Factors in the patient which have been commonly cited by therapists as relevant in assessment for psychotherapy are examined as well as the research done on them. These factors are discussed under four categories: (a) factors related to the illness, (b) personal factors related to the treatment, (c) personal factors not directly associated with the illness and (d) current life circumstances. Research on methods of assessing patient suitability is discussed together with an account of the reasons for the rather disappointing contribution of systematic research.

Patients with premenstrual syndrome recorded their symptoms daily using menstrual distress questionnaires. These were analysed by a least mean square method of fitting sine waves. After recording an untreated cycle, patients were given progesterone 200 mg b.d. and placebo in a double-blind crossover manner; 75 per cent of patients were then given progesterone 400 mg b.d. and placebo in a similar manner. Treated cycles were rated by both daily menstrual distress questionnaires and retrospective self-assessment. Both rating methods showed there was no significant difference between progesterone and placebo in reducing symptoms of premenstrual syndrome, and in the majority of cases placebo was more effective, although never significantly so.

Brain monoamine concentrations were determined post mortem in 19 patients with dementia of Alzheimer type. Samples were taken from 10 parts of the brain and compared with an age-matched control group.

There were lower mean concentrations of dopamine in the demented group of patients in seven regions of the brain, and two of these were at a significant level. There were also significantly lower concentrations of homovanillic acid in the nucleus caudatus and in the putamen. The means of the concentrations of noradrenaline were also lower, and in the putamen and the cortex gyrus frontalis significant differences were observed. The 5-hydroxytryptamine concentrations were slightly lower in the demented group but the differences did not reach significance. The degree of intellectual deterioration was negatively correlated with the noradrenaline concentrations in the hypothalamus and the cortex gyrus cinguli.

The association between lateralized hemispheric dysfunction and psychiatric diagnosis was investigated with a measure of summation of dichotic clicks and with a dichotic competing message task. Ear asymmetries of affective psychotic patients were similar to those of right temporal lesioned controls and differed from those of schizophrenic patients and normal controls. In contrast, schizophrenic patients did not display abnormal auditory perceptual asymmetries.

Schneider's typology of the personality disorders is described briefly. Three psychiatrists made diagnoses on two sets of patients, both of which contained one example of each type. The diagnoses were made with the help of a glossary and based upon the examination of clinical summaries and audio-recordings.

Values of two reliability coefficients showed considerable variation between types. High reliability was found for Schneider's asthenic, explosive, depressive and affectionless types. Low reliability was found for the fanatic, labile and hyperthymic types. The insecure and attention-seeking types were overused. Some possible causes of this variation are discussed.

In an attempt to demonstrate a valid boundary between schizophrenia and the affective psychoses, discriminant function analyses have been carried out with history, mental state and follow-up data in two populations of patients. A bimodal distribution of discriminant scores was obtained in one of them (a general psychotic sample of 128 patients), using a discriminant function derived from the same sample; but when the function was applied to the second population (a schizoaffective sample of 106 patients) the distribution was ambiguous. Functions derived from the schizoaffective sample produced highly skewed distributions of discriminant scores in the general psychotic sample.

Kraepelin's hypothesis that the functional psychoses consist of two distinct disease entities receives some support from our findings, but there is still no compelling evidence that the universe of psychotic patients falls naturally into these two groups.

One hundred and fifty four patients admitted to a general hospital psychiatric unit with a history of poor diet were examined. Serum pyruvate was estimated in all, red cell transketolase in 74 and red cell aspartate transaminase in 66. Significantly more of the 58 abnormally low thiamine patients than of the normal thiamine group showed clinical signs of malnutrition or were diagnosed as chronic alcoholics, drug addicts, schizophrenics or endogenous depressives. Significantly more endogenous depressives than other patients had a raised aspartate transaminase activity coefficient (pyridoxine lack.) While most low thiamine findings are probably manifestations of malnutrition pyridoxine lack may have some aetiological significance in endogenous depression.

In two randomized double-blind controlled trials on 63 depressed female in-patients subject to recurrent affective disorder (bipolar and unipolar manic-depressive psychosis) lithium was shown to have major acute antidepressant effects. At the end of three weeks lithium produced more uniform improvement than did imipramine; lithium in combination with tryptophan (in the form of Optimax) was superior to tryptophan alone—the latter drug having no discernible antidepressant activity in this group of patients.

Lithium did not produce an antidepressant effect until the second and third week of both trials.

With the aim of aiding primary prevention of parasuicide by Samaritans, a study of 325 parasuicide patients admitted to hospital was undertaken to discover the extent of knowledge about Samaritans, the proportion of patients who had contacted Samaritans and the reasons why the remainder had not done so. Ignorance about Samaritans was found in 28 per cent, such ignorance being significantly more common among teenagers than in other age groups. Only 1.4 per cent had sought help from Samaritans immediately before the present parasuicidal act, though a further 13 per cent had contacted Samaritans previously. Suggestions are made for future public education programmes about Samaritans.

One hundred and forty patients seen in a suburban walk-in walk-out clinic over a period of 30 days were studied. Twenty-eight (20 per cent) of them were found to be primarily psychiatrically disabled, 83 (59.3 per cent) primarily physically disabled and the diagnosis of the rest (20.7 per cent) was uncertain. The psychiatric patients were found to be suffering from anxiety and depressive states. Their sex, age, education, economic status, symptomatology and duration of the illness were analysed.

The findings suggest among other things that the prevalence of psychiatric disorders in the rural setting in Kenya is high and therefore calls for a proportionate provision of mental health care facilities. They also suggest that anxiety and depression in African patients are masked by somatic symptoms, often leading to unnecessary delays in diagnosis and management.

A case of addiction to tranylcypromine is described where tolerance occurred and a severe withdrawal illness followed discontinuation of the drug. Previous reports in the literature of similar cases are reviewed and comparisons made, and the implications for management are discussed.

It is ironic that one of the most difficult tasks confronting the psychiatrist is to assess a parasuicidal patient, while the conditions under which he is commonly obliged to do so may be the least favourable that can be imagined. Often he is asked to see the patient, who as likely as not is drunk and just getting over a stomach wash-out, in a crowded corner of a teeming Casualty Department; this is analogous to asking a surgeon to operate in the lavatory. Even if the patient has been admitted, he or she is likely to have been grudgingly lodged in an emergency ward with harassed staff whose hostility surfaces all too easily. It might be a valuable use of time to explore with medical colleagues how to provide the optimal environment for the patient and psychiatrist alike, and to review policy constantly. But the parasuicide violates all the rules of the medical game and rarely fits the culture of the general hospital. Attempts to change staff attitudes will probably have limited success if the social realities remain unaffected. A ward designed for patients with perforated ulcers and broken limbs generates its own values; mores reflect function as well as vice versa.