An investigation was undertaken into the first admissions to (for the years 1963, 1965, 1968, 1972) and the total discharges from (for the years 1963–72) Scottish mental hospitals and psychiatric units of male doctors and other social class I males. The overall rates for both first admission and for all discharges were more than twice as high among male doctors as among other social class I males. First admission and total discharge rates for drug dependence, alcoholism, neurotic and ‘functional’ depression and for affective psychosis were all significantly higher among doctors than non-doctors. Doctors were more likely than non-doctors to have been referred by themselves or by medical sources other than general practitioners, and were as willing as non-doctors to enter hospital voluntarily. Greater access to psychiatrists may have contributed to their higher rates of in-patient care, but it is improbable that such factors accounted for all of the excess in rates of drug dependence, alcoholism and depression.

A study of the cases of 100 doctors admitted to The Retreat, York, confirmed the findings of a'Brook et al (1967) in all important respects, addiction being the outstanding feature of the series.

A description is given of the coping behaviour of seven men who survived a shipwreck and were not rescued until 13 days later. The principal behaviours shown by the men were attachment ideation, drive to survive, modelling, prayer and hope. Particular attention is paid to the first of these, and consideration given to its likely origins in behavioural evolution. It is proposed as a hitherto inadequately recognized coping behaviour. A follow-up examination 12 to 24 months later showed that five of the seven men available had developed substantial psychiatric disorder, while by contrast one was not only well but claimed to have been enriched by the experience. Exposure to extreme adversity or disaster may have long-term effects on mental health. Further longitudinal studies of disaster victims are necessary for the design of informed after-care.

Pathological bereavement reactions following the death of a close relative or friend have been well documented in the literature. Similar grief reactions have been described following other personal losses, such as the loss of a limb or the loss of one's home.

The cases of three women are described in whom pathological grief followed another category of loss, that represented by the death of a much loved domestic pet. The patients suffered disabling psychiatric symptoms following the death of their pet dogs. The dogs were all of the toy dog variety and had been at least 13 years of age at the time of their death. Institution of psychiatric treatment resulted in rapid recovery and at follow-up after a year there had been no recurrence of symptoms.

In an investigation of the relation between life events (stressors) and illness, 87 medical students reported on a prospective basis their health and life events history over a three year period. There were a few positive findings, e.g. that subjects who reported more life events during the period also reported more illnesses during that period. Overall, however, the study showed a lack of statistically significant association between life events and illness.

A case of multiple personality is presented and described. Psychological and neurophysiological parameters obtained on the personalities are evaluated. Major differences between the personalities in the processing of sensory information (augmenting-reducing parameter) are discussed.

An analysis has been made of patients aged 15 + referred to the community psychiatric service in a Danish rural population during 18 years. The mean referral rate per year was 17·9 per 1,000.

The majority of the patients (79 per cent) were referred to the clinic by the general practitioners, and it is stressed that a close and good co-operation between the psychiatrists and the local physicians is one of the most important factors in establishing a good community psychiatric service.

Only 11 per cent of all referrals were admitted to a psychiatric hospital. The admission frequency for psychoses was only 19 per cent, and it was estimated that it would have been approximately 44 per cent higher, if the service had been of the usual hospital-oriented type. Forty-three per cent of the patients were visited by the psychiatrist in their home at least once and 42 per cent of all 6,000 consultations were home visits.

When evaluating the treatment possibilities it was considered that approximately 50 per cent of all patients referred could be treated by the local physicians after examination by psychiatrists and discussion of the cases with them.

In 26 depressed patients, a high correlation (0·89) was found between the Hamilton score and a psychiatrist's global rating and between the change (0 · 68) in these ratings during treatment. The Hamilton scale was able to differentiate at the 0·01 level four degrees of severity based on the global rating. Limiting the range of severity measured was found to lower significantly the correlation between the ratings. A prospective examination of a six-item sub-scale of the Hamilton scale developed by Beck and associates failed to confirm its claimed improvement in sensitivity or validity.

Seventy-eight depressives were assessed on the Delusions-Symptoms-States Inventory. The results supported Foulds' and Bedford's hierarchy model, in that nearly all patients fitted this model, and the relationship between delusions of Contrition and state of Depression was found to be an inclusive, non-reflexive one. Suggestions are made for extensions to this study.

To test the Foulds and Bedford hierarchical model of personal illness, the Delusions-Symptoms-States Inventory (DSSI) was administered to 100 psychiatric in-patients. Ninety-six had symptom patterns compatible with the hierarchy. This is significantly more than expected on the basis merely of the number of DSSI items affirmed, and overall the results support the model.

Red blood cells (RBCs) from normal volunteers were incubated in vitro at four different extracellular lithium concentrations. Extracellular lithium concentration affected RBC lithium accumulation in several ways. As extracellular lithium concentration increased, the inter-individual variability of RBC lithium accumulation increased. Furthermore, the ratio of RBC lithium concentration to extracellular lithium concentration (lithium ratio) increased in relation to increasing extracellular lithium concentration. A lack of agreement among the authors of recent reports dealing with the significance of the lithium ratio as a psychobiological measure has been noted. It is suggested that this lack of agreement may be due, in part, to the study of patients with differing levels of extracellular lithium.

