This paper reviews explanations of sex differences in mental hospital admission rates, taking account of age and marital status effects. Six propositions derived from the review are tested on data from a nationwide community survey of 259 respondents, using a standardized symptom check list.

Women report more psychological symptoms than men, but this is unrelated to marital status. It is suggested that being married acts to keep a potential patient out of hospital rather than to reduce symptoms. Whether or not a woman is in paid employment outside the home is a major predictor of symptom levels, especially in depression. Women with unemployed husbands are also particularly likely to report high levels of depression. However, there is no reciprocal effect of wives' employment status on the psychological well-being of their husbands.

One hundred and ten young women aged 18 to 30 years who had attempted suicide by drug overdose were divided into three groups on the basis of the physical threat to life of their suicide attempt. Young women whose suicide attempts resulted in the greatest risk to life were more often unmarried or not in a de facto relationship; reported little use of alcohol; had had recent contact with a psychiatrist; had taken more than 20 tablets or capsules, most often antidepressants; and had a high degree of suicidal intent and hopelessness. Furthermore, there were trends for them to be of high socio-economic status; to have had less history of violence, both used and sustained; to more often demonstrate schizoid personality traits; and to report less death anxiety.

Five hundred patients who had completed a suicide intent scale after self injury were followed up over five years. Seven definite and six doubtful suicides occurred. The future suicides tended to have high scores on the scale for their original self injury episodes and had very high scores for the penultimate self injury before suicide. Discussion centres on the small number of suicides ascertained and on the use of the scale as a suicide predictor. A group of very high risk patients was identified by repeated use of the scale, and the suggestion is made that the scale might be used as part of a suicide prevention programme.

One hundred and sixty Scottish psychiatrists complete a questionnaire eliciting the extent of their use of the term ‘borderline patient’ and the factors affecting this. The term was used by 27.5 per cent, the majority of whom felt that it ought to be included in current diagnostic classification systems. There was, however, general dissatisfaction with the vagueness of current definitions of the term and a confusing use of numerous diagnostic labels.

Use of the term was not related to status, geographical location, or familiarity with American psychiatric literature. The practice of psychodynamically-oriented psychotherapy and extended working contact with psychiatry in North America were found significantly to increase its use.

The plasma prolactin (PRL) response to haloperidol 2 or 4 mg i.m. was studied in 18 schizophrenic men during their routine treatment with neuroleptic drugs. A substantial rise of the PRL level above the treatment baseline occurred in all but four of the 20 tests showing that the PRL elevation induced by treatment was not maximal. The challenge was ineffective only in patients receiving very high daily doses of medication. The increment was inversely correlated to the daily dose of medication but unrelated to plasma haloperidol concentrations during the test. Chronic schizophrenics who were receiving long term treatment and had low basal PRL levels did not show tolerance to the prolactin stimulating effect of haloperidol. That prolactin rose during the test in patients who had improved during their current treatment indicates that the degree of dopamine receptor blockade required for therapeutic effects is below that which produces a maximal PRL response.

Anterior pituitary response to TRH 200 μg i.v. was studied in ten chronic schizophrenic patients during long-term neuroleptic treatment. Nine patients had normal prolactin (PRL) response as compared with controls but in one the response was blunted; one patient had an exaggerated response. Prolactin increment was higher following TRH than haloperidol challenge. No growth hormone (GH) response to TRH was found and TSH responses were comparable to controls.

Hormonal responses to apomorphine 0.005 and/or 0.01 mg/kg body weight were studied in 17 schizophrenic patients during their routine treatment with neuroleptic drugs. Plasma growth hormone (GH) rose in 9 of the 20 tests and in 4 of these GH peak exceeded 5 ng/ml. This preserved GH response to apomorphine was significantly but weakly associated with lower daily doses of neuroleptics. It was unrelated to the extrapyramidal side-effects, plasma prolactin (PRL) level, duration of treatment or its therapeutic effect.

In 13 of the 20 tests, plasma PRL declined by more than 20 per cent of the baseline level. This was similar to the fall in PRL observed after placebo in the group studied previously. The absolute decline in plasma PRL following apomorphine correlated positively with the baseline PRL concentration and was unrelated to the daily doses of neuroleptics or to any other variable considered.

Ten depressed elderly female patients in hospital (mean age 82 years) received a single oral dose of 50 mg nortriptyline prior to commencing treatment with this drug. The nortriptyline concentration in a plasma sample obtained 24 hours afterwards was used to predict the daily dose required to achieve a steady-state concentration within the range of 50–150 μg.l-1. The mean daily dose prescribed was 50 mg (range 20–100 mg). These dosage regimes provided a mean observed steady-state nortriptyline concentration of 104 μg.l-1, with a range of 76–180 μg.l-1 (S.D. 30 μg.l-1). Use of this prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success.

The therapeutic benefit of combining propranolol with diazepam over either of these drugs given alone was tested in a placebo-controlled crossover study with twenty-four chronically anxious out-patients. The combination was generally more effective than diazepam. Diazepam was more effective than placebo or propranolol. A reduction in the resting pulse rate by propranolol of more than 7.5 beats per minute resulted in a greater therapeutic response to this drug, alone and in combination. Lesser degrees of pathology responded better to treatment. Psychological factors in treatment showed themselves to be important in moderating pharmacological response. Chronically anxious patients generally derived little benefit from continued anti-anxiety treatment.

