In the early moderera the notion of imagination was made responsible for phenomena which were later explained in terms of embryology, genetics, psychology, bacteriology or other scientific disciplines. Images, often seated in the upper abdomen (hypochondriac region) or the womb (hysteria), were regarded as powerful influences on material reality. In the course of the seventeenth and eighteenth centuries the hypochondriac forms of imagination became mere whims and spleens, but they kept much of their original potency in respect of the uterus, accounting for monstrosities and the shaping of human offspring. The hysterical conversion of imagination into somatic phenomena has never been questioned. Since the two World Wars the realm of imagination has again expanded beyond the uterus and the older disease-concepts. In the last 10–20 years images seem to have regained some of their original creative force.

Behavioural psychotherapy has long historical roots. Recently it has led to effective treatment for selected neuroses, including phobic, obsessive-compulsive and sexual disorders. Potent therapy has become a tool of experimental psychopathology which advances theory and practice. A pervasive principle is exposure of the patient to those stimuli which evoke his discomfort until this subsides. Level of arousal during exposure does not affect outcome. Theoretical issues are reviewed which decide when exposure will be sensitizing or habituating. Both psychoanalytical and conditioning models of neurosis are out of date, and models derived more directly from clinical experiment are becoming possible. The aetiology of phobias and rituals can be seen as failed extinction rather than enhanced acquisition. Relevant phylogenetic and biological factors are discussed. At the other extreme, well-documented faith-healing indicates huge gaps in our knowledge of psychotherapy.

An account is given of the role of an attached social worker to a primary care team in the management of chronic neurotic illness in the community. The medico-social implications of the findings are discussed.

The characteristics of patients and information-gathering processes in general practice consultations producing prescriptions for antibiotics and psychotropic drugs are discussed. The contribution of patients presenting symptoms and the exploration of these by the general practitioner in the prescribing of psychotropic drugs, is compred with that of diagnosis.

Two earlier studies conducted in the vicinity of London (Heathrow) Airport compared the rate of admissions to a psychiatric hospital from areas exposed to different levels of aircraft noise. Their methods and results were not identical. A third study, reported here, examined standardized rates of admission to the same hospital for a longer period and for a larger area divided into 4 bands of aircraft noise. Statistically significant trends of decreasing admission with increasing noise levels were found. Comparisons between the investigations show how the contradictory results are related to the methods used and the accuracy of the data, and that caution should be exercised in formulating conclusions from exploratory research.

Perception of body size, subjective experience of body image distortions and differentiation of body concept in the human figure drawing were assessed in adolescent anorexia nervosa patients and controls shortly after hospital admission, and again 6 months later during the recuperative phase. Size estimation was not found to be a distinguishing variable, as both groups exhibited overestimation tendencies of comparable magnitude at both time periods. By contrast, experiences denoting estrangement from the body, insensitivity to body sensations, and weakness of body boundaries were more prevalent in anorexics, and persisted at high levels after frank symptoms of weight and eating disorder had subsided. Anorexics were also shown to depict the human figure with less differentiation relative to controls. Within the anorexic sample the presence of vomiting was linked to greater subjective experience of body image distortion, and such phenomena appear to be a more enduring feature in this subgroup. Overall, the results were viewed as lending support to the argument that defects in body image formation render the anorexic vulnerable to their manifest pathology, which is itself activated by maturational conflicts unique to adolescence.

Patients with anorexia nervosa have previously been shown to display disturbances in visual self-perception and interoception. In the present investigation we wished to determine the stability of these disturbances and the effects of weight gain on them. We studied 29 females, 16 patients with primary anorexia nervosa and 13 controls, who had also been studied one year previously. Each subject took part in investigations of body image, using a distorting photograph technique, and interoception, using a satiety aversion to sucrose test. We found that some anorexic subjects tend to overestimate body size and have an absence of aversion to repeated sucrose tastes. Moreover, these disturbances were stable over the year and were not affected by weight change.

The origins of present misconceptions of pathological intoxication are reviewed, and the main symptoms examined in relation to possible aetiological factors. The diagnosis is infrequently made in clinical practice, and has little use in court in cases of alcohol-related violence. It is suggested that ‘pathological drunkenness’ (lCD 291.4) should be removed from the International Classification of Diseases.

