Periodic brain stimulation, particularly in the limbic system, at stimulus intensities initially too low to produce any behavioural or EEG effects, progressively produces EEG changes, motor automatisms, and eventually convulsions, an effect called kindling. Data are presented and reviewed that suggest that the severity of alcohol withdrawal symptoms progressively increases over years of alcohol abuse in a stepwise fashion similar to the kindling process. The model is presented that the limbic system hyperirritability which accompanies each alcohol withdrawal serves over time to kindle increasingly widespread subcortical structures. These long-term changes in neuronal excitability might relate to the progression of alcohol withdrawal symptoms from tremor to seizures and delirium tremens, as well as the alcoholic personality changes between episodes of withdrawal.

Twelve patients who feigned bereavement are described. Most appeared depressed on admission, and in over half bereavement was erroneously believed by staff to be an important cause of their depression. This type of behaviour, leading to admission to hospital, may be regarded as abnormal illness behaviour, and reasons are given for considering most of the cases as variants of the Münchausen syndrome. Motivation for these deceptions is discussed, and reference is made to features which might arouse suspicion that bereavement is feigned.

In this presentation of two cases it is suggested that many Münchausen syndrome patients present with psychiatric symptoms. This syndrome, however, should be differentiated from other clinical psychiatric conditions.

During a six-month period, physical disorder was found among 50 per cent of the 133 patients at a day hospital. Few of these cases (5) had organic brain syndromes. Among the remainder (62) physical disorder was not associated with sex, formal psychiatric diagnosis or time of referral to the hospital; of those 33 patients with a neurological disorder, one-third had previously been diagnosed to be hysterical. For this ‘hysterical’ group, however, associations with folate deficiency, organic brain disease, and depression were noted. The need is demonstrated for routine investigations among day hospital patients with particular attention for those with atypical features.

Thirty-two patients who had responded to amitriptyline (150 mg daily) when suffering from a depressive illness were allocated either to receive placebo or to remain on the same medication for one year.

Plasma concentrations of the drug were regularly estimated. There was no correlation between plasma concentration and subsequent residual affective morbidity. In spite of considerable encouragement, three of the patients did not take the prescribed amitriptyline and they all relapsed. Five out of sixteen patients who received placebo relapsed. None of the patients who continued to take amitriptyline relapsed.

It is emphasized that the patients studied were selected, inasmuch as they were apparent responders to amitriptyline. It is concluded that this group of patients should continue to be treated with antidepressant medication for eight months after apparent recovery, and care should be taken to ensure the patients' compliance.

The patient described in this report is the second case in which the Capgras syndrome has occurred in association with pseudohypoparathyroidism (Hay et al, 1974). Her admission was for evaluation and treatment of psychosis, but after detailed metabolic and psychometric testing it was established that pseudohypoparathyroidism and cerebral dysfunction were antecedent conditions. In view of recent reports in the literature, the significance of these conditions in the pathogenesis of the Capgras syndrome will be discussed.

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.

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.

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.

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.

Transsexuals are defined as subjects who have a sustained feminine gender identity combined with a wish to alter their bodily appearance towards the feminine. The results of this study indicate that they can be differentiated into two clinically discrete groups.

In an investigation of 29 transsexuals who sought a change of sex operation it was found that those who had experienced fetishistic arousal were significantly more likely to be older, to have experienced heterosexual intercourse, to be married and to show penile responses to pictures of men and women indicative of a more heterosexual orientation. They had less experience of homosexual contact to orgasm as compared with transsexuals who had not experienced fetishistic arousal, but this difference was not statistically significant. Frequency of cross-dressing, strength of feminine gender identity and intensity of desire for a sex change operation did not discriminate the two groups. The fact that desire for a sex change operation may be associated with experience of fetishistic arousal could be one reason for the higher incidence of transsexualism in men than in women.

—Previous reports of sexual orientation and gender identity in subjects with XYY karyotype are reviewed. Two patients seeking a change of sex operation and found to have an XYY karyotype are described. It is argued that an XYY karyotype may predispose to a disturbed gender identity and possibly to the development of the transsexual syndrome.

Twenty-five schizophrenic patients with tardive dyskinesia were given 600 mgs sodium valproate daily with their neuroleptic medication. After one month there was no change in their signs, as judged by a panel of nine viewing films of them taken before and at the end of this treatment.

Dr Post has been known to generations of students of psychiatry passing through The Maudsley Hospital, London, as a clinician and clinical teacher. He retired in July 1978.

George W. Henry's Sex Variants, published in 1941, presents the frustrating problem of having a valuable body of data which is inaccessible because it is not extracted statistically. It was originally brought out in two volumes and contained close to two hundred pages. It consisted of extensive case histories on 40 male and 40 female homosexuals carefully studied psychiatrically and medically. Each history was accompanied by a chart of the family pedigree. The individuals comprising the study were volunteers, mostly from the professional classes, and in age varied from 20 to about 40 years. Interviews were open-ended as well as by questionnaire and were repeated two years later for validation.