An account is given of how a clinician guided by attachment theory approaches the clinical conditions to which the theory is held to apply, which include states of anxiety, depression and emotional detachment. Assessment of a patient is in terms of the patterns of attachment and caregiving behaviour which he commonly shows and of the events and situations, both recent and past, which may have precipitated or exacerbated his symptoms. The problems posed by relevant information being suppressed or falsified are noted.

Viewed in this perspective a psychotherapist is seen to have a number of interrelated tasks: (a) to provide the patient with a secure base from which he, the patient, can explore himself and his relationships; (b) and (c) to examine with the patient the ways in which he tends to construe current interpersonal relationships, including that with the therapist, and the resulting predictions he makes and actions he takes, and the extent to which some may be inappropriate; (d) to help him consider whether his tendencies to misconstrue, and as a result to act misguidedly, can be understood by reference to the experiences he had with attachment figures during his childhood and adolescence, and perhaps may still be having.

Fifty-three psychiatric patients who had been receiving treatment with lithium continuously for more than two years were examined to estimate the prevalence of lithium-induced hypothyroidism. It was found to be 20 per cent among women. No men were affected among these patients. In order to study the characteristics of the disorder further cases were drawn from another population. One third of the patients developed hypothyroidism during their first year of treatment, others not until after 9 years. About two thirds of the female patients with hypothyroidism had thyroid antibodies. All cases with lithium-induced hypothyroidism showed elevated levels of serum thyrotropin, which in our experience is the laboratory examination of choice in these as well as other cases of ‘primary’ hypothyroidism. Since the probability of detecting these cases at a given control visit was found to be low, we feel that such visits need not include extensive laboratory investigations. Hypothyroid patients responding well to lithium treatment should continue their medication combined with appropriate thyroxine substitution.

Control subjects voluntarily overbreathed to produce end-tidal PCO2 levels similar to those found in patients suffering from neurotic or endogenous non-retarded depression. Red cell sodium content was found to decrease during overbreathing in all the subjects. The changes were similar to those usually reported for depressed patients.

The results imply that red cell sodium levels are in part dependent on respiratory behaviour. They suggest a need for considerable caution in interpreting red cell sodium values from psychiatric patients.

Animal experiments have demonstrated the likelihood that all known neuroleptics inhibit transmission in central CA-ergic systems, regardless of their chemical structure and via different mechanisms. For clinical psychiatry this fact prompts a number of questions: (1) is this phenomenon also to be found in human individuals; (2) if so, is it of importance for the clinical (side) effects of neuroleptics; (3) do patients with (schizophrenic) psychoses show signs of central CA-ergic hyperactivity ? This article presents a survey of clinical research focused on these questions which, for the sake of brevity, is confined to DA metabolism. The available data indicate the plausibility of a correlation between inhibition of DA-ergic transmission on the one hand, and on the other hand the therapeutic effects of neuroleptics and the occurrence of hypokinetic-rigid symptoms. The hypothesis that DA-ergic hyperactivity is an important pathogenetic mechanism in schizophrenic psychoses can be based only on indirect arguments; direct studies of the DA metabolism have so far failed to reveal supporting evidence. The possible causes of this failure are discussed.

How patients are seen by themselves and others close to them may influence the process of re-integration in the community after discharge. In a study in a psychiatric admission unit employing a therapeutic community approach, patients who sought little or no contact with the unit after discharge saw themselves, and were seen by others, as less ‘pleasant’ but less ‘ill’ than those who continued more regular contact. Perceptions were measured with the semantic differential technique. Patients' social class and household position were found to have a marked effect on the level of contact and on its association with how patients were seen. Diagnosis did not appear to influence hospital contact.

This preliminary study investigates the effect on patients' performance of a set time off, in the form of a short holiday, from a strict reinforcement (token economy) regime.

Assessment was by the patients' mean token earnings before and after the holiday and their self-care and work performance throughout. The results suggest that a holiday from a token economy has beneficial effects for patients.

The programme in an intensive rehabilitation unit in a large psychiatric hospital is described. Features include the use of non-medical staff as primary therapists, the use of a mini-bus to facilitate regular visits by patients to their home areas, the inclusion of the mini-bus driver on weekly staff conferences, the use of sociodrama, the re-organization of hospital money payments to patients, the promotion of relations with community-based facilities through occasional ‘teach-in’ days, and a special liaison social worker providing intensive follow-up after discharge. Rehabilitation was prolonged (average stay about one year) and about half of those selected for rehabilitation from the long-stay wards were discharged. Follow-up showed that these patients benefited from discharge, in spite of a relatively high incidence of psychopathology and of social problems. Those transferred back to long-stay wards showed increased institutionalization.

During the Arab-Israeli war of 1973 measures had to be taken by the kibbutz civilian population in Israel to cope with the stresses of war. The measures adopted, and the specific characteristics of an organized cohesive group, appear to have succeeded in reducing the severity of the reactions to stress and in lowering the incidence of psychiatric casualties among children and adult members of the kibbutzim.

The birth records of 78 subjects born to psychotic parents and 72 subjects born to normal parents were studied.

No significant differences in the rates of pregnancy and birth complications (PBCs) were found between the offspring of psychotic parents and normal control parents. There were no differences between offspring born to psychotic mothers compared to psychotic fathers. Neither the onset of the parent's illness, nor the mother's age at delivery, nor the sex of the offspring seemed to influence the rate of PBCs. The offspring of chronic schizophrenic mothers and manic-depressive fathers had lower PBC rates than the offspring of parents of other diagnostic categories. The parents of these two groups, which were of a limited size, did not differ on any variable of significance, excepting the time of their first psychiatric hospital admission.

Evidence was found against the hypothesis that heterozygous carriers of a schizophrenic gene have a reproductive advantage through enhanced fertility. In consequence an investigation was made of the possibility that an advantage is gained through diminished early mortality among the offspring of carriers. The results were equivocal. While an observed deficit of infant deaths was attributable to under-reporting, the possibility of a true advantage could not be ruled out, because of the statistical unreliability of the findings in a sample of the size available. A plea is made for a collaborative effort to settle the issue.

Groups of subjects were tested on a paced serial reaction-time task in order to study the effect of varying the rate at which information was presented. The groups were: two groups of patients with acute schizophrenia but differentiated on the basis of primary symptoms, a group of institutionalized schizophrenic patients, a group of neurotic patients and a normal group. All groups showed a reduction in efficiency when the presentation rate was increased. The groups most adversely affected were the non-integrated and institutionalized schizophrenic patients. The integrated schizophrenic and the neurotic groups were affected to a lesser degree, the normal groups being least affected. These results favour a dimensional view of personal illness, in which deficits are most marked in patients with non-integrated schizophrenia.