It has been argued by many biographers of King Ludwig II that he was not mentally ill but simply labelled mad as part of a conspiracy to remove him from the throne. The evidence for his mental disorder is reviewed and the conclusion drawn that he was probably suffering from a schizophrenic illness of some twenty years duration prior to his suicide in 1886.

Some experiments, reported in detail elsewhere, on the effects of mother–infant separation in rhesus monkeys are here reviewed and compared. They involved 4 groups – one in which mothers were removed for 13 days leaving the infant in the social group; one in which infants were removed; one in which mothers and infants were removed and separated; and one in which mothers and infants were removed but not separated. The nature of the separation experience had a profound effect on the infant's response: infants left in a familiar environment while their mothers were removed showed marked but brief ‘protest’ and then profound ‘despair’, whilst infants removed to a strange cage showed more prolonged ‘protest’. A major factor determining the effects of the separation experience in the weeks following reunion is the degree to which the mother–infant relationship has been disturbed by it. The multiplicity of factors affecting the outcome of a separation experience are discussed.

The hypothesis that neuroleptic drugs exert their therapeutic effects by blocking dopaminergic transmission has been investigated by examining the effects of 3 neuroleptic drugs on dopamine turnover in 2 dopaminergically innervated regions of brain – the neostriatum and nucleus accumbens. The drugs chlorpromazine, thioridazine and fluphenazine, known to be therapeutically active in the treatment of schizophrenia, but to have differing incidences of extrapyramidal side effects, were administered to rats in dose ratios approximating to those effective in man. All 3 drugs induced a similar rise in the content of the dopamine metabolite homovanillic acid (HVA) in the nucleus accumbens, whilst the changes in HVA observed in the neostriatum were in the rank order in which these drugs produce extrapyramidal side effects. While the concentrations of dopamine metabolites in the frontal cortex were too low to assess the possibility that neuroleptic drugs have actions at this level, our results are consistent with the hypothesis that these drugs exert their therapeutic effects by dopamine receptor blockade in the nucleus accumbens.

Prolactin, FSH, LH and TSH were determined in repeated samples of serum from 16 unmedicated male patients with chronic schizophrenia. Changes in the mental states between the 2 occasions were related to changes in hormone levels. Significant inverse correlations were established between prolactin and incoherence of speech, between prolactin and total positive symptoms and between FSH and poverty of speech. A significant positive correlation was established between FSH and delusions. These findings are discussed in the context of evidence concerning the role of monoamines in the control of anterior pituitary function, and of the dopamine and other monoamine hypotheses of schizophrenia. Although prolactin secretion was not as low, as would be predicted on the basis of the dopamine overactivity hypothesis of schizophrenia, the relationship between symptom change and change in prolactin secretion was consistent with the hypothesis that increasing symptom severity is associated with increasing dopamine release from the tubero-infundibular system.

Changes in the erythrocyte membrane cation carrier following lithium ingestion in normal human subjects were studied; ouabain sensitive potassium influx fell significantly during the lithium treated phase. Lithium was fed to rats and no change in erythrocyte Na-K ATPase was shown. These findings contrast with studies of lithium in manic depressive psychosis. The fluctuations in the erythrocyte membrane cation carrier were studied in 5 normal subjects over 12 weeks and the correlations between the parameters calculated. The erythrocyte sodium concentration correlated positively with the ouabain sensitive potassium influx. This too contrasts with findings in manic depressive psychosis.

Previous research has suggested that patients suffering from anorexia nervosa tend to overestimate their body size, whereas normal females tend to be very accurate in this respect. This paper presents the results of further investigations of body perception amongst anorexic and normal females. The results, in contrast to earlier findings, indicate no such difference between groups. Detailed analysis of the data, however, points to the likelihood of certain differences between the present group of anorexic patients and previous groups. Moreover, it seems that body perception disturbance is not a consistent feature of anorexia nervosa and is only present amongst some patients at certain stages during their illness. On subdividing the anorexic group it was demonstrated that patients who vomit tend to overestimate their size more than do non-vomiters. It also seems likely that normal females are far from homogeneous in terms of body perception. In line with previous findings, a direct relationship was found between marked overestimation of body size and an early relapse. Evidence is also discussed which suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.

Two alternative explanations of the body-image abnormality in anorexia nervosa patients are outlined: namely, the ‘abnormal sensitivity’ and ‘adaptational failure’ hypotheses. Evidence relating to these 2 conflicting hypotheses was obtained from body-perception measurements carried out on groups of pregnant women.

In the first study 40 pregnant women, at approximately 4 months' duration, were found to overestimate their bodily dimensions, albeit to a lesser extent than the previously tested group of anorexia nervosa patients (Slade & Russell, 1973a). When they were subdivided on the basis of a history of weight change over the previous 12 months, the ‘stable weight’ subgroup was found to overestimate significantly more than the ‘weight gain’ and ‘weight loss’ subgroups.

In a second study 16 of the original group of pregnant women were retested at approximately 8 months' duration. Although their weight and bodily dimensions had increased on retesting, their tendency to overestimate was found to be significantly reduced.

It was concluded that the phenomenon of body-image disorder is not specific to anorexia nervosa, extending not only to patients with obesity and to some normal women, but also to women during pregnancy. Moreover, the ‘abnormal sensitivity’ hypothesis was considered to fit these and other recently accumulated data better than the alternative ‘adaptational failure’ hypothesis. Some of the theoretical and clinical implications of these findings are discussed.

