Nineteenth-century theory held that mental disorder was rare in stable, traditional rural societies. Today most societies are rapidly changing, but Tonga still fits that model and the evidence suggests that the psychoses are genuinely infrequent there. It is proposed that both the theory and the evidence deserve further examination.

The incidence of psychiatric symptoms in a community sample of mother-bereaved women was not excessive. No differences emerged when a series of 160 female psychiatric patients whose mothers died before age 11 were compared with 80 female controls. Fifty bereaved women who had bad relationships with their mother replacements had specific clinical characteristics.

A systematic evaluation was made of the reliability, validity and psychometric properties of the Symptom Rating Test Langner 22-Item Scale in the order to determine whether they are suitable for use in community surveys of psychiatric epidemiology. On the basis of studies on several samples (total N = 846), both scales were shown to be suitable for this purpose. Although the subscale structure of the Symptom Rating Test was not confirmed, it appeared superior in most respects to the Langner Scale

The reliability of reporting of life-events was examined in 52 subjects attending clinics. An inventory of events and longer-standing difficulties was administered on 2 occasions, 7–14 days apart. High levels of reliability were found for the number of events, the mean score for distress or change over all events, and for the single event with the highest score. The reporting of individual events was less reliable: only 70 % of those events reported at either interview were reported under the same heading at both interviews. Subjective reactions to events differ in reliability according to the type of response, and they are less reliable for single events than overall. Lastly, the reliability of highly distressing events is in fact lower than for the less distressing. These findings point to some of the shortcomings of inventory methods in life-event research.

The dipeptidyl peptidase, angiotensin-converting enzyme (EC 3.4.15.1), was measured in various regions of post-mortem brains. Results from 51 patients with the hospital diagnosis of schizophrenia who were divided into the clinical categories of ‘schizophrenia’ and ‘schizophrenialike’ illness on the basis of case-note analysis were compared with those from 40 control subjects. A significant reduction in angiotensin-converting enzyme activity was observed only in the substantia nigra pars reticulata and in the lateral and medial segments of globus pallidus in the ‘schizophrenia’ group, with no significant differences in enzyme activity in substantia nigra pars compacta, caudate nucleus, nucleus accumbens, subthalamic nucleus or cerebellar cortex. Reduced enzyme activity was not seen in the ‘schizophrenia-like’ group, and occurred most significantly in ‘schizophrenia’ patients in whom the onset of the illness had occurred between the ages of 15 and 24 years. In the control population the activity of angiotensin-converting enzyme in substantia nigra pars reticulata decreased significantly with age. It is possible that patients with early onset ‘schizophrenia’ may represent a separate disease entity, rather than belonging to a spectrum of a single disease.

The assessments of deliberate self-poisoning patients carried out by 8 doctors and 8 nurses were compared. Both groups of staff had undergone special training in the assessment procedure. The adequacy of the assessments was determined by blind judges' ratings of transcripts of assessment interviews, comparisons of the types of treatment offered and repetition of self-poisoning. The attitudes of the patients and their general practitioners were also investigated.

No major differences were found between the assessments of the 2 groups of subjects. It is concluded that nurses under supervision of a senior psychiatrist can safely carry out the assessment of self-poisoning patients, provided they have received appropriate training. The findings suggest that services in which nurses assess most self-poisoning patients could be established in district general hospitals. This would reduce the demands currently placed on psychiatrists and physicians.

Two psychiatric screening instruments, the Mini-Mental State (MMS), a test for cognitive disturbance, and the General Health Questionnaire (GHQ), were administered to 197 neurological in-patients. The results suggest a high rate of psychiatric disturbance. The highest rate of cognitive disturbance detected by the MMS was found in patients with Parkinson's disease. The highest rates of emotional disturbance indicated by GHQ scores were found in patients with myasthenia gravis and multiple sclerosis. MMS scores but not GHQ scores were related to standardtests of cognition, the diagnosis of cerebral pathology, and CAT scan abnormality. The results also demonstrate that the GHQ does not adequately detect patients with cognitive impairment. It is concluded that in populations at high risk for cognitive impairment a tandem screening procedure utilizing tests for both cognitive and emotional disorders is needed.

It is argued that people who are predisposed to mistake a vivid imagination image for a genuine percept (i.e. hallucinators) should show an impaired ability to make clear perceptual–conceptual distinctions (i.e. boundary confusion) and should lack familiarity with internal sources of information. A test of these hypotheses was undertaken by comparing a group of ‘alcoholic’ hallucinators with a group of ‘alcoholic’ non-hallucinators. Some support is claimed for the ‘boundary confusion’ hypothesis but not for the ‘lack of familiarity’ hypothesis. Specifically, it was found that hallucinators performed significantly worse than non-hallucinators on the Embedded Figures Test (a measure of perceptual boundary confusion) and on the Intersensory Time Judgement Test (a measure of conceptual boundary confusion). These results are discussed in relation to other aspects of the predisposition to hallucinate. Some specific research needs are described.

It is generally recognized that social relationships occupy a central position in psychiatry. To examine the role of social relationships in the onset of minor psychiatric morbidity it is necessary to construct an instrument which will meet the need for a valid, reliable and comprehensive index of social relationships. Such an instrument has now been developed and used in a sample of the general population.

The Interview Schedule for Social Interaction arose from a research need, and was constructed to assess the availability and perceived adequacy for any individual of a number of facets of social relationships. These consist both of persons and of the provisions obtained through them. Data from a general population sample suggest this instrument to be sufficiently valid and reliable, and also sensitive to predictable variations between sociodemographic groups, to justify its use in clinical and epidemiological studies, both in psychiatry and general medicine.

