The aims of this study were to compare the psychiatric morbidity occurring in the close relatives (N = 332) of patients showing nuclear forms of schizophrenia with that of a control group (N = 201), and to consider the findings in relation to the concept of the schizophrenic ‘spectrum’ and to some genetic theories of schizophrenia. About one third of each group were interviewed by a psychiatrist using defined diagnostic criteria, and information of varying degrees of completeness was obtained about the remainder. After considering possible biases, it was concluded that the ‘spectrum disorders' most likely to be biologically related to schizophrenia were personality disorders of non-neurotic type, either alone or in combination with another diagnosis. The results, however, did not fit well with the model of dominant inheritance of schizophrenia and schizoid disease proposed by Heston (1970).

The hypothesis that schizophrenia and some non-psychotic abnormalities occurring in the close relatives are both manifestations of a unitary ‘schizoid state’ due to a major dominant gene is further examined. Comparisons are made (1) of the observed and expected frequencies of the different types of parent mating; and (2) of the observed and expected risks among sibs in families with neither, or with one or both, of the parents abnormal. It is concluded that the results do not fit well with the model of inheritance of the schizoid state through a major dominant gene.

Since some hereditary contribution in schizophrenia can be regarded as established, the excess of personality disorders and heavy drinking in the families is thought to be due to a combination of polygenic inheritance and environmental influences. The findings are regarded only as tentative, but suggest several hypotheses which could be tested.

Serum copper concentrations were determined by atomic absorption spectrophotometry in 102 schizophrenic patients and 95 healthy control subjects. The serum copper concentrations were significantly higher in the schizophrenic patients than in the normal control subjects. The average serum copper in schizophrenic females was higher than in schizophrenic males, but the difference was not statistically significant

Early reports on enhancing occipital alpha through feedback noted that subjects reported the experience as being pleasant and relaxing. This paper reports the subjective experiences of 140 subjects who participated in four studies which examined the alpha enhancement phenomenon. Under both eyes-open and eyes-closed conditions, approximately 50 per cent of the subjects reported that alpha enhancement was ‘pleasant’ and 50 per cent ‘unpleasant/neutral’. With eyes-open training conditions, about half the subjects stated that the experience was ‘relaxing’ and the other half ‘not relaxing’. During eyes-closed training, 63 per cent of the subjects noted that enhancing alpha was ‘relaxing’, while 37 per cent reported that the experience was ‘not relaxing’. However, in the last case the circular relationship between increased alpha and deep relaxation may obtain.

This paper describes a controlled study of 22 non-psychotic female habitual self-cutters. In this study an habitual self-cutter is defined as a patient who has cut herself with a sharp object on at least two separate occasions.

A coroner concludes an open verdict if there is insufficient evidence to record any of the other verdicts, namely, suicide, accident, homicide and natural causes (Purchase and Wollaston, 1957). In practice, open verdicts are most often used when the coroner cannot decide between suicide and accident. They are therefore of interest to doctors, especially family doctors and psychiatrists, and to social scientists, because suicides may be so classified for want of evidence of intent to die. Thus the study of open verdicts may increase knowledge about suicide itself and the accuracy of suicide statistics. To further these aims we describe, for the first time, a consecutive series of such deaths which occurred in a London coroner's district. The psychiatric aspects have been given special emphasis.

The potential difference across the rectal mucosa (rectal p.d.) is generated by the active transport of sodium across the mucosa, and it is sensitive to the action of aldosterone. The rectal p.d. values of depressive patients on no treatment, tested whilst depressed or after recovery, were found to be similar to those of control subjects, indicating that sodium transport across the rectal mucosa and the activity of aldosterone were normal in these patients. This contrasts with previous reports of abnormalities of sodium transport and of aldosterone levels in manic-depressive patients. Manic-depressive patients taking lithium carbonate as a prophylactic agent were found to have significantly elevated rectal p.d. values when normothymic. Patients who had become depressed whilst taking lithium, and in whom prophylaxis had therefore failed, were found to have normal rectal p.d. values. Lack of elevation of rectal p.d. in response to lithium administration may be a characteristic of patients who fail to respond to lithium prophylaxis.

This paper describes an attempt to validate a behaviour rating scale used to predict the likelihood of discharge among elderly and long-stay patients in a psychiatric hospital. The scale measured behaviour on the ward as rated by nursing staff. The scale was a sensitive predictor of discharge among those with a low score (indicating least disability), except for patients with organic psychoses. However, many patients with low scores were not discharged. In order to improve the scale's use as a screening technique additional information was considered. The significance of the findings is discussed.

