Few psychiatrists now take a lively interest in the social sciences, and few social scientists listen to what psychiatrists have to say. For the handful who do, the widening gap between the two fields of knowledge is regrettable, for we have much to learn from each other. The gap seems to have grown for two reasons: psychiatrists, increasingly occupied with pharmacotherapy, have drawn closer to general medicine, and there is comparatively little interest in the social therapies which seemed to offer so much promise back in the 1950s. The open-door system was a success, and so was the idea of community care, even if the practice left much to be desired. Incidentally, these developments destroyed many of the interesting experiments in group dynamics which were at one time a feature of mental hospital life. Social workers, once seen as allies, went off on their own in the new, powerful and largely incomprehensible Social Services Departments, where they had many other tasks to occupy them. Sociologists became shrill and hostile. Many psychiatrists ceased to read sociology after the publication of Goffman's Asylums (Goffman, 1961) because it seemed that sociology was off on some kind of egotrip which was deeply antithetical to their own professional experience. People who talked about “madness” instead of “mental illness”, rejected diagnosis as labelling, and regarded mental patients as victims of a capitalist plot were (and are) difficult to talk to. One of the distinguishing features of mental health reform over the past 200 years has been its apolitical nature—people of all political views could agree on what seemed essentially a matter of common humanity. Suddenly it became highly politicized, both in theoretical terms, since the new analysis was basically neo-Marxist, and in the action of pressure groups in the Civil Liberties lobby. Confused by the Right to Treatment, the Right to Refuse Treatment, the Right to Information and the Right to Confidentiality, most psychiatrists have (wisely in the circumstances) kept their heads down and got on with the job.

It is proposed that some cases of depressive illness in cancer patients may be caused by immunological interference with the activity of serotonin, one of the neurotransmitters thought to be implicated in depression. This interference could be mediated in two ways. Antibody induced against a protein released from cancer cells could, on the basis of cross-reactivity with CNS tissue, bind to receptors for serotonin and block them. Such primary antibodies could stimulate the production of anti-idiotypic antibodies, which would act as an alternative receptor for serotonin and reduce its synaptic availability.

This study investigated parental bonding patterns of hypochondriacal patients using the Parental Bonding Instrument. Hypochondriacal patients and a matched control group were drawn from in and out-patients of a psychiatric hospital. Maternal over-protection was found much more frequently (P <.005) in the hypochondriacal group than in the control group. This offers support for previous clinical observations on hypochondriacal patients. The implications of this and other findings of the study are discussed.

Patients diagnosed as reactively or endogenously depressed were given electroconvulsive therapy (ECT). The endogenously depressed patients tended to respond to the treatment more quickly and favourably. Measures of age and severity of depression were as predictive as the classification into endogenous or reactive depression using the Newcastle rating scale. The degree of psychological stress ascertained and presumed to be operating did not contribute to the prediction of outcome.

Acetylator phenotype, determined by blood levels after sulphadimidine, was related to outcome in a controlled trial of phenelzine in patients with depression and mixed anxiety depression. Slow acetylators showed more improvement and greater phenelzine-placebo differences than did fast acetylators, at two, four and six weeks. A tendency towards faster acetylation was observed in subjects with previous increased alcohol intake. Acetylator phenotype was not related to other symptom, diagnostic or history data.

Significant deficiencies in personal social networks and social support in non-psychotic psychiatric out-patients have been reported by Henderson and his colleagues. In a replication study, 50 non-psychotic psychiatric out-patients were compared with 50 matched controls. Patients reported spending less time in social interaction, but more time in unpleasant interaction during the previous week; they also had fewer attachment figures, close relatives and good friends and fewer social contacts than controls. However, the separate analysis of Neurotic and Retarded depressives (using the Present State Examination) failed to replicate all these findings in the Retarded depressives. It is concluded that these associations are confirmed in neurotic patients, but that the more severe depressive disorders require further investigation.

Sixty-nine patients, each with a combined diagnosis of epilepsy and psychosis, were compared with 53 patients with a diagnosis of functional psychosis. The epileptic affective patients often lacked convincing psychotic features; ECT and lithium were rarely prescribed; only three showed evidence of bipolarity. The epileptic schizophrenic patients were judged to have the better premorbid personality, experienced more paranoid delusions and delusions of reference, and showed less catatonic features than the functional schizophrenic patients. The course of the epileptics' illness was more variable.

The concept that the schizophrenia-like psychosis associated with epilepsy is a distinct nosological entity is supported, but not the suggestion of a relationship between affective psychosis and epilepsy.

Seventeen patients were seen by a neurologist for diagnosis of temper tantrums. The referring psychiatrist had thought that they might have been caused by organic disease, either epilepsy or the episodic dyscontrol syndrome. The final diagnosis in every case was temper tantrums due to psychological causes. The patients had a wide range of psychiatric disorders. Theories that might explain the tantrums are discussed.

Socio-economic differences between schizophrenics on an acute in-patient unit and their parents were studied in relation to indices of dangerousness and of psychiatric status, It was found that, whatever their class of origin, a large proportion of patients had dropped in occupational attainment, relative to that of their parents, but that patients tended to be higher in education than their parents. Patients who had committed an assaultive act prior to admission were lower in social status than their parents.