This study compares the clinical and social outcome for 2 cohorts of patients who had a first admission for schizophrenia 4 years earlier. One cohort was treated in a psychiatric unit attached to a teaching district general hospital (DGH(T)), while the other was treated at an area mental hospital (AMH) with modern rehabilitation facilities. The clinical outcome for the 2 cohorts was broadly similar, but the DGH(T) imposed less of a strain on relatives, and was associated with less unmet need. The DGH unit tended to have significantly shorter durations of stay for its patients, so that its total hospital costs were less than those for the AMH despite higher unit costs. The cost benefit analysis shows that, where these particular patients are concerned, the DGH(T) unit is economically superior to the AMH despite the fact that it supports a large teaching staff, and that these economic advantages are accompanied by various non-monetary advantages.

Loss of neurons from the ageing human brain is accompanied by reduction in biochemical markers. Compared with age-matched controls about one third of nerve cell components are lost from the temporal lobe of patients with senile dementia of Alzheimer's type. There is marked loss of choline acetyltransferase activity, especially in the hippocampus. This alteration parallels the intensity of neuropathological damage and relates to prior mental impairment. Smaller changes in other neurotransmitter synthesizing enzymes are generally found.

The sensitivity in detecting a click was measured separately for the right and left ear of psychiatric patients and non-patient controls using a three-interval forced-choice staircase procedure. Patients with affective disorders showed reduced right ear sensitivity, while schizophrenic patients did not show reduced sensitivity. Lower sensitivity correlated with higher structured-interview ratings of speech retardation.

The effects of social desirability and defensiveness on scores on 2 self-report psychiatric inventories, the General Health Questionnaire (GHQ) and the Middlesex Hospital Questionnaire (MHQ) were investigated in a female subject group assessed for research purposes in an occupational setting. It was found that defensiveness did not affect the reporting of somatic symptoms, but it significantly affected the reporting of all psychological distress. The effect of social desirability was more specific, only the GHQ social dysfunction subscale showing a significant correlation, an effect attributable to the influence of the setting in which the data were obtained.

In an attempt to replicate findings reported by Slade (1976), 12 hallucinating and 12 non-hallucinating schizophrenic subjects were compared on tests of verbal ability, personality and mental imagery variables and the Verbal Transformation Effect. No significant difference between the groups was demonstrated. When the data from both groups of schizophrenics were combined, a significant correlation was found between 2 measures of the Verbal Transformation Effect and the P-score of the Eysenck Personality Questionnaire.

Two hundred and forty neurotic out-patients were allocated to no diagnostic category but were rated in terms of observer and self ratings of both depression and anxiety at weekly intervals during a 4-week trial of amitriptyline, diazepam, amitriptyline and diazepam, and placebo. The sample could not be divided into anxious and depressed groups on the basis of the clinical picture. The outcome tended to be good irrespective of medication but the significant drug effects found were due to amitriptyline and concerned measures of anxiety as well as depression. It is concluded that a distinction between anxiety and depression in neurotic out-patients is of no practical value with regard to drug treatment.

This report concerns a group of schizophrenics whose visual evoked potential reduced in amplitude most markedly in A5 (averaged potential evoked by 1 Hz flashes which started 5 min after the addition test for 15 min). These patients in general had poor productive symptoms and progressed very slowly. Most of them were simple schizophrenics.

A reliable method for recording the site and duration of purposeless movements was devised. With this method 267 subjects were studied, 182 of whom had been exposed to neuroleptics. The results were submitted to a principal components analysis and 3 movement dimensions emerged. One group of movements resembled a parkinsonian syndrome. The other 2 groups of movements both conformed to the generally accepted criteria for tardive dyskinesia. These groups were: (1) head and neck movements and (2) trunk and limb movements. The possibility of the second and third groups representing clinically relevant sub-syndromes of tardive dyskinesia is discussed.

In the context of an ongoing WHO research programme in depression, a total of 573 patients consulting psychiatrists in Canada, Iran, Japan and Switzerland were assessed with the WHO/SADD schedule which proved to be a simple and reliable instrument for standardized recording of clinical data. The results indicated that the ‘average’ depressive patients seeking care in culturally different settings have many clinical features in common. A screening instrument, developed in the same study, has been shown to be effective in selecting depressive patients among in- and out-patient populations.

A group of bipolar manic depressive patients attending a routine lithium clinic were investigated. The results suggest that, when on treatment with lithium, manic depressive patients with a good prognosis tend to have a higher erythrocyte Na-K ATPase and higher plasma and erythrocyte lithium concentrations than those with a poor prognosis. There was no evidence to suggest that the erythrocyte: plasma lithium ratio was useful in predicting clinical response to lithium therapy. There was also a positive correlation between plasma lithium concentration and Na–K ATPase activity, confirming that in manic depressive subjects lithium produces a rise in erythrocyte Na–K ATPase activity.

The natural course of anxiety before and after surgery was examined using the State– Trait Anxiety Inventory in 4 studies involving 136 surgical patients. The results suggested that high levels of anxiety were experienced before admission to hospital, between admission and surgery and following surgery, and were not restricted to the immediate pre-operative period. Only a small percentage of patients reached their maximum level of anxiety on the morning of surgery.

These results have implications for those planning interventions to alleviate anxiety associated with surgery and for those studying surgical stress as a model for other naturally occurring stresses.