Patients who presented with acute psychoses and were treated with chlorpromazine were first divided into 2 groups with good (23) and poor (13) outcome. These outcome groups differed little in their initial clinical features and showed no difference in 2 indices of dopamine receptor blockade (extrapyramidal symptoms and plasma prolactin concentrations). The group which improved was then subdivided on the basis of evidence of dopaminergic blockade into 15 who had improved and also showed anti-dopamine effects (‘responders’) and 8 who had improved but showed no anti-dopamine effects (‘remitters’) The remainder were eventually classified as ‘resistant’ to the effects of the drug. The group of ‘remitters’ contained no patients with nuclear schizophrenia; the ‘responders’ were mainly nuclear schizophrenics; and the ‘resistant’ patients were schizophrenic or schizo-affective. The 3 groups who were defined in this way also differed in their subsequent clinical course. It is suggested that this scheme for dividing patients may be useful in clinical work and could also assist research workers to identify the patients who can most appropriately be studied to determine mechanisms of drug action.

A pilot study is described on 41 men and women of similar age, social and educational backgrounds, in 2 working environments. The use of psychiatric interviews in such occupational settings is demonstrated to be acceptable to both management and employees. Preliminary coefficients of validity for the General Health Questionnaire are found to compare favourably with those in clinical or community settings. Though the prevalence of minor psychiatric morbidity in these small samples did not differ between the sexes, the women had twice as many spells of absence as the men. Considering women separately, minor psychiatric morbidity was found to be significantly correlated with absence. However, psychiatric illness was a less important predictor of absence in men.

Forty patients on chronic haemodialysis were studied in order to gather information about the relationship of locus of control and adjustment. Negative correlations of high statistical significance were found between locus of control and compliance with the diet, and locus of control and vocational rehabilitation, as well as between locus of control and acceptance of disability. All the findings indicate that patients with internal locus of control adjust and adapt better than those with external locus of control. The number of years on dialysis did not correlate with locus of control. It might be suggested that the shift from internal to external locus of control occurs prior to dialysis in the stage of chronic kidney disease.

Erythrocyte Na–K ATPase and sodium pump site numbers were estimated in groups of depressed, manic and recovered patients. The activity of Na–K ATPase per pump site was lower in the depressed group than in the recovered group. In the manic group Na–K ATPase was lower than that of the recovered group, whereas there was no difference in the pump site numbers. In the more severe manics the activity of Na–K ATPase per pump site was significantly lower than that of the recovered patients. Therefore, the change occurring in the erythrocyte membrane cation carrier in manic-depressive psychosis is probably in the activity of individual Na–K ATPase molecules and not in the number of Na–K ATPase molecules per cell.

The functional organization of chemically transmitting synapses in the brain are described with special emphasis on recent studies demonstrating the localization of different transmitters to specific anatomical circuitries. The use of pharmacological tools for manipulating levels of chemical transmitters is referred to briefly, but particular attention is given to the problems of studying the function of these pathways with lesion techniques.

Noradrenaline (NA) and dopamine (DA) are selected for detailed consideration and experimental evidence reviewed, suggesting that these two catecholamines in the forebrain serve different functions: NA with processes of attention essential for learning, and DA with the execution of appropriate responses. Hypotheses suggesting dysfunction of forebrain DA and NA systems in schizophrenia are discussed.

This study had 3 aims: to determine whether rheumatoid arthritics had certain personality traits; to examine the relationship between psychological factors and the presence of rheumatoid factor in blood serum; and to explore the prognostic significance of psychological factors in the management of rheumatoid arthritis. Within a few days of discharge, 129 in-patient rheumatoid arthritics were clinically and psychologically assessed and allocated at random to 1 of 3 forms of follow-up care. The psychological assessment included measures of personality, non-psychotic psychiatric disturbance, and attitudes and beliefs. A year later all patients were reassessed. It was found that rheumatoid arthritics were more neurotic in personality, more likely to give socially desirable responses, and more prone to psychiatric disturbance, than the general population. Seropositive patients were less susceptible to psychiatric disturbance than seronegative patients. None of the psychological variables predicted disease activity, but those patients who rated themselves as ‘slow, dependent, and weak’ lost more time off work in the subsequent year.

There are many reports which suggest that patients with affective illness (mania and/or depression) have abnormalities in the functioning of one or more neurobiological systems. At a conference convened by the Clinical Research Branch, Division of Extramural Research Programs, National Institute of Mental Health, these findings were reviewed and some of the factors impeding movement towards a more complete and integrated view of the functioning of neurobiological systems in patients with mania or depression were identified. As a result, a multi-research centre, collaborative approach to the study of the psychobiology of affective disorders was developed. In this collaborative programme, which has now been underway for several years, the focus has been upon: (a) the assessment of the functioning of several different types of biological systems in the same patient, both before and during treatment; (b) obtaining a reasonably large number of patients and comparison subjects; and (c) the use within and across centres of standardized diagnostic categories and behavioural rating methodologies. In this paper the history, background, and rationale for this collaborative effort are reviewed. Those biological systems chosen for study are noted, and issues such as reliability and validity of diagnoses, measurement of state variables, assessment of change with treatment, and logistical and coordinating problems are discussed.

