On 17 November 1969, Dr. A. A. Baker, then Senior Principal Medical Officer, Department of Health and Social Security, sent a letter to consultants at mental subnormality hospitals in which he requested them to introduce the World Health Organization International Classification of Diseases, Eighth Edition, 1965, in the completion of Mental Health Inquiry Index Cards. The booklet A Glossary of Mental Disorders, No. 22 in the General Register Office Studies on Medical and Population Subjects was enclosed with the letter for information and to facilitate the use of the Classification.

In a previous paper (Leff, 1973) data from the International Pilot Study of Schizophrenia (IPSS) (WHO, 1974) were analysed, and it was found that patients from developed countries showed a greater ability to differentiate between unpleasant emotional states than those from developing countries. The data on which this finding was based were scores derived from the sections on Depression, Anxiety and Irritability in the Present State Examination (PSE), a semi-structured psychiatric interview (Wing, Cooper and Sartorius, 1974). The scores were the sums of ratings made by psychiatrists interviewing patients from their own countries. The psychiatrists judged whether or not a symptom was present on the basis of the patient's verbal response to a series of questions, most of which are stipulated in the PSE. The patient's nonverbal behaviour is not taken into account in making these ratings.

Classification systems such as diagnosis have two primary properties, reliability and validity. Reliability refers to the consistency with which subjects are classified; validity, to the utility of the system for its various purposes. In the case of psychiatric diagnosis, the purposes of the classification system are communication about clinical features, aetiology, course of illness and treatment. A necessary constraint on the validity of a system is its reliability. There is no guarantee that a reliable system is valid, but assuredly an unreliable system must be invalid.

Arguments about the role of heredity in schizophrenia have largely given way to arguments about the genetic mechanisms involved. Discussions of the various genetic models by leading workers in the field have been presented in recent years (Rosenthal and Kety, 1968; Kaplan, 1972). Single gene theories have prevailed, Slater's intermediate model being preferred because of its good fit with the observed risks of schizophrenia in specific categories of blood relatives (Slater and Cowie, 1971).

Although there have been several reports of investigations of speech perception in schizophrenia (Laffal, 1961; Lawson, McGhie and Chapman, 1964) in all cases the assumption was made that the patients’ difficulties arose, not from an inability to perceive the individual words, but from a deficiency in perceiving the words in a meaningful relationship to each other, as part of an organized pattern. In this study, however, instead of examining the performance of schizophrenic patients on a task involving the perception of sentences, as these earlier workers had done, we have used individual words as stimuli in a series of tests of speech perception.

Historically, doctors have not always acknowledged that they have an obligation to prevent suicide, partly because they shared the prevalent idea that most suicides were caused by moral crises, no concern of theirs—and indeed suicide was a criminal matter until quite recently; but more, perhaps, because a fatalism has characterized their attitudes to its prevention, even where the suicide was clearly suffering from mental illness. Yet two recent American studies have shown more than 90 per cent of suicides to be mentally ill before their death (17, 8); this finding and the familiar clinical observation that suicidal thoughts disappear when the illness is successfully treated provide a strong case for a medical policy of prevention.

The aim of the present study is to investigate probable socio-cultural determinants in the epidemiology of attempted suicide in Trinidad and Tobago. In an earlier paper the author described the clinical features which were noted among those patients who attempted suicide and were admitted to the only psychiatric unit in these islands (Burke, 1974). During the period before this unit was in full operation other workers had noted a tendency for suicide attempts to be made more frequently by women of East Indian origin, who most often reside in rural areas, than among the more urban African ones (Haynes, 1966; Roberts and Russell, 1969). Since those studies a suicide prevention service has been established which admits all patients who attempt suicide. The present study was intended to re-investigate the ethnic sub-cultural findings which occur in the new service. It was hypothesized that there was no difference in the distribution of attempted suicide, between the two sub-cultural groups.

Nearly all the authors who have concerned themselves with puerperal psychoses have discussed the occurrence of mental illness in the families of the patients. However, as Jansson (1964) has pointed out, there exists no systematic study on the importance of hereditary factors in this disorder.

