I only met Sir Aubrey Lewis on one occasion and that was in passing. Most of what little I know of his career is derived from the admirable biographical account which Professor Michael Shepherd provided in his Adolf Meyer Lecture delivered to the American Psychiatric Association in 1976 (Shepherd, 1977). But that little is reassuring. Aubrey Lewis clearly took a catholic view of the scope of the field of psychiatry, for at the age of 25 he was combining the study of psychological medicine with anthropological research among the Australian Aborigines! I cannot myself claim this kind of many-sided expertise and, knowing little or nothing about the language or theory or practice of psychiatry, I foresee a problem of communication which calls for the establishment of a frame of discourse.

Brown and his colleagues have presented evidence for the social origins of depression from results of 2 community surveys in Camberwell. This paper examines critically their methodology, conceptualization of variables, mode of argument and statistical techniques. Log-linear analysis of their published data fails to substantiate their differentiation of risk variables into vulnerability factors and provoking agents.

Many of the criticisms of our work made by Tennant & Bebbington in the current edition of this journal touch on issues which have already been discussed in our recent book Social Origins of Depression. We do not think that any of their points pose significant threats to our aetiological model of depression. We welcome this opportunity to clarify their questions about our data, and to use their re-analysis of our material as a basis for a wider discussion of certain general aspects of the statistical analysis and interpretation of data and the pitfalls which await the unwary.

A standardized social interview, designed to assess social maladjustment and dysfunction is described. The interview is composed of items grouped under the 3 headings of Material conditions, Social management and Satisfaction. Ratings are made on a 4-point scale by interviewers standardized in its use. The interview, which takes approximately 45 minutes to administer, covers housing, finance, occupation, social and leisure activities, and relationships with significant individuals in the subject's life. The inter-rater reliability is assessed and principal component analyses performed, and the results of these are provided and discussed. Various methods of scoring are examined and the use of the schedule in a number of studies in the setting of general practice is described.

The Psychosocial Adjustment to Illness Scale (PAIS) was administered to 37 Hodgkin's disease patients and 38 parents of children with Hodgkin's disease or solid tumour, and the scores were analysed for inter-rater reliability as well as construct and criterion validity. A significant inter-rater reliability coefficient was obtained for the total scale score, and also for 6 of the 7 subscale scores. The 7 subscale scores were shown to be relatively independent of each other, with 5 contributing strongly to the total score. Subscales analysed for criterion validity were shown to correlate significantly with independent assessments of their domains of adjustment. Results indicate that the PAIS can be administered by a diverse group of interviewers with an acceptable degree of reliability and with initial confidence in its validity.

Results are compared in studies of 4 male cohorts – 1 all white, 1 all black, and 2 racially representative of the population – growing up in different eras, followed past varying portions of their adult lives, living in different parts of the US. Despite sample differences and differences in sources of information and in the variables used to measure both childhood predictors and adult outcomes, some striking replications appear with respect to childhood predictors of adult antisocial behaviour. All types of antisocial behaviour in childhood predict a high level of antisocial behaviour in adulthood and each kind of adult antisocial behaviour is predicted by the number of childhood antisocial behaviours, indicating that adult and childhood antisocial behaviour both form syndromes and that these syndromes are closely interconnected. Also confirmed across studies are: (1) adult antisocial behaviour virtually requires childhood antisocial behaviour; (2) most antisocial children do not become antisocial adults; (3) the variety of antisocial behaviour in childhood is a better predictor of adult antisocial behaviour than is any particular behaviour; (4) adult antisocial behaviour is better predicted by childhood behaviour than by family background or social class of rearing; (5) social class makes little contribution to the prediction of serious adult antisocial behaviour.

Forty-two couples with marital problems were randomly allocated to conjoint therapy of (i) a directive, (ii) an interpretative or (iii) a supportive (control) type. Self and independent assessment at the end of treatment showed the directive significantly superior to the control procedure on several measures. This superiority was maintained to 18 months' follow-up, when the interpretative procedure also showed some superiority over the control.

Seventy-three patients with the features of ‘cycloid psychosis’, adopted from Perris and Leonhard, were identified from case records. Information concerning background, presenting illness and follow-up was compared with that from the case-records of patients with schizophrenic, affective and schizoaffective psychoses. The characteristic features of ‘cycloid psychosis’ were a female predominance and a remittent course. The ‘cycloid’ group resembled the conventional groups in some respects, but differences from schizophrenic, affective and, to a lesser extent, schizoaffective groups were also striking. The factors which might account for the apparent independence of the ‘cycloid’ group from other diagnostic categories are discussed.

