A representative sample of 105 women were assessed by Goldberg's Standardised Psychiatric Interview (SPI) on two occasions during pregnancy and twice more in the puerperium. Total SPI scores increased significantly after childbirth. Thirteen out of the sample had a severe postnatal depression and a further 17 women had milder depression, which in 15 lasted at least four weeks. Marked deterioration of their marital relationships was reported by the depressed women but no other social or obstetric characteristics of postnatal depression were found. Women with severe postnatal blues were particularly at risk of developing persistent depressive symptoms subsequently. The only two women referred to a psychiatrist had personality disorders rather than depressive illnesses.

In contrast to all previous reports of psychoses in genetically identical siblings, identical triplets aged 28 were discordant by major Kraepelinian type of psychosis. Two of them had been diagnosed schizophrenic while the third was diagnosed manic depressive. Re-evaluation of their illnesses using standardized methods and diagnosis by blind raters suggested that the discordance was not due to simple misdiagnosis or different diagnostic bias between psychiatrists. These triplets illustrate some of the shortcomings of a strictly applied Kraepelinian dichotomy and show that a genetic perspective is important in attempting to resolve the classificatory problems of atypical psychoses.

Almost invariably, a professional man becomes the captive of his chosen profession. His training and his subsequent experience in practice leave an indelible mark. It is often said that married couples grow to look like each other, and in extreme cases like their dogs. So lawyers, accountants, bank managers, doctors and perhaps even psychiatrists appear to take on a stereotyped form. The cartoonist spots the uniform clothes, the rimless glasses or the mid-European accent, as the trade mark of the particular profession. But more crucially there is also the growth of stereotyped modes of thought, of common assumptions and traditional patterns of argument which are to a large extent subconscious and so more likely to pass unnoticed.

One hundred and fifty-six women with menorrhagia of benign origin were interviewed before hysterectomy, and re-interviewed six months post-operatively (n = 147), and again 18 months post-operatively (n = 148). Levels of psychiatric morbidity were significantly higher before the operation than after. On the Present State Examination, 58 per cent of patients were psychiatric cases before surgery, as against 29 per cent at the 18-month follow-up. Similar post-operative improvements were found on measures of mood (POMS), and of psychosexual and social functioning. Most of these improvements had occurred within three to six months after the operation. Both before and after hysterectomy, levels of psychiatric morbidity were high by comparison with women in the general population, but lower than in psychiatric patients. The pre-operative psychiatric morbidity had been mainly of long duration.

The results described are based on data from 47 male and 83 female patients randomly assigned to treatment with imipramine or phenelzine in an open trial. All were fresh (untreated) cases diagnosed as suffering from depressive illness (melancholia). They were rated before treatment and 2 and four months later. Imipramine did not give results which were significantly better than phenelzine. With both drugs it was found that patients had done either very well or very poorly at follow-up, i.e. the distribution of scores was U-shaped (or bimodal at the least).

The 55 men and 90 women who were unsuitable for treatment with drugs or who had failed to respond to such treatment were given a course of ECT and followed-up at corresponding intervals. The improvement after ECT was better than with drugs and the distribution of scores is quite different. An earlier series of male patients treated with ECT in the pre-drug days did not show as good a response to the treatment.

Twenty-seven diabetic men with erectile impotence were given physical and psychosexual assessments. Physical assessment included vascular and neurological evaluation. Psychosexual assessment was by means of a semi-structured interview. Seven potent diabetic men formed a control group. Patients with erectile failure Had a varied clinical picture which differed from the stereotype of diabetic impotence: morning erections were preserved in over a half (55 per cent), eight patients (30 per cent) had intact spontaneous erections, and sexual interest was reduced in 12 patients (44 per cent). In 13 patients (48 per cent) ejaculation was disturbed and a further four patients (15 per cent) described unusual disorders of sexual function.

Within the group there were no differences in clinical picture between those with and without autonomic neuropathy, retinopathy or potential psychogenic factors.

In a consecutive sample of 50 adolescents aged 13–18 admitted to hospital after taking overdoses, 90 per cent were girls. There were other clear differences between this sample and adolescents in general. Twenty-four per cent had visited their general practitioners in the previous week, and 50 per cent during the previous month. The most common difficulties preceding the overdoses were problems with parents, boy or girlfriends, and with school or work, including unemployment. A substantial proportion of the subjects had recent or current physical ill health. In the majority of cases the problems appeared to be transient so that one month later two-thirds of the adolescents had shown considerable general improvement. However, 14 per cent were referred to hospital for further self-poisoning or self-injury in the following year. The recent increase in the incidence of self-poisoning among adolescents suggests that more attention must be paid to this group in terms of both primary and secondary prevention.

In a two-year period, 186 patients were admitted from Heathrow Airport to the nearest psychiatric hospital. Affective illness was related to time zone change. Depression was diagnosed significantly more often on flights from east to west (P < 0.012 east to west versus west to east; P < 0.015 north to south combined with south to north versus east to west, Fisher's exact probability test, two tailed). Hypomania was inversely related to depression in an east to west comparison (P < 0.025). No other associations with direction of travel were seen in other diagnoses. Ninety-three (50 per cent) were diagnosed as schizophrenic; 24 of these had been aimlessly wandering. Twenty patients had been admitted at least once before under similar circumstances. Schizophrenic patients from Heathrow constituted 20 per cent of the total number of schizophrenic patients admitted to the hospital during that period.

