the motives of a psychiatrist may be particularly easily misconstrued. These inherent risks in a psychiatrist's situation are illustrated by a case from the 19th century.

The 1955–56 Annual Report of the Department of Research Psychology at the New York State Psychiatric Institute begins by noting that –Dr. Joseph Zubin, who had been Associate Research Scientist in this department since September, 1938, resigned January 15th, 1956 to become Principal Research Biometrician, heading a new Department [now Unit] of Biometrics Research…” While this move soon proved to be a stimulus for the development of significant new avenues of research, it by no means marked a sharp break with previous work. As Zubin has often noted, the late Carney Landis, when he was head of the Department of Research Psychology, actively fostered a variety of biometric studies, and indeed the annual reports of that department had eventually come to contain a separate section devoted to biometrics, in which the work of Zubin and his colleagues figured prominently. Much of this work would serve as the foundation of the new unit's research programme. In particular, an extensive study of prognosis in early and chronic schizophrenia had already been in progress for several years. In addition to interviews, a battery of tests was employed to sample a range of levels in the patients' functioning: psychophysical, psychophysiological, psychomotor, perceptual, behavioural, and conceptual.