It has been hypothesized that the mechanism of action of antidepressant treatments is related to their ability to decrease the sensitivity of the alpha-2 adrenergic autoreceptor. In order to assess alpha-adrenergic autoreceptor sensitivity, the effects of clonidine, the alpha-2 adrenergic receptor agonist, on plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenethyleneglycol (MHPG), blood pressure (BP) and patient-rated sedation were measured in nine depressed patients before and during amitripytline treatment. Postsynaptic alpha-2 adrenergic receptor sensitivity was assessed by determining the growth hormone (GH) response to clonidine before and during treatment. Amitriptyline significantly attenuated the effects of clonidine on plasma MHPG, standing systolic BP, and sedation, indicating that alpha-2 adrenergic autoreceptors had become subsensitive. In addition, baseline plasma MHPG levels were significantly reduced. Amitriptyline had no effect on the GH response to clonidine.

The medical schools of origin were identified in 1229 psychiatrists who qualified in the United Kingdom in the years 1961–75. The group was defined operationally as those who had entered for the preliminary test of the membership examination of the Royal College of Psychiatrists. From 1966–75 only 4 per cent of doctors opted for a career in the specialty. There are wide discrepancies between medical schools in the proportion of their graduates who enter psychiatry. The most likely reasons for this have to do with differences in student selection, the models of psychiatry put forward, the enthusiasm of teachers and the career pull from other specialties, notably general practice. A number of suggestions which might help to improve recruitment to psychiatry are put forward.

A sample was collected of schizophrenic patients exhibiting nonverbal signs of intermittent auditory hallucinations. A video-tape record was made for each of a session, during which the patient's skin conductance was monitored. Independent raters achieved reasonable agreement on the onset of periods of hallucinatory activity, as judged from non-verbal signs. The skin conductance tracing was scored independently for spontaneous fluctuations. In the 10 patients with satisfactory records the onset of hallucinatory periods was significantly (P <0.01) associated with a rise in the spontaneous fluctuation rate.

In a prospective study the criteria and characteristics associated with the admission of acutely ill psychiatric patients to in-patient or day hospital care were examined. Over a four-month period, 54 patients were admitted to hospital and 43 to a day hospital. There were significantly more schizophrenics in the hospital. Day hospital patients were significantly younger, had shorter psychiatric histories, were considered less severely ill and had more insight into their illness. Hospital patients had poorer employment histories, and perceived their families as less supportive; admission had more often been requested by them or their families.

The relationship between hand preference, age, and developmental functioning was examined in 70 autistic patients. Unilateral or mixed handedness appeared to be stabilized by the age of five years. Patients with established hand lateralization tended to function better in all developmental areas including intelligence, language, and visuospatial abilities. It is a tenable hypothesis that the presence or absence of hand lateralization by age five may be an important predictor of outcome in autism.

The prevalence of an abnormal response to the dexamethasone suppression test (DST) was examined in 119 in-patients suffering from a major depressive disorder and in 79 normal controls. Only 11 per cent of controls showed an abnormal DST as against 70 per cent of depressed patients. The specificity of the DST was examined by testing patients with other psychiatric disorders. Abnormal responses were found in one-fifth of a sample of schizophrenics, over one-quarter of abstinent alcoholics, two-fifths of neurotics (including neurotic depressives) and almost half of senile dements. Abnormal DST was also found in 33 per cent of patients receiving prophylactic lithium for recurrent affective disorders.

A range of memory and perceptual tests not previously used in the assessment of the effects of ECT has shown no impairment in 38 depressed patients after six unilateral (one dominant and five non-dominant) ECT.

The results of 41 standardised dexamethasone suppression tests (DST) with the Newcastle Scale diagnostic weighting for endogenous depression correlated significantly (P <.001). Specificity of the DST was found to be 89 per cent, sensitivity 82 per cent and the diagnostic confidence for endogenous depression 94 per cent. This strongly supports the validity of the Newcastle Scale diagnostic weighting for endogenous depression.

The systematic application of guidelines derived from the British National Formulary resulted in a substantial reduction of the amount and frequency of medication used in two hospitals for the mentally handicapped.

Twenty compulsive gamblers were randomly allocated, half to receive aversion-relief therapy and half to receive imaginal desensitization; both groups were followed-up for one year. Compared with those who received aversion-relief, gamblers who received imaginal desensitization reported a significantly greater reduction of gambling urge and behaviour; they also showed a significant reduction in trait anxiety at one year and in state anxiety at one month and one year following treatment. A high level of state anxiety at one month following treatment predicted failure to respond to treatment at one year in the subjects who received imaginal desensitization, but not in those who received aversion-relief. The relationship between reduction in anxiety and in gambling urge in response to imaginal desensitization was predicted from the theory that compulsive gambling is driven by aversive tension.

