The attitude to mental illness in early Jewish thought and the contributions of some modern Jewish workers to psychiatry are summarized. The possible associations of mental illness among Jews are discussed.

The clinical and neuropathological features are reported of 10 patients who had suffered, usually for several years, from the after effects of an acute or sub-acute necrotizing encephalitis of the limbic grey matter and of the adjacent temporal lobes. Emphasis is laid on the memory disturbance and on the behavioural and emotional aberrations that tended to occur and that are in some ways reminiscent of the Klüver–Bucy syndrome.

It has been proposed that schizophrenia is a prostaglandin-deficiency disease and also that it is a disease of prostaglandin excess. New evidence is reviewed which suggests that ‘classic’ schizophrenia is due to a specific deficiency of prostaglandin E1 while certain toxic and vitamindeficiency psychoses may be due to a broader spectrum of prostaglandin deficiency. There is also good evidence that a particular schizophrenic subgroup, which includes catatonic schizophrenia but may not be confined to it, is associated with an excess of prostaglandins. Part of the explanation may be that prostaglandin E1 has a ‘bell-shaped’ dose-response curve with high concentrations having effects similar to those of prostaglandin deficiency.

Plasma free tryptophan is significantly decreased in monopolar, depressed patients. No evidence was found to suggest that poor nutritional history prior to hospital admission was responsible for these low levels. Factors known to influence tryptophan—albumin binding in plasma, e.g. concentration of plasma proteins, albumin and non-esterified fatty acids, did not account for the low levels of free tryptophan in depressed patients. A significant decrease in plasma free tryptophan levels was found in perimenopausal but not in pre- or post-menopausal female controls. This mirrors the decrease in circulating oestrogens. Although exogenously administered oestrogens do not have any therapeutic efficacy in relieving mild residual depressive symptoms of lithium treated patients, they increased the levels of plasma free tryptophan. Clofibrate also displaces tryptophan from plasma protein binding sites in both depressed patients and controls. Utilization of the increased levels of plasma free tryptophan is reduced in depressed patients. A situation therefore exists in depressed patients where the plasma free tryptophan is not only reduced but also leaves the plasma less readily than in control subjects.

Evidence from a controlled, comparative trial indicates that oral pimozide is clinically at least as effective as depot injections of fluphenazine decanoate in the continuation therapy of a group of schizophrenic patients discharged from hospital. The administration of pimozide was associated with fewer unwanted effects. The implications of the findings are discussed.

Three hundred and sixty depressed in-patients initialy treated with imipramine, chlorpromazine or a placebo were re-evaluated a year later. Patients showing the poorest adjustment at one year were those who failed to show a good initial response to treatment and those who responded positively to a placebo.

Evoked potentials and reaction times were obtained from chronic schizophrenics and normal controls to light and sound stimuli presented in random order. In the ‘ certain’ condition subjects were told what the next stimulus would be, in the ‘uncertain’ condition they were asked to guess. Amplitudes were usually larger for normals than for schizophrenics, for ‘uncertain’ than for ‘certain’ conditions, and in cross- than in ipsimodal stimulus-sequences. The effect of certainty was stronger in normals across 4 leads; so was the effect of modality shift at vertex. While these findings replicate earlier results from acute schizophrenics, no condition x group interactions could be found in the reaction time measures.

Two additional results were interpreted as showing basically different attitudes with respect to the predictability of events: (1) there was a slow positivity between the verbal information and the following stimuli which was largest for schizophrenics in the conditions of certainty; (2) while normals showed long-term habituation only in N1- but not in P3-amplitudes, the reverse was true for schizophrenics.

The responses of 6 representative physiological parameters frequently assumed to be measures of anxiety along with a set of 4 psychological tests for measuring anxiety were obtained under naturalistic conditions from 25 patients hospitalized with a first myocardial infarction. A canonical correlational analysis failed to show any relationship between anxiety as assessed by the Taylor Manifest Anxiety Scale, Mood Adjective Check List, State-Trait Anxiety Inventory and Multiple Affect Adjective Check List psychological tests, and anxiety as assessed by the physiological indices of heart rate, systolic and diastolic blood pressures, epinephrine, norepinephrine and VMA. The intercorrelation matrix revealed a significant positive pattern of relationships among all 4 psychological tests, a non-significant, positive pattern of relationships among the physiological indices, and a non-significant, negative pattern of relationships between the psychological and physiological measures. The absence of mood-specific physiological measures for anxiety, as measured by the psychological tests, supports previous theory and investigation and points to the inadvisability of assuming that studies on anxiety that use diverse physiological and psychological measures yield results that may be compared as though they were assessing a common mood.

As expected, dements, depressives and patients with a mixed psychopathology were differentiated from one another on the sedation threshold measure and on a number of psychological tests. In depressives responding to treatment significant changes in physiological and psychological measures, which had been reported in an earlier study, could not be replicated except for an increase of psychomotor speed. In the present sample of patients there were significant correlations between various psychological measures and between them and the levels of the sedation threshold, suggesting that sedation thresholds and psychological tests measured related cerebral functions. Evidence obtained from the earlier investigations to the effect that cerebral age changes short of those occurring in dementia may facilitate the occurrence of depression in late life was only weakly confirmed by the replication study.