A 10-year follow-up study is reported of 50 hypogonadal males, 34 of whom had the karyotype 47,XXY and 16 karyotype 46,XY. The social class of the former group was significantly lower and the frequency of criminal behaviour higher when compared with the latter group and the Danish male population. The frequency of mental illness was higher in the Klinefelter males with karyotype 47,XXY than in the remainder. The aetiology and pathogenesis of deviant mental development in the patient population and various aspects of their treatment are discussed.

Of 50 women charged with crimes of violence, 44% committed their offence during the paramenstruum (P < 0·02) and there was a significant lack of offences during the ovulatory and post-ovulatory phases of the menstrual cycle (P < 0·01). This association could not be accounted for by psychosocial factors. Offences were unrelated to symptoms of premenstrual tension. When considering treatment, recurrent behavioural changes rather than subjective symptoms should be looked for.

Two groups of medical students answered a modified version of the Leyton Obsessional Inventory twice, with 8 weeks between tests. On one occasion it was administered in its original card-sorting (postbox) form; on the other, it was given as a written questionnaire. Fifty students answered the postbox form first, 50 the questionnaire first. Correlation between the 2 tests was reasonably good (r = 0·73–0·77). Scores on the first occasion of testing were significantly higher than on the second, but differences between scores on the 2 forms were not significant. Mean scores of male and female students were similar.

The rate of recovery of the H-reflex, an electrical evoked monosynaptic spinal cord reflex, was abnormally high (fast) in over 20% of unmedicated psychotic patients of all major diagnostic classes. A few patients had significantly lower H-reflex recovery curves. Chronic neuroleptic treatment produced relatively lower recovery curves, whereas fluoxetine, a specific serotonin uptake blocker, produced relatively higher curves.

A preceding paper has reviewed the history, background, and rationale for this collaborative effort exploring the biologic basis of the affective disorders. This paper details the ‘flow’ of a subject through the experimental protocol, the instrumentation used to obtain the clinical and behavioural data, and the biologic methodologies employed in the analysis of the body fluids. Data management and analysis techniques developed for this study are also examined.

Janis (1958) has proposed a curvilinear relationship between pre-operative anxiety and post-operative emotional state. While other hypotheses share the prediction of a poor outcome for patients with pre-operative high anxiety, Janis' theory is unique in predicting a poor outcome for those with low anxiety. Subsequent research has failed to confirm Janis' hypotheses, perhaps because the designs have been insensitive to the predictions for low anxiety patients.

The current study tests the hypothesis more directly and finds some support for a linear relationship between pre-operative anxiety and post-operative negative affect, with no support for Janis' curvilinear hypothesis. On the whole, pre-operative anxiety was a poor predictor of other measures of recovery but, on one measure, patients with low anxiety showed a slower recovery than those with moderate anxiety, i.e. supporting the prediction of a poor outcome for low anxiety patients.

The implications of these results for pre-operative preparation of surgical patients and the development of theories of anxiety are discussed.

Awareness of pulse rate was tested in 60 psychiatric out-patients with anxiety, phobic or hypochondriacal neuroses by asking them to record how fast their hearts were beating during exposure to short film sequences. Correlations between subjective and objective heart rate (ECG) were significantly higher in anxious and hypochondriacal patients than in phobic ones. The results suggest that somatic symptoms in hypochondriacal and anxiety neurosis reflect increased awareness of bodily function.

The extent to which the second member of a pair of monotic clicks facilitates simple reaction time was examined for 35 psychiatric patients and 43 non-patient controls across 2 studies. Affective psychotic patients showed greater reaction time facilitation than did either schizophrenic patients or non-patient controls. Computer simulations of a ‘statistical facilitation’ model for these data are also presented.

Over the past few years, a new WHO mental health programme has been formulated through a process of consultations within WHO, with other UN bodies, with governments, the scientific community and various non-governmental organizations (Sartorius, 1978; WHO, 1978 a, b). This report will attempt to give an outline of research activities that are being initiated, co-ordinated and supported by the programme at country, regional and global level.

The relationship between herpes simplex virus type 1 and mental retardation is explored by studying the antibody levels to this virus in a group of 86 severely and profoundly retarded adults. A tendency towards higher antibody levels is found in patients whose retardation is of unknown aetiology. The relationship of these observations to previous research findings and the possible significance of herpes simplex virus in the aetiology of mental retardation are discussed

Previous research on meditation and the EEG is described, and findings relating to EEG patterns during meditation are discussed. Comparisons of meditation with other altered states are reviewed and it is concluded that, on the basis of existing EEG evidence, there is some reason for differentiating between meditation and drowsing. Research on alpha-blocking and habituation of the blocking response during meditation is reviewed, and the effects of meditation on EEG patterns outside of meditation are described. In conclusion, the need for more precisely formulated research is pointed out.