The ‘conversational model’ of psychotherapy was investigated with a view to discovering which behaviours distinguish psychotherapists trained in this method from others, of equal clinical experience. A rating scheme designed to capture the theoretical aspects of the model, and 30 predictions were made concerning behaviours which were expected to distinguish the psychotherapists. Five psychotherapists were matched to five psychiatrists who had not been trained in this method; each doctor took on four patients for therapy, and each patient was seen on five occasions. All interviews were recorded, and excerpts from the recordings rated. Only ten of the 30 predictions were upheld. In ten further predictions, the psychotherapists displayed the appropriate behaviours, but the behaviours were not peculiar to the model, since eclectic psychiatrists also displayed them. Six model behaviours were not practised frequently by the psychotherapists, and four ‘non-model’ behaviours were equally common in either group. The research formed the basis for the preparation of materials to teach psychotherapeutic skills in a more efficient way.

A teaching package was produced to help trainees in psychiatry learn the techniques specific to a ‘conversational model’ of psychotherapy, prior to group supervision. This consisted of a booklet and three videotapes. The third tape used a micro-counselling approach to illustrate each key skill and was viewed together with a teacher. After this, trainees met in groups of three with a psychotherapist for eight weekly sessions. To evaluate this teaching, 12 trainees were asked to interview simulated patients before and after they used the package and after supervision. These interviews were recorded on videotape and rated. There were significant improvements on most of the key skills as a result of this training, and nine of the 12 trainees improved considerably. There was a strong negative correlation between improvement scores and a biological orientation to psychiatry. It is concluded that the teaching package is an economic but effective way of helping trainees learn the basics of a method of psychotherapy before they are given supervision.

The possible psychiatric diagnostic utility of certain quantitative EEG measures was evaluated by further analysis of previously reported data from 242 unmedicated patients and 94 non-patients. Time series of amplitude, frequency and wave symmetry measures for 12-lead EEGs (eyes closed and open) were factor analyzed across leads. Factor scores meeting specified criteria in multivariate analyses were entered into discriminant analyses comparing pairs of the following groups: non-patients, neurotics, personality disorders, overt schizophrenics, latent schizophrenics, major depressives and manics. The following discriminations were obtained with at least 50 per cent sensitivity, and diagnostic confidence rates from 69 to 92 per cent: (a) non-psychotic patients (neuroses, personality disorders) from overt schizophrenics, latent schizophrenics or manics; (b) major depressives from latent schizophrenics or manics; (c) non-patients from schizophrenics (overt and latent), depressives or manics. Most discriminations were replicable in split-half analyses. Possible utility of EEG measures in differential diagnosis is supported.

Ninety one patients with new episodes of minor affective disorder were selected by their general practitioners as suitable for anxiolytic medication. Half the patients were allocated randomly to a drug-group (anxiolytic medication), and half to a non-drug group (brief counselling without anxiolytics). Psychiatric and social assessments were made (i) at initial consultation when treatment was started; (ii) one month later; (iii) seven months later. Before treatment the two groups were similar on all main variables. On the General Health Questionnaire, 85 per cent of patients were psychiatric cases before treatment, 40 per cent at one month and 30 per cent at seven months. Similar improvements were found with other measures of psychiatric state (Profile of Mood States; Present State Examination) and social functioning (SAS-M). Improvements were similar and parallel in the two groups. Neither group of patients increased their consumption of alcohol, tobacco or non-prescribed drugs. The non-drug group did not make increased demands on the doctors' time.

Factors associated with psychiatric outcome were examined in a series of 87 patients who had presented in general practice with new episodes of minor affective disorder. Two outcome measures were used: (i) Status on Present State Examination (PSE) seven months after initial consultation; (ii) prescribing of psychotropic medication between one-month and seven-month follow-up assessments. Outcome according to the PSE was significantly associated with: worse measures of psychiatric state (General Health Questionnaire, Profile of Mood states) and of social functioning (SAS-M) at initial consultation and one month later; and with persistent anxious or depressed mood during the follow-up period; but not with life events. During the follow-up period 20 patients received at least one psychotropic prescription; they were significantly associated with worse initial GHQ scores, consumption of tobacco and non-prescribed medication, and initial anxiety. A sub-group of 11 patients received multiple psychotropic prescriptions; they were significantly associated with the same initial measures, and also with poor outcome measures (psychiatric and social).