Body image estimations in 86 normal-weight adolescent girls showed (a) a tendency to overestimate body width and underestimate body length and (b) an association between the younger ages and the extent of overestimation of body width. In particular there is a sharp drop in overestimation between ages 10 and 11 and thereafter a more gradual and non-significant decline. These age-specific normative data are useful in assessing body image distortions in a variety of medical and psychiatric disorders.

To test the hypothesis of an association between schizophrenia and coeliac disease, the sera of 380 chronic schizophrenic in-patients in two mental hospitals in the West of Ireland have been screened for the presence of reticulin antibodies. Antibodies were found in 26 patients. Twenty-one of these patients were further studied by proximal duodenal mucosal biopsy. None of the biopsies showed the morphological and histological features found in untreated coeliac disease. The incidence of reticulin antibodies in schizophrenic patients and controls is similar. The findings of this study lead to the rejection of the hypothesis of a positive genetic relationship between schizophrenia and coeliac disease.

On the basis of information abstracted from case histories, 41 patients who had experienced epileptic seizures thought to be due either to treatment with psychiatric drugs or to withdrawal from sedative drugs were compared with a control group of patients. Those who had experienced seizures were more commonly first born and had a history of post-natal brain damage. During the week preceding the seizure there had been a marked increase in drug prescribing. The implications for drug management are discussed.

Seventeen patients with hysterical fits, previously diagnosed and treated by neurologists as epileptics, were distinguished from a matched control group of 17 epileptics by 5 factors: a family history and personal history of psychiatric disorder, attempted suicide, sexual maladjustment, and a current affective syndrome.

The study was undertaken in order to test a dream-rating scale and to propose some modifications, especially for use in laboratory situations, where the effect of a given experimental factor is to be assessed on mental activity in sleep. Dreams collected from normal subjects under EEG monitoring were analysed in detail in order to establish definitions for each rating point of each dimension of the rating scale. The scoring of a second set of dreams by two judges using this scale resulted in an inter-rater agreement significantly above the level of chance agreement.

Measures of depression and undischarged drive were obtained for 292 psychiatric in-patients. In 200 of these cases inhibition of aggression was also assessed. All patients were classified as being endogenously depressed, reactively depressed, or as suffering from non-depressive primary disorders. The latter group was subdivided into secondarily depressed and non-depressed groups. The 3 depressed groups were then compared with the non-depressed subjects in respect of drive level and inhibition of aggression.

All 3 depressed groups showed significantly higher drive level than did the non-depressed subjects. The endogenous depressives also inhibited significantly more of their aggression than did the non-depressed subjects. These results are consistent with a drive inhibition theory of depression. However, while endogenous depression seems to be associated more specifically with the inhibition of aggression, reactive depression may be associated rather with the inhibition of drive generally.

A representative sample of 130 people was interviewed shortly following self-poisoning or self-injury. The interview method is described. Events in the week prior to the attempt, and the incidence of various kinds of chronic problems are reported. Events involving key relationships were much more common than other kinds. The most important event was a quarrel, particularly in the 48 hours prior to the attempts and more common with female than with male attempters. The possible relevance of quarrels to understanding overdose behaviour is discussed.

Nearly a third were receiving non-psychiatric treatment at the time of the ‘attempt’ Approximately one quarter were currently receiving psychiatric treatment and a half had received it at some time. A substantial proportion had been admitted to either psychiatric or non-psychiatric hospitals within the past year.

The proportions indicating the need for various kinds of help are reported. Most people said they needed ‘someone to talk to’. More than half had been in contact with some form of helping agency during the week prior to the attempt. The possible significance of these findings is discussed.

An attempt was made to look for ‘syndromes’ or groupings of problems. The resulting analysis, whilst of interest, did not lead to a satisfactory method for classifying individuals. It was concluded that a more satisfactory typology of ‘attempters’ is likely if types of relationship problems are investigated in more detail.

In a controlled population study 111 families of children with asthma and wheezy bronchitis were screened. The mothers of asthmatics suffered more depressive illness than controls. This correlates with the severity of the child's asthma. There was no difference in immunological status between depressive and non-depressive mothers of asthmatics.

Faculty ratings of 22 foreign medical graduates (‘FMGs’), all of whom entered psychiatric residency training at the University of Missouri–Columbia from 1966 through 1973, were compared with those of a similar group of North American medical graduates (‘AMGs’). An on-going evaluation programme provided data for a variety of parameters ranging from ‘theoretical knowledge’ to ‘clinical skills’. Results indicated that in most areas of performance the median FMG started at a level substantially lower than that of the median AMG and very slowly caught up. When achievement criteria were utilized it became apparent that, at least by the third year of training, ‘superior’ FMGs could equal or surpass the median performance of ‘superior’ AMGs, whereas ‘marginal’ residents, whether foreign or native-born, seldom attained even competence in most major spheres of functioning. Implications of these findings and those in related studies are discussed.

All West Africans and West Indians living in Camberwell who made a psychiatric contact between 1 January 1965 and 31 December 1968 were selected using the Camberwell Psychiatric Register as a sampling frame. Inception rates of psychiatric illness were then calculated using the 1966 10% census figures for West Africans and West Indians in Camberwell. The rates found were compared to those among the British living in Camberwell. For each major diagnostic category, with the exception of reactive depression and paranoid states, the inception rates are significantly higher among West Africans than West Indians. They are also significantly higher among West Indians than the British. However, the differences in inception rates are generally greater between West Africans and West Indians than between the latter and the British.

Chronic in-patients from a sample population of 48 women and 43 men were selected for an experimental hospital-hostel and for local authority hostels. Two-thirds were found suitable for the former but only a sixth for the latter. The problems of selection for and management at the experimental hostel are described, and the overall results discussed in relation to recent proposals for the residential care of chronic patients.