One hundred and seven unrelated Danish patients considered to be manic-depressive according to strict diagnostic, symptomatic and course criteria were typed for antigens of the HLA system, the major histocompatibility system in man. Preliminary results from the first 47 patients had previously been reported to suggest a positive association between manic-depressive disorders and HLA-A3, HLA-B7, and HLA-Bw16 and a negative association between such disorders and HLA-B8. Results from the extended series provide confirmatory evidence that there is a positive association between manic-depressive disorders and HLA-Bw16 and also strongly suggest a positive association between HLA-B7 and such disorders. HLA typing may prove to be a useful way of identifying sub-groups of manic-depressive patients for other biological studies. The associations described provide a potential lead for formulating hypotheses about the nature of the biological mechanisms which predispose to manic-depressive disorders.

The capacity of the hypothalamic–pituitary axis to respond with changes in LH release to the negative and positive feedback effects of oestrogen was assessed in 19 patients with anorexia nervosa at different stages of the illness. Ethinyl oestradiol, 200 μg daily for 3 days, was administered and serial estimations of serum LH were carried out during and after the course of oestrogen.

In patients with anorexia nervosa tested when markedly underweight, negative feedback effects of oestrogen were demonstrated in those patients with detectable levels of LH. None of the patients demonstrated positive feedback release of LH to the oestrogen stimulus.

After the resumption of a more normal weight, basal LH levels were higher and negative feedback effects of oestrogen were observed in 11 out of 12 patients. The complete response to oestrogen with a subsequent positive release of LH to the oestrogen stimulus was shown by only 3 patients. Two of these 3 patients maintained a normal weight during the subsequent 6 months and both resumed regular menstruation shortly after the test. Three additional patients who had shown only negative feedback effects of oestrogen on LH release similarly maintained a normal weight and only 1 of them resumed menstruation, starting 3 months after the oestrogen test.

It was concluded that in recovery from anorexia nervosa there is a return of normal hypothalamicpituitary–gonadal activity in a definite sequence with recovery of the hypothalamus to respond normally to the negative feedback effects of oestrogen followed by return of the positive feedback capacity between oestrogen and LH which allows menstruation to resume. The resumption of normal hypothalamic–pituitary function is clearly dependent in part upon correction of the malnutrition. However, after correction of the malnutrition some patients fail to menstruate, and this appears to be determined by a continuing impairment of the hypothalamus to respond normally to the feedback effects of oestrogen upon gonadotrophin release.

The pineal in man is an active endocrine gland throughout life. Historically the gland has been associated with speculation on the nature of mind and its disorders. Modern research is now demonstrating it to be an endocrine gland capable of affecting the brain and behaviour. The implications for future research into this aspect of pineal function are discussed in the context of a critical review of the current literature.

This study examines the influence of 40 mg of propranolol on agoraphobics throughout 5-hour periods of exposure in vivo on 3 alternate days. Twenty-three patients were studied using a double-blind parallel design and 19 followed up for 3 months. The propranolol group spent significantly less time than the placebo group travelling alone in the month after treatment, and had improved significantly less on a measure of general symptoms at 3 months. The adverse influence of propranolol on treatment outcome appeared mainly due to a waning effect in the last hour of exposure. Attempts to measure coping with panics as an independent variable were largely unsuccessful.

Serum total androgens were estimated by radioimmunoassay on blood samples of treatment-seeking homosexuals and heterosexual controls. There was no significant difference in androgen levels between the homosexual and control group, nor was there any relationship between androgen levels and response to treatment. These results suggest that androgen levels have no aetiological significance in treatment-seeking homosexuals and have no relevance as indicators of treatment outcome.

Two hundred and thirty-five entrants into the MRC trial for mild to moderate hypertension were matched with control subjects in order to assess the psychological effects of a screening programme and recruitment into a clinical trial. The prevalence and incidence of psychiatric morbidity among the trial participants were compared with those of the controls by means of responses to a self-administered questionnaire and diagnostic psychiatric interviews. No differences among the groups were shown between screening and entry into the trial, but after entry the prevalence of psychiatric morbidity among the trial participants fell. This was due to a greater improvement of those with psychiatric symptoms at entry in this group, the incidence of new morbidity being similar among the groups.

