A research neuroscientist in his fifties, who has recovered from endogenous depression after several years, describes the experience and makes some comments on treatment and management. He found electroconvulsive therapy, mianserin, lithium carbonate and diazepam acceptable. He considers that occupational therapy and conventional psychotherapy were counter-therapeutic. He stresses how physically ill he felt when depressed, and compares this with prolonged influenza. He hypothesises that the underlying psychological disorder in endogenous depression is the learned extinction of optimistic thoughts, and suggests that any psychotherapy used should be aimed at restoring these.

A 46-year-old mother with a history of chronic headaches and other symptoms, and a clinical diagnosis (in Western terms) of depression, ascribed her condition to non-observance of Chinese postpartum ritual. The characteristic features of ‘wind illness' are described. Western medicine proved useless but acupuncture was beneficial. The case underlines the importance of understanding the patient's own view of his/her illness and its causes in arriving at a correct diagnosis and intervening effectively: this is particularly true when the gap between the doctor's and the patient's cultures is wide. The value of the distinction between the disease (the pathological process, which may be universal) and an episode of illness (the personal and cultural construction of disease) is emphasized.

The prophylactic effects of carbamazepine (CBZP) were studied in 32 patients with affective disorder who were receiving long-term therapy with CBZP. Complete inhibition of both manic and depressive episodes was observed in four cases, reduced incidence of episodes or decreased intensity of symptoms in twenty, and no change in eight. CBZP was significantly more effective in cases with an onset before the age of 20, and subjects showing a continuous pattern of alternating episodes responded better than those with a more intermittent history of mania and depression. Where CBZP had an effect it was generally apparent soon after therapy started. These results suggest that in some cases CBZP is an agent suitable for long-term continuous prophylactic therapy in manic-depressive disorder.

Intracavernosal injection of phenoxybenzamine, in a dose too small to have significant general effects, caused full erection lasting between half an hour and 30 hours in 3 of 4 potent men (2 normal, 2 anorgasmic) and in 6 of 11 impotent men. In the remaining potent man and 3 of the remaining impotent it caused the penis to be stiff enough for intromission. Six of the eleven impotent men have had sexual intercourse, for the first time for months or years, while under the drug.

The practical implications of this new discovery are discussed.

Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6–8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are more lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.

Eighteen agoraphobic patients were randomly assigned to 12 week treatment with imipramine (I) or imipramine and programmed in-vivo exposure practice (l+BT) to investigate the contribution of behavioural instructions to the clinical effects of pharmacotherapy. Significantly greater improvement on phobic measures was found in the l+BT group compared to the I group. Differences were less marked on measures of panic and anxiety. The results suggest that imipramine possesses an antiphobic effect which can be substantially enhanced with programmed practice. Controlled large-scale investigations of the pharmacological and instructional effects of the pharmacotherapy of agoraphobia are needed for a definitive evaluation of the specific antiphobic effect of antidepressant drugs.

Thirty-two agoraphobic patients were randomly allocated to four groups and treated by repeated exposure to cine-films at twice weekly intervals for three weeks. Three of the groups saw the same cine-film, comprising a range of agoraphobic scenes, and a control group saw a potter working on his wheel. The three groups seeing the phobic cine-film included one who viewed it at an illumination level below the visual threshold (subliminal group), one seeing it under normal conditions (supraliminal group) and one which underwent graduated exposure from subliminal to supraliminal viewing levels as the study proceeded (faded group). The faded group showed significantly greater improvement than the control and supraliminal groups and this improvement was maintained over twelve weeks.

All men receiving hospital orders (Section 60) in the UK in the year 1963–64 (excluding those receiving restriction orders (Section 60/65)) were followed up over 15 years with regard to (1) subsequent offences and convictions, (2) hospital admissions, and (3) death. Nine per cent of the patients involved could not be traced. Sixteen per cent had died by 1978, a quarter of them by suicide.

Of the mentally ill only 4 per cent subsequently committed serious offences (manslaughter, wounding, GBH, robbery, rape or arson), although a further 4 per cent committed assaults repeatedly. Sex crimes were uncommon. Among the mentally subnormal, 7 per cent committed serious sex crimes subsequent to committal. A further 9 per cent were considered to be persistent sex offenders and another 9 per cent were judged to be persistently violent. In general the mentally subnormal were much younger and were detained for much longer than the mentally ill. Since 1964 the use of hospital orders for the detention of such people has become much less frequent.

The best predictor of subsequent offences was found by multiple regression analysis to be the number of previous offences: this was especially true for acquisitive offences committed by the young. The mentally ill were less often reconvicted than the mentally subnormal.