This study questions the prevailing view that schizophrenic delusions, hallucinations and incoherence of speech (positive symptoms) reflect loss of cognitive control and that flattening of affect and poverty of speech (negative symptoms) reflect restriction of cognitive processing.

The prevailing view was examined by analysing the thematic organisation of speech produced by 18 patients describing pictures. Results showed that (a) positive and negative symptom schizophrenics did not differ in the control and restriction of thematic speech organisation; (b) speech disordered schizophrenics, positive as well as negative, showed cognitive restriction, by producing fewer inferential ideas than non-speech disordered schizophrenics.

The wider implications of these results are discussed, particularly the implications of (b) for the notion of concreteness in schizophrenia.

Twenty-five out-patients with generalised anxiety or panic disorders were interviewed. A characteristic ideational component was identified, centering on the theme of personal danger and, in particular, on physical harm. A range of features of the ideational content is described. In the 12 months preceding onset 88 per cent of the patients had experienced significant stresses. For 50 per cent the onset of panic attacks was precipitated by somatic symptoms other than those of anxiety. The relationship between ideational content, stress and somatic symptoms is discussed.

Eleven male chronic schizophrenics were given, serially, oral pimozide, fluphenazine, and flupenthixol; the two latter were also given intramuscularly as decanoates in oil. Oral haloperidol was given before and after each drug. Analysis of variance of steady state plasma levels of the different neuroleptics showed considerable within-individual variation in such levels, probably due to differences in absorption and metabolism and between routes of administration. The findings suggest that if a patient fails to respond to one neuroleptic, there may be good pharmacokinetic reasons for switching him to another belonging to a different group, or for giving the same neuroleptic by a different route of administration. The study also showed that previous administration of one neurololeptic may influence the steady state level of another. The various neuroleptics produced different effects on plasma prolactin levels.

One hundred and eighty nine consecutive in-patients with treatment-resistant affective disorder were administered the Renard Diagnostic Interview to determine whether the 45 with secondary affective disorder (SAD) differed from the 144 with primary affective disorder (PAD). The SAD group, including 15 subjects with bipolar disorder, had an earlier mean age of onset of depression and contained more unmarried individuals. The total secondary group could not usefully be differentiated by assessment of clinical symptoms or discriminating analysis of social and clinical variables. While the present study of a severely depressed population does not lend itself to generalisability, this combined sample does have characteristics of patients used in biological investigations. No significant inter-group discrimination was found to support a previous assumption that identification of a prior psychiatric disorder provides the most suitable mechanism for selecting a population for research in affective disorders.

The growth hormone responses to clonidine (1.3 μg/kgm) and apomorphine (0.005 mg/kgm) have been measured in 8 drug free patients with endogenous depression. In these patients the growth hormone responses to clonidine were significantly smaller than to apomorphine. As these doses of clonidine and apomorphine have previously been reported to cause similar growth hormone responses in normal subjects, these findings support the hypothesis of a defect in the adrenergic but not the dopaminergic regulation of growth hormone in patients with endogenous depression.

Two patients are described in whom diabetes mellitus and anorexia nervosa occurred together. The nature of the relationship between the two conditions is discussed. It is suggested that weight loss is not always the primary goal in such patients.

Serial post-ictal serum prolactin levels were obtained over a period of one hour after bilateral or unilateral electroconvulsive therapy (ECT) in six patients. Bilateral ECT yielded significantly higher mean post-ictal prolactin levels than unilateral ECT at the 15,20,30 and 60 minute sampling times. These findings demonstrate a greater hypothalamic-stimulating effect of bilateral than unilateral ECT, and may explain the reported therapeutic advantage of bilateral over unilateral ECT in the treatment of patients with melancholia.

Life histories and interview descriptions of 23 young men diagnosed as schizoid in middle childhood and adult life and of 20 control subjects not given this diagnosis were presented for diagnostic rating to two independent general psychiatrists. Agreement about the presence or absence of schizoid personality was good. It is concluded that, in the case of boys, the syndrome of schizoid personality in childhood (Asperger's syndrome) corresponds to or is subsumed by the more general clinical picture psychiatrists have of schizoid personality in adult life, and that our original use of this diagnostic label for the youngsters we described was not idiosyncratic.