One hundred and seventy-two successive admissions to a district general hospital psychiatric unit were examined. Routine psychiatric, drug and dietary histories were taken and signs of avitaminosis B specifically noted. Red cell transketolase (for thiamine deficiency), glutathione reductase (for riboflavin deficiency) and aspartate transaminase (for pyridoxine deficiency) were measured. Of the patients, 53 per cent were deficient in at least one vitamin, 12 per cent in more than one (30 per cent in thiamine, 27 per cent in riboflavin and 9 per cent in pyridoxine). Schizophrenics and alcoholics were significantly over-represented in those patients low in thiamine and in more than one vitamin. Patients with an affective disorder had low riboflavin and low pyridoxine. It is suggested that affective changes are characteristic of riboflavin and pyridoxine deficiency.

Possible psychiatric implications of impairment of the blood-brain barrier were studied in 25 patients with paranoid psychosis. Determination of the ratio between the albumin concentrations in cerebrospinal fluid and serum showed increases, indicating impairment of the blood-brain barrier, in seven patients and normal values in 18. The two groups were compared for clinical, pharmacokinetic, neurophysiological and anamnestic variables. The highly significant finding that onset of psychosis had occurred, on average, 20 years earlier in the patients with impairment of the blood-brain barrier than in those without suggests that such impairment might influence the development of psychosis in predisposed individuals.

The purpose of the study was to evaluate whether the mood of an alcoholic contributed to the impairment on intellectual tests. The Marke-Nyman Temperament Scale and the Beck Depression Inventory were administered to 37 male alcoholics. It was found that there were no significant differences in personality or mood between intellectually impaired and intellectually intact subjects.

A systematic study of 50 adolescent self-poisoners aged from 13 to 18 demonstrated considerable discrepancies between the reasons chosen by the subjects to explain the overdoses and those chosen by clinical assessors. Most adolescents indicated that they had been feeling lonely or unwanted, or angry with someone, and had taken the overdose to alleviate or demonstrate this distress. A third said they had wanted to die. In contrast, clinical assessors tended to attribute the overdose to punitive or manipulative reasons and suggested that only seven out of the 50 had wished to die.

The adolescents rarely indicated that they had taken the overdose to get help; this may explain the resistance that may be shown to psychiatric intervention, and casts doubt on the possible effectiveness of preventive agencies. Modification of attitudes to both self-poisoning and early help-seeking may be a more effective means of prevention.

An unselected series of 100 psychiatric in-patients was independently diagnosed by two clinicians using the PSE and by two computer diagnostic systems: CATEGO based on PSE items and DiaSiKa based on AMDP items. The computer programs are compared with respect to their diagnostic agreement with the clinical diagnoses.

Over a six-month period, 142 referrals of patients aged over 65 to a community-orientated psychogeriatric service in North London were studied, and their progress followed for a further two years. The emphasis was on domiciliary management by initiating and supporting caring networks. More active involvement in the community by hospital staff is suggested.

The Huli people of the Southern Highlands Province of Papua New Guinea mourn in culturally patterned ways that differ for men and women. One difference is that women are expected to express their emotions, while men are discouraged from doing so. In this study the mortality of bereaved spouses was determined by following 100 widowers and 208 widows for four years following their bereavements. Widowers showed an excess mortality in the first year following bereavement while widows showed no such tendency. The possible relationship between these findings and Huli mourning practices is discussed.

Are more adolescent in-patient places needed? This has been the recommendation of a number of national and local working parties (Ministry of Health, 1964; Royal Medico-Psychological Association, 1965; Association for the Psychiatric Study of Adolescents, 1975; Court, 1976; Royal College of Psychiatrists, 1976) and it would be echoed by many exasperated doctors and social workers up and down the country to whom the local adolescent unit seems always full or too selective. At present there are some 30–40 adolescent units scattered throughout the U.K. sometimes 50 miles apart, and they vary considerably in their treatment policies and therefore in the sort of young person they admit (e.g. see Warren, 1952; Turle, 1960; Allchin et al, 1967; Berg and Griffiths, 1970; Evans and Acton, 1972; Bruggen et al, 1973; Wardle, 1974; Framrose, 1975; Perinpanayagam, 1978; Wells et al, 1978; Bedford and Tennant, 1981). They have tended to become specialised in one direction or another in order to develop reasonably coherent management systems for their turbulent clientele, so that in any given area one or other category of disturbed adolescent is likely to be left out, leaving many professional workers more conscious of what is missing in residential services than what is being done.

To begin with, a few facts. Karl Jaspers' Allgemeine Psychopathologie (General Psychopathology) was first published in 1913 (1). The author was then barely 30 years of age, working as a physician in the psychiatric hospital at Heidelberg. Two years later he moved away from medicine towards first psychology and then philosophy, the field in which he was to emerge as one of the outstanding figures of the twentieth century. He continued, however, to retain an interest in psychopathology, revising and expanding his book in several later editions. Within the German-speaking world it was at once recognized by leading psychiatrists as a unique achievement, a mountainous landmark in the history of the subject. If Jaspers' reputation was to decline in Germany between the two world wars, this is attributable chiefly to his outspoken, uncompromising resistance to national socialism. Philosophy for him was a public as well as a private concern, and it was his courageous political stand which led Hannah Arendt to describe him as a contemporary successor of Immanuel Kant.