Review of the literature concerning the relationship between deafness and psychiatric disorder reveals differences in the pattern of illness depending on the severity of deafness and the age of onset. In particular, the prevalence of schizophrenia in the prelingually deaf is similar to that found in the normal population, whereas the hard of hearing are over-represented among samples of patients suffering from paranoid psychoses in later life.

Possible modes of action of long-standing hearing loss in the aetiology of paranoid illnesses are considered: the psychological and social consequences of deafness, the possible contribution of sensory deprivation phenomena, and the interference of hearing loss in attention, perception and communication. Finally, possible future lines of research are suggested.

This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.

As the first phase of a project designed to institute controlled drinking as a therapeutic goal for alcoholics, it was decided to recruit volunteers who were dissatisfied with their present mode of drinking but who had not previously sought help. This was done by requesting them to phone a private number. When these volunteers had been recruited it was proposed to modify their drinking habits to their own requirements, using non-averse training, drinking practice and ongoing group psychotherapy. This project however has not been implemented because of a paucity of volunteers. The methods of recruitment are listed and those drinkers who volunteered are described. The reasons for the low rate of response are discussed.

Reported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising.

Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die be replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy.

This study is a replication and extension of past work carried out by Brown, Birley and Wing (1972) concerning the influence of family life on the course of schizophrenia. In the original research the index of emotion expressed by a key relative about the patient at the time of key admission proved to be the best single predictor of symptomatic relapse in the nine months after discharge from hospital. In the present study this main finding of Brown et al has been replicated for two clinically different groups of psychiatric patients. The expressed emotion of the relative again seems to be associated with relapse independently of all other social and clinical factors investigated. In addition, important additive effects between various social influences and pharmacological treatments have been revealed which make it possible to predict relapse patterns in schizophrenia with considerable precision. The patterns of these relationships with relapse are different for the two clinical groups studied, patients with schizophrenic psychosis and with depressive neurosis.

From an original cohort of 471 admissions of male schizophrenics (260 individuals) to Leverndale Hospital, Glasgow, in the years 1967–70 inclusive, 39 patients were found who in December 1973 had become long-term residents by virtue of over three years' stay. These patients were followed up two years later, when it was found that 33 remained. Three had died and two had been discharged, though one was later admitted elsewhere. Those remaining had an average age of 45.4 years, and an average duration of illness of 15 years. The patients are considered in terms of their clinical state, management problems, accommodation, occupational grade, and social circumstances. It is concluded that they represent a hard core and that very few of them are likely to be suitable for such alternative forms of care as are at present available.

Monoamine oxidase (MAO) is an important enzyme in the catabolism of brain biogenic amines. Platelet MAO has been reported to be moderately reduced in manic-depressive patients and markedly reduced in schizophrenic patients. This enzyme's activity has been shown to be under a large degree of genetic control and has been proposed as a ‘genetic marker’ in schizophrenia. A transcultural replication of the finding of low platelet MAO in schizophrenia and manic-depressive illness was carried out at the Jerusalem Mental Health Centre. Manic-depressive patients were found to have higher platelet MAO activity than schizophrenic patients, as reported previously, but control individuals were as low as the schizophrenic patients. It is unlikely that platelet MAO activity is a transculturally-valid marker for schizophrenia.

The effects of tricyclic antidepressants on the heart are reviewed. Statistically significant increases in heart rate and in atrioventricular conduction times were found following the administration of tricyclic drugs to 32 depressed patients. The method of His bundle electrocardiography was used to study atrioventricular conduction in ambulant patients and in patients admitted after an overdose of tricyclic antidepressant drugs. Distal conduction defects were frequently found in patients following tricyclic overdosage, but these were not seen with doxepin overdosage. Impaired distal conduction was also found in occasional patients on therapeutic doses of tricyclic drugs. Some animal experiments giving similar results to the above clinical findings are also described. The clinical implications of these findings are discussed.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets.

Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.

The chemical structure of a neuroleptic does not reliably predict the exact profile of its therapeutic action. We considered the question whether the biochemical action of a neuroleptic, and specifically the ratio between DA-receptor block and NA-receptor block, might have a higher predictive value in this respect. In this context we carried out a double-blind study of the therapeutic value of clozapine and perphenazine in acute psychoses of varying symptomatology and aetiology. There are strong indications that clozapine has only a slight inhibitory effect on transmission in central DA-ergic neurons, but markedly inhibits transmission in central NA-ergic neurons, and that the reverse applies to perphenazine. In view of these data we expected perphenazine to be a stronger antipsychotic and a weaker sedative than clozapine, and vice versa. The plausibility of this hypothesis was demonstrated. Partly also on the basis of earlier research, we concluded that the biochemical action of a neuroleptic is a more faithful predictor of its therapeutic action profile than the chemical structure.

In four studies homosexual patients were randomly allocated to receive either different forms of aversive therapy; or aversive therapy or a positive conditioning procedure. Before and after therapy the patients' sexual orientation was determined by measuring their penile volume responses to moving pictures of nude men and women.

