During 1984 there were 253 admissions to the in-patient drug dependence treatment unit at Tooting Bec Hospital. Of the 198 patients responsible for these admissions, 60% were male and 43% were over the age of 30 years. There were 151 patients admitted for opiate detoxification, and 75% completed the withdrawal schedule. However, only 15 out of 25 patients admitted for benzodiazepine withdrawals were found to be physically dependent. Other reasons for admission included stabilisation of the dose of opiate (24%) and the treatment of physical complications of addiction.

In order to establish whether the maternity blues is peculiar to the puerperium a selfrating blues questionnaire was administered to women after childbirth and after surgery. A period of dysphoria, similar in many respects to the maternity blues, was experienced by women post-operatively. The main difference between maternity and post-operative patterns of dysphoria seemed to lie in the timing of the blues, but on closer analysis many post-operative dysphoric symptoms peaked in a similar way to those in the maternity group. In the search for the cause of the maternity blues it may be helpful to study the same parameters in post-operative dysphoria.

The activities of the A and B forms of the enzyme monoamine oxidase (MAO, E.C. 1.4.3.4) have been assessed with the substrates 5-hydroxytryptamine and benzylamine respectively in seven areas of the brains of 39 patients with schizophrenia and 44 control subjects. Whereas previous studies have found the enzyme unchanged in brain in schizophrenia, in this study there was a modest but significant decrease in the activity of MAO-B in frontal and temporal cortices and in amygdala. This decrease could not be accounted for by neuroleptic medication, age, sex or post-mortem variables. In a series of 22 patients who had been assessed in life, the reduction in MAO-B activity was found to be associated specifically with the presence of negative symptoms (flattening of affect and paucity of speech). The findings are therefore consistent with other evidence for structural and neurochemical change in the temporal lobe that have been associated with the type II (defect state) syndrome of schizophrenia. The change in enzyme activity is unlikely to be related to a change in monoamine metabolism but may reflect a disturbance in glial function. The change in MAO-B activity in brain in this study is confined to particular areas of brain and a subgroup of patients; it is thought to be entirely unrelated to earlier reports of reductions of enzyme activity in platelets, which are probably attributable to prolonged neuroleptic medication.

A ten-year follow-up on the criminal records of men discharged from Grendon Prison was carried out. These records were compared with those of a matched control group, and no differences were found regarding frequency or severity of post-discharge convictions. The validity of this exercise is questioned, and several case histories presented. An examination of subsequent offending within the Grendon group suggests that for some men, the better motivated and more intelligent, exposure to the Grendon regime may have contributed to a change in their criminal behaviour.

A survey of 54 firesetters who had been in hospital or prison was conducted. The results confirmed earlier findings on several aspects, such as male predominance, unstable childhood and proclivity to self-injurious behaviour. Revenge emerged as the commonest motive overall and an association with alcohol was found. Only 11% of the fire-raising episodes, whether among hospital or prison groups, were truly trivial. Arsonists in prison and hospital had many features in common and generally were quite psychologically disturbed, which contrasted with those who set fires for profit. A poor outcome was found, with continuing self-harm and a high suicide rate. Our findings suggest that arson recidivism arises in at least 35% of arsonists.

This paper reports on a study of psychiatric morbidity in 920 patients attending 18 General Practitioners in Lewisham, South East London. Two indices of morbidity were computed on the basis of the patients responses to the General Health Questionnaire (GHQ) and the GPs' own estimates. Indices of the GPs' detection ability were found by comparing questionnaire and GP rating. The results are compared to those obtained by other workers in a sample of Manchester GPs. The GHQ gave a prevalence estimate of 42.9% which is comparable to that of 39.6% obtained in the Manchester study. In addition, the variation in caseness across sociodemographic groups was consistent with the Manchester findings. The GPs' estimates of morbidity, while much lower than those obtained in Manchester, have similar sociodemographic profiles. The results support the use of the GHQ as a screening device in epidemiological studies, and suggest the need for further investigation of the individual GP's performance as a case detector.

A ten-year follow-up study of 74 opiate (most heroin) addicts referred to the Drug Dependence Clinic in Southampton showed that overall, little use was made of the treatment facilities available. Half of the patients on whom we were able to obtain follow-up data appeared to be no longer abusing drugs. An appreciable number of subjects had committed offences prior to abusing drugs and a large proportion offended during the follow-up period, adding support to the view that most addicts are not driven to crime because they are unable to obtain the help they need. The death rate of 15% is that expected in a long-term follow-up study. The results suggest that the natural history of many heroin addicts is uninfluenced by therapeutic intervention.

The ‘gains' of Munchausen syndrome cannot readily be understood on a rational level, and are presumed to be intra-psychic. The presenting fabrications often follow a remarkably similar pattern, and some psychodynamic insight might be gained by analysis of the general themes and contents. The case of one typical patient is reported here, and the aetiology and symbolic significance discussed.

Twenty-four chronic schizophrenic patients were assessed by the Morningside Rehabilitation Status Scale, the Krawiecka Scale, and the Social Adjustment Scale by Self-Report. Inter-rater correlations suggest that the MRSS can be used by a rater with little previous knowledge of the patient. Between-scale correlations suggest the three scales assess somewhat different dimensions. A standard approach to rehabilitation assessment is suggested.

A consecutive series of prison suicides in Scotland between 1970 and 1982 was examined. The initial phase of imprisonment was found to be the most vulnerable stage of confinement, with almost two-thirds of the deaths having taken place within the first month. A disproportionately high number were found to be on remand. A history of some form of psychiatric involvement was common, and a third of the group had received previous psychiatric inpatient treatment. In contrast to results from general population studies, there was little evidence to link suicide with a history of depressive illness. A record of problems with either alcohol or drug dependence was found in almost half the cases. The importance of general measures designed to reduce stress and promote coping mechanisms is emphasised.