A review of the psychosocial literature relating to Crohn's disease reveals that most available studies have been aetiologically oriented and that there are important gaps in our knowledge about the psychological and social concomitants of the disease. Some future research possibilities are discussed.

Changes in levels of prolactin, growth hormone, luteinizing hormone, and follicle stimulating hormone in serum, and testosterone in plasma, have been studied in 38 patients with acute schizophrenic illnesses in a 4-week double-blind comparison of the 2 isomers of flupenthixol and placebo. Only prolactin showed changes which could be related either to changes in clinical state or to the effects of medication. Prolactin levels increased during treatment with the therapeutically active α-isomer of flupenthixol but were unchanged with the inactive β-isomer and placebo. Although there was a significant relationship between prolactin level and antipsychotic effect in patients on α-flupenthixol, in the individual case prolactin level was not a strong predictor of therapeutic response; and in patients on inactive medication changes in prolactin level could not be related to symptom change. There was a time lag of at least 2 weeks between the increase in prolactin secretion in patients on α-flupenthixol and the therapeutic effect attributable to medication. This delay suggests that if the antipsychotic effect is dependent upon dopamine receptor blockade it is not a direct consequence of this action. Perhaps dopamine receptor blockade permits other, and slower, changes to take place and it is these changes, rather than dopamine receptor blockade itself, which are reflected in clinical improvement.

The possibility that pharmacological response might help to refine psychiatric nosology has been the subject of recurrent speculation, but few clear-cut results have been obtained. Only bipolar depressives and several other minor patient subgroups manifest consistent drug responses in association with characteristic psychobiological features. The presence of multiple intervening variables, such as individual differences in drug metabolism, drug-taking behaviour and biological sensitivity to drugs, may mitigate against the reliable identification of clinically distinguishable drugresponding subgroups. Furthermore, the majority of available psychoactive drugs have either multiple or broad spectrum effects inconsistent with hypotheses utilizing the mechanism or site of drug action to argue for a diagnosis-specific biological disorder at such sites.

Nonetheless the successful use of drug-response models in other areas of medicine suggests a rationale for continued exploration in this area, and a number of recent advances make this approach potentially more productive. Pharmacological developments have rendered it possible to assess the biological availability of drugs in potential responders, thus eliminating some of the confounding intervening variables. Further consideration should also be given to the use of drugs with more specific neurochemical effects, even when they themselves are not necessarily therapeutic. The comparison of drug responder and non-responder groups has also been made more meaningful by the availability of more reliable methods of assessing clinical phenomena, more sophisticated diagnostic models and the introduction of other biological measures. Combining several of these approaches may allow the use of one to validate the other.

This review collates evidence of substantial physical morbidity in patients who receive psychotropic drugs, and evidence that these drugs are not infrequently prescribed for patients with known physical illness. Minor tranquillizers are the psychotropic drugs most commonly prescribed, and the category of physical illness most likely to be associated with psychotropic medication is cardiovascular disease.

Forty-eight medical students took part in a study to assess the value of giving students some feedback about their interviewing skills. During the study they all received training from their clinical firms. In addition, 36 of the students received 1 of 3 types of feedback training. This was given by tutors who used television replays, audiotape replays or ratings of practice interviews conducted by the students.

As in previous studies there was little improvement in the interviewing skills of those students who only received training from their clinical firms. In contrast, all 3 feedback groups improved their ability to elicit accurate and relevant information. However, only the television and audiotape groups also showed gains in techniques. While the differences between these 2 groups were not significant, they all favoured the television group.

Patients admitted to Friern Hospital in 1972 stayed on average for about 5 weeks and spent a total of less than 2 hours individually with senior and junior doctors. Long-stay patients (1 year or more) saw their doctors for an average of less than 1 hour a year. These findings, which in the case of junior doctors were corroborated in 1974, refer only to the time doctors spent with patients alone. The admission, and long-stay discharge rates were greater in the Islington than in the Camden division, and probably reflect differences in clinical practice. It is argued that more psychiatrists are needed – precisely how many will depend on studies of the relative efficiency of different services and training programmes, and on agreement among psychiatrists about minimum professional standards.

One hundred and nineteen primiparae, who were routinely attending ante-natal clinics, were interviewed repeatedly between the 12th and 36th weeks of their pregnancies. The incidence of depression was highest in the first trimester and, overall, about a fifth of the sample was found to be suffering from clinically significant neurotic disturbances. In a proportion of these expectant mothers there was an association between depression and anxiety early in pregnancy and a previous history of induced abortion; this phenomenon may reflect a reactivation of mourning which was previously suppressed.