This article discusses the trial of a woman accused of murder in 1890 whose defence rested on the claim that she acted unconsciously under the hypnotic influence of her older lover. This relatively banal case brought together two rival schools of French psychiatry – that of J.-M. Charcot in Paris and that of Hippolyte Bernheim in Nancy – and provided a wide-ranging examination of views on the nature of unconscious mental activity as well as the social, political and professional implications that their theories on hypnotism and hysteria contained. Discussions on women's sexuality, family relations, crowd behaviour and political radicalism all played a part in the debate and are examined through the case study that the trial of Gabrielle Bompard permits. Moreover, the trial shed incidental light on the campaign by physicians against amateur healers and hypnotists whom they blamed for unleashing a wave of mass hysteria through their theatrical representations. The episode was one important element in the struggle for the passage of the law of 30 November 1892, which outlawed amateur practitioners and established the medical monopoly over healing in France.

A Delphi study was conducted with a multi-disciplinary group of experts attending a conference on mental illness in primary care settings. Respondents' priorities for research which could maximize benefits for service developments in this field were elicited by asking them to distribute hypothetical annual research budgets among (a) 6 mental health priority areas, and (b) 7 subjects ‘needing’ investigation within the primary care priority area. The respondents' three top-ranked priority areas for research were: (1) primary care; (2) the elderly mentally ill; and (3) chronically disabling mental illness. Their three top-ranked subjects for investigation within the primary care priority area were: (1) the effectiveness of treatment measures; (2) the problems of mental health presenting to primary care services; and (3) the training requirements for family doctors in psychiatric skills.

The results are discussed with reference to the method used and to the economic concepts of programme budgeting and marginal analysis.

In a study of abnormal behaviour in women aged 16–25 in one large group practice a screening instrument and an interview were used to identify Briquet's Syndrome. The prevalence, 2·04 per 1000, was lower than that found in previous studies. The fact that many other patients showed both the high consultation rates and the other correlates of Briquet's Syndrome brings the usefulness of a discrete syndrome into doubt.

Fifty hospitalized patients with bipolar affective disorder were interviewed on discharge from hospital. Over the subsequent 12 months, 36 of these patients were readmitted to hospital. Compared with the remainder, those readmitted had had more past hospital admissions and on interview were rated as being less able to recognize and respond to early symptoms of relapse and were less accepting of medication.

This paper investigates the memory disorder of Alzheimer-type dementia by comparing the performance of Alzheimer patients on selected memory tests with that of Korsakoff patients and healthy controls. Alzheimer patients have deficits in both primary and secondary memory, and this finding is compared with that which pharmacological studies predict would occur on the basis of cholinergic depletion. The deficits in primary memory are unlikely to be accounted for in terms of cholinergic depletion, and provide a possible explanation for the disappointing results of trials of cholinergic replacement therapy in this disorder. On the other hand, the pattern of deficit in secondary memory is entirely consistent with that expected from cholinergic depletion.

Criteria necessary for establishing the existence of qualitatively-different subtypes of a disorder are proposed. A review is made of the existing literature on Alzheimer's Dementia which proposes subtypes on the basis of either psychological or neuropathological data. It is concluded that, as yet, this research has not met the criteria for establishing qualitatively-different subtypes. However, Alzheimer's Dementia does seem to show quantitative variability in a number of respects and this appears to be related to factors of aetiological significance. The possibility that this quantitative variability could provide the basis for subtyping is discussed.

There is a need for a method, useful both to the clinician and to the research worker which can assess both the ‘quantity’ and the ‘quality’ of daily life. In this paper two ‘diary’ methods are described for obtaining accounts of daily activities, social contacts and patterns of interaction from people diagnosed as having multiple sclerosis. The information obtained is compared with that derived from a major decennial national survey of the population aged over 4 years and from a selected group of matched non-patient controls. The paper is divided into two parts, each concentrating on one of the techniques. The first is a postal 24-hour written account; the second a detailed tape-recorded interview known as the ‘Standard Day Interview’. Difficulties and advantages in using these approaches to assess both the quantitative and the qualitative changes during disabling illness are discussed and proposals for developing the methods are presented. Indications of substantive variation in the use of time by samples drawn from the ‘healthy’ and from populations with multiple sclerosis are reported.

The Type A behaviour pattern and other measures of psychological traits and symptom states were assessed in 92 subjects (predominantly male) presenting for coronary angiography. These measures were correlated with three angiographic indices of coronary heart disease (CHD) severity and two clinical indices (angina and the duration of CHD). The only psychological measures associated with atherosclerosis (assessed by angiography) were indices of personality: Type A (the Jenkins Activity Survey), trait tension, trait anxiety and suppression of anger. It was concluded that these traits may have some role in the pathogenesis of coronary atherosclerosis. None of the measures of psychological symptoms showed a significant association with angiography indices. However, depressive symptoms and expressed hostility were associated with the severity of angina and duration of heart disease. It was concluded that these affects are the consequences of the physical disability of CHD.

The 60-item General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS) were administered to a consecutive series of 194 patients with established or presumptive coronary heart disease (CHD) attending an out-patient cardiology unit. The GHQ proved to be a valid instrument for the routine screening of this population. The presence of organic anginal pain was associated with high scores on the GHQ, but with a lower specificity and a higher percentage of false positives. This was not found in patients with atypical or non-cardiac chest pain. These findings suggest a need for an upward revision of the cut-off score on the GHQ in patients with organic anginal pain. False negatives were found predominantly among patients with personality disorders, and in those characterized by the longstanding nature of their symptomatology and by higher levels of defensiveness.

