For 150 years the diagnostic concept at first called ‘moral insanity’ has been troubling psychiatric nosologists. Initially emphasis was laid on the affective disturbance in this condition, which was unaccompanied by intellectual impairment. Then its conformity to the idea of a degenerative process became prominent. At various times its relation to epilepsy, hereditary disease, and vice and crime has held the stage. Latterly little advantage has been taken of the information provided about personality by the investigations of psychologists.

Despite diagnostic imprecision and terminological confusion, the concept of personality disorder remains indispensable to clinical psychiatric practice. In relation to the International Classification of Diseases the problems were examined at a seminar which formed part of the World Health Organization's programme on Psychiatric Diagnosis, Classification, and Statistics. The conclusions of the seminar are presented in this paper.

An account is given of how research over the last 30 years has led to progress in the delineation of the mechanisms involved in the genesis of the behaviour covered by the term ‘infantile autism’. The validity, nature, and basis of the syndrome are discussed with reference to treatment.

[Methylene-14C]-L-tryptophan was administered intravenously to five patients suffering from severe depression before and after clinical recovery, and to six control subjects; all subjects were tested while on a standard diet. [14C]-5-Hydroxyindoleacetic acid and [14C]-indoleacetic acid were isolated from urine during the following 48 hours and purified to constant specific radioactivity (SA). From the SA and the determination of the total excretion of the two acids their percentage conversion from labelled tryptophan was estimated. There was no consistent difference found, in patients before and after recovery, or between patients and controls, in the conversion of tryptophan to these indole acids. In another series of 11 depressive patients and 11 controls, plasma total (acid-soluble) tryptophan was measured at frequent intervals up to three hours after intravenous administration of a loading dose (1 g) of L-tryptophan. The height of the curves of plasma tryptophan throughout the three hour period was greater than in the depressive patients, even after they had recovered, than in the controls. It is concluded that the apparent volume of distribution of tryptophan is reduced in depressive individuals. This is consistent with other findings of increased protein-binding of plasma tryptophan and reduced CSF tryptophan levels in depressive patients.

The study was undertaken in order to clarify the clinical pharmacological basis for a correct design of controlled trials of the prophylactic effect of tricyclic antidepressants. Twenty-two patients, successfully treated with nortriptyline (NT) in hospital for endogenous depression, continued the treatment for up to five months in the outpatient clinic. Plasma levels of NT were checked, and ratings were performed regularly. Depressive relapses, all related to low plasma levels of NT, were seen in three patients. The gas Chromatographic method, described in detail, has proved suitable for clinical routine and the results demonstrate the value of monitoring plasma levels in achieving therapeutic control.

Two samples of Special Hospital patients who had posterior temporal slow wave foci were selected and matched for age, sex, and duration of stay with patients from the same hospital who had normal EEG records. A high prevalence of between 20 and 31% was found. No significant differences were found between the index and control groups with regard to a number of developmental, forensic, psychiatric, behavioural, and psychometric variables. A striking feature was the high average age of almost 30 years of the posterior temporal slow wave patients. This finding suggests that the current maturation defect hypothesis in relation to cerebral function in psychopaths requires revision. The possible role of early social and environmental factors in the genesis of these EEG anomalies is discussed.

Videotape recordings were made of brief diagnostic interviews with 27 patients newly admitted to a psychiatric hospital in London and then shown to groups of English-speaking psychiatrists in London, Paris, and Munich. Comparison of the diagnoses made by these three audiences suggests that English, French, and German psychiatrists have similar concepts of schizophrenia, neurotic illness, personality disorder, and alcholism, but differ markedly in their concept of affective illness, particularly manic-depressive illness. English psychiatrists have much broader concepts of both neurotic and psychotic depression and of mania than the French, with German psychiatrists in an intermediate position. Important differences in the use of other technical terms like agitation, perplexity, and thought disorder also emerged. The ratings of the English and German audiences were closer to one another than either was to the French.

Using data collected by the Salford Psychiatric Case Register from 1 January 1968 to 1 January 1972, the current use of psychiatric inpatient beds is presented and trends discussed. Estimates are given for the likely occupancy at 1 January 1982, for short and medium stay (under one year), and long-stay (one year or more) beds. Three methods of projecting the accumulation of new long-stay patients are described and discussed. The total occupancy by 1982 is likely to be about 2·3 beds/1,000 total population, about 1·7/1,000 for long-stay patients.

A method is described for comparing the speed of recall of pleasant and unpleasant experiences. Pleasant experiences have proved to be recalled significantly more quickly than unpleasant experiences in healthy volunteer subjects, and especially in those scoring low on neuroticism or high on extraversion as measured by the Eysenck Personality Inventory. The overall pleasant/unpleasant differential was found to persist on re-testing some months later with an alternative form of the test. The technique appears to be a valid and simple means for exploring hedonic selectivity in memory.

Five emaciated patients suffering from anorexia nervosa were studied. Mean plasma prolactin levels, as measured by radioimmunoassay, were within the normal range, although mean plasma levels of luteinizing hormone were depressed. This association is of interest as it suggests that basal levels of circulating prolactin are not affected by the hypothalamic disorder found in patients with anorexia nervosa.