A double-blind, placebo controlled, crossover trial of carbamazepine in 12 severely and profoundly mentally retarded, overactive adult patients is described. The trial lasted 7 months and those patients in whom overactivity was the dominant problem responded to some degree to carbamazepine with a reduction in overactivity. This was particularly so in patients in whom overactivity was accompanied by some elevation of mood. Patients in whom overactivity was part of a wider spectrum of multiple behaviour disorders showed a scatter of responses. There was no relationship between response to carbamazepine and the presence or absence of epilepsy. The trial identified a small group of mentally retarded patients in whom carbamazepine might be clinically useful.

Suicide pacts, though occurring infrequently, are neglected occurrences. They have features distinguishing them single suicides which can be seen as residing in the characteristics of the pact relationship. Dyadic, family and collective suicides are reviewed and found to have several common features, including exclusivity and isolation, the threat of dissolution of the relationship, and the presence of a powerful initiator.

There is little evidence of a curvilinear relationship between pre-operative emotionality and post-operative adjustment, as predicted by a model which supposes that moderate preoperative anxiety assists adjustment. This paper suggests that the negative affect, or stress, associated with the work of worry should be distinguished from the active coping orientation which it also implies. In this study stress and arousal were assessed pre-operatively in a sample of cholecystectomy patients, and correlations between these scores and various indices of post-operative adjustment were computed. Stress before surgery was positively related to stress and pain experienced post-operatively. Arousal, by contrast, was negatively related to pain, medications and period before discharge. Female patients had higher stress scores than the males, while the direction of the difference was reversed in the case of arousal. These findings are interpreted as support for the significance of the role of coping orientation, as represented by arousal, in promoting adjustment, with emotionality or stress playing a less significant and even negative role.

A national community survey of psychological symptom levels among samples of Indian immigrants and natives is reported. Using a quasi-random sampling procedure, a sample of 200 Indian-born residents of large towns in England was selected to match the age and sex structure of the total Indian immigrant population. An indigenous population, selected in the same way, was matched with the immigrants for comparison purposes. Psychological disturbance was measured with the Langner 22-Item Scale which has previously been specifically validated for use in this context. Other indices were constructed to test specific hypotheses.

The pattern revealed by mental hospital admission statistics was strongly supported by survey. Indian immigrants as a group experience far less psychological disorder than natives, despite the experiences of migration and of being an immigrant. On other measures Indians also manifested an adjustment superior to that of natives.

Among the Indian sample stable psychological adjustment was related to being young at migration, being acculturated to life in England and being socially integrated. A subgroup of higher social status, Indian females who had been upwardly socially mobile, emerged as the only group with a higher than average symptom level. However, even this group was at least as well adjusted as its English counterpart.

The strategies used by 40 chronic schizophrenic out-patients with persistent auditory hallucinations to cope with the intrusive phenomena were explored. Frequent coping mechanisms included changes in activity, interpersonal contact, manipulations of physiological arousal, and attentional control. A high risk of suicide was noted.

Coping behaviour appeared somewhat independent of clinical and sociodemographic variables. Successful coping appeared to result from systematic application of widely used coping strategies. The implications for the clinical management of patients with persistent auditory hallucinations are discussed.

One hundred patients, selected to be representative of those attending general practitioners with non-psychotic psychiatric disorders were followed up for one year. standard assessments of mental state, personality, social stresses and supports were carried out for each patient at the outset and after a year.

The outcome for this cohort determined both by the level of psychiatric morbidity at interview after one year and by the pattern of the psychiatric morbidity during the year has been analysed with reference to the assessment measures. Discriminant function analysis indicates that the initial estimate of the severity of the psychiatric morbidity and a rating of the quality of the social life at the time of follow-up are the only factors that significantly predict the psychiatric state after one year. Social measures also predict a pattern of illness charactorized by a rapid recovery after the initial assessemtn. Patients who reported continuous psychiatric morbidity during the year were, older, physically ill and very likely to have recevied psychotropic drugs. Receipt of this medication during the year was associated with initial assessments of abnormality of personality, older age, and a diagnosis of depression.

The findings of this study are seen to support a triaxial assessment and classification of non-psychotic psychiatirc disorders, with symptoms, personality and social state being rated independently.

The clinical features, course, aetiology, epidemiology, differential diagnosis and management of Asperger's syndrome are described. Classification is discussed and reasons are given for including the syndrome, together with early childhood autism, in a wider group of conditions which have, in common, impairment of development of social interaction, communication and imagination.

