One hundred and fifty-six women with menorrhagia of benign origin were interviewed before hysterectomy, and re-interviewed six months post-operatively (n = 147), and again 18 months post-operatively (n = 148). Levels of psychiatric morbidity were significantly higher before the operation than after. On the Present State Examination, 58 per cent of patients were psychiatric cases before surgery, as against 29 per cent at the 18-month follow-up. Similar post-operative improvements were found on measures of mood (POMS), and of psychosexual and social functioning. Most of these improvements had occurred within three to six months after the operation. Both before and after hysterectomy, levels of psychiatric morbidity were high by comparison with women in the general population, but lower than in psychiatric patients. The pre-operative psychiatric morbidity had been mainly of long duration.

One hundred and fifty-six patients with monorrhagia of benign origin were interviewed before hysterectomy, and again six months (n = 147) and 18 months (n = 148) after the operation. Psychiatric outcome, measured in terms of PSE cases detected at 18 months, was strongly associated with pre-operative mental state, neuroticism, previous psychiatric history, and family psychiatric history. No association was found with organic pathology in the uterus, bilateral oophorectomy or demographic variables.

In the well-known condition of primary complete anorgasmia in women, the glandipudendal (‘bulbocavernosus’) reflex is often absent, and this is strongly correlated with failure of treatment. From these facts, and from properties of the glandipudendal reflex, we argue that organic abnormalities in the spinal cord contribute to causing the condition in some cases.

We report nine cases of complete primary anorgasmia in men, two of whom lacked glandipudendal reflexes. The condition need not imply sterility; in all these nine (as also in three incomplete cases) we were able to obtain semen by electroejaculation or vibratory stimulation, and the wife of one patient is now pregnant.

The study concerns 46 children who had set at least one fire and had been admitted to a psychiatric ward. Their firesetting behaviour has been related to variables such as age, IQ, and psychiatric disorder in parents, and to the distinction between children who present with firesetting as their chief problem and those in whom it is a secondary complaint. Thirty subjects were followed up after one to five years. Seven, all boys and all less than 13 years old, were still setting fires, but these were less serious than the ones set before treatment. The persistent firesetters may have come from less stable homes and they tended to be more antisocial at follow-up than children who no longer set fires.

Twenty-six male compulsive gamblers were seen in one hospital over the last 8 years. Five were single, and only 5 had stable marriages. In most cases the compulsive gambling preceded their marriage. The majority had criminal records arising out of their gambling debts. All were offered treatment based on behavioural principles, but only 5 gained and maintained control over their gambling, 7 lapsed intermittently, and the remaining 14 were gambling when last seen. The problems in treatment are discussed, and modifications suggested.

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

Ninety-one undergraduates who had been referred to the Southampton University psychiatrist and matched controls who had not sought psychiatric help were followed up yearly for five years by questionnaire. The response rate for cases and controls was poor, but the difference in psychiatric morbidity was large. At least 26 of the patients subsequently consulted a doctor for emotional problems as against five of the controls; 17 of the patients were again referred to a psychiatrist but none of the controls. It is concluded that students who are referred to a psychiatrist during their University course have a much higher rate of psychiatric morbidity in the five years after they leave University than do students who have not been so referred.

This study extends earlier work on the evaluation of depression by general physicians, and compares the results obtained with that group with those from a group of experienced psychiatrists. Differences within each group were larger than those between them. In neither group were individuals able to describe their own diagnostic processes with great accuracy, but psychiatrists were, as expected, somewhat more consistent than general physicians. They became even more so when allowed to select their own cues; of which, however, they made use of a smaller number. These tended to be of a specific rather than (as with the physicians) of a general nature.

We derived a discriminant function based on clinical features to classify patients with endogenous depression (‘melancholia’) and non-endogenous (‘neurotic’) depression. The difference between the groups was not one of overall severity of illness alone. Bipolar melancholic patients were classified less well than were unipolars, supporting previous findings of clinical differences between these groups.

The discriminant function (DF) was reduced to a discriminant index (DI) which classified a separate group of unipolar melancholic and non-endogenous patients with comparable accuracy. Approximately 80 per cent of all cases received a definite classification by the DI. The agreement between the 105 definite DI classifications and the clinical diagnoses was 90 per cent when results from the derivation and validation groups were combined.