The offenders committed to local hospitals in 1962 and 1964 under a hospital order with restriction of discharge were followed up for 15 years with regard to subsequent court appearances, hospital admissions, and death. One hundred and forty-six were traced. Of these, 49 per cent had been diagnosed as mentally ill: most of this group were committed for violent offences. Thirty-five per cent were mentally subnormal: they were frequently committed for sexual offences, arson and property offences. Twelve per cent were diagnosed psychopathic: this group had a wide variety of committal offences.

Fourteen per cent of the mentally ill and 17 per cent of the mentally subnormal were still in hospital after 15 years, but 51 per cent of the mentally ill and 36 per cent of the mentally subnormal were released within three years. Sixty-one per cent of the psychopaths were released within two years. Few of the subsequent offences were serious in any of the diagnostic groups.

Since 1973 there has been a dramatic fall in restriction orders, especially for mentally subnormal patients.

A comparison of a group of chronic schizophrenics with controls showed that: the patients had significantly less interest in sex, frequency of intercourse, and satisfaction from sex; the percentage of individuals with sexual dreams and sexual fantasies did not differ between the two groups; the severity of psychopathology influenced frequency of intercourse and satisfaction from sex, and the length of institutionalization influenced interest in sex; the schizophrenics had a variety of sexual disorders, but there was a significant difference between the sexes in disturbances of thought and perception; and, significantly more male schizophrenics, in comparison with females, had sexual dysfunction associated with pharmacotherapy, but feminization in the males was far from predominant.

The patients' sexual disorders are not disturbing to the social life of the open mental hospital or the community surrounding it.

Births occurring in winter months, which are high viral infection months, have been repeatedly shown to produce a slight excess of later-diagnosed schizophrenics. As a result, some researchers have speculated on the possible aetiological effect of viral infections on some forms of schizophrenia. The implications of the viral hypothesis were indirectly tested in the context of an ongoing prospective study of Danish children at high-risk (HR) for schizophrenia. A third-order analysis of variance interaction was hypothesized. Genetically vulnerable individuals, born in winter, in an urban environment (which increases the likelihood of the presence and transmission of viruses) would be more likely, as foetuses or neonates, to have suffered some CNS damage due to the infection; thus they would show higher rates of schizophrenia diagnoses. This hypothesis was supported. The rate of schizophrenia in the HR-urban-winter birth condition reached 23.3 per cent, considerably above population base rates (1 per cent) or rates for the HR subjects (8.9 per cent). Alternative explanations for the results were explored.

The association between the risk for schizophrenia and season of birth was studied using a standard actuarial life table method. This method of analysis eliminates the possibility of the previously described statistical artifacts from the data. An increased risk for schizophrenia for winter born individuals was demonstrated. The analyses also supported the hypothesis that season of birth is associated with an increased risk for a subtype of schizophrenia.

Despite a large research effort, there is still some doubt whether life events can increase the rate of psychiatric morbidity. It is argued that this doubt arises from a confusion between measures of goodness of fit and measures of causal importance. The distinction between these types of measures is discussed.

Epidemiological studies of life events and psychiatric cases are reviewed. It is argued that, in general, 32 per cent of psychiatric cases can be attributed to stressful life events. Within female samples, approximately 41 per cent of psychiatric cases can be attributed to life events. It is suggested that the effect of specific types of events on specific psychiatric disorders may be of even greater importance.

Past history of suicidal behaviour was investigated in 51 depressed women (27 unipolar and 24 bipolar) in whom the TSH response to TRH was studied. Patients with a history of violent suicidal attempts were shown to have a reduced TSH response to TRH, compared to depressed patients with a history of non-violent suicidal attempts and depressed patients with no history of suicidal behaviour. A five-year follow-up study on these patients revealed that four patients who died from suicide had an absence of TSH response to TRH.

A case of tuberculous Addison's disease presenting with psychosis, profound hyponatraemia, and detectable plasma antidiuretic hormone is reported. Clinical and biochemical improvement after corticosteroid replacement was followed by relapse with further psychosis and inappropriate antidiuretic hormone secretion: both were promptly reversed by demethylchlortetracycline. The association of psychological symptoms with Addison's disease, the role of anti-diuretic hormone secretion in Addison's disease, and the inter-relationship between Addison's disease, psychosis and anti-diuretic hormone secretion are discussed.

A case of childhood bipolar disorder, manic type, is presented in which electroconvulsive therapy was used for the acute manic episode. The pharmacological complications which led to this choice of treatment and the computerized tomography finding of ventricular enlargement, are discussed.

The tradition of medical practice is based on the assumption that the patients come to the doctor for professional advice and service. Having done so, they have the right to reject the advice or refuse the service, and to go elsewhere. There are a few exceptions to this general rule. Children do not come to doctors, they are brought to them. In that case, the rights pertain to the parents. Persons who are so seriously injured or ill that they cannot exercise their judgement, will be brought for treatment, and it is then assumed that the doctors will use their professional judgement and do their best, considering the circumstances, for them. This applied also to those patients who were mentally disturbed in such a way that they could not make proper decisions.