Before 1600 the ‘hysteric affection’ was a paroxysmal ailment of women explained as primarily due to the condition or malposition of the womb. During the seventeenth century attention shifted from the womb to the brain. Then Thomas Sydenham's clinical method yielded a view of hysteria which comprehended a wide range of illness with a mental component, and which was related to the whole person. In the course of this paper the relation of the hysteric affection to witchcraft, demonic possession, St Vitus' dance (chorca), hypochondria and melancholy is also noted.

A sufficient number of studies of geographically defined populations have now been done so as to make it clear that when all the various kinds of mental illnesses are lumped together, the total prevalence rates commonly amount to 20% or more. These findings imply major challenges to theory, policy, administration, and practice in the health field, and point to a need for vastly more information and understanding. This article sketches some of the directions such investigations might take.

Enuresis is a disorder of micturition occurring in the absence of an organic urinary tract lesion. To understand its possible causation, the mechanisms controlling micturition are described together with the possible sites of action of various anti-enuretic agents, particularly imipramine. It is concluded that further research into the central control of micturition is required before the precise actions of centrally-acting anti-enuretic agents can be elucidated. Knowledge of these may give insight into the nature of the defect causing enuresis.

Twenty women with anorexia nervosa were investigated at varying stages during weight gain. Basal prolactin and TSH and prolactin responses to TRH were normal and unrelated to body weight. LH, FSH and 17β oestradiol were low in emaciated patients and rose with weight gain. There was no correlation between serum gonadotrophin and prolactin concentrations. T3 and T4 concentrations were low but T3 rose with weight gain during refeeding over 4–6 weeks, whereas T4 remained low. A positive correlation was found between the TSH response to TRH and body weight.

The abnormalities in the hypothalamic–pituitary–thyroid axis were similar to those seen in a variety of chronic illnesses and appear to be unrelated to the amenorrhoea. The failure of restoration of normal function at least after short-term refeeding requires further investigation.

It was concluded that the amenorrhoea in anorexia nervosa is not associated with changes in prolactin but is determined primarily by changes in the hypothalamic–pituitary–gonadal axis. These changes are induced largely by nutritional factors but psychological factors may also be involved.

Data on the development of a 40-item measure of the symptoms in anorexia nervosa are reported. The scale (EAT) is presented in a 6-point, forced choice, self-report format which is easily administered and scored. The EAT was validated using 2 groups of female anorexia nervosa patients (N = 32 and 33) and female control subjects (N = 34 and 59). Total EAT score was significantly correlated with criterion group membership(r = 0·87, P < 0·001), suggesting a high level of concurrent validity. There was very little overlap in the frequency distributions of the 2 groups and only 7% of the normal controls scored as high as the lowest anorexic patient. Female obese and male subjects also scored significantly lower on the EAT than anorexics. Recovered anorexic patients scored in the normal range on the test, suggesting that the EAT is sensitive to clinical remission.

It has recently been suggested that the bilateral asymmetry of electrodermal activity (EDA) reported in schizophrenia may be related to unilateral temporal lobe dysfunction. To test this hypothesis, 3 aspects of EDA – skin conductance level (SCL), number of spontaneous fluctuations (SF), and skin conductance response (SCR) – were measured bilaterally in 10 patients who had undergone unilateral temporal lobectomy. No differences could be detected between the operated and non-operated sides within the patient group, nor between the patient and control groups. The implications of these findings are discussed.

Eleven behaviourally abnormal XYY males who had been treated in a structured combined programme of antiandrogen medication and counselling were followed up 1 year after cessation of the programme. Behavioural ratings were made in each of 5 categories: assault against people, destructiveness against things, threatening behaviour, stealing, and self-harming. On examining the follow-up findings, therapeutic success appeared questionable.

Emotional disturbance was assessed in a group of women in the first few days following childbirth and again 2 months and 1 year following childbirth; the clinical features are described. Variables such as social class, age and parity were not related to the level of emotional disturbance, but a history of marital problems, sexual difficulties, poor relationships with immediate family or disrupted family relationships in childhood were so related.

