At the beginning of the 19th century France had many experts on the ‘moral treatment of insanity’. Very few of them, however, applied their experience and theories to the role of language in the development of behaviour from childhood on, in the pathogenesis of mental disorders, and in psychotherapy. To Dr. Louis Cerise, one of the founders of the Annales Médico-Psychologiques, belongs the great distinction of formulating a theory which tried to take account of the necessary contribution of language to individual development. In his book Des Fonctions et des Maladies Nerveuses (1842), he put forward a view of the relationship between the individual and society. His concept of ‘the goal of activity’ still merits our attention.

Thirty drug-free patients suffering from chronic anxiety states were compared with 30 normal controls matched for age, sex, and social class on a variety of physiological and psychological measures. The tests included the electroencephalogram, the auditory evoked response, and skin conductance recorded during a passive and an active condition and auditory reaction time, the digit symbol substitution test, and arithmetic. The patients showed increased EEG voltage, shorter latencies of the evoked response, higher skin conductance levels, higher pulse rate and less pupillary constriction, and they responded less to the increase in activation. They also showed impairment on complex psychological tests. It is concluded that pathological anxiety involves an increase in arousal irrelevant to the task and has a disorganizing rather than a facilitating effect on performance.

Twenty outpatients with chronic anxiety states were tested on a large battery of physiological and psychological tests after amylobarbitone sodium, chlordiazepoxide, diazepam, and medazepam given in flexible dosage and compared with a placebo. Each patient received all five treatments for two to four weeks under double-blind conditions, as part of a fully balanced design. The tests included the electroencephalogram, the auditory evoked response, skin conductance, the Digit Symbol Substitution Test, the Gibson Spiral Maze, and arithmetic tests, together with psychiatrist and patient ratings. Correlations within and between the different measures were computed. The benzodiazepines depressed slow wave and increased fast wave activity of the EEG, diminished the evoked response, reduced fluctuations in the skin conductance, and decreased motor speed on the Gibson Maze. Amylobarbitone had less physiological effect but impaired performance on the Gibson Maze and arithmetic tests. Significant correlations were found between the mean Hamilton and patient ratings and the physiological measures. It is concluded that physiological changes show useful correlations with clinical effects.

Twenty outpatients suffering from chronic anxiety states completed a trial of anxiolytic drug therapy. They each received five treatments: amylobarbitone sodium, chlordiazepoxide, diazepam, medazepam, and a placebo in flexible dosage in a fully balanced design, using doubleblind procedures. They were assessed on the Hamilton rating scale for anxiety after a period of two to four weeks on each of the treatments and they completed self-ratings every three days. The selfratings were composed of at least three prime symptoms chosen by the patient himself and phrased in his own words as well as ‘loss of appetite’ and ‘insomnia’. Neither placebo nor amylobarbitone produced any substantial improvement from pre-drug levels of anxiety but all three benzodiazepines produced significant and very similar decreases in both Hamilton ratings and self-ratings. These two measures also correlated highly. The majority of the patients continued with medazepam at the end of the formal trial.

Clorazepate and diazepam were compared with respect to clinical effectiveness and concentrations of benzodiazepine compounds in plasma in 15 severely anxious outpatients. Each patient was studied in a double blind trial incorporating two-week periods of the two drugs and of placebo. The doses were almost equimolar—5 mg diazepam or 7·5 mg clorazepate three times daily. Clinical progress was assessed by visual analogue scales and by the Symptom Rating Test. Psychopathology scores were highest at the end of the placebo periods, and lowest at the end of the clorazepate periods, regardless of the order of treatments. After diazepam, both diazepam and N-desmethyldiazepam (nordiazepam) were detected in blood, and after clorazepate, only N-desmethyldiazepam was detected. N-Desmethyldiazepam concentrations were higher after clorazepate. Clinical progress was apparently related to the concentration of N-desmethyldiazepam in plasma.

The introduction of reserpine into western medical practice led to an outbreak of iatrogenic depression. It also stimulated research into the fundamental biochemical errors underlying depressive illness. In view of this historical incident it is surprising that other drugs used in the treatment of hypertension, especially those producing their therapeutic effects by a similar mechanism to reserpine, have not been more critically evaluated. This field of research calls for valid self-rating instruments in order to survey a large population. Using this method, it was found that there was no evidence of a relation between the administration of methyldopa or other drugs and depressive illness. These findings are an indication that adverse psychiatric effects of drugs for hypertension, and methyldopa in particular, may be less common than is sometimes supposed. It is concluded that the matter should be clarified by a careful prospective study.

Children's daily activities and interactions were quantified from mothers' accounts of the preceding 24-hour period. These ‘diaries’ were obtained on three occasions from 54 families with two pre-school children. Effects of age, birth order, sex, and social class were found which support the findings of other studies: an inverted U-shaped relationship existed between the intensity of attention received and the child's intelligence and developmental quotients. A relatively high correlation between IQ and an affective measure of child care furnished further evidence that the differences in caretaking relevant to intellectual development are qualitative rather than quantitative ones.

Two hundred and forty adult psychiatric patients, comprising 60 phobic, 60 anxious, and 120 depressed patients, were interviewed about problems of school attendance during their childhood. Using a specially designed questionnaire, non-attendance due to school refusal was swparated from that due to truancy. A control population of 120 orthopaedic and dental patients, matched for age and sex with the psychiatric sample, was also interviewed. It was found that school refusal had occurred significantly more often among the psychiatric patients than among the controls (P < 0·05). The incidence of truancy was similar in both groups. Both school refusal and truancy had occurred more frequently in female than in male patients. The results suggest that, contrary to some studies, there is a link between childhood and adult neurotic disorders and that some children who present with problems of school refusal are at risk in adult life.

