Now that the evidence for genetic factors in the major psychoses is very strong but still essentially circumstantial (what is transmitted is unknown), there is a danger that myths about the nonexistence of mental illness may be replaced by equally misleading myths about its inheritance. The need for genetic counselling is therefore likely to increase (counselling is advice given as a result of consultation). Admittedly, the literature on counselling in mental illness is scanty, the author's own experience slight, and the public demand small. Reed (1972) stated that less than 1 per cent of the 3,000 cases seen at the Dight Institute over 20 years were concerned with schizophrenia. Nevertheless, it is probable that much unrequested and ill-informed advice is being given.

This paper presents the results of a prospective controlled study evaluating a programme of directed masturbation against a combined sensate focus and supportive psychotherapeutic approach in the management of female primary orgasmic failure. Of the 20 patients who followed the masturbation programme 90 per cent gained orgasmic capacity compared with 53 per cent of 15 patients who were treated conventionally. Eighty-five per cent of the patients treated by the masturbation programme and 47 per cent of the control group of patients became coitally orgasmic on at least 75 per cent of coital occasions. The difference is statistically significant at the 5 per cent level. The results suggest that directed masturbation is an effective adjunct in the management of primary female orgasmic failure.

The formation of a therapeutic relationship involves the negotiation of a treatment contract which conforms to the general principles of any contractual agreement. Attempts have been made to formalize the therapeutic alliance, and this paper reports the development of a written contract for psychiatric in-patients.

The psychological effects of an injection of methylamphetamine have been measured in 22 drug-free patients with endogenous depressive illness and in 9 patients with other psychiatric illness. A new distinction between the time course of the euphoric and anti-depressant effects is described. The euphoric effects were seen in the first hour after the injection, but the anti-depressant effects were delayed for 1–3 hours and then lasted for as long as 36 hours. These findings are at variance with the noradrenaline depletion hypothesis of depressive illness which (in its simplest form) predicts an immediate alleviation of depression as a result of an immediate rise in the concentration of noradrenaline at central receptor sites.

Cognitive functions were investigated in seven manic-depressive patients while on lithium, after two weeks off lithium, and after a subcutaneous injection of physostigmine while on lithium. Test performance was unaffected by lithium, but after physostigmine the I.Q. score of a shortened version of the WAIS was significantly increased.

An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.

Genetic factors play an important role in drug metabolism and drug response. In order to investigate genetic variables in lithium prophylaxis and lithium distribution across the erythrocyte in manic-depression, we have examined forty-two pairs of twins monozygotic (n = 25) and dizygotic (n = 17) with manic-depression. Concordant twins as a group show better lithium prophylaxis than do discordant twins. These results are consistent with previously published family studies of affective illness suggesting a positive relationship between genetic background and success of lithium prophylaxis.

Lithium distribution across the red blood cell (RBC) was assessed by estimating lithium RBC/plasma ratios. The lithium ratio's intrapair differences in both groups of twins were minimal with a high heritability index suggesting that genetic factors play a role in lithium ion distribution. A high linear correlation was found between lithium ratio and plasma lithium and there was no difference in lithium ratios according to sex, affective state and response to lithium. The distribution of lithium ratios was homogenous in the lithium responders' population but this was not the case in the non-responders, suggesting biological heterogeneity of lithium distribution in lithium failures. The implications of these results are discussed as they relate to the genetic determinates of lithium prophylaxis in manic-depressive illness.

These results indicate that lithium ratios are of limited value in lithium maintenance therapy. Our lithium kinetic data, however, are consistent with the concept of a lithium extrusion mechanism from red blood cells.

The investigation to be reported in this paper was undertaken following a query concerning the relationship between road accidents and the use of psychotropic drugs. One aspect of this problem could be studied easily by using the file of linked records of the Oxford Record Linkage Study (Acheson, 1967; Baldwin, 1973). Statistical methods have been developed to estimate the degree of association between conditions occurring in time-ordered sequences (Baldwin et al, 1978). The existing file of linked hospital discharge and death records in the Oxford Record Linkage Study was therefore searched and relevant material analysed to test the hypothesis that admission to hospital for schizophrenia was followed by an increased risk of accident or injury. (The present data do not allow the more specific question of phenothiazine treatment to be investigated). The statistical procedures simultaneously provide data on the converse situation, namely where injury occurs prior to hospital admission with schizophrenia, and this was studied also.

A weekly clinic was held for one year in a London probation office with 41 probation officers. Only 23 cases were referred but the clinic was found to be a valuable forum for discussion of problems with the officers, 10 per cent of whose clients were estimated to be receiving psychiatric treatment elsewhere. Suggestions are made to improve collaboration between psychiatrists and probation officers.

American women awaiting trial were administered the Eysenck Personality Questionnaire. Compared to a heterogeneous control group, these women scored significantly higher on the neuroticism and psychoticism scales and on Burgess's ‘hedonism’ variable, though they did not differ with respect to extraversion or lie scale scores. Women awaiting trial were more likely to fall in the neurotic-extravert quadrant (a trend more marked for non-white women). In general, the results support Eysenck's theory of criminality and the usefulness of Burgess's ‘hedonism’ variable.

Assessment of cognitive and behavioural disability on 100 elderly psychiatric admissions was carried out by means of the Clifton Assessment Schedule and the Shortened Stockton Geriatric Rating Scale. The results provided useful predictive indices, confirming the relationship between cognitive impairment and unfavourable outcome at two-year follow up.

A recurrent nightmare of 14 years' duration rapidly disappeared after it was rehearsed repeatedly in treatment. The nightmare was independent of co-existing compulsive rituals and sexual problems, but was related to co-existing depression.

The term forensic psychiatry is used broadly here to describe the involvement of the psychiatrist at any stage—pre-trial, during the trial, or post-trial—of the legal process, whether this be criminal or civil. In its widest sense, it is also concerned with the procedures associated with the Mental Health Acts. The subject interdigitates closely with general and adolescent psychiatry, mental handicap, criminology, sociology, social work, psychology, legal studies, alcohol and drug dependence studies. Accordingly, reading in forensic psychiatry must necessarily carry the student into such related fields.