We compared reality orientation with reminiscence therapy for elderly people in a large residential home, using a controlled cross-over design. Both kinds of therapy group were enjoyed by both staff and residents, and enabled staff to get to know moderately and severely confused residents. The group that received reality orientation followed by reminiscence therapy showed improvement in cognitive and behavioural measures which was not found in the other two groups. It may be important to use reality orientation techniques with confused residents before involving them in a reminiscence group.

The demographic features, clinical picture, antecedent events and family background in 13 male patients with anorexia nervosa are compared with those in a control group of 39 adolescent female anorectics; the general picture of the illness in males is similar to that in females. Focusing on a group of males, usually less vulnerable to anorexia nervosa, can highlight possible predisposing factors.

A three-stage community survey of a representative group of Southampton mothers was carried out. A semi-structured psychiatric interview was administered at 3, 9 and 15 months post-partum. The results of these interviews are presented and used to assess the extent and timing of psychiatric disorders arising in this period. In contrast to previous studies, it was found that the highest incidence of new cases, variously defined, occurred between the third and ninth month post-partum and not immediately following childbirth. These results are discussed in the context of previous studies using the same definition of caseness.

There have been reports of a high prevalence of bulimic episodes and the syndromes of bulimia nervosa and DSM-III bulimia in community samples. A group of American authors recently compared the findings of a contemporary survey with those of a survey they had conducted previously and reported a three-fold increase in the prevalence of DSM-III bulimia. The present study replicates a community survey conducted four years ago in Britain. The prevalence of bulimic episodes, self-induced vomiting and bulimia nervosa found in the present survey was very similar to that found in the earlier study.

Using PET, we investigated the potency in six patients of therapeutic doses of neuroleptic drugs for preventing specific binding of trace doses of intravenously administered 76Br labelled bromospiperone to corpus striatum in vivo. Measured receptor occupancy showed a clear-cut dose-dependent saturation curve with increasing daily oral dose of neuroleptics, indicating the validity and reliability of the method when used as an in vivo radioreceptor assay. Following drug withdrawal in eight patients, recovery to normal or supranormal receptor availability occurred in a matter of days. The results demonstrate an approach that may help resolve controversies about, and design better strategies for, neuroleptic treatment schedules.

Fifty-five dependent (DSM-III) male alcoholics, chosen for good social adjustment, were personally followed up about 20 years after their first admission to hospital. The conditions of all the alcoholics were evaluated with a multidimensional diagnostic schedule when first admitted. At the follow-up, 11 were abstainers, 11 reported a change to social drinking via abstinence, and 10 reported a change to social drinking by gradual stages. Improvement after the age of 45 was mainly due to gradual change to social drinking. This type of improvement was in half of the cases attributed to a decreased tolerance for alcohol. In the present sample, there were no indications of any relationship between premature ageing and gradual change to social drinking. It is hypothesised that physiological processes of normal ageing with concomitant changes in reactions to alcohol may be of importance for remission from alcoholism in middle-aged and older alcoholics. The relationships of personality, social factors and the degree of alcohol-dependence to patterns of successful long-term adjustment are discussed.

Recent studies raise questions regarding use or abuse of alcohol by phobics, and about compatibility of behaviour therapy and benzodiazepine use. In this study 40 patients, referred with mainly anxiety-related problems to a nurse behaviour therapist, and a comparison group of 40 psychiatric nurses completed a self-administered questionnaire assessing use of alcohol, sedative drugs and tobacco, and their perceived anxiolytic effectiveness. The paper confirms earlier findings that the patients, in general, drank less than the general public. They also drank less than the nurses, but used more sedative drugs and were heavier smokers. Alcohol was an unreliable anxiolytic. A few patients, including two agoraphobics, drank heavily and did not enter treatment made conditional on stopping drinking. Implications for case management are discussed.

Data from a group of males aged 13 to 23, who as children exhibited extensive cross-gender behaviour, was analysed. In boyhood they frequently played with dress-up dolls, role-played as females, dressed in girls' clothes, stated the wish to be girls, primarily had girls as friends, and avoided rough-and-tumble play. The majority of the group evolved a bisexual or homosexual orientation; two types of behaviour, boyhood doll play and female role-playing, were found to be associated with later homosexual orientation. The findings suggest developmental associations between specific types of boyhood cross-gender behaviour and the objects of later sexual arousal.

Descriptive studies of a crisis intervention service replicated previous findings of relationships between staff members' attitudes towards treatment and their ‘personal styles'. The attitudes and personal styles of crisis team members and non-members differed, largely because of differences in the professions making up these groups. While all staff groups shared the same concept of crisis, they differed in their discrimination of crisis cases from ‘furores'. Initial crisis intervention interviews exhibited more confrontation and less exploration by therapists than did initial psychiatric out-patient clinic interviews. Patients referred to the crisis team differed from significant other people in their lives, and from control patients referred to the ordinary out-patient clinic, in aspects of their perception of problems.

Since recent reports suggest structural brain abnormalities in autistic patients, we analysed magnetic resonance imaging (MAI) scans of autistic children. Planimetric measurements were done on midsagittal MRI scans, produced with a 0.5 T superconducting magnet. Scans of 13 ‘high-level’ austic subjects were compared with 35 control MRI scans, read as anatomically normal by a neuroradiologist. Corpus callosal, fourth ventricular, cerebellar, cerebral, and cranial areas were measured. The fourth ventricle was found to be significantly larger in the autistic group. No other areas in the midsagittal scans differed statistically between groups. Results suggest that structures defining the fourth ventricle are anatomically altered in autistic patients.