In the mid-1960.s, reports came from Scotland and England of a high frequency of gonosomal aberrations among male patients in maximum security hospitals (Jacobs et al., 1965; Casey et al., 1966). This led to a lively discussion. If these observations could be generalized so as to apply also to similar institutions in other countries, the question would be whether gonosomal aneuploidy had any bearing on the development of criminality and psychic diseases? In particular, the significance of a double Y condition as a predisposing factor was called in question. Unfortunately, from the outset the discussion became too categorical and oversimplified. When in subsequent studies socially well-adjusted individuals of normal intelligence were found, it was doubted whether aneuploidy had any importance at all. In a survey as recent as 1972, for example, Owen questions whether there is any connection at all between excess Y-chromosomes and behaviour disorders and mental diseases. Hook (1973), on the contrary, in a somewhat more detailed compilation, shows that there is a clear connection between the occurrence of double Y-chromosomes and individuals whom he defines as ‘mental-penal’. A common feature in all the literature, however, is that almost all writers insist on the importance of more research in this field.

The steady stream of publications on the XYY syndrome, including recent papers by Christensen and Nielsen (1973) and a comprehensive review by Hook (1973), demonstrates clearly that confirmation or refutation of the relationship in this syndrome between dull intelligence, even mental deficiency, and impulsive or delinquent behaviour requires further evidence. In an attempt to supply such evidence this report presents psychological and anthropometric information about five XYY subjects detected from amongst attenders at the Special School in the city of Aberdeen.

It has been shown by Knobloch and Pasamanick that a disproportionate number of oligophrenics are born during the first months of the year. This appears to be true mainly in warmer climates and is supposed to be related to nutritional problems which arise when the most sensitive weeks of pregnancy coincide with the unpleasantly warm summer months. Such findings have led to a revival of the interest in the monthly birth distribution of schizophrenics. There is some evidence that this pattern actually differs from that of the general population, and para-natal complications could be the explanation.

The role of a broad range of life events, especially those viewed as stressful, in the genesis of somatic illnesses or psychiatric disturbances is a subject of considerable interest. Recently attempts have been made to develop quantitative measures of life events and to explore the relationship between the ‘amount’ of life events and/or stress and illness in a general population (Rahe et al., 1968; Rahe et al., 1970): for example, The Social Readjustment Rating Questionnaire (SRRQ) (Holmes and Rahe, 1967). In the development of this scale a list of 43 life events was presented to a sample of 394 subjects. Marriage was arbitrarily assigned a value of 500, and the subjects were asked to compare the amount of relative readjustment they would anticipate from the other events. Means and item rankings (Masuda and Holmes, 1967) have been reported to be relatively consistent in groups of different age, sex, marital status, education, social class, generation American, religion, race and cultural background (Holmes and Rahe, 1967). These findings have been found reliable with patients on our unit and in a group of medical students (Mendels and Weinstein, 1972). Paykel et al. (1971) performed a study of weightings of a list of life events and obtained weights which were highly significantly correlated for the 14 items that were identical to those found on the SRRQ. They tested a mixed group of psychiatric patients and found that in general those events defined as ‘exits’ were scaled high, whereas events defined as ‘entrances’ had lower values.

In a previous paper (Morrice, 1973a) an account was given of a day hospital run as a therapeutic community. Emphasis was laid upon the way staff had learned to diagnose and treat patients not only according to conventional labels but also in terms of their disturbed social relationships—so-called social diagnosis and social prescription. At that time also an attempt was begun to identify life events which appeared to have precipitated the patients’ referral to psychiatric care. This paper considers the data derived from 266 consecutive admissions to the day hospital. Information obtained in each case was discussed by the staff group and noted on a standard form (Fig. 1) according to agreed principles.

Lippold and Redfearn (1964) reported psychological effects from sending small direct electrical currents through the brain (polarization). For 26 subjects they found that scalp-positive current caused ‘alertness or more involvement in the environment’, whereas scalp-negative current caused ‘quietness and withdrawal’ (p. 771). Three other subjects reliably produced opposite changes. The observations were made during brief talks by judges unaware of the kind of current being administered. The present study, details of which are given by Nias (1968), aimed to observe the effects of polarization upon symptoms of depressed patients.

A girl is briefly described who had typical bipolar manic-depressive psychosis starting unusually early at 14 years of age. Symptoms at the time of onset included severe anorexia, school phobia and attempted suicide, about the time of onset. She required unusually high doses of lithium carbonate to obtain adequate plasma levels, and there was a tendency for the administration of antidepressant medication to cause her to switch rapidly from depression to hypomania. The last two findings were shared by her father who also had bipolar manic-depressive psychosis.