Previous work suggests that allusive thinkers have a broader attentional process associated with weak central inhibition. The method of dichotic stimulation was used to investigate this concept. Sixty-three university students completed a battery of tests including 2 dichotic listening tasks. The Object Sorting Test was used as a measure of allusive thinking.

Allusive thinkers showed a trend towards impaired shadowing performance. Mislabelling of shadow as distractor words and vice versa, on recall and recognition tasks, showed the strongest correlation with allusive thinking. Such mislabelling was considered to reflect impaired discrimination learning, and provides further support for a hypothesis relating allusive thinking to weak Pavlovian central inhibition.

This review has searched the literature to examine the hypothesis that illegitimate pregnancy in girls of school going age is an indicator of underlying psychopathology and, in particular, that pregnancy or sexual activity provide a form of gratification for otherwise deprived young girls. Surveys suggest that precocious sexual activity is more common in disadvantaged young teenagers and that pregnant schoolgirls are especially likely to come from large families, and to have unskilled parents. There is a suggestion that the younger groups of pregnant teenagers come from unsatisfactory home backgrounds. However, these conclusions are derived from inadequate studies and should be treated with caution.

Relatively few sexually active teenagers use contraceptives but there is no evidence that this represents a subconscious intent to conceive and there is greater support for more straightforward explanations. There is a further suggestion that girls who continue with their pregnancy when the choice for termination is available are more disadvantaged than girls who obtain a termination, although the reasons for this association are not clear. Children born to very young mothers appear to do less well than children born to older mothers. However, it may be that this difference can be attributed to greater overall disadvantage in the younger group rather than to specific age related deficiencies in ‘mothering ability’.

The problems of schoolgirl pregnancy are compounded by interruption of her schooling and early re-conception. There is evidence that these complications can be lessened by the provision of specially designed intervention programmes.

One hundred and twenty-seven out-patients attending a gynaecology clinic completed the General Health Questionnaire (GHQ, 60-item version) and a role problems checklist (RPCL). Principal factors analysis of the GHQ yielded 8 factors which were named: poor performance (which accounted for 63·3 % of total variance), depression-anxiety, sleep-disturbance, anhedonia-anergia, loss of confidence, general illness, social dysfunction and headache. These results were compared with previous principal components analyses of the GHQ (Goldberg, 1972; Goldberg et al. 1976).

A multiple regression analysis indicated that age and 7 of the 8 factors were significantly related to the number of role problems reported by the patients. However, it appears that psychiatric distress (as measured by the GHQ) and role problems were only related to a small degree (multiple R2 = 12·69% only).

Serum folate and B12 estimations were carried out on 272 admissions to a psychiatric unit during 1972 and 1973. 21–3% had serum folate below 2 ng/ml and 26–1% serum B12 below 150 pg/ml. The organic psychosis patients had a significantly lower mean B12 than the others, and were over-represented among the low B12 group. Low B12 status was also associated with low RBC and WBC. Low folate status was linked with depression, malnutrition, physical illness and low Hb, RBC and WBC. There were more chronic alcoholics than others with serum folate > 4·9 ng/ml, low RBC and macrocytosis. The presence of one or more haematological abnormalities (macrocytosis, low Hb, low RBC or low WBC) predicted low folate in 76%, and low B12 in 79%, but these were also found in 40% of the normal folate and 41% of the normal B12 patients. Macrocytosis may prove to be a reliable sign of alcoholic abuse.

Sixteen depressed in-patients from a hospital in Athens were assessed using the Hamilton Rating Scale and the Hostility and Direction of Hostility Questionnaire. Comparison of admission, discharge and mid-treatment scores showed that:

(1) There was a larger drop in depression score in the first half of treatment.

(2) Hostility scores, except for extrapunitiveness, decreased significantly over time, larger changes occurring in the first half of treatment.

(3) Comparisons with British scores showed that during illness there were no significant differences between British and Greeks, though the latter tended to be more extrapunitive. At recovery, the Greeks were significantly more extrapunitive.

The movement of hostility in depressive illness, the validity of the HDHQ and need for national norms are discussed.

This preliminary communication reports that the mothers of 104 schizophrenic patients had: (1) a significantly higher incidence of thyroid disease than a carefully matched control group; (2) significantly more abortions, still-births and greater infant mortality. The findings and possible relevance of thyroid disease to schizophrenia are discussed. Three prospective studies currently in progress are outlined.

Fourteen chronic male schizophrenic patients and six male control subjects were com pared in an escape paradigm involving temporal warning of the presentation of an aversive tone stimulus to which an escape response was to be made. The characteristic heart rate deceleration shown immediately prior to the aversive stimulus by control subjects was absent in the schizophrenic group. Further features of this novel test paradigm distinguished the control and schizophrenic groups. This psychophysiological test procedure may be fruitful for schizophrenia research.