Almost invariably, a professional man becomes the captive of his chosen profession. His training and his subsequent experience in practice leave an indelible mark. It is often said that married couples grow to look like each other, and in extreme cases like their dogs. So lawyers, accountants, bank managers, doctors and perhaps even psychiatrists appear to take on a stereotyped form. The cartoonist spots the uniform clothes, the rimless glasses or the mid-European accent, as the trade mark of the particular profession. But more crucially there is also the growth of stereotyped modes of thought, of common assumptions and traditional patterns of argument which are to a large extent subconscious and so more likely to pass unnoticed.

For a foreign observer who has been trained in German and French psychopathology, British psychiatry is very attractive at first glance for a number of reasons. Its eclectic and principally non-theoretical approach (Cooper, 1975), characterized by an open acceptance of foreign concepts and by the tendency to question traditional structures and hypotheses and to test them by means of statistical methods, appears most impressive. The substantial contribution British authors have made toward the development of structured tools in psychopathology, like for instance the Present State Examination or the Hamilton Rating Scale in order to facilitate such a statistical evaluation, which reflects clearly the inheritance of Sir Francis Galton, is also a cause of sincere admiration. The European observer realizes furthermore that the British approach is rooted mainly in continental, especially in German, clinical psychiatry, and is not as heavily influenced by psychodynamic theories as, for instance, the American schools were, at least until recently. This provides him with a comfortable feeling of familiarity and he is not inclined to question certain British tenets until his involvement progresses and he becomes aware of the comparative lack of attention paid by British schools to some of the fundamentals of continental psychopathology.

Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations. The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia—Alzheimer type (SDAT). Reliability, validity, and correlational data are discussed. The CDR was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired.

Seventy-one neurotic patients requiring follow-up were randomly assigned to routine psychiatric out-patient care or to supportive home visiting from community psychiatric nurses as their main treatment agents and were assessed every six months for 18 months. No differences were found between effectiveness of the two modes of service on symptoms, social adjustment or family burden. Patients seeing community psychiatric nurses reported greater satisfaction with treatment. Community psychiatric nursing resulted in a marked reduction in out-patient contacts with psychiatrists and other staff, more discharges, and a small increase in general practitioner contact for prescribing. Care of such patients by community psychiatric nurses is a valuable alternative mode of deployment within the psychiatric team.

A review of all known schizophrenics from a discrete geographical area, Nithsdale in Dumfries and Galloway Region, found a point prevalence of 2.38 per 1000 of the total population; this figure fell to 1.73 when only Feighner positive schizophrenics were considered. Only 3 per cent of the population interviewed had no abnormality in mental state or behaviour; negative schizophrenic symptoms were prominent positive symptoms uncommon. Approximately one quarter were in-patients, who were an atypical group, showing much more obvious social and psychiatric disability. In- and day patient care and state benefits for schizophrenics cost each member of the Nithsdale community approximately £12 a year.

In a review of all known schizophrenics (n = 133) from a discrete geographical area, Nithsdale in Dumfries and Galloway Region, 88 per cent were examined for evidence of tardive dyskinesia (TD) and parkinsonism. The prevalence of both TD and parkinsonism was 31 per cent. The TD group was older and more often showed negative schizophrenic symptoms than the non-TD group. The trend was towards a higher prevalence among in-patients and Feighner positive schizophrenics. Parkinsonism was common in patients receiving antiparkinsonian drugs. Ten per cent of patients had both TD and parkinsonism. The findings will act as a baseline for regular reassessment of the population.

Handedness was assessed in 87 per cent (n = 116) of all known schizophrenics from a discrete geographical area, Nithsdale in Dumfries and Galloway Region. Seventy-three per cent were right-handed, a proportion greater than that found in a normal population. It was especially Feighner positive schizophrenics and non-in-patients who produced the excess of right-handers. Within the Feighner positive group, 68 per cent of mixed or lefthanders, but only 29 per cent of right-handers, had tardive dyskinesia.

Segregation analysis was applied to blind family data concerning schizophrenia to decide if the transmission of schizophrenia could be explained by a single major gene. Our results showed that the Mendelian model was unacceptable. Therefore, the monogenic hypothesis could not account for the transmission of schizophrenia. Since the hypothesis of no parent-child transmission was also not accepted, there was an indication that some form of vertical transmission existed which could be psychosocial, or an interaction between genetic and psychosocial factors. Our results suggest genetic heterogeneity in schizophrenia. Currently available clinical criteria for defining subgroups must be improved in conjunction with detection of biological indicators so that segregation analysis of family data could be effectively used in determining modes of transmission in schizophrenia.

The more recent large scale family investigations of schizophrenia are reviewed, particularly studies in which the authors have compared the rates in relatives of index cases with those of the general population. The risk of psychotic illness is increased four-fold in first-degree relatives and two-and-a-half-fold in second-degree relatives over that of the population at large. The possible genetic mechanisms are evaluated, with the conclusion that modified dominant transmission, based on a single major gene, is a plausible system.