The perception of and attitude to drinking patterns in recovering problem drinkers (N = 29) is analysed, utilizing a similar methodology to that of Richard & Burley (1978). Fault is found, however, in the latter study both in a failure to define variables and in the authors' statistical handling of the results. In the present study, it was found that controlled drinking is only seen as close to the problem drinker's concept of himself when it entails reasonably high levels of consumption. The importance of this finding for therapy is outlined. The possible negative effects of role conflict are mentioned. It is also found that problem drinkers perceive themselves as having quite different characteristics from those they themselves attribute to alcoholics. This finding is interpreted in terms of the fundamental attribution error (Jones & Nisbett, 1972).

Comprehensive psychosexual histories were elicited from 31 female patients with anorexia nervosa. The subjects showed a wide spectrum of sexual knowledge, attitudes and behaviour. Some appeared to be markedly inhibited, while others were experienced and assertive in regard to sexual matters. Age at interview appeared to be the major factor determining whether individual patients were sexually experienced or not.

A majority of patients felt that a sexual challenge had precipitated their illness, and most reported a decrease in sexual interest and enjoyment following weight loss, particularly when this was severe. The effect of the illness on actual sexual behaviour, however, was variable, some patients decreasing and others increasing their sexual activity.

Three statistical models are presented to describe different aspects of the natural history of depression (as recognized by a general practitioner) during a 20-year study of a single general practice. After controlling for age, the prevalence of recognized depression in men increased during the 20 years of the study (1957–76), but there was little change in women. In any given year, however, women are both more likely to become depressed than men, and are less likely to recover. The changes in prevalence are shown to be due to changes in observed incidence and recovery rates. Taking into account attendances over the previous 5 years at which a diagnosis of depression was made, the models enable one to predict, for example, incidence rates for ‘first episodes’ of recognized depression, and recovery rates for ‘chronic’ patients. In all situations there is a significant sex difference (women always being more likely to be recognized as depressed), but this difference is smaller at the end than at the beginning of the 20 years.

This paper presents some results from a survey conducted in West London in 1977. The 2-week prevalence of psychotropic drug consumption was found to be 10·9 %, an almost identical figure to that obtained in an earlier survey conducted 8 years previously. The reasons for the absence of the expected rise in prevalence of consumption are discussed.

Consumption was found to be strongly associated with various measures of health, and there was a marked sex difference in drug consumption (females > males) which was independent of health.

Computer linkage of obstetric and psychiatric record systems made it possible to identify all women resident in the city of Edinburgh who had given birth to live or stillborn children in 1971–7 and to study (a) the distribution of psychiatric admissions relative to the time of childbirth and (b) the correlates of psychiatric admission in the first 90 days after childbirth. Having a first baby, being unmarried and undergoing Caesarian section were all associated with an increased risk of admission; twin births, perinatal death and maternal age were not. It is difficult to account for these and other established relationships purely in psychological or purely in somatic terms, suggesting that influences of both kinds are probably involved in the genesis of puerperal disorders.

There have been recent attempts to re-define those offenders who are sufficiently dangerous to justify a longer sentence for their current offence than is normally provided in law, but there is little information about the frequency with which serious sexual offenders are reconvicted. Follow-up studies of the re-conviction in the subsequent 24 years and 15 years of those found guilty of rape, incest, and unlawful sexual intercourse with girls under 13 in 1951 and 1961 have therefore been made. The present paper deals with those prosecuted for unlawful sexual intercourse with girls under 13. The results suggest that there is a low but more persistent tendency to re-conviction than is found in property offenders.

We report the eleventh documented case of the concurrence of anorexia nervosa and ‘Turner syndrome’. Although some authors have suggested that the 2 syndromes occur together more often than by chance, and 5% of anorexia nervosa patients karyotyped to date have ‘Turner syndrome’, recent evidence in fact suggests that the 2 conditions do not occur together more often than one would expect by chance.

A two-stage psychiatric survey of a random sample of adults aged 18–64 from Camberwell is described. Agency interviewers carried out the first stage (N = 800), using the shorter form of the Present State Examination (PSE). MRC interviewers, using the full PSE, saw a stratified sample of these (N = 310) in the second stage. A second interview was sought with all those of Index of Definition (ID) level 5 and above at the first interview (‘cases’) and with a random sample of those below that level. 20·9% refused or were never available for the first interview. Of the 800 subjects successfully interviewed, 10% refused a further interview and 12·4% of those finally selected for this interview were either unavailable or changed their minds. The MRC data, weighted to represent the whole sample, are used in our analyses. The prevalence of psychiatric disorder as defined in our study was calculated at 6·1% for men and 14·9% for women. Women shared a higher prevalence of disorder in the age-groups 25–34 and 45–54, but in men there was no significant association with age.

