Interest in the different diagnostic groups of the mentally retarded started in the 19th century, but this made little contribution toward better treatment and care. Medical interest was mainly focused on the prevention of mental retardation. It was not until the 1950's and 60's that interest in research in the care and treatment of these persons intensified. The next step, study of the interaction between handicapped persons and the environment is the key to a better understanding of how to plan for work with the handicapped. New members of the therapeutic team (e. g., psychologists, and sociologists) will take over (Edgerton, 1984) if medical groups, especially psychiatrists, do not become more aware of the importance of the interaction between the handicapped and the environment.

The possibility that chronic abuse of volatile substances can cause permanent neurological, psychiatric, and intellectual sequelae is critically reviewed. Toluene, present in the commonly used adhesives, is most often implicated in ‘glue sniffing’; this review focuses on its potential long-term effects. Many criticisms—particularly poor matching of control samples and inability to distinguish between acute and chronic effects—can be levelled at the available studies, while no adequate follow-up studies have been performed. In the light of present knowledge, the possibility that permanent structural brain damage, with accompanying psychiatric manifestations, results from solvent abuse remains inconclusive.

The concept of ‘sluggish schizophrenia’ is virtually limited to the USSR and some other East European countries, and may contribute to the mis-diagnosis of democrats as psychiatric patients. Recently, a number of articles have appeared in the Soviet literature relating the diagnosis of ‘sluggish schizophrenia’ or ‘slowly progressive schizophrenia’ to affective disorders, especially hypomania. Soviet publications on this theme from 1980 to 1984 are discussed, together with their relationship to questions on the abuse of psychiatry.

The internal construct validity of the endogenous sub-type of major depression was investigated by statistically modelling the RDC endogenous and DSM-III melancholia diagnostic criteria. Data consisted of symptom ratings on 788 patients with major depression from NIMH Collaborative Depression Study. Results indicated that the symptoms in the criteria do not specify a dichotomous classification, melancholic-non-melancholic or endogenous-nonendogenous. Results did support the existence of two sub-typings, one related to anhedonia, and one related to vegetative symptoms. The vegetative sub-type rarely occurred in non-anhedonic patients. Previous studies may have found support for a simple endogenous sub-type because of this hierarchical relationship and as a result of methodological differences.

Standardised measures of mental state were used to compare patients with bulimia nervosa with those with major depressive disorder. The two groups were found to be similar in terms of severity of psychiatric disturbance, as measured by the Montgomery & Åsberg Scale and the Present State Examination. Noteworthy symptomatic differences were a greater frequency of obsessional ruminations and anxiety amongst the first group, and a greater frequency of depressed mood, apparent sadness, and suicidal ideation amongst the second. Discriminant function analyses revealed that the two patient groups had a different pattern of symptoms. Examination of the character of the psychiatric symptoms of patients with bulimia nervosa suggests that the anxiety and depressive symptoms are likely to be secondary to the eating disorder itself, rather than of primary significance.

Our aim was to test the findings of a study which claimed that if the syntactic structure of schizophrenic speech were subjected to a detailed linguistic analysis, clear differences would be demonstrated between schizophrenic, manic and control populations. It was confirmed that schizophrenics do have less syntactically complex speech which contains more errors. Using linguistic variables in a discriminant function analysis, it was possible to predict diagnoses correctly in 79% of cases.

Measures of parental affective style were compared for families of schizophrenics participating in a controlled treatment study which contrasted individual and family-based therapeutic programmes. The total number of critical statements and non-critical, intrusive remarks was significantly lower after three months for parents of schizophrenics participating in family therapy, compared to those whose offspring received only individual therapy. An increased risk for relapse was associated with an increase in the number of critical and/or intrusive remarks for patients in individual treatment. A significant increase in non-emotional, problem-solving statements was observed in parents who received family therapy, compared with those who did not. The results suggest that a behaviourally-oriented, problem-solving family approach may have reduced the risk of relapse in the first nine months after discharge from hospital by teaching families concrete ways of solving problems and concomitantly reducing the amount of negative emotional relating between family members.

The incidence of traumatic events during the first ten years of life was investigated in two groups of patients suffering from major affective disorder, as well as in mixed psychiatric patients and in healthy subjects. While there were no significant differences between the two groups of affective patients or between the two control groups, the incidence of subjects who underwent such trauma was significantly higher in depressives, compared with controls. These differences are small and are further reduced if events secondary to psychiatric disturbances of family members are excluded.

The evaluation of illness behaviour can be complicated by subjective influences in either the patient or the clinician; these often arise in the evaluation of persons seeking compensation for injuries in which the symptoms are apparently exaggerated. The present study attempts to assess the usefulness of the CE Scale in determining the degree of conscious exaggeration by compensation claimants. Comparisons were made between psychiatrists' clinical evaluations of claimants and the scores obtained on this scale. The relationship between these two measures was found to be significant at the 1% level and specificity and sensitivity for less than 25% exaggeration on psychiatrists rating with a CE Scale cut-off of 11.69% and 100% respectively: for less than 34% exaggeration, they were 88% and 83%.

The influence of type of seizure and medication on psychological disability was assessed using the Standard Psychiatric Interview in matched epileptic patients. In comparison to patients with idiopathic tonic-clonic seizures, those with temporal lobe epilepsy complained of more irritability and impaired concentration, and were rated as more depressed and slowed up. Compared to patients on phenytoin, those on carbamazepine complained of more sleep disturbance and were more likely to be taking an hypnotic.

A psychometric study on Swedish and Dutch samples used the EMBU, a self-report instrument designed to assess memories of parents' rearing behaviour. Of the four primary factors identified previously with Dutch individuals (Rejection, Emotional Warmth, Over-protection, and Favouring Subject), the first three were retrieved in a similar form in the two Swedish groups (depressives and healthy, non-patients). Examination of the metric equivalence of the scales and the strength of the factors for each group indicated that comparisons of patterns and levels between groups from the respective countries on the three factors showing cross-national constancy would be warranted. Scale-level factor analyses of these dimensions produced identical two-factor compositions (CARE and PROTECTION) across national groups which further supported this conclusion.

In 1965 a psychiatric in-patient population was surveyed for the prevalence of facial dyskinesia. The present investigation reports on their survival time. Among male and female patients with functional disorders (mostly schizophrenia) there was a strong association between moderate or severe facial dyskinesia and shortened survival, but no clinical factors were found to explain this. Mild facial dyskinesia in functional disorders was not associated with reduced life expectancy and may be attributable to the general effects of ageing rather than to a specific pathological process. Among patients with primary organic brain syndromes, dyskinesia was not associated with reduced life expectancy.

Lateral ventricular size, as assessed by computed tomography, was not significantly greater in manic-depressive cases than in neurotic patients, but 19% of manic-depressive cases had ventricular brain ratios (VBR) more than two standard deviations above the neurotic mean. Few correlates of VBR were found in the features of the illness and the treatment given, apart from the fact that in the outpatient sample, there was a significant association between increased VBR and hypothyroidism. Hypothyroidism was relatively common in this sample, but was treated and not associated with cognitive impairment. There was no relationship between lithium administration and VBR.

Professor Rothman's book made a profound impression on me when I first read it. More to the point, perhaps, was the impression it made on his peers. The American Historical Association awarded it the Albert J. Beveridge prize for the best English language book published in American History. It is a beautifully written account of an exciting and ultimately tragic episode in American history: the attempt to use the institution as a means of reforming bad habits and curing mental illness.