The hallucinations of 23 patients with predominantly religious themes were compared with descriptions of visions from the Middle Ages. Although there were many points of similarity between the two classes of phenomena, none of the medieval visionaries was identified as mentally ill. The role of cultural norms in determining the attribution of mental illness, and the limitations of Euro-American criteria of psychoses, are discussed in the light of these findings.

During recent years there have been important changes in the prevailing concepts of psychiatric disorder, in views concerning the goals of treatment, and in therapeutic strategies and tactics. These changes are reviewed, together with evidence on the efficacy of psychological therapies in the treatment of child psychiatric disorders, in order to consider some of the key clinical and research issues, as well as prospects for the future.

One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan–amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active tratment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the difference was not significant. Plasma amitriptyline and nortriptyline and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.

Assortative mating among 56 married in-patients with primary affective disorders and their spouses was studied by determining the prevalence of psychiatric illness among the spouses by means of direct interviews and standardized diagnostic criteria. A high degree of assortative mating among both male and female patients was observed for total psychiatric illness, broad spectrum affective illness and major depression. A significantly higher prevalence of psychiatric and affective illness was found among the first-degree relatives of the ill spouses when compared with the first-degree relatives of the well spouses. There was a high degree of diagnostic concordance between the patients and spouses for both affective illness and alcoholism, with a higher degree of assortative mating among bipolar patients than among unipolar patients. The finding in this study of an increased prevalence of psychiatric disorder in the first-degree relatives of the ill spouses would support the hypothesis that there is a tendency for individuals with a predisposition to psychiatric illness to marry, rather than the existence of a marital interaction which causes an increased concordance for psychiatric illness.

Cluster analyses with 60 depressive patients resulted in a division of the patients into 4 groups: (1) one main group of endogenous depressives; (2), (3) two mixed groups, indicating that it is not always possible to distinguish between endogenous and neurotic depression by means of symptoms; (4) one group of neurotic depressives. Our interpretation of the results is that the latter 3 clusters differ from the main group of endogenous depressives by their greater inner involvement with the world around them, though this involvement assumes different forms in the 3 groups.

Higher than normal auditory thresholds were demonstrated in chronic schizophrenic patients. A greater right ear sensitivity than left was exhibited, although right ear superiority diminished with repeated testing over weeks while left ear thresholds remained relatively stable. The results of acoustic impedance measures suggest that these findings are not associated with peripheral outer and middle ear disorders.

In a 2-year study of conjugal bereavement, 26 of 99 women remained highly distressed throughout the course of the study. Of the remaining 73 women, 30 never gave evidence of ‘high distress’. Deficits in social support, health and financial problems correlate with enduring ‘high distress’. Personality traits consonant with a socially acceptable and expected ‘widow role’ were found to differentiate the women with enduring ‘low distress’.

Two age cohorts of young people were interviewed at times up to 2½ years after leaving school to investigate the association between unemployment and risk of minor psychiatric morbidity, as assessed by the General Health Questionnaire (GHQ), taking into account differences due to sex, ethnic group and educational qualifications. Cross-sectional data are presented on 2767 interviews. The psychometric properties of the GHQ justified the use of a total score. Although females had a higher risk of psychiatric morbidity, the strongest association was between unemployment and GHQ. The association between unemployment and GHQ scores was shown to be present after controlling for sex, ethnic group and educational qualification differences. Longitudinal analyses showed that the experience of unemployment was more likely to create increased symptoms, rather than the reverse.

After the journalists of a national newspaper had been issued with redundancy notices, a prospective study was carried Out to examine the effect of the threat of their redundancy on minor psychiatric morbidity. Following the subsequent withdrawal of redundancy notices, there was considerable reduction in minor symptomatology, and the implications of this are discussed.

Emotional distress as assessed by the self-report Hopkins Symptom Checklist (HSCL) was examined in a sample of 607 urban black high school students aged 15–18. These adolescents reported high distress primarily about feelings of disadvantage, volatile anger, interpersonal sensitivity and loneliness. Females were significantly more likely than males to indicate emotional distress, although several of the leading distress items were endorsed equally by both groups. Male and female scores across the HSCL factors differed in degree rather than form. The great majority of these adolescents did not report significant emotional distress. These data provide a base from a non-clinical sample for comparison with other adolescent groups where emotional distress may play a role.

A study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12·5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20–30% higher than in the rest of the United Kindom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45–59 years; neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.

Visual artists of acknowledged creativity but not students with divergent thinking showed allusive (loose) thinking on an Object Sorting Test. It was concluded that high but not low level creativity in some fields may be associated with a predisposition to schizophrenia.

Previous investigations have reported an increased rate of behavioural disorder in children with epilepsy. The role, if any, played by temporal lobe epilepsy (TLE) in predisposing to psychopathology is unclear. In order to evaluate the relationship between seizure type and psychopathology, 35 children with TLE were compared with 48 children with primary generalized epilepsies (GE) on standardized measures of social competence, aggression and overall behavioural disorder via analyses of covariance. Additionally, Pearson correlations were computed in order to evaluate the relationships between psychopathology and several seizure and subject variables. It was found that the presence of TLE per se bore no relationship to aggression, social competence or overall behavioural disorder. Some specific subject- and seizure-related variables were found to be associated with increased aggression and behavioural dysfunction in children with TLE and the interpretation of these findings are related to the larger epilepsy/psychopathology literature. Finally, an alternative approach for studying the precursors of behavioural disorder in epilepsy is suggested.

A new diagnostic instrument, The Diagnostic Interview Schedule, was evaluated for use by lay interviewers by comparing its DSM-III diagnoses when given by lay interviewers with results obtained through an independent interview by a psychiatrist using the same schedule, his clinical judgement after the interview, his clinical judgement after both the interview and a free question period, and with diagnoses on the medical chart.

Psychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for a large sample of female anorexia nervosa (N = 160) and female comparison (N = 140) subjects. An abbreviated 26-item version of the EAT (EAT-26) is proposed, based on a factor analysis of the original scale (EAT-40). The EAT-26 is highly correlated with the EAT-40 (r = 0·98) and three factors form subscales which are meaningfully related to bulimia, weight, body-image variables and psychological symptoms. Whereas there are no differces between bulimic and restricter anorexia nervosa patients on the total EAT-26 and EAT-40 scores, these groups do indicate significant differences on EAT-26 fractors. Norms for the anorexia nervosa and female comparison subjects are presented for the EAT-26, EAT-40 and the EAT-26 factors. It is concluded that the EAT-26 is a reliable, valid and economical instrument which may be useful as an objective measure of the symptoms of anorexia nervosa.

Various types of reliability measures were conducted on the Disability Assessment Schedule, a structured interview devised to elicit from parents or care staff details of impairments, skills and behaviour problems in mentally retarded children and adults. The results indicated high overall agreement when the schedule was repeated over time, and also when used by several trained interviewers to rate the same interview. Problems arising from the use of such interview schedules are discussed, and suggestions are made for improving the design and method of administration.