The case histories of 72 women admitted to prison for contempt of court in 1979–83 were reviewed. The sample included 45% of all women imprisoned for contempt in England and Wales over the 5-year period. The contemnors were significantly older than other sentenced prisoners, one third were foreign born and 37–5% were suffering from psychiatric disorder. Two thirds of the mentally disordered group had a paranoid disorder, litigiousness was a prominent feature of their illness, and 52% committed contempt in the context of a matrimonial dispute or a dispute with neighbours. Recent legislation may help to prevent the imprisonment of mentally ill contemnors.

National statistics for railway fatalities in England and Wales show a reduction of train crashes and a fluctuating level of deaths, of which an increasing proportion is from suicide. A closer examination of a two-year sample from the South of England revealed a large proportion of probable suicides and a small proportion of pure accidents. The remainder appeared to have medical, mainly psychiatric, contributions to their death, of which alcohol was an important factor in single young men. Rail suicides appear to be younger, the men less often married, the women more often married, and both sexes less often widowed than other suicides. They included more cases of major psychosis and neurosis, but fewer and less severe alcoholics. Characteristic patterns of this method of suicide are described with examples. Hypotheses to explain the choice of method suggest that it is not related to either volume of traffic, or residence in a rail-dense area or in an area with a high suicide rate, or the proximity of a psychiatric hospital.

It has recently been claimed that Boolean Factor Analysis (BFA) is superior to more traditional approaches to empirical syndrome identification in psychopathology (Weber & Scharfetter, 1984). This paper examines the underlying assumptions and the empirical basis of this claim. A hypothetical data set, with a more complex structure than the examples used by Weber & Scharfetter to support their claim, is analysed by means of both BFA and Ordinary Factor Analysis (OFA). It is shown that, as data sets resemble empirical conditions more closely, BFA may break down completely while OFA continues to yield adequate results.

District psychiatric services often supplement intramural mental health programmes. They usually result in an increase in the number of referrals to the mental health facilities, which reflects a cumulative need for psychiatric examination and treatment in the population. A significant decrease in the annual first referral rates per 1000 inhabitants aged 15 years and above is apparent in an analysis of the trends in the Danish Samsø community psychiatric service from its inception in 1957 until 1982. The average annual rates were 19·4 in the first 5-year period, 10·0 in the second 5-year period, and 8·4 in the ‘steady state period’ from 1967 to 1982. The conclusion is, therefore, that the work load connected with the cumulative need for psychiatric examination and treatment should be terminated in approximately 10 years. A comparison of the two 5-year periods, 1957–61 and 1978–82, demonstrated a decrease in first referral rates in almost all diagnostic groups: this is significant among manic-depressive psychoses, neurotic states and unspecified mental disorders. The rates of no mental disorders and senile and arteriosclerotic psychoses were almost unchanged. In the 10-year age groups there was a decrease in first referral rates for all groups, except for the groups aged 75 years and above whose rates were unchanged. The concept of cumulative need for psychiatric examination and treatment is discussed in relation to the reports of various district psychiatric service programmes in different European countries.

The construction and testing of a short self-report questionnaire identifying social problems, difficulties and dissatisfactions is described. The questionnaire covers housing, occupation, finance, social and leisure activities, child/parent and martial relationships, relationships with relatives, friends, neighbours and workmates, and legal problems. The results of the administration of the questionnaire in a number of settings are provided and discussed, and a final version is included in the Appendix.

The General Health Questionnaire (GHQ-12) (Goldberg, 1972) and the Self Report Questionnaire (SRQ-20) (Harding et al. 1980) were simultaneously validated against the criterion of the Clinical Interview Schedule (CIS) (Goldberg et al. 1970) in three primary care clinics in the city of Sao Paulo, Brazil. A comparison between the two screening instruments was carried out. The product-moment correlation between the two sets of scores was +0·72, and the validation coefficients for the GHQ-12 and the SRQ-20 were respectively: sensitivity 85% and 83%; specificity 79% and 80%; overall misclassification rate 18% and 19%.

The two screening instruments were further compared by the application of Relative Operating Characteristic (ROC) analysis and, again, were found to be very similar in performance. The area under the ROC curve was 0·87 for the GHQ and 0·90 for the SRQ-20 (Z = 0·92, NS). Both psychiatric screening instruments were therefore found to be acceptably valid when assessed against the CIS in three primary care settings in Brazil.

The application of ROC analysis to studies of this kind was feasible and straightforward. It was found to be superior to the conventional method of presentation of validity data. It is recommended that the application of ROC analysis to psychiatric screening studies be further utilized and explored.

The 4th- and 5th-year pupils of four large comprehensive schools, which were broadly typical of the schools serving an urban population, were screened using a multiple criterion approach. The screen results were compared with those found in a younger population drawn from the same area, and a similar rate of efficiency was found. However, in the adolescent age group the screen was more accurate at detecting true negative cases (specificity) but less able to identify true positive cases (sensitivity). Overall, the multiple criterion screen proved more efficient than a variety of single screen criteria, and the findings also suggest that certain screen measures used in adolescence may be more effective at identifying disturbed girls while others are more effective at identifying disturbed boys. This confirms the principle that the choice of screening instruments must be made with reference to their proposed use.