The concept of allusive thinking is briefly reviewed and a Pavlovian model of thinking advanced. It is hypothesized that allusive, as compared with non-allusive thinkers, have a broader but less intense attention process associated with weaker inhibition. From this model it was predicted that on word tests which require judgements of similarity of meaning, allusive thinkers would tend to choose more remote or unusual words as similar in meaning.

The Word Halo Test and the Word Sorting Test were administered to 63 university students using the Object Sorting Test as a measure of allusive thinking. The prediction that allusive thinkers would choose more unusual words as similar in meaning was supported. A tendency for allusive thinkers to be more verbose than non-allusive thinkers was also noted.

The 52-item Illness Behaviour Questionnaire (IBQ) was administered to 134 general practice patients of Greek, Anglo-Greek, and Anglo-Saxon origin. Responses were scored on 7 dimensions of illness behaviour labelled general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial and irritability. Results of a three-way analysis of variance (ethnicity, age and sex) indicated that Greek patients were significantly more likely to differ from their Anglo-Saxon counterparts on the initial 3 IBQ scales. Compared with the Anglo-Saxon group, the Greek sample showed greater hypochrondriacal concern, were more likely to manifest conviction as to the presence of serious physical disease, and took a more somatic view of illness. Anglo-Greek patients varied from one scale to another in the degree to which their responses resembled the pattern of illness behaviour reported by Greek patients. They were most similar to the latter in their hypochondriacal attitude, and least similar in their psychological perception of illness. Although the IBQ responses to the Greek sample were consistent with patterns described in other studies of Mediterranean cultural groups, it was found that relationships observed between ethnicity and illness behaviour were to some extent dependent upon age and sex.

A modified version of the Manic State Rating Scale comprising 28 items with a glossary has been tested on 16 manic patients. The scale has satisfactory inter-rater reliability and appears to be valid.

Thirty chronic bronchitic patients with severe airways obstruction were individually matched with non-bronchitic controls from the general population. The 2 groups were compared using the Zung Self-Rating Depression Scale (SDS) and the General Health Questionnaire (GHQ) to assess non-psychotic psychiatric disturbance, the Eysenck Personality Inventory (EPI) to assess personality traits, and the Marlowe–Crowne (M–C) scale plus the L (Lie) scale of the EPI to assess social-desirability response set. Chronic bronchitic patients were both more psychiatrically disturbed and more neurotic in personality than were their matched controls; but there were no differences between the 2 groups on the personality trait of extraversion or on measure of social desirability response set. The results are discussed in the context of both chronic bronchitis specifically and chronic illness in general, and future investigations are proposed.

Patterns of adult psychiatric referral, of child guidance referral and of juvenile delinquency in a metropolitan borough were examined. The 3 sets of rates showed parallel trends among the 20 electoral wards of the borough, all 3 being similarly related to socio-demographic indices. A cluster analysis technique was used to combine the 450 enumeration districts of the borough into 22 clusters defined by social characteristics rather than by geographical boundaries. Ecological correlates of treated psychiatric disorder and of delinquency, based on these clusters, were found to be similar to those derived from the electoral ward data.

The findings suggest that it may be possible to demarcate relatively small urban areas with high concentrations of psychiatric disorder, maladjustment and delinquency.

The method is described of a point-prevalence survey of minor psychiatric morbidity among a sample of healthy community residents. The General Health Questionnaire was used as the sole means of case identification. The demographic characteristics of the sample were compared in detail with those of the total population. The factors mainly responsible for sample bias were difficulty with the English language, the varying degree of personal contact made with residents, and the difficulty in contacting the employed population during working hours. The overall response rate of the survey was 66·%. The demographic groups found to be at significantly higher risk for minor psychiatric morbidity included women, the young, non-British migrant women, and lower social class men.

Census data from the Danish island of Samsø have provided information on all but 20% of the population. Fifty per cent of the population with past or present mental illness had been referred to the psychiatric service during the 18-year-period 1957–74; the proportion varied from 85 % for patients with psychoses (100 % for schizophrenic patients, and 90% for manic-depressive patients) to 43 % with non-psychotic disorders. The frequency of past and present mental illness was 24 %, higher for women with manic-depressive disorders, psychogenic (reactive) psychoses, and neuroses. The possible reasons for these and other findings are discussed.

A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that nonmedical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviewers. Over a short period of time, such as a week, repeatability is satisfactory.

The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of ‘normal subjects’. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists. The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.

Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countries.