A syndrome is described in three elderly women who all suffered from cerebral arteriosclerosis, and who in their dependent condition were looked after by their daughters. These women accepted their daughters as their daughters when carrying out directly caring tasks related to them, but spoke of them and addressed them as different women, with the same forenames as their daughters, when their daughters were engaged in other duties. This syndrome is compared with the syndromes of Capgras and similar conditions. It is likely to be detected with increasing frequency as psychiatrists become involved in the community aspects of the speciality.

In 23 acute, unmedicated, schizophrenic patients, psychotic behaviour and β-endorphin serum level were measured before and during four weeks of neuroleptic therapy. Prior to drug treatment, β-endorphin level of all patients was within the normal range. Neuroleptic therapy induced marked elevations of β-endorphin in eight subjects; statistical analysis revealed a slight but significant increase for the whole group. This endocrine effect was not correlated with therapeutic efficacy of neuroleptic treatment.

The cerebrospinal fluid (CSF) circulation was studied with isotope cisternography in 30 patients with a schizophrenic type of psychosis. All had previously received neuroleptic treatment. Disturbed CSF circulation was found in 10 cases. In four of these, persistent intraventricular radioactivity was observed as well as partly obstructed CSF spaces. In the other six cases a slow CSF circulation was noted as well as evidence of partly obstructed CSF spaces especially of the upper posterior frontal region. Signs of atrophy of the cortex and vermis were found on CT scan in 10 cases. In four of these subjects a local atrophy was noticed in the upper posterior frontal cortex and around the frontal part of the interhemispheric fissure. Seventeen of the patients (57 per cent) had pathological findings at isotope cisternography and/or at CT. Disturbed circulation did not correlate with CT-findings, age, duration of psychosis, alcohol abuse, drug consumption or family history for psychosis. CT evidence of brain atrophy was significantly related to nonfamilial type of psychosis.

One hundred and fifty successive referrals to a psychogeriatrician were assessed for visual hallucinations. Forty-four (29.33 per cent) patients reported visual perceptual disturbances. No differences between hallucinators and non-hallucinators were found in terms of sex, age, length of illness, underlying psychiatric diagnosis or cognitive score. There was a significant correlation between presence of hallucinations and eye pathology (<.001) and delusions (<.001). The phenomenological characteristics of the visual hallucinations are analyzed. The “picture” sign is described in 7 patients and the Charles Bonnet syndrome in two. The significance of these findings is discussed.

Hypnosis has never reached a widespread acceptance as a therapeutic technique and psychiatrists, especially, appear to give it a wide berth. Since the time when John Elliotson (1791–1868) was forced to resign from the Chair of Medicine at University College Hospital because of his advocacy of mesmerism, the attitude of the medical profession has been one of frank hostility subsiding, in this century, into a lingering mistrust of medically qualified hypnotists. Hypnotherapy is regarded as a form of ‘alternative medicine’ and a recent survey (British Medical Journal, 1978) found that organized teaching of the subject occurred in two of the 33 medical schools and two of the 18 dental schools in Britain. Although I have no exact figures, in a conversation with Professor Gwynne Jones, we suspected that there was also widespread disregard of the subject in psychology courses at both undergraduate and postgraduate level. “Why” asked Sir William Trethowan (1976), in a somewhat sceptical vein, “if hypnotherapy is so effective as some authors of books claim it to be, is the subject not more widely taught on medical courses?”. He partly answered his own question by pointing to the lack of good quality research, but I would add a more fundamental inhibitor and that is the manner in which the subject is presented; if the interested trainee in psychiatry or clinical psychology picks up any of a number of recommended texts, disillusion will rapidly follow. Hypnotherapy is too frequently presented in terms which seem to be frankly anti-scientific and at variance to all other teaching. The expectation of the dramatic disappearance of symptoms, and even disease, at the authoritative command of the practitioner, is clearly allied to the practice of the fairground rather than accredited healing; psychiatrists, especially, shudder at such frequently repeated statements as that hypnosis enables the therapist to ‘directly converse with the unconscious mind of the patient’.