A monozygotic twin assaulted his wife and daughter, killing both in an extremely brutal manner. Three years previously he had been like his co-twin today: a dutiful husband and father, an extremely hard-working and successful farmer, and a devout Christian known throughout the district for his gentle and considerate manner. His life changed following two frightening accidents after which he developed severe anxiety symptoms necessitating in-patient psychiatric treatment. This highlights the importance of psychological effects from an accident in producing marked personality change.

Children with typical autism, other early childhood psychoses and severe mental retardation without autistic behaviour were identified in an epidemiological study in an area of South East London. The social class distribution of their fathers was examined and no significant differences were found between the groups, nor in a comparison with the general population of the area. Fathers of children with autism and related conditions referred to an out-patient clinic with a special interest in autism, mostly at their own request, and fathers joining the National Society for Autistic Children, were of higher social class than both the average for England and Wales and the fathers of the study children. Joining the NSAC during its early years, and keeping up membership were also linked with higher social class. The findings supported the view that reports of a social class bias in autism may be explained by factors affecting referral and diagnosis.

Sixty-six agoraphobic patients were followed up five to nine years after their treatment in three clinical trials of behaviour therapy. The main outcome measures used in the original trials were repeated by an assessor who interviewed the patients. Ninety-five per cent of patients were interviewed and partial information was obtained on a further two patients. The measures taken at follow-up were compared with those obtained prior to treatment and six months after treatment ended. On most measures of agoraphobia the patients were much better at follow-up than they had been before treatment. The assessor's ratings suggested that there had been little change in the patients' agoraphobia since six months after treatment. Some of the patients' self-ratings showed evidence of a slight improvement over this period. No evidence of symptom substitution was found.

Two hundred and ninety West Indian and 73 West African patients were identified and matched against 204 and 53 English patients respectively. Significantly more migrant patients were: not referred to hospital by their GPs, showed disturbed behaviour prior to psychiatric contact, and were admitted formally. Studying consecutive attendances or admissions to one hospital may lead to an unrepresentative sample.

The effects of three single oral doses (25 mg, 50 mg and 100 mg) of amitriptyline and desipramine, and of placebo, were compared on a range of cholinergic functions (resting pupil diameter, pilocarpine-evoked miosis, baseline-sweating, carbachol-evoked sweating, salivation, heart rate) in eight healthy volunteers. Three measures (pilocarpine-evoked miosis, carbachol-evoked sweating and salivation) reflected the antimuscarinic property of the antidepressants; in two tests (pilocarpine-evoked miosis and salivation) amitriptyline appeared to be more potent than desipramine. Resting pupil diameter was not affected by amitriptyline, whereas desipramine caused mydriasis, indicating that pupil size is not a reliable measure of anticholinergic activity in the case of drugs which also affect adrenergic mechanisms. Baseline-sweating and heart rate were not affected by the antidepressants.

In a four-week, double-blind, clinical trial thirty-one patients with depressive neurosis were treated with viloxazine, doxepin, or placebo. There were no differences among the three groups in therapeutic effects. Many depressed out-patients improve on placebo. Viloxazine hydrochloride is one of a series of compounds developed to explore the central nervous system activity of the aryloxypropanolamine type of β-adreno-receptor antagonists. Initial clinical studies support the hypothesis that viloxazine has antidepressant properties in man (Bayliss et al, 1974; Bereen, 1973; Pichot et al, 1975; Tsegos and Ekdawi, 1974).

Plasma levels of antidepressant drugs were measured in 17 depressed patients at roughly monthly intervals over follow-up periods of three to 26 months. Good results in seven were associated with small fluctuations in level from visit to visit, while big fluctuations were associated with poor outcome. Such fluctuations were probably from poor compliance or drug interaction from self-medication. Severe side effects and cardiotoxicity were associated with high levels.

It has been suggested that reversal of stress-induced tachycardia by beta-adrenergic blockade might be of benefit in the treatment of phobias. This was tested in a double-blind cross-over trial by exposing 22 female volunteers with spider or snake phobias to their phobic object 1 ½ hours after administration of either tolamolol 200 mg, diazepam 10 mg or placebo. Although tolamolol abolished the stress-induced tachycardia, it had no beneficial behavioural or subjective effects. In contrast, diazepam, which had no significant effect on heart rate, improved behavioural performance. Subjective measures were more influenced by order effect than by medication.

No benefit attributable to propranolol (1000 mg/day) could be detected in a trial lasting at least 22 weeks, 6 weeks of which was double-blind placebo-controlled, in 5 chronic schizophrenic patients. The mean propranolol CSF/plasma ratio was 0.08, and there was good agreement between CSF and free plasma propranolol levels. Basal plasma prolactin was slightly but insignificantly reduced by propranolol, and metoclopramide-stimulated prolactin release was unaffected. Propranolol was associated with a significant temporary increase in HVA, a non-significant rise in 5-HIAA and a significant decrease in MHPG, in the lumbar cerebrospinal fluid of 4 patients.

In a series of fifteen aggressive mentally subnormal patients treated with lithium carbonate, there was an improvement in aggressive behaviour in eleven cases, three patients showed no change and one patient became worse during lithium treatment. The response to lithium therapy was assessed by clinical observation and retrospective analysis of daily ward reports. Treatment had to be discontinued in one patient who developed tardive dyskinesia, but otherwise side effects were not a problem.

The psychotherapeutic treatment of 15 patients is described. The goals were defined in terms of target problems and target dilemmas, traps and snags, and the outcome was assessed by rating these or with a symptom questionnaire and a dyad repertory grid before and after treatment. Patients who rated dilemmas as resolved showed appropriate changes in construct correlations on the dyad grid.