The HLA antigens distribution was studied in 56 chronic schizophrenic in-patients with or without brain atrophy determined by CAT examination, and compared with that of 200 controls. There was no difference in the incidence of HLA-A2 in the whole sample, and an increase in those without brain atrophy (by comparison with normal controls) failed to reach statistical significance. A decrease of Bw35 in the whole sample, more prominent in those without brain atrophy, again failed to be significant after multiplying the probability by the number of antigens studied.

Demethylation was compared in acute and chronic schizophrenics and in non-schizophrenics by the administration of C14 labelled 2,3,4-trimethoxyphenylethylamine (TMPEA). The results did not show a significant difference in the urinary levels of the monodemethylated catabolites of TMPEA among any groups of patients. However, there was a significant decrease in demethylation in untreated chronic schizophrenics after ten days of L-methionine orally, whereas the non-schizophrenic group similarly given methionine did not change. This suggests the possibility of a biological weakness in schizophrenia.

Six patients are reported in whom mental illness led to severe cold injury. The main contributory factors were cold surroundings, inactivity and neglect. The additional factor of impaired microcirculation in these patients may also be significant.

In the winter of 1979 two instances of cold injury in patients with mental illness came to our attention. A search of the medical records at the Whittington Hospital revealed a further three cases over a period of 14 years. One patient was seen at the National Hospital for Nervous Diseases, Queen Square.

Patients receiving prophylactic lithium therapy for primary affective disorder during a four year period were studied for recurrence of affective illness. Patients who had affective episodes during this period did not differ from those who remained well in age, sex or diagnosis. Those with a favourable outcome had spent significantly less time at serum lithium levels above 0.9 mmol/litre than those who had a recurrence of affective episodes.

Neurotoxicity is a rare but well recognized unwanted effect of lithium therapy (Moore, 1972; von Hartitzsch et al, 1972; Tyrer and Shopsin, 1980) which tends to be associated with high serum lithium levels. In clinical practice it is normally assumed that once signs of toxicity are detected and treatment stopped, serum levels will return to normal. We report here a patient who developed toxic symptoms while her serum levels were in the therapeutic range but who developed severe neurotoxic sequelae and high serum levels after treatment was stopped.

Month of admission data to psychiatric facilities in New South Wales, 1971–76, were examined for some 23, 000 patients with a depressive disorder to determine if seasonal variations in admissions, described in the northern hemisphere, exist there. In addition, data were examined on month of occurrence of some 3, 000 deaths due to suicide and self-inflicted injury, over the same period. Seasonality was demonstrated for three ‘psychotic’ depressive disorders, but not found for neurotic depression, further supporting the binary view of depression. A peak incidence in spring was found for MDP-mania and reactive depressive psychosis, while the peak incidence for MDP-depression was was in late winter. It is suggested that the increase in certain affective disorders around spring may follow a rapid increase in luminance, and in stimulation of the pineal gland. Suicidal deaths of males did not show significant seasonality, while those of females showed two incidence peaks, the significant one occurring in spring.

The possible effects of clinical depression on intellectual function were investigated in unipolar and bipolar patients. Ninety-six hospitalized depressed patients completed the Wechsler Adult Intelligence Scale (WAIS) on admission and 34 were retested on remission. The high average full scale IQs found remained relatively stable throughout, consistent with earlier studies indicating a limited relationship between intellectual function and clinical severity of depression. No evidence was found for retarded psychomotor activity in bipolar groups or increased psychomotor activity in unipolar groups on three WAIS subtests of psychomotor function, but full scale IQ increased slightly in hypomania.

R. D. Laing's The Divided Self was never reviewed in this journal. The author's first book, it was published in 1960, and became essential reading in the intellectual counter-culture of the 1960's and 1970's. It is found convincing by critics of psychiatry. By 1965 it was brought out in paperback, and it has remained in print ever since. The current edition has sold over 400, 000 copies, “and continues to sell very well indeed. The book has been translated into virtually every other language in which books are published” (Middleton, 1981). Laing's later books, also, are discussed by sociologists, psychologists, philosophers and historians of ideas. Apart from many articles and essays, books have been devoted to Laing's written work—for example, Laing and Antipsychiatry (Boyers and Orrill, 1971); R. D. Laing: the Philosophy and Politics of Psychotherapy (Collier, 1977); R. D. Laing: His Work and its Relevance for Sociology (Howarth-Williams, 1977) and a volume, Laing, in the Fontana Modern Masters series (Friedenberg∗, 1973). Yet Laing is anathema to many psychiatrists, and his views on schizophrenia and insanity get brief mention in standard psychiatric textbooks, usually dismissed as extreme and/or unscientific.