The existence of a nation-wide twin register and central psychiatric register has made possible a catamnestic investigation of an unselected and representative sample of twins with manic-depressive disorders.

From a total population of 11,288 same-sexed twin pairs born 1870–1920 in Denmark 126 probands from no pairs were ascertained. Among the co-twins of 69 monozygotic probands there were found 46 with manic-depressive disorders, and a further 14 had presented other psychoses or marked affective personality disorders or had committed suicide, yielding a proband rate of strict concordance, C1 = 0·67 and of broad, partial concordance, C2 = 0·87. The corresponding direct pairwise concordance rates were 32/55 = 0·58 and 46/55 = 0·84 respectively. For the dizygotic twins the proband concordance rate of C1 was 11/54 = 0·20 and of C2 20/54 = 0·37, and the direct pairwise rates were 9/52 = 0·17 and 18/52 = 0·35 respectively. The differences between the pairwise rates for the monozygotic and dizygotic twins are significant (P < 0·001 at χ2 analysis). This finding is in accordance with previous twin studies of manic-depressive disorders and confirms the evidence of a strong genetic factor. The concordance with respect to unipolar and bipolar forms was not in contradiction to recent evidence of a genetic difference between the bipolar and unipolar form, the latter probably related to the female sex.

Chromosome examination was made in 22 monozygotic and 27 dizygotic twin pairs of whom one or both of each pair suffered or had suffered from manic-depressive disorder. We found a significantly higher frequency of chromosome variations among dizygotic twin pairs than was expected from population studies, but not in monozygotic pairs. There was no association between the chromosome variations and manic-depressive disorders. We found no greater intra-pair correlation in monozygotic twins compared with dizygotic twins as regards hypodiploidy, hyperdiploidy and unstable chromosome aberrations, which indicates that the aetiology of such aberrations is mainly of exogenic nature.

A study, covering the years 1964–67, of an integrated psychiatric service for a population of 92,000 was described in this Journal in 1969. This paper describes the continuation of this study to cover the further period 1967–75 and comments on data relating to the whole 11-year period. In this comment, the needs of this psychiatric service have been compared with data from other workers and with current Guidelines from the Department of Health and Social Security.

Ninety-eight matched pairs of patients treated respectively on first admission in a general hospital psychiatric unit or a psychiatric hospital have been followed-up for from five to eight years. The periods of treatment received in either setting remained comparable, and only 3 per cent of patients were in-patients or day patients at five years, while 14 per cent were out-patients and 20 per cent attended their family doctor. There was no evidence in these patients of a transfer of chronicity to the psychiatric hospital, but patients with longer periods of treatment were noted to change hospital from both the general hospital unit to the psychiatric hospital, and in the reverse direction.

Haloperidol treatment for stuttering was examined in a double-blind cross-over study of 26 adult volunteers with long-standing stuttering. Most had had unsuccessful speech and drug therapy. During the three-month study, their speech and stuttering patterns were repeatedly evaluated from videotaped readings of a standard passage and during spontaneous speaking. Of the 18 patients completing the trial 11 were significantly more improved on haloperidol than on placebo, three benefited equally from both, and four were unchanged. Improvement over placebo was indicated by fewer dysfluencies, increased speed of speaking, and reduced secondary 'struggle’ phenomena. Side effects were common on a dosage of 3 mg haloperidol daily. Poor concentration, akathisia and dystonic movements caused 8 patients to discontinue the trial despite significant improvement in 5 of them. Although 'statistically significant’ improvement occurred in most patients on haloperidol, the ‘clinical significance’ of this form of therapy will be limited by the partial response, the need for continuous medication, the side effects of haloperidol and the attitude of stutterers to this type of therapy.

Questionnaire replies from 43 experienced psychiatrists showed wide variation in the ways they would manage a common type of neurotic problem. There were considerable differences in the nature and duration of treatment and in the use of other members of the psychiatric team. The conclusions have implications for training and for the use of health care resources.

The difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation, method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.

Three hypotheses are abstracted from Laing's writings on the interrelationships between self-consciousness, anxiety, and self-evaluation. Indicators of self-consciousness are obtained from an open-ended instrument which requires the respondent to provide twenty answers to the question (asked of himself): ‘Who am I ?’ Statements indicative of self-consciousness are those on which the respondent inserts a self-reference into the statement made about himself and are distinguished from statements in which no explicit self-reference is found. The data indicate that the mark of the self-conscious person is anxiety and that anxiety is largely restricted to those statements devoid of self-consciousness. The structure of a system likely to produce this configuration is considered by drawing upon Kierkegaard's conjectures on the joint emergence of consciousness and anxiety. Equating self-consciousness with ‘reflection’, it is suggested that while reflection brings about anxiety in a system as a whole, the act of reflection deters the emergence of anxiety at the particular points within the system upon which it is deployed. Thus the function of reflection is two-fold, creating anxiety at the same time (but not at the same place) as anxiety is reduced.

One hundred and nine out of one hundred and twenty-two cases of endogenous depression were followed-up after their index diagnosis 3–13 years earlier. No recurrence occurred in 28 cases. Forty-two cases turned out to be bipolar and 21 remained unipolar. Manic episodes outnumbered the depressive ones. The change of polarity from depression to mania occurred within three years after the initial depression, though in others the shift occurred between three years and twelve years. The number of episodes of depression before the onset of mania varied from 1 to 3. While the onset of depression before the age of 40 years predisposed to recurrences, there was risk of chronicity in those patients who developed the illness after 40.

The distribution of the plasma cholinesterase variants found in 1,374 mentally ill patients differs from that of a random control sample. The patients are more likely to have a rare phenotype than an individual from the normal population. None of the diagnostic groups have been shown to differ in the distribution of the E1a gene, but there is strong statistical evidence that Group IV (psychosis) patients have a higher frequency of the E1f gene than the other groups. The overall frequency of the electrophoretic variant C5 + did not differ significantly from that observed in a Caucasian population, with the exception of the increase observed in Group IV c2.

Twenty-eight unrelated patients with Huntington's chorea were found to have a significantly altered incidence of the C5+ variant and six patients from this group were found to have the rare E1f gene. Our results indicate that the plasma cholinesterase variants may provide some insight into the inheritance of Huntington's chorea.

Thirty families with a newborn mongol baby were matched with thirty families with a normal baby. Both groups were followed for eighteen months to two years and interviewed six times. Few differences could be found in the mental or physical health of the two groups of parents, but marital breakdown or severe marital disharmony was found in nine of the mongol families and in none of the controls.