[Methylene-14C]-L-tryptophan was administered intravenously to five patients suffering from severe depression before and after clinical recovery, and to six control subjects; all subjects were tested while on a standard diet. [14C]-5-Hydroxyindoleacetic acid and [14C]-indoleacetic acid were isolated from urine during the following 48 hours and purified to constant specific radioactivity (SA). From the SA and the determination of the total excretion of the two acids their percentage conversion from labelled tryptophan was estimated. There was no consistent difference found, in patients before and after recovery, or between patients and controls, in the conversion of tryptophan to these indole acids. In another series of 11 depressive patients and 11 controls, plasma total (acid-soluble) tryptophan was measured at frequent intervals up to three hours after intravenous administration of a loading dose (1 g) of L-tryptophan. The height of the curves of plasma tryptophan throughout the three hour period was greater than in the depressive patients, even after they had recovered, than in the controls. It is concluded that the apparent volume of distribution of tryptophan is reduced in depressive individuals. This is consistent with other findings of increased protein-binding of plasma tryptophan and reduced CSF tryptophan levels in depressive patients.

Depressed patients were followed-up after 10 months, and factor scores reflecting respectively general severity, the endogenous-neurotic distinction, and an admixture of anxiety versus depression were used as predictors. The main prognostic relationships were with the endogenous-neurotic distinction and provided validating evidence for it. Endogenous depressives showed generally better prognoses. Individual rating variables used to derive the factors showed little relationship to outcome and prediction appeared to derive from a summation of elements relevant to the endogenous-neurotic distinction across many variables.

Twenty outpatients suffering from chronic anxiety states completed a trial of anxiolytic drug therapy. They each received five treatments: amylobarbitone sodium, chlordiazepoxide, diazepam, medazepam, and a placebo in flexible dosage in a fully balanced design, using doubleblind procedures. They were assessed on the Hamilton rating scale for anxiety after a period of two to four weeks on each of the treatments and they completed self-ratings every three days. The selfratings were composed of at least three prime symptoms chosen by the patient himself and phrased in his own words as well as ‘loss of appetite’ and ‘insomnia’. Neither placebo nor amylobarbitone produced any substantial improvement from pre-drug levels of anxiety but all three benzodiazepines produced significant and very similar decreases in both Hamilton ratings and self-ratings. These two measures also correlated highly. The majority of the patients continued with medazepam at the end of the formal trial.

In the waking dog, a small dose of morphine (0·1 mg/kg intravenously) was sufficient (1) to induce a quite appreciable state of sedation which might be more closely related to clinical analgesia than experimental nociception, and (2) to allow for precipitation of clear-cut signs of abstinence (agitation, tachycardia, tachypnoea, mydriasis, hyperthermia, tremors, salivation, urination) when naloxone (3 mg/kg subcutaneously) was injected 1·5 hours later.

The study was undertaken in order to clarify the clinical pharmacological basis for a correct design of controlled trials of the prophylactic effect of tricyclic antidepressants. Twenty-two patients, successfully treated with nortriptyline (NT) in hospital for endogenous depression, continued the treatment for up to five months in the outpatient clinic. Plasma levels of NT were checked, and ratings were performed regularly. Depressive relapses, all related to low plasma levels of NT, were seen in three patients. The gas Chromatographic method, described in detail, has proved suitable for clinical routine and the results demonstrate the value of monitoring plasma levels in achieving therapeutic control.

Clorazepate and diazepam were compared with respect to clinical effectiveness and concentrations of benzodiazepine compounds in plasma in 15 severely anxious outpatients. Each patient was studied in a double blind trial incorporating two-week periods of the two drugs and of placebo. The doses were almost equimolar—5 mg diazepam or 7·5 mg clorazepate three times daily. Clinical progress was assessed by visual analogue scales and by the Symptom Rating Test. Psychopathology scores were highest at the end of the placebo periods, and lowest at the end of the clorazepate periods, regardless of the order of treatments. After diazepam, both diazepam and N-desmethyldiazepam (nordiazepam) were detected in blood, and after clorazepate, only N-desmethyldiazepam was detected. N-Desmethyldiazepam concentrations were higher after clorazepate. Clinical progress was apparently related to the concentration of N-desmethyldiazepam in plasma.

The psychomotor performance of patients with presenile dementia was investigated in two experiments. It was found that motor retardation in dementia was due more to impaired effector processes rather than slowness in deciding when and where to move.

This report is concerned with a simple statistical model of the way the brain may function, suggested by the analysis of intelligence test results in two groups of children. The model describes the statistical behaviour of an ideal array of elements, representing the brain, during tests of cognitive ability. Predictions from the model indicate that comparison of the EEC recording taken from groups of children who were good or poor readers would show amplitude differences. These were found between the groups when the eyes were open but not when the eyes were closed–a result explained by the model.

Forty-five patients with analgesic nephropathy showed a trend towards introversion and neuroticism on the Eysenck Personality Inventory. Other analgesic abusers without renal impairment also showed these traits, while controls with renal disease not due to analgesie abuse were significantly less introverted and neurotic. It is suggested that these personality traits predisposed the patients to analgesie abuse and therefore to renal damage.

Two samples of Special Hospital patients who had posterior temporal slow wave foci were selected and matched for age, sex, and duration of stay with patients from the same hospital who had normal EEG records. A high prevalence of between 20 and 31% was found. No significant differences were found between the index and control groups with regard to a number of developmental, forensic, psychiatric, behavioural, and psychometric variables. A striking feature was the high average age of almost 30 years of the posterior temporal slow wave patients. This finding suggests that the current maturation defect hypothesis in relation to cerebral function in psychopaths requires revision. The possible role of early social and environmental factors in the genesis of these EEG anomalies is discussed.