Twenty-four hour urinary excretion of cyclic AMP (adenosine 3' 5' cyclic monophosphate) was estimated in the same group of women on 2 occasions in the week following childbirth and again 2—3 months later in approximately one third of the original sample. Excretion of cyclic AMP in the few days following delivery was elevated compared with excretion 2—3 months later, and there was a significant rise in urinary excretion of cyclic AMP between the 1st and 2nd urine collections.

Those women showing most emotional disturbance on the 3rd day after delivery and women indicating most mood change in the direction of becoming elated had the highest levels of cyclic AMP in the 2nd urine collection.

In a study of 40 normal men it was found that self-ratings on variability of mood were positively correlated with self-ratings on hysterical traits. These results are similar to those found in normal women and lend support both to the validity of the concept of hysterical personality and to the idea that men and women experience fluctuations of mood in a similar way.

The Leyton Obsessional Inventory was administered to 73 obsessive-compulsive neurotics, and their responses compared with those of 100 normal subjects. The ratio of the mean patient to normal scores ranged from 2·4: 1 for obsessional traits and 3·2: 1 for symptoms to 6·2: 1 for resistance and 12·5: 1 for interference with other activities. A principal components analysis on the patients' replies produced 3 unitary components (household order, personal contamination, and doubting) plus 2 bipolar components (checking/parsimony and desire for closure/unpleasant ruminations). These appeared to be more definitive representations of components identified from a similar analysis on normal subjects, suggesting that obsessional neurotics differ from normal subjects quantitatively rather than qualitatively. A cluster analysis on the patients' responses produced 3 subgroups. Thirty-two patients were predominantly hesitant and indecisive (‘doubters’), 30 were concerned with bodily and clothing contamination (‘contaminators’), and 7 were preoccupied with checking (‘checkers’).

Temporal ordering of core items in the alcohol dependence syndrome was investigated in 38 men admitted to an alcoholism treatment unit. An analysis of rank sums yielded a modal sequence which resembled classical descriptions of alcoholism, though ‘loss of control’ appeared very early.

Fifty-four patients suffering from primary depressive illness were rated on the Newcastle diagnostic scale while taking part in a pharmacokinetic study of amitriptyline therapy, and their clinical response was assessed by the Hamilton Rating Scale for depression. Patients with a Newcastle score of 4−8 showed the best response to amitriptyline. Patients with low Newcastle scores, representing the non-endogenous or neurotic group, responded poorly. Patients with high scores on the Newcastle scale, representing those with marked endogenous features, also responded poorly.

One hundred and fifty-three completed questionnaires received from families with a history of Huntington's chorea were analysed to discover their attitudes towards the disease. Of special interest were: (a) how and when they were first informed about their illness; (b) what effects the knowledge of the hereditary aspects of the disease had on them and on their children; and (c) their reaction to a possible future predictive test

This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: ‘conspicuous morbidity’ by the doctor's own assessments, and ‘probable prevalence’ by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was +0·36, but the range was very wide (0·09–0·60).

The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death.

The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67 % of the variance of correlation coefficient mainly in terms of 2 dimensions: ‘interest and concern’ and ‘conservatism’. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.

Referral rates to psychiatric services in North-East Scotland by 147 individual urban and rural general practitioners were calculated. Among city doctors, the greater the number of years since qualification the more patients were referred. Single-handed city doctors also had very high referral rates. Subsequent interviews were conducted with 76 general practitioners. Topics covered included reasons for referral to psychiatric services. Psychotics, severely depressed patients, alcoholics and violent patients were the most frequently referred groups.

There is considerable difficulty in providing clinicians with statistics relating to their work which are both relevant in content and suitable in style. As a contribution towards the solution of the problem for psychiatrists, a new type of statistical feedback, the Hospital/National Comparison Tables, has been produced in Scotland. In these tables the work of individual hospitals is compared with the work of all other hospitals of the same type. These are critically examined, together with examples of analyses showing the uses to which the data can be put.

Twelve male children were diagnosed with psychological gender disturbances by 3 independent clinical psychologists using independent data sources focusing on behavioural deviance from normal comparison groups, on conventional psychological testing, and on parent report instruments which had been validated on normal comparison samples. These children received a paediatric evaluation consisting of a medical history, complete physical examination, chromosome analysis including 2 cells karyotyped and 15 counted, and sex chromatin studies. All gender disturbed boys were found to be normal genetically and physically with the exception of one subject with one undescended testicle.