One hundred and thirty-three Chinese schizophrenic patients first seen in 1965 were traced for a follow-up assessment in 1975. Eighty-two patients attended and were fully evaluated, 47 failed to attend and 4 were known to have died. The course and outcome were graded into four categories, and it was found that 65 per cent of the fully evaluated group had full and lasting remission or showed no or mild deterioration only, despite some relapses. Intra-group comparison showed that being female, a shorter duration of illness, an acute onset, symptom-groups other than disturbances of emotion and volition, and the presence of a supportive relative are factors which affect the prognosis favourably.

Previous research suggests that the predictability of speech in schizophrenic patients may be related to certain measures of thought disorder. Two uninterrupted passages of 200 words were taken from 25 randomly selected schizophrenic patients recently admitted to hospital and were ‘Clozed’ by students under both fourth- and fifth-word deletion. Thought disorder was measured by the Bannister-Fransella test, and the Cloze scores were found to be related neither to Intensity nor to Consistency.

Theoretically, one would expect to find increases in prolactin secretion in patients with anorexia nervosa: the evidence for this is reviewed. However, relevant work to date seems to indicate that this is not so. These paradoxical findings are discussed, and areas of further research are outlined.

During recent years there have been published a number of reports of more than one case of transsexualism or other sexual pathology occurring within the same family. As long as the aetiology of transsexualism remains unknown the authors consider that a possible effect of recessive genes cannot be definitely excluded. To ascertain whether transsexual patients are born of cousin marriages to a greater extent than expected the authors have fully investigated family relationships for 61 known cases of transsexualism. No case of cousin marriage was disclosed.

The case histories are examined of 41 patients who were admitted to hospital for the first time with a diagnosis of obsessive-compulsive neurosis. Aspects of the phenomenology are reported which presented between the first appearance of obsessive-compulsive symptoms and discharge from the first admission.

The mean age for admission was 31·6 years (SD 14·3) and 68 per cent of the sample were women. The women showed significantly higher incidences of contamination phobia and of compulsive cleaning behaviour than did the men. Cleaning behaviour and avoidance of feared stimuli were the most frequently encountered manifestations of compulsive behaviour.

The matrimonial stability of 142 families where a child with neural tube malformation (mostly spina bifida) was born between 1964 and 1966, including 56 families with a surviving spina bifida child, was examined in January 1976. The divorce rate for families with a surviving child was found to be nine times higher than that for the local population and three times higher than for families experiencing bereavement of their spina bifida child. Marriages which followed a pre-nuptial conception resulting in a spina bifida child were particularly vulnerable and had a divorce or separation risk of 50 per cent. All the divorced fathers had remarried, but only one of the mothers. It is concluded that a handicapped child adds greatly to the strain on a marriage, especially when this has not been cemented before the arrival of a child. This strain is diminished by the child's early death.

Two hundred and seventeen women between the ages of 40 and 55 years referred to a gynaecological out-patient clinic were screened for psychiatric illness by means of the General Health Questionnaire (GHQ) and a brief special questionnaire. Of the 114 women identified as possible psychiatric ‘cases' 104 were interviewed. A standardized psychiatric interview schedule was used. Compared with a general population sample from the same geographical area and in the same age range, women presenting at the gynaecological out-patient clinic were predominantly pre-menopausal and from the lower end of the 15-year age range, and were more likely to be separated or divorced, less likely to be single, and more likely to have had previous or to have subsequent contact with the local psychiatric services. A higher proportion of women were identified as psychiatric ‘cases' in the clinic population than in the general population, and their psychiatric disorder appeared to be more severe and more depressive in nature. The findings for this age group support the view that among women presenting for hysterectomy there is already an excess of psychiatric illness before the operation.

The association of gynaecological complaints and psychiatric morbidity in the pre-menopausal years is discussed.

This paper presents information on a shortened form of the Stockton Geriatric Rating Scale, which is shown to be as effective as the original version in discriminating among the elderly. The results for 400 people in the care of hospital or social services provide provisional normative data for the use of the scale, which should be of value in assessing the behavioural competence of the elderly on an individual and group basis.

In 1975 a long-term follow-up was undertaken on patients collected as in-patients, treated and studied in 1962–64 (Bovill, 1972). Treatment was by didactic group psychotherapy and relaxation. Treatment was for a mean of six months and of 30 sessions, treatment remained available on demand for a mean of two years after discharge from attendance. In 1975 30 treated patients and 24 control patients were traced out of the original 36 in each group. The criterion of success was, as before, the inverse of days spent re-hospitalized. The success ratio fell from 7: 1 in 1962–64 to 2½: 1 in 1965–74 and to 2: 1 in the single year 1974. This fall was expected in view of the known spontaneous recovery rate operating on the controls.