Jellinek's proposed phases in the development of alcohol dependence covered a wide diversity of areas. Trice and Wahl and others have rejected these detailed proposals on the grounds that not all alcoholics experience all symptoms and those that do experience them do not necessarily experience them in the same order. Data from 59 halfway house residents confirmed these two points. However, a small number of clusters of items were isolated which were reported to occur in characteristic sequence. These were: firstly, the onset of psychological dependence; secondly, tremor, morning drinking, and amnesia; and, thirdly, aspects of alcoholic psychosis. The conclusion is that there is a characteristic ordering of new events and symptoms suggestive of a developmental process in alcoholism, but this ordering is apparent only if attention is confined to a limited part of the broad spectrum of events and symptoms associated with alcoholism. This process is obscured by a consideration of the social concomitants of alcohol dependence.

The introduction of reserpine into western medical practice led to an outbreak of iatrogenic depression. It also stimulated research into the fundamental biochemical errors underlying depressive illness. In view of this historical incident it is surprising that other drugs used in the treatment of hypertension, especially those producing their therapeutic effects by a similar mechanism to reserpine, have not been more critically evaluated. This field of research calls for valid self-rating instruments in order to survey a large population. Using this method, it was found that there was no evidence of a relation between the administration of methyldopa or other drugs and depressive illness. These findings are an indication that adverse psychiatric effects of drugs for hypertension, and methyldopa in particular, may be less common than is sometimes supposed. It is concluded that the matter should be clarified by a careful prospective study.

In 1971 a national random sample of 388 consultant psychiatrists answered questions about their views and practices in relation to abortion. Ten per cent of the consultants who saw relevant age groups had no patients for abortion assessment in 1970, while 5% had 100 or more (mean estimated number = 26). The process of referral, consultation, decision-making, and follow-up is looked at, as are the psychiatrists' views on abortion. Their views and practices are seen to vary with their religion and with their links with teaching hospitals, although not with their age, sex, or marital status.

Recent work on the central mechanisms of food intake is reviewed in relation to anorexia nervosa. On the basis of the present review a number of conclusions are drawn as possible avenues for future research. A proposal is outlined for the investigation of L-dopa as a potential treatment for anorexia nervosa.

Children's daily activities and interactions were quantified from mothers' accounts of the preceding 24-hour period. These ‘diaries’ were obtained on three occasions from 54 families with two pre-school children. Effects of age, birth order, sex, and social class were found which support the findings of other studies: an inverted U-shaped relationship existed between the intensity of attention received and the child's intelligence and developmental quotients. A relatively high correlation between IQ and an affective measure of child care furnished further evidence that the differences in caretaking relevant to intellectual development are qualitative rather than quantitative ones.

Videotape recordings were made of brief diagnostic interviews with 27 patients newly admitted to a psychiatric hospital in London and then shown to groups of English-speaking psychiatrists in London, Paris, and Munich. Comparison of the diagnoses made by these three audiences suggests that English, French, and German psychiatrists have similar concepts of schizophrenia, neurotic illness, personality disorder, and alcholism, but differ markedly in their concept of affective illness, particularly manic-depressive illness. English psychiatrists have much broader concepts of both neurotic and psychotic depression and of mania than the French, with German psychiatrists in an intermediate position. Important differences in the use of other technical terms like agitation, perplexity, and thought disorder also emerged. The ratings of the English and German audiences were closer to one another than either was to the French.

Treatment of neurosis is selectively surveyed, including physical methods. At least four differing aims of psychotherapeutic techniques can be distinguished—to produce a rewarding experience; to nurture self-knowledge; to allow confession or catharsis; and to effect a lasting change in behaviour. The report concentrates on the last two aims. Effects of psychological treatments are considered first by syndromes and then by procedures. Prognostic issues are defined and research strategies outlined. Further work is suggested, including the relief of acute neurotic distress before referral for specialist help, the combination of psychotropic drugs and psychological treatments, the application of specific psychotherapeutic techniques for defined ends, and elucidation of the active therapeutic ingredients in these methods.

Using data collected by the Salford Psychiatric Case Register from 1 January 1968 to 1 January 1972, the current use of psychiatric inpatient beds is presented and trends discussed. Estimates are given for the likely occupancy at 1 January 1982, for short and medium stay (under one year), and long-stay (one year or more) beds. Three methods of projecting the accumulation of new long-stay patients are described and discussed. The total occupancy by 1982 is likely to be about 2·3 beds/1,000 total population, about 1·7/1,000 for long-stay patients.

Eleven patients with anorexia and 11 matched controls were given questionnaires on hunger and satiety before and after a standard meal in order to evaluate the way in which patients with anorexia nervosa consciously recognize and describe their sensations of hunger and satiety. The findings showed that the patients perceived hunger in a manner similar to the controls, but they were more preoccupied with thoughts of food, had a stronger urge to eat, and were more anxious when hungry. The patients, unlike the controls, frequently did not describe satiety in terms of gastric fullness. The disordered perception of satiety, however, was not related to clinical outcome. These findings are discussed in terms of their implications for treating anorexia nervosa.

Two hundred and forty adult psychiatric patients, comprising 60 phobic, 60 anxious, and 120 depressed patients, were interviewed about problems of school attendance during their childhood. Using a specially designed questionnaire, non-attendance due to school refusal was swparated from that due to truancy. A control population of 120 orthopaedic and dental patients, matched for age and sex with the psychiatric sample, was also interviewed. It was found that school refusal had occurred significantly more often among the psychiatric patients than among the controls (P < 0·05). The incidence of truancy was similar in both groups. Both school refusal and truancy had occurred more frequently in female than in male patients. The results suggest that, contrary to some studies, there is a link between childhood and adult neurotic disorders and that some children who present with problems of school refusal are at risk in adult life.