Juvenile court histories were investigated of male and female juvenile drug offenders and of control groups of juvenile delinquents never charged with drug-related offences. On most of the parameters of drug-related and of other criminal offences, criminal involvement was greatest among opiate abusers, followed by those abusing sedatives, and then by cannabis abusers. However, this difference was less marked among females than among males. Involvement with crime not related to drugs was greater among delinquents abusing opiates and sedatives than among delinquent controls, while the criminality of delinquents abusing cannabis was less than that of the controls. There were significant differences between the patterns of offences of the four groups, which did not support the economic necessity hypothesis of crime among (at least juvenile) drug abusers. The findings were consistent with progression from soft to hard drugs, and with the view that where juvenile delinquency and drug abuse co-exist, the former tends to precede the latter. The association between juvenile drug abuse and delinquency seems to be accounted for by a common denominator of a sociopathic character development, rather than by some form of causal relationship between these two phenomena.

A comparison was made between ‘offender’ (part V) and ‘non-offender’ (part IV) male patients admitted to the State Hospital, Carstairs, over a ten year period. More than a third of the ‘non-offender’ group had at some time in the past been in penal institutions. During their stay in the State Hospital, the ‘non-offender’ patients were more disturbed in behaviour than their ‘offender’ counterparts, and relatively fewer of them were discharged during the period of study.

There are considerable practical and ethical difficulties that confront a psychiatrist preparing a report for the defence when the case against the accused rests upon his confession of guilt. Until recently there has been widespread belief that a false confession is not made to a serious crime except in highly unusual or irregular circumstances. Indeed, Sir Henry Fisher, a former high court judge, who had been requested by the Home Secretary to examine the cases of three youths who had confessed to the murder of Maxwell Confait, a transvestite prostitute, concluded that their confessions could not have been made unless at least one had been involved in the killing. His belief has now been considered ill-founded, yet it was an opinion made after the three boys had been given their absolute discharges at appeal.

Delirium remained a stable psychiatric category until the early 19th century when it underwent aetiological and phenomenological redefinition, precipitating the transformation of the functional insanities into psychoses.

Confusion, introduced by French workers during the second half of the century, referred to a syndrome wider than (but including) delirium. It emphasized chaotic thinking and cognitive failure. The notion of clouding of consciousness (and temporo-spatial disorientation) established a common denominator for the two concepts, while Chaslin and Bonhoeffer redefined confusion and delirium as the stereotyped manifestations of acute brain failure.

The purpose of the study was verification of a genetic distinction between bipolar and unipolar affective illness and investigation of hypotheses concerning the mode of genetic transmission of both illnesses. The investigation demonstrated a difference between a group of 150 probands with bipolar affective illness and 50 probands with unipolar affective illness.

A genetic-correlation analysis of both diseases showed that they are determined by different, partly correlated liabilities. Evaluation of the mode of inheritance suggests a multifactorial mode of inheritance of both affective illnesses: although genetic factors are of basic importance, continuously acting environmental factors also have a significant influence on the manifestation of the illness. The results suggest possible heterogeneity of both illnesses from the genetic standpoint.

An educational history, corroborated by records where available, was obtained on 54 of the 58 adult offspring of 17 bipolar manic-depressives. The offspring were also interviewed and psychiatric status was ascertained.

Primary and other affective disorder in the offspring was not associated with a lower IQ or lower ultimate educational attainment than that of the remaining offspring. There was a trend towards increased educational failure in the offspring with primary affective disorder, but they were as likely as other offspring who had failed to have resumed their education at a later date. Ill offspring with any form of school failure had a significantly earlier onset to their psychiatric illness, although school failure could not be shown to be a part of an early symptom complex.

Despite the high prevalence of unipolar depression in the general population, few genetic studies are available on subtypes of unipolar illness. We evaluated morbid risks for depression, alcoholism and/or sociopathy in the relatives of early onset (before age 40) and late onset (after age 40) unipolar patients in a sample of 106 probands consecutively admitted to the New York State Psychiatric Institute. Unipolar patients with an early onset disease have a greater familial morbidity for depression, alcoholism and sociopathy than unipolar patients with a late onset disease. There is an excess of unipolar depression in female relatives of early onset unipolars when compared to late onset probands, regardless of the proband's sex. Alcoholism and sociopathy are also more prevalent in the relatives of early onset unipolars versus late onset probands. Our morbidity risk data show familial genetic differences between early and late onset forms of unipolar illness and partially confirm Winokur's concept of two subtypes of unipolar depression.

There is only a small literature on the psychiatric complications of acromegaly. Manfred Bleuler (1954) reported an acromegalic man who had blunted affect and apathy and suggested that this clinical picture represented a special variation of the endocrine psychosyndrome. Avery (1973) reported a further case of depression and anxiety in association with the illness. There are relevant reviews by Michael and Gibbons (1963), Beumont (1972), Labhart (1974) and Lishman (1978).

Since de Clérambault (1920) described the syndrome of erotomania, there have been several reports in the literature amplifying various aspects of the condition. However, it was only recently that Raschka (1979) reported two cases of what he labelled the ‘incubus syndrome‘. This syndrome is a variant of erotomania and the feature central to it is a delusion of imposed intercourse with an imaginary lover during one's sleep.