The DI classification was then validated against an objective biological marker, the dexamethasone suppression test (DST). The diagnostic discriminant index predicted the DST result with the same accuracy as the clinical diagnoses. The discriminant index can serve as an operational definition of the patients diagnosed as endogenous or nonendogenous unipolar depression in future studies by ourselves and other groups of investigators.

The factor structure of the General Health Questionnaire (GHQ) was investigated in a non-clinical sample in relation to the role of field dependence (assessed by the Hidden Figures Test) in influencing the extent to which different aspects of psychoneurotic disturbance are differentiated. Greater differentiation was achieved by the field independent (FI) group than by the field dependent (FD) group, as shown by: (i) the proportion of variance accounted for by the general factor in the principal components analysis of the 60-item GHQ data was lower (17 per cent) in the FI group than in the FD group (33 per cent); (ii) the factor loadings in the FI group, but not the FD group, corresponded closely with the four subscales of the 28-item scaled GHQ; (iii) the interscale correlations were significantly lower in the FI group than in the FD group. The implications of these findings are discussed, particularly their relevance to ‘unitary’ and ‘distinct-syndrome’ models of minor anxiety and depressive disorders, and the greater probability of occurrence of mixed states in field dependent subjects.

This project tested the association of 12 blood marker systems with the Eysenck Extraversion-Introversion/Neuroticism forms and the Buss-Plomin Temperament forms. The sample was about 400 males and 470 females who were given medical examinations during the Tecumseh Community Health Study (Michigan). ANOVA and Scheffe tests were used to test for significant differences; personality traits were adjusted for age. The Lewis red blood cell phenotypes were significantly associated with Anger and Impulsivity for males and Sensation-seeking (a subscale of Impulsivity) for females. It is suggested that these temperament factors merit further exploration.

Hypotheses which have been proposed to account for the unusual seasonal birth pattern observed in schizophrenic populations are discussed. These competing hypotheses were tested by retrospectively studying season of birth in 975 schizophrenics divided according to family history of psychiatric illness. Information was obtained from case notes, item sheets, and questionnaires sent to general practitioners. The results were inconclusive, but there was a trend for high genetic risk cases to be born less often in the first quarter of the year. Although no clear support could be provided for one or other season of birth hypothesis, it is tentatively suggested that a seasonal constitutional damage factor may be responsible for the excess of births described in schizophrenic populations in the early months of the year.

In a prospective study of offspring of schizophrenic mothers, perinatal complications reported in midwife protocols were analysed for those offspring who, as adults, were diagnosed as schizophrenic, borderline schizophrenic or as not suffering from mental illness. The schizophrenics were found to have had the most complicated births, and the borderlines, the least complicated births. This difference is interpreted in terms of a ‘diathesis-stress' model. It is proposed that birth complications can decompensate borderline individuals towards schizophrenic breakdown.

Since Helmchen and Hippius (1967) noted that half a sample of 120 schizophrenics had depressive symptoms at the time of admission, more than 30 papers have appeared associating depressive symptoms in schizophrenics with neuroleptic medication (Ananth and Chadirian, 1980). Many authors and clinicians in fact think that a causal relationship has been proven, and the term ‘pharmacogenic depression’ and the associated concept ‘akinetic depression’ have come into use. The assumptions underlying these concepts and the evidence to support them need critical examination. They will be considered with the results of more recent studies which answer some of the outstanding questions, but in turn raise new ones about the relationship of schizophrenia and depression to their underlying pathophysiology.

Kurt Schneider asserted that certain symptoms which he termed ‘first-rank’ invariably distinguished between schizophrenia and manic-depressive psychosis. This assertion, which has attracted considerable critical attention during the past ten years, will be examined in the light of these recent investigations.

There has been an exponential growth in family therapy literature in recent years. An outpouring of new books and journals have deluged the market which is bewildering to new readers. Fortunately, there are now some excellent introductory texts which help orientate the newcomer, such as Walrond-Skinner (1976), Skynner (1976) and Glick and Kessler (1980). For those who like encyclopaedic coverage there is also a recently published excellent and critical handbook edited by Gurman and Kniskern (1981). However, to gain a deeper understanding of the way the field has developed, I would like to focus on a number of texts and papers which have helped me in my own understanding over the years.