The ages of 87 patients attending an open out-patient group in a general hospital psychiatric out-patient department are analysed in relation to persistence with treatment. A highly significant correlation (p <.001) is obtained between increasing age and continued attendance, and a significantly greater number are found to attend for six months or more in the age-range 37–47 than at other ages. In a sub-group of 35 patients, all of whom had attended more than four sessions and had returned a questionnaire, significant correlations are obtained between age and symptomatic improvement (p < .05) and between continued attendance and improvement in interpersonal relationships (P < .05).

Non-attenders at a psychiatric new-patient clinic were seen and interviewed six weeks after the missed appointment, as were a group of controls who did attend.

The non-attenders were more likely to have had frequent changes of occupation or belong to families where this was the case with the family breadwinner; a history of court conviction; and a history of previous psychiatric treatment. They were less likely to have improved since referral to the clinic; and to have a diagnosis of manic depressive psychosis, depressed type.

The findings are discussed. There appears to be some self-selection, the most treatable patients keeping their appointments.

1. 1. Twenty-six out of 28 out-patients with agoraphobia and social phobias who had originally been treated with phenelzine or placebo in a double-blind clinical trial were followed up for a mean period of one year. During the follow-up period patients received further pharmacotherapy or behaviour therapy, except that those patients originally receiving placebo were not allowed therapy with monoamine oxidase inhibitors.

2. 2. Ratings of phobic and additional symptoms, social adjustment and degree of personality disorder were made after one year by one of the authors (D.S.) who had no prior knowledge of the treatment each patient had received.

3. 3. There were no significant differences in any of the ratings between the patients of the two groups, but those originally receiving placebo had more additional treatment in the follow-up period. Patients continuing to receive phenelzine frequently experienced a return of symptoms if the drug was withdrawn before six months treatment had elapsed.

4. 4. Degree of personality disorder showed a significant negative correlation (p = –0.6) with improvement in the phenelzine group but not in those receiving placebo originally.

5. 5. Improvement in social adjustment items was less than improvement in symptoms at follow-up. The implications of this are discussed.

6. 6. The results suggest that phenelzine is of comparable efficacy to other symptomatic treatments for agoraphobia and social phobias, but that it acts mainly by symptom suppression. Prolonged treatment in patients with personality disorders is not indicated, for improvement is less likely and the dangers of dependence are greater.

Medical practitioners have begun to look for ways of helping the psycho-sexual problems of their patients with increasing awareness that it is impossible to ignore their sexual lives if they are to treat the whole patient. Sexual problems occurring in marriage have been treated in the past in two main ways, by some form of insight therapy or by behaviour therapy, and recently some adherents of both these schools have moved towards treating the disordered relationship rather than the individual patient. Dicks (1967) at the Tavistock Institute has pioneered the treatment of what he calls the ‘diad’ by two therapists, male and female, in a basically analytic framework, whilst Masters and Johnson (1970) in America have used an approach based largely on behaviour therapy techniques, also using two therapists.

This is a study of one mode of inception into psychiatric care in Birmingham, Mentally disturbed people coming to the attention of the police are referred to a mental welfare officer and assessed by him, usually in a police station. The mental welfare officer may then refer for a psychiatric decision with regard to further management, and the patient is examined by the doctor in the police station.

The annual frequency of use of this referral system was studied from 1962–73 inclusive. It is shown that there was an increase in referral over the years and that such referral from the police became an increasing proportion of new referrals to the Mental Health Department (Social Services Department).

The sample of referrals from the police for 12 months is studied in greater detail (252 cases), surveying social characteristics of individual patients, the relationships between such police intervention and areas of the city, the nature of situation requiring intervention and the management and treatment which these patients received. The referrals were traced from contact with the mental welfare officer to hospital where the case notes of those admitted were studied for details of legal status and mental state on admission, diagnosis, duration of stay and disposal. The effectiveness of this method of entering treatment is discussed and some recommendations are made.

The literature relating to the training opportunities offered to overseas graduates in this country and the United States is reviewed. Although overseas trainees in psychiatry do not see themselves at a great disadvantage, the fact that the great majority are working in non-teaching hospitals means by implication that overall their training is not as good as that of home graduates.