The difficulties of developing a classification of the non-psychotic disorders of early childhood are discussed. A cluster analysis technique is described for determining whether the pattern of behavioural items in 3 year olds could be used as a basis for such a classification. Among the clusters found were two suggesting conduct and neurotic disorders. Two pieces of evidence suggest that the clusters produced are clinically meaningful and have prognostic significance: (1) a group of children with a high risk for later psychiatrie disorder (children in local authority care) are over-represented in the ‘pathological’ clusters, and (2) the mothers of the children in these latter ‘clusters’ have significantly higher scores than mothers of children in the remaining clusters on an index of mental health one year later. It is suggested that evidence for the psychiatrie syndromes of early life is sufficiently strong to warrant further investigation.

The incidence of past school phobia was surveyed by questionnaire in 786 women under 60 years of age who were members of an agoraphobia correspondence club. Twenty-two per cent admitted to previous school phobia, a proportion similar to that found in 57 non-agoraphobic neurotic controls. Past school phobia predicted an earlier onset of subsequent agoraphobia and a more severe psychiatric state as far as symptoms not specifically agoraphobic were concerned. Adolescent agoraphobic difficulties were more associated with school phobia than with agoraphobia in adult life. It was concluded that school phobia leads to agoraphobia in only a small proportion of cases. Although school phobia may predispose to later agoraphobia, it seems more likely that both conditions reflect a lasting tendency to neurotic illness.

A comparison is made between two forms of treatment for patients with interpersonal difficulties—one, an established treatment in the form of brief psychotherapy, and the other, social skills training, a form of behaviour modification designed to provide or improve the social skills necessary for successful social interaction. In a pilot study using social skills training, six out of seven patients showed marked clinical and social improvement. In the controlled trial, there was evidence that both types of treatment improved behaviour, but that social skills training tended to maintain its effect for longer, even though psychotherapy patients had more than twice the number of therapy hours.

Depressives and matched first admission schizophrenics were compared with respect to life events experienced in the six months before the onset of illness. Depressives reported more events than schizophrenics, but this excess involved only certain types of events. Depressives reported more exits from the social field, and a variety of undesirable events, particularly those involving interpersonal arguments. They reported no more events in some other classes. These findings support previous work involving life events, particularly exits and undesirable events in the genesis of depression, and indicate that qualitative implications of events influence their effects.

This paper reports the relationship between mood, as measured by the Visual Analogue Mood Scale, and digit-symbol performance within individual hospitalized patients in a consecutive series of admissions with functional psychiatric disorders. It confirms the earlier finding of Folstein and Luria that a significant mood-digit-symbol relationship distinguishes clear cases of affective psychoses from clear non-affective disorders. Furthermore, it shows that, among patients who do not present with classical affective syndromes, those who manifest a significant mood-digit-symbol relationship tend to receive specific treatments for mood disturbances, have a positive family history of depression or mania, and improve significantly at discharge.

Standardized clinical instruments were used to examine a consecutive series of 89 mental hospital admissions in the west of Ireland and 174 admissions representative of mental hospital admissions in London. The diagnoses given to these patients by the U.S./U.K. Project psychiatrists were compared with diagnoses given the same patients by the hospital psychiatrists in the two countries. Similar levels of agreement were obtained between hospital and Project psychiatrists in the two countries and, where the alcoholic patients were removed, the proportion diagnosed as schizophrenic by the Project in the two samples was identical.

Much of the development of behavioural methods of treatment for phobic anxiety has relied on volunteer subjects participating in analogue studies investigating appropriate procedures. In this study a group of volunteer subjects with specific phobias is compared on psychometric tests with phobic patients and a normal control group. Results indicate significant differences between the volunteers and patients, in spite of the two groups sharing a common disabling symptom. The patients are distinguished by their high level of neuroticism, anxiety, and general psychiatric symptomology. Such differences raise difficulties of interpretation and indicate the need for caution in the extrapolation of analogue study results to the clinical situation.

This paper presents findings from a controlled investigation of psychomotor performance in depression and mania to test Court's (1968) continuum model. This model proposes that, unlike the common bipolar view of depression and mania, there is a continuum ranging from normal, through depression, to mania. Simple reaction time measures did not confirm this hypothesis. However, results of more complex psychomotor performance did provide some confirmation, and, also, provided evidence of a ‘central processing’ deficit in both manic and depressed subjects.

On the Aubert illusion, involving judgement of visual vertical in the absence of visual field cues, depressed patients were shown to display regressive tendencies compared with controls. In fact, their performance was very similar to that of children. However, their performance at judging postural vertical without the use of visual field cues was normal. The impaired performance of the depressed patients was compared with the deficits observed on the same experimental tasks for various other groups of patients with psychiatric or neurological disorders.

The Unit for Research on Addictive Drugs, University of Aberdeen, was established in October 1973 in order to facilitate the continuation and expansion of the research activities of the Department of Pharmacology in the field of narcotic analgesics when Professor H. W. Kosterlitz retired from the Chair of Pharmacology. The formation of the unit was made possible by the provision of sufficient laboratory and office space by the university, by the continuing support from the U.S. Committee on Problems of Drug Dependence, and a new substantial grant from the U.S. National Institute of Mental Health (Special Action Office of Drug Abuse Prevention), now provided by the National Institute on Drug Abuse.