This pilot study seeks to identify the psychological problems in middle aged and elderly subjects with impaired hearing, and to determine whether hearing aids improve these.

The results indicate three main areas of psychological handicap and suggest that these are reduced by the provision of a hearing aid.

A characteristic withdrawal reaction following the cessation of long-term benzodiazepine treatment in seven patients was accompanied by a significant increase in output of urinary monoamine oxidase inhibitor. This finding provides further support for the concept that the urinary inhibitor excretion pattern may be related to stress or anxiety.

For a foreign observer who has been trained in German and French psychopathology, British psychiatry is very attractive at first glance for a number of reasons. Its eclectic and principally non-theoretical approach (Cooper, 1975), characterized by an open acceptance of foreign concepts and by the tendency to question traditional structures and hypotheses and to test them by means of statistical methods, appears most impressive. The substantial contribution British authors have made toward the development of structured tools in psychopathology, like for instance the Present State Examination or the Hamilton Rating Scale in order to facilitate such a statistical evaluation, which reflects clearly the inheritance of Sir Francis Galton, is also a cause of sincere admiration. The European observer realizes furthermore that the British approach is rooted mainly in continental, especially in German, clinical psychiatry, and is not as heavily influenced by psychodynamic theories as, for instance, the American schools were, at least until recently. This provides him with a comfortable feeling of familiarity and he is not inclined to question certain British tenets until his involvement progresses and he becomes aware of the comparative lack of attention paid by British schools to some of the fundamentals of continental psychopathology.

One hundred and fifty-six patients with monorrhagia of benign origin were interviewed before hysterectomy, and again six months (n = 147) and 18 months (n = 148) after the operation. Psychiatric outcome, measured in terms of PSE cases detected at 18 months, was strongly associated with pre-operative mental state, neuroticism, previous psychiatric history, and family psychiatric history. No association was found with organic pathology in the uterus, bilateral oophorectomy or demographic variables.

The psychiatric morbidity of chronic epileptic out-patients unknown to psychiatric agencies was assessed using two questionnaire measures of psychopathology (GHQ and CCEI). Nearly half of the epileptics were classified as probable psychiatric cases. Psychiatric morbidity was both more prevalent and more severe in this group than in a comparison group of chronic neurological out-patients. Depression, anxiety and hysterical symptomatology were the commonest characteristics of psychiatrically impaired epileptics. The type and severity of epilepsy were found to influence both the degree and pattern of psychiatric morbidity. Contrary to previous findings, age of onset had no relation to psychopathology.

In the well-known condition of primary complete anorgasmia in women, the glandipudendal (‘bulbocavernosus’) reflex is often absent, and this is strongly correlated with failure of treatment. From these facts, and from properties of the glandipudendal reflex, we argue that organic abnormalities in the spinal cord contribute to causing the condition in some cases.

We report nine cases of complete primary anorgasmia in men, two of whom lacked glandipudendal reflexes. The condition need not imply sterility; in all these nine (as also in three incomplete cases) we were able to obtain semen by electroejaculation or vibratory stimulation, and the wife of one patient is now pregnant.

A simple method of classifying adolescent self-poisoners into three sub-groups on the basis of the duration of their problems and the presence or absence of behavioural disturbance is described. The three groups differed markedly in terms of factors concerning their families, especially their relationships with their parents, and in their medical and psychiatric histories, the nature of their overdoses and the problems they were facing at the time. The treatment offered to members of the three groups also differed. The method of classification may offer a useful means of distinguishing between subjects in terms of outcome, including subsequent adjustment and repeat attempts.

Forty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Reality orientation is now extensively used with psychogeriatric patients. The evidence for its effectiveness is reviewed and the underlying philosophy and assumptions are critically examined. Whilst reality orientation does appear to have some effect the benefits are small and restricted in range. It can be argued that it is not directed at the most appropriate therapeutic goals. Reality orientation should be seen as the starting point for the development of more effective intervention techniques for use with this client population and not as an end in itself.

Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations. The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia—Alzheimer type (SDAT). Reliability, validity, and correlational data are discussed. The CDR was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired.

Plasmas of 12 patients currently taking part in a double-blind trial of lecithin in senile or presenile dementia of Alzheimer type were analysed for plasma choline levels at fixed intervals during lecithin treatment. The values were not maintained at a constant level and showed a decline after one or two months of treatment, often followed by a subsequent rise. Possible explanations for this observation are given, and its significance to the treatment of dementia discussed.

Seventy-one neurotic patients requiring follow-up were randomly assigned to routine psychiatric out-patient care or to supportive home visiting from community psychiatric nurses as their main treatment agents and were assessed every six months for 18 months. No differences were found between effectiveness of the two modes of service on symptoms, social adjustment or family burden. Patients seeing community psychiatric nurses reported greater satisfaction with treatment. Community psychiatric nursing resulted in a marked reduction in out-patient contacts with psychiatrists and other staff, more discharges, and a small increase in general practitioner contact for prescribing. Care of such patients by community psychiatric nurses is a valuable alternative mode of deployment within the psychiatric team.