The aversive therapies produced reduction in homosexual feelings and behaviour. In the fourth study the reduction was significantly greater following the aversive compared with the positive conditioning procedure. No significant change in measured sexual orientation occurred in the patients who received aversive therapy compared with those who received positive conditioning. The measured sexual orientation of the homosexual patients after treatment differed significantly from that of heterosexual patients who received aversive therapy for sexual anomalies.

Data from non-rapid-cycling bipolar (manic-depressive) patients who were receiving long-term treatment with lithium carbonate were analysed by the life table method to determine when lithium carbonate prophylaxis failures occurred. Forty-four of 96 patients failed to keep well in spite of maintenance lithium therapy. The analysis revealed an early, rapid failure rate during the first six months of treatment, which was followed by a slower rate of failure. Several clinical factors were assessed to determine if any of them predicted which patients would experience their initial failure in the early or late interval, but none of these factors, which included age, sex, age of onset, rate of affective attacks, family history, and the nature of the preceding episode, were found to have any predictive value regarding lithium prophylaxis failure. We found, however, that patients who had early failures tended to have a subsequent early failure in spite of continued maintenance with lithium carbonate.

New psychiatric out-patients were offered immediate or delayed appointments (average delay 12 weeks) in random order. The two groups thus formed, comprising 234 patients, were shown to be comparable in some important respects. Immediate appointments were taken up significantly more frequently than delayed appointments, and 12 per cent of immediate and 22 per cent of delayed patients did not receive any psychiatric service. No evidence was found that delay increased other medical services supplied. Non-attenders were presumed to suffer from ‘neurosis’ and ‘personality problem’. Initial attenders used more services than those who failed to keep their first appointment but came later. A waiting list is proposed as a screening device to limit out-patient referrals.

An epidemiological study of the first admission rate for mania was carried out in London and Aarhus. The case registers in these two centres were used to conduct a retrospective study of case notes covering several years, and a screening procedure was used for the prospective collection of new cases over the course of one year. The annual incidence of mania was found to be virtually identical in both centres. The retrospective study gave a figure of 2.6 per 100,000 population in both Aarhus and London. But the London sample was found to contain 45 per cent of immigrants in contrast to the Aarhus sample in which only a negligible proportion were born outside Denmark. Male West Indians, in particular, were over-represented in the London sample.

The antidepressant activities of mianserin hydrochloride were investigated and compared with those of amitriptyline. The therapeutic efficacy of the two drugs appeared similar, but the incidence of side-effects was significantly higher with amitriptyline. Plasma levels of mianserin were determined during the trial and were not related to the therapeutic activity of the drug.

Whole blood cell ATP concentration was estimated in a group of manic and depressed patients and in a group of normal subjects. There were no significant differences between patient and control groups, nor in the patient groups were there any significant changes with recovery.

A sample of 471 enlisted men 183 cm or taller serving in the US Navy, Coast Guard, and Marine Corps was screened for Y-chromosome aneuploidy by use of quinacrine fluorescence of peripheral blood smears. Two 47, XYY males were detected, resulting in a prevalence of .00425 or approximately 1 in 236. The prevalence of 47, XYY males (.00331) in a number of samples of tall, non-institutionalized males is significantly higher than the incidence in newborn males (.00091), indicating that 47, XYY males are disproportionately represented in tall male populations. The 47, XYY males had significantly higher scores than 46, XY males on the Schizophrenia, Schizophrenia + 1K, and Prejudice scales of the Minnesota Multiphasic Personality Inventory and significantly lower scores on the Dominance scale. Since the probability that a randomly selected pair of subjects in the sample had four or more scale scores significantly different from the remainder of the group was greater than .05, it is possible that the differences between the 47, XYY and 46, XY males occurred by chance. On the other hand, one or more of these scales may measure personality dimensions on which non-institutionalized 47, XYY males may, in fact, differ from 46, XY males.

Biochemical screening for thyroid dysfunction in 98 unselected female psychiatric admissions led to the diagnosis of hypothyroidism in three cases which would otherwise have passed unrecognized. It is suggested that female psychiatric patients over the age of 40 should routinely be screened for thyroid disorder.

The possibility that schizophrenia and creativity are two aspects of the same process is discussed, and parallels between different types of schizophrenia and different factors of creativity are sought. The discussion begins at a theoretical level, but its main thrust is an analysis of the research literature at an empirical level. Similarities are pointed out between tasks used for the purpose of operationally defining the schizophrenic ‘deficit’ and tasks used to define creativity. Some evidence is found for different subtypes of schizophrenics exhibiting different factors or types of creativity.

Children whose mothers received prenatal progesterone have been shown to be advanced in development at one year and to have greater academic achievement at 9–10 years. This study compares the educational attainments at 17–20 years of 34 progesterone children with 37 normal and 12 toxaemic controls. More progesterone children continued schooling after 16 years compared with controls; a higher proportion left school with ‘O’ level and ‘A’ level passes, the average number of passes per child was greater at both levels and more obtained a university place. The best academic results were in those whose mothers had received over 5 grams of prenatal progesterone, and for whom administration commenced before the sixteenth week and treatment lasted longer than eight weeks.