I am indeed sensible of the honour which you have conferred upon me, first, by including me among the honorary Fellows of the Royal College, and further by inviting me to deliver the 1979 Maudsley lecture. Equally am I conscious of my conspicuous lack of qualifications for these honours. My original university degree was in economics, a subject which hardly impinges upon psychiatry. My interest in your profession derives primarily from 44 years' experience as a magistrate (more often than not presiding) in London adult or juvenile courts, and, secondarily, from service as the former head of a University Department training social workers. Through these experiences I have not only had contacts with numerous psychiatrists about court cases and students, but have also got to know many of them personally, both at home and abroad. In this country my particular friends were the late Aubrey Lewis and our much beloved Peter Scott whose premature death has left a gap which many of us feel can never be filled. But I stand before you as a layman without any relevant professional qualification.

In thirteen cases of senile dementia of the Alzheimer type severe loss of nerve cells from the locus caeruleus was frequently seen together with reductions in nucleolar volume and cytoplasmic RNA in surviving cells, averaging 14 and 21 per cent respectively. These histological findings were matched in two cases by biochemical measurements of loss of noradrenaline from all brain regions examined, ranging from 10 per cent in temporal cortex to 53 per cent in hypothalamus. By contrast, neither nucleolar volume nor cytoplasmic RNA was altered in cells of the substantia nigra, nor was dopamine content significantly altered in most regions. In vascular dementia neither noradrenaline nor dopamine metabolism was changed except in regions of local circulatory deficiency. These findings provide evidence of a primary degeneration of the noradrenergic system in Alzheimer type dementia.

This paper describes 35 patients whose artefactual illness gained them admittance to hospital. The 15 wanderers were more likely than the 20 non-wanderers to have been in more than 10 hospitals, possessed histories exceeding 10 years, presented with abdominal or psychiatric complaints, volunteered poor work records and displayed psychopathic traits. The non-wanderers were more likely than the wanderers to possess socially conformist personalities. Twenty-six patients had severe sexual/marital problems. Neither group attended well for psychiatric follow up appointments.

This is a study of the symptoms and treatment of 61 patients with hysterical conversion. The incidence rate is high and the clinical picture showed different qualities from that seen in other studies. Treatment by suggestion under various procedures produced favourable results. All symptoms were removed, and after twelve months follow-up only 12 patients relapsed. Symptom substitution was minimal. The prognosis is related, among other things, to the duration of the symptoms before treatment.

Atkinson (1971), in his chapter studying the role which coroners and research workers play in defining suicide, noted that by 1927 Hans Rost's bibliography of suicide cited nearly 4,000 works on the subject, while 2,000 further publications were listed by Schneidmann and Farberow between 1927 and 1961. He had personally traced another 300 studies subsequently. In the face of this vast output one hesitates to add yet another paper. However, historical surveys of popular views on suicide have received relatively scant attention, much of the most valuable work being carried out by historians.

The study analysed qualitative and quantitative dermatoglyphic features in schizophrenia and manic-depressive psychosis. Differences were found which support the view that these two psychoses are genetically distinct. A possible field for further study is discussed.

A left-sided preponderance of psychogenic symptoms has often been reported. A Suggestion Test for the study of the laterality of psychogenic symptoms is described. Psychiatric patients and nurses received, on tape, the suggestion of a sensation in the hand to which they could give either right, left or bilateral responses. In both groups there was a majority of left-sided responses. Also, a history was obtained of previous psychogenic symptoms. These had occurred more on the left than on the right side of the body, and an association was found between left-sided symptoms and left-sided response to the test in individual patients. Left-sided symptoms were more prevalent among patients who were not strongly right-handed. These findings are considered in relation to ideas about the differential involvement of the cerebral hemispheres in the production of psychogenic symptoms.

Patients with anorexia nervosa show a decrease in psychoneurotic symptomatology as measured by the Crown-Crisp Experiential Index (CCEI) as their clinical status improves. Those who remain ill continue to display a moderate degree of varied psychopathology 4 to 8 years after their presentation. Vomiters and those with anxiety on eating with others can be distinguished on the CCEI from those without such features. Lower anxiety, phobia, obsessional and somatic scores at presentation are predictive of good outcome in terms of weight and menstrual function 4 to 8 years later.

A standardized study of the point prevalence of non-psychotic disorder was carried out on a systematic sample of Canberra residents (N = 756). Rates were estimated for PSE CATEGO diagnoses and the Index of Definition. The association between neurosis and deficiencies in social relationships was examined, using the Interview Schedule for Social Interaction (ISSI). An objective measure of exposure to adversity was also obtained at interview. Both attachment and social integration (affectionally close and more diffuse relationships) were found to be negatively associated with neurosis. This association holds in its own right, in addition to an interaction with the load of adversity. The associations are weaker for men.

The significance of this work lies in its demonstration of an association between neurosis and the lack of social ties, and in its attempt to obtain a specification of those elements in social relationships which, when deficient, may be associated with neurosis. The direction of causality has now to be investigated.

Erythrocyte and leucocyte numbers and cyclic AMP content were monitored weekly in a mentally defective short-cycle manic-depressive woman. The erythrocyte count remained relatively constant but cyclic AMP content when manic was significantly higher than when depressed, and the mood and biochemical data appeared to have the same periodicity, with coincident peaks and troughs. Total leucocytes were related to mood, with peaks in the manic phase. Mononuclear cyclic AMP content varied without relation to manic or depressive phases.

Plasma concentrations of thioridazine, mesoridazine, sulphoridazine and thioridazine ring sulphoxide have been measured individually by specific gas-liquid chromatographic (GLC) methods, and collectively by a radio-receptor assay, in 16 elderly in-patients during chronic treatment. The sulphoridazine level was above 0.135 μg/ml in 5 out of 6 symptomatically well-controlled patients, and below this level in 9 out of 10 who were poorly controlled. No such division was so clear for the other substances measured. A new assay for the total dopamine receptor-blocking activity of the plasma correlated highly at lower levels with the sum of drug plus metabolites obtained by GLC, but exceeded the sum at higher values. Both sulphoridazine and neuroleptic levels need further study.

The prevalence of Klinefelter's Syndrome in new-born males in large surveys throughout the world has shown a scatter of 1.4 to 1.9 per thousand. Forssman (1970) accepted by pooling results a figure of 0.17 per cent as the average proportion of males born with at least one too many X chromosomes in some or all cell lines. Studies of mental hospital populations have consistently shown a higher prevalence of extra X chromosomes in males, averaging 0.54 per cent. The two largest studies, in Great Britain (Maclean et al, 1968) and in Sweden (Hambert, 1966) made no differentiation in the psychiatric diagnosis of the patients, although Hambert stated that the high prevalence did not stem from the mentally retarded population.