One hundred psychotic patients referred to a consultation service in a general hospital were compared with 50 psychotic patients without physical illness in a psychiatric unit. Background, mental and cognitive state were evaluated. In addition to providing a list of likely causes of cerebral dysfunction in such a sample, the study revealed an increased incidence of prior depression in those with cerebral dysfunction, and identified a group where psychosocial factors appeared more significant than cerebral dysfunction in determining the psychosis. The various ways in which a psychosis can be associated with a physical condition, and the various forms that it can take even when cerebral dysfunction is present, are discussed.

Among a consecutive unselected series of 29 patients with Cushing's syndrome 21 had bilateral adrenal hyperplasia and 8 had tumours. Twenty-five (86 per cent) were significantly depressed; three of the tumour patients, but only one of the hyperplasia group were free of symptoms so that if there are no psychiatric symptoms there is a three in four chance that the patient has a tumour. There was a family history of depression or suicide or a history of early bereavement or separation in half the cases. In six of the hyperplasia patients a major emotional disturbance had preceded the onset, and in five this was a loss. The severity of the depression was not related to the level of circulating Cortisol. The depression was rapidly relieved when the tumour or hyperplastic glands were removed. Depression in Cushing's syndrome might result from a substance other than Cortisol produced by the adrenal under excessive pituitary and/or hypothalamic stimulation, which could play a part in the aetiology of depressive illness in general.

Fifteen patients with active Cushing's syndrome have been compared with 15 other patients who had been treated successfully for Cushing's syndrome and with 13 patients with other pituitary tumours. Depression was the main psychiatric diagnosis made by the CATEGO programme after Present State Examinations. Patients with active Cushing's syndrome were significantly more depressed (Hamilton Rating Scores), than were the other patients. Compared with the control patients, those with active Cushing's syndrome had slightly lower plasma concentrations of total tryptophan, though the concentrations of freely diffusible tryptophan were not significantly changed.

Data from interviews with 64 women who were to undergo or already had undergone an augmentation mammaplasty were compared with data from a control group of 28 women. Great differences existed between the groups, mainly with regard to personality test data and childhood milieu. The women operated on were in general less certain of themselves and felt less feminine. These factors seem to be a sufficient basis for the appearance of the problem. Cultural norms are obviously also important but seem to influence all women in the same way.

The brothers of 73 delinquent boys were found themselves to be more antisocial than the brothers of 73 matched control boys. Further, the average antisocial score of the probands’ brothers increased with the number of brothers in the family, holding the number of sisters constant, and decreased with the number of sisters, holding the number of brothers constant. These results are interpreted in terms of male potentiation and female suppression of antisocial behaviour in boys. Results are also reported for 59 pairs of matched delinquent and control girls and their siblings.

A history of life events in the three months before onset of illness was taken in a group of schizophrenic and a group of depressed neurotic in-patients. The Expressed Emotion (EE) of the patients’ key relatives was measured. There was no difference between the schizophrenic and depressed patients in the rate of events in the three month period before onset or in the proportion of undesirable events. However, the two groups exhibited significantly different patterns of interaction between life events and relatives’ EE. Schizophrenic patients living with high EE relatives had a low rate of life events compared with those living with low EE relatives, whereas depressives living with high criticism relatives had a high rate of events compared with those living with low criticism relatives. The implications of these findings are discussed in relation to schizophrenic and depressive patients’ differential vulnerability to environmental stress.

In a double-blind parallel group study, thirty-two patients suffering from a primary affective disorder received either dothiepin or amitriptyline. Serum concentrations of total dothiepin plus northiaden or amitriptyline and nortriptyline were estimated. A similar therapeutic response was seen with both drugs but there was no correlation with serum concentrations of amitriptyline or nortriptyline, whereas serum dothiepin correlated positively with clinical response.

Forty obsessive-compulsive ritualizers received nightly placebo or clomipramine up to 225 mgs nocte for 8 months, and received behavioural treatment (exposure in vivo) from weeks 4 to 10. Plasma concentrations of clomipramine and its primary metabolite N-desmethylclomipramine steadily increased over the first 4 weeks of treatment after which they remained relatively steady. Plasma levels correlated significantly with dose and with outcome but not with side effects. Patients with plasma clomipramine levels in the range 100–250 ng/ml and N-desmethylclomipramine levels between 230–550 ng/ml were found to improve significantly more than patients outside these ranges, thus suggesting a therapeutic window for clomipramine and its primary metabolite.

Diagnostic and demographic data were collected from all 2,298 psychiatric hospital admissions for affective illnesses from private households in the City of Plymouth for the six-year period 1970–1975 inclusive. Intercorrelations of diagnostic subtypes were performed, together with a multiple regression analysis against spatial and ecological data from the 1971 Census. Rate differences were related to the geographic structure of Plymouth. With psychotic illnesses, ecological correlations were low for male and female first admissions and for male readmissions. However, important correlations relating to socio-economic status, housing tenure and structure, population instability, and other sociodemographic features emerged in varying degrees of specificity for reactive and neurotic illness in males, and for all readmissions in females, largely irrespective of diagnostic subtype. Explanations for the processes underlying these patterns are offered in terms of population structure, particularly the differing vulnerability of age and marital status groups, the referral and diagnostic process, social and physical stresses in the lower socioeconomic groups, and urban drift.

The social, criminal and psychiatric backgrounds of 878 male patients admitted for the first time to the three English Special Hospitals during the years 1961–1965 are examined and the implications of differences between them for research discussed. It is noted that only 35 per cent of the admission group have been discharged within a four year period. The need for long term follow-up studies is stressed.

Two patients developed an extrapyramidal syndrome after therapy with lithium carbonate. Although the clinical features of this syndrome were indistinguishable from those of drug-induced parkinsonism, it was made worse by the anti-parkinsonian drug, orphenadrine. These findings were reproduced later under laboratory conditions when extrapyramidal symptoms and physiological tremor were recorded before and after challenge doses of orphenadrine. This unwanted effect of lithium carbonate may be explained by selective blockade of dopamine receptors.