In contrast to the findings of Brown & Harris (1978), social class did not have a strong association with disorder. Single men had much higher rates than married men, while the reverse was true in women. In both sexes employment was associated with lower rates of disorder. An attempt to explain the high prevalence in women in terms of their role in marriage and child-care was only partly successful.

Nine thousand persons admitted to three large psychiatric hospitals, over a period of four years, were classified according to the aircraft noise exposure of their home address, using the Noise and Number Index. The analysis searched first for simple associations between exposure and admission rates, then for complex interactions with socio-economic characteristics of the area of residence. There was no common pattern of admissions across the three hospitals: in one case the rates decreased with aircraft noise; in the other two the rates increased with noise exposure. However, since in all cases the trends could be attributed to non-noise factors characteristic of the population, it was concluded that the effects of noise, if any, could only be small, weakly influencing other causal variables but not overriding them. Further analyses showed that positive associations between noise and admissions occurred in some groups and in some districts. People 45 years old and over exhibited higher admission rates than expected in the highest noise zone in one hospital. The districts where a positive trend between noise and admissions was evident were those with a higher proportion of one-person households, a higher proportion of immigrants, or a higher proportion of professionals and managers; however, these results were only found in one hospital with counterexamples in others. No strong, significant noise effect could be found. Limitations of the hospital records and specific difficulties in setting up the data for these studies are discussed.

The variations in suicide mortality in England and Wales over a 100-year period (1876–1975) are explained by the development of a descriptive model. The model used is a stepwise linear regression using 5 variables including toxic gas production. The variables give a good description of the observed changes in suicide mortality. The limitations of the method and the data are discussed. Despite the limitations of the method, it can be concluded that toxic gas production affected total suicide mortality.

An earlier survey of a random sample of women in Camberwell in South London has shown that the majority of new occurrences of depressive disorders were brought about by certain kinds of life event and ongoing difficulty (provoking agent) and that the risk was increased under these circumstances by the presence of certain other social factors (vulnerability factors). Working-class women were much more likely to develop depression because they experienced more of these factors. A new survey in a rural population in the Outer Hebrides has confirmed the importance of these factors in the genesis of depression, although provoking agents occurred much less frequently in this rural setting. However, integration into the traditional way of life, rather than a middle-class status, was related to a lower chance of developing depression, and this appears to be explained by the relationship of provoking agents and vulnerability factors to such integration in the Outer Hebrides, and to social class status in Camberwell.

Data were gathered on 38 obese women and 16 obese men attending a weight-reduction programme and on an equal number of normal weight controls, regarding accuracy of perception of body width in 4 regions, as well as attitudes towards body size. Obese subjects, particularly women, tended to overestimate body width and to dislike their bodies, but neither of these factors predicted success in losing weight. Age of onset of obesity was not related to degree of adult obesity or to accuracy of estimation of body width.

The occurrence of hierarchical patterns in the incidence of psychiatric symptoms in individual patients and community subjects is investigated. Data obtained from interviewing a sample of people from the population of Camberwell, south-east London, using the Present State Examination (PSE), were analysed as were similar data concerning three series of patients referred to different kinds of psychiatric service.

The population series showed that each of the common PSE symptoms tends to occur in association with other symptoms. Symptoms that are rarer in the general population are associated with the presence of many other symptoms or with other symptoms present to a severe degree. The rarer the symptom, the higher is the total symptom score indicated by its presence. The more indicative symptoms are also associated with a measure of social disability derived from the MRC Social Performance Schedule, which asks about serious problems in functioning in each of 8 role areas.

The implication of this study is that total symptom score is a valid measure of the current severity of the disorder. The hierarchy model of Foulds & Bedford (1975) is discussed and is shown to be a more specific formulation of the same idea.

Investigation of the referred series confirmed these conclusions. When compared with community subjects, patients tend to have a much higher total PSE score; they display symptoms which are very rare in the community; they tend to be disabled socially. However, they are less likely to fulfil the requirements of a specific formulation for the presence of minor symptoms. In particular, only about half of psychotic subjects display specific neurotic symptoms, although virtually every subject with ‘specific’ symptoms of some sort displayed non-specific neurotic symptoms.