Certain specificities of the human leukocyte antigen (HLA) system have been shown to be associated with particular diseases. A review of recent studies in schizophrenia shows inconsistent results for schizophrenia as a whole, although a significant increase in HLA A28 remains on combining the data. There are more consistent findings for disease subtypes. In particular, HLA A9 and HLA CW4 are increased in paranoid schizophrenics, while HLA Al and the A1–B8 haplotype are increased in nuclear forms. It is postulated that the relationship between the schizophrenias and certain HLA types could be due to an influence of the latter upon neuronal postsynaptic membrane sensitivity to central neurotransmitters such as dopamine.

Platelet MAO activity was found to be elevated in primary depressive illness, and the severity to correlate positively with MAO activity. The reactive depression subgroup's mean platelet MAO activity was not significantly different from that of the controls. The endogenous group's unipolar and bipolar subgroups had significantly different platelet MAO activity, respectively high and low. The differences in MAO activity between unipolar and bipolar patients appeared to persist in the well state, but not after lithium carbonate therapy. These differences in MAO activity were apparent with the substrate tyramine but not with benzylamine. Altered MAO activity in patients with affective disorders may be determined through genetic mechanisms.

Depressed affect as a cause of associated somatic problems is explored by means of data on affect, appetite, energy, and sleep collected from a community sample and from subsamples contacted after each of several time lags. The analysis of the data indicates that depressed affect is a cause of the major somatic problems associated with it. It is suspected that depressed affect involves continuing high density neural firing which, over a period of months, causes a reduction of post- synaptic biogenic amine receptor cell sensitivity in the brainstem, with the diencephalon as the major site. This results in a functional impairment responsible for the somatic problems.

Thirty-nine male and 90 female patients aged 40 and over, who had been given a primary diagnosis of depression, were followed up for 2⅓;13–4 years. During this period 9 male and 9 female patients died. Five male patients and 1 female died from cancer that had not been diagnosed at the time of their psychiatric admissions. The male cancer deaths are significantly higher than expected. The possible relationships of malignant neoplasm to affective disorder are discussed.

Foulds' short psychiatric screening questionnaire and personality measures were administered to a representative Greek sample. The results were significantly different from British norms, highlighting the importance of the interaction between states and traits in population morbidity and the need for local norms.

Analysis of DHSS statistics from the Mental Health Enquiry for 1975 indicates that, contrary to some predictions, district general hospital psychiatric units (DGHU) are assuming a proportionate share of the burden of hospital care for most groups of mentally ill individuals. Comparisons of admissions to mental illness hospitals and DGHUs indicate no major differences in most categories of patient characteristics (age, sex, order of admission and diagnosis); where differences do exist, they appear to be decreasing. Concern that DGHUs might ‘cream off’ patients with less serious illnesses, with a resultant ‘two-tier’ system of mental hospital care, would thus appear to be unwarranted.

The reliability of 26 items from the ninth edition of the Present State Examination (PSE) was assessed using both the conventional categorical scales and separately constructed analogue scales. Reliability was also calculated when the analogue responses were rescaled down to 2, 3 and 4 categories. The levels of inter-rater agreement obtained were comparable to those achieved in previous studies of PSE reliability, although as expected the levels of agreement on audiotapes were greater than those for independent interviews performed on the same day. These levels were not significantly affected by any of the changes in scale format, but there were apparent differences in reliability depending on the statistics used. In selecting or constructing a psychiatric rating scale, the question of reliability should not influence the choice of a categorical or continuous scale, or the number of scored points in the scale.

Alzheimer's disease confirmed by histological examination is described for the first time in identical twin brothers who both died at the age of 38 years. Their mother died of a dementing illness at the age of 42 years and her brain was atrophied at post mortem.

A further case of anorexia nervosa with an associated urogenital malformation, namely hypospadias, is presented. The prevalence of urogenital abnormalities in patients with anorexia nervosa is much higher than expected on the basis of coincidence.

A relationship between anorexia nervosa and urogenital malformations has been suggested previously. We report a further case with certain unique features.

The activity of platelet monoamine oxidase(MAO)was measured in 22 severely depressed patients before and after treatment with 45 mg and 60 mg phenelzine. The per cent inhibition of platelet MAO after both doses was not related to acetylator status.

Phenelzine, since it is a hydrazine derivative, is probably metabolized by polymorphic acetylation. Patients who were phenotypically slow acetylators have been reported to show a better clinical response (Johnstone & Marsh, 1973) and more side-effects (Evans et al. 1965) to a given dose of phenelzine than patients who were fast acetylators.