Using data from the Salford Psychiatric Case Register, point-prevalence patterns of service use in Salford County Borough are compared for 1968 and 1978 with respect to type of care, age and diagnosis. In a declining population, overall point-prevalence ratios increased from 9.52 to 13.44/1,000 adults, due almost entirely to two extensive new services — “injection-only” nurse contact with out-patients, and community psychiatric nurse domiciliary contact. Their development has apparently hardly affected use of other services. The increase was similar in most age-groups and in the predominating diagnostic groups (schizophrenia and depression). Prevalence ratios for long-stay patients barely changed in total, and increased for those accumulated in a ten-year period, but there was an upward shift in age. Day care increased, but its contribution remained relatively small. The diagnostic distribution of social work contact changed, as community psychiatric nurses (CPNs) assumed domiciliary care of people with schizophrenia.

Ear differences on a task involving a simple phonetic judgement were investigated in schizophrenic subjects using both healthy normal and depressed patient control groups. A deficit in phonemic differentiation was demonstrated and appeared to be specific to the schizophrenic group. The result is interpreted as supporting the hypothesis of a central dysfunction lateralized to the left hemisphere in schizophrenia.

First rank symptoms (FRS) in association with affective features predict improvement on ECT. When affectivity was disregarded in 142 schizophrenic probands given ECT and the relationship between FRS alone and ECT response examined, those without FRS had a significantly better ECT outcome score than those with FRS. In various schizophrenic sub-samples, defined in terms of hypothesized predictive abilities of different sets of FRS, no differences came to light.

In an effort at replication of the original report (Rosenthal and Bigelow, 1972) of increased callosal thickness in schizophrenic brains, the corpus callosum was measured in a blind study of 64 brains autopsied between the years 1972 and 1976. Diagnosis was established by independent chart review. The mean corpus callosum mid sections of 21 early onset chronic schizophrenic brains were found to have a significantly greater thickness when compared with 8 subjects with late onset schizophrenia, 13 patients with neurological diagnoses, or 14 patients with other psychiatric diagnoses. These studies, if independently confirmed, should provide an impetus for testing the hypothesis that some chronic schizophrenic patients have an illness associated with a pathological process in the corpus callosum.

In 23 young male adults with antisocial personality, mostly guilty of violent crimes, insulin measurements during the glucose tolerance test showed an enhanced insulin secretion only in those with unsocialized aggressive conduct disorder. The hypothesis that in antisocial personality there are at least two aetiologically different groups is supported.

Computerized assessment which is objective, standardized and easily repeated has been shown to be acceptable to general psychiatric patients. Fifty-three subjects (43 phobics and 10 normals feigning phobias) showed no unusual apprehension in approaching this novel procedure; all were able to complete the computer interview. Furthermore, half of them claimed that they found the interview more acceptable and found it easier to communicate with the computer than with a clinician. Only nine patients preferred the clinician. The reasons for this are discussed.

Long-term antiparkinsonian medication given to 20 mentally handicapped patients also on neuroleptics was abruptly withdrawn. Transient extrapyramidal signs developed in most patients during the following four weeks but in 60 per cent had disappeared by 12 weeks. Reintroduction of medication was necessary in only three patients, who developed acute dystonic reactions within one week of withdrawal.

In a double blind controlled study, 14 affectively ill patients (2 bipolars, 12 unipolars) were randomly allocated to L-Deprenil treatment (an irreversible selective MAO-B inhibitor without “cheese effect”) and 13 patients (3 bipolars, 10 unipolars) to placebo only. Patients on L-Deprenil showed a significantly greater clinical improvement than placebo patients. A positive relationship was found between clinical improvement and degree of platelet MAO inhibition in patients treated with L-Deprenil.

Seventy-five autistic children, 52 males and 23 females, were admitted to the Iowa Autism Programme over a 3-year period. An overall male-female ratio of 2.26:1 was found, but in the patients with IQs less than 50, the ratio was 1.31:1. When IQ and receptive language functioning were considered together, significantly more females than males showed a more deviant form of autism. Autistic females were more seriously affected than autistic males; and more autistic females than males had IQs of less than 50 and evidence of cerebral dysfunction. However, when autistic males and females were closely matched in chronological age and receptive language functioning, the males and females were equally impaired in cognitive and perceptual-motor abilities. The findings suggest that the overall greater degree of morbidity in autistic females was accounted for by a significantly greater proportion of autistic males affected with a mild form of autism, whereas a significantly greater proportion of autistic females were affected with a more deviant form of autism. The findings were linked to the hypothesis of differential genetic loading in males and females.