Plasma Cortisol, free and total tryptophan were determined in 71 subjects on 8 occasions between 36 weeks gestation and 6 weeks post-partum. Affect was measured by rating scales and clinical interview. Twenty-eight subjects were judged to have experienced post-partum ‘blues'. Seasonal variation occurred in the incidence of ‘blues' and in Cortisol and free tryptophan levels. Puerperally-depressed mood was correlated with high Cortisol at 38 weeks irrespective of season. Free tryptophan was reduced in ‘blues' subjects but only at the time of year when free tryptophan was normally high. Total tryptophan was low antenatally; a rapid rise on days 1 and 2 post-partum was superimposed on a slower return to normal. This initial peak was clearly absent in 37 per cent of subjects. Its absence was significantly related to occurrence of post-partum ‘blues' and of complaints of depression in the ensuing 6 months. This finding is discussed in relation to the possible occurrence of an occult disturbance of tryptophan handling in subjects susceptible to depression.

Three patients experienced complex formed hallucinations during progressive visual failure from eye disease. The hallucinations began abruptly, were brightly coloured stereotyped figures, animals or objects, and appeared to be provoked by light.

As blindness progressed the clarity, frequency and duration of the hallucinations faded. The patients had no abnormalities other than their eye disease, which in two cases was macula degeneration, and choroideraemia in the third.

Two patients developed an extrapyramidal syndrome after therapy with lithium carbonate. Although the clinical features of this syndrome were indistinguishable from those of drug-induced parkinsonism, it was made worse by the anti-parkinsonian drug, orphenadrine. These findings were reproduced later under laboratory conditions when extrapyramidal symptoms and physiological tremor were recorded before and after challenge doses of orphenadrine. This unwanted effect of lithium carbonate may be explained by selective blockade of dopamine receptors.

Plasma concentrations of thioridazine, mesoridazine, sulphoridazine and thioridazine ring sulphoxide have been measured individually by specific gas-liquid chromatographic (GLC) methods, and collectively by a radio-receptor assay, in 16 elderly in-patients during chronic treatment. The sulphoridazine level was above 0.135 μg/ml in 5 out of 6 symptomatically well-controlled patients, and below this level in 9 out of 10 who were poorly controlled. No such division was so clear for the other substances measured. A new assay for the total dopamine receptor-blocking activity of the plasma correlated highly at lower levels with the sum of drug plus metabolites obtained by GLC, but exceeded the sum at higher values. Both sulphoridazine and neuroleptic levels need further study.

Twenty-six patients with proven myasthenia gravis were interviewed to assess the length of time between onset of symptoms, presentation to the general practitioner and diagnosis. In one third the initial diagnosis was psychiatric and the average time between presentation and correct diagnosis was 2.8 years for men, 1.2 years for premenopausal women and three weeks for postmenopausal women. Diagnosis could have been made much earlier if doctors had been familiar with early symptoms in this relatively rare disease. Symptoms and signs fluctuated and were at times absent, especially in the mornings.

The prevalence of Klinefelter's Syndrome in new-born males in large surveys throughout the world has shown a scatter of 1.4 to 1.9 per thousand. Forssman (1970) accepted by pooling results a figure of 0.17 per cent as the average proportion of males born with at least one too many X chromosomes in some or all cell lines. Studies of mental hospital populations have consistently shown a higher prevalence of extra X chromosomes in males, averaging 0.54 per cent. The two largest studies, in Great Britain (Maclean et al, 1968) and in Sweden (Hambert, 1966) made no differentiation in the psychiatric diagnosis of the patients, although Hambert stated that the high prevalence did not stem from the mentally retarded population.

Seventy-four overweight psychiatric in-patients were treated with weight reducing diets for periods varying from 6 months to 34 months. Seventy per cent lost weight and 18 per cent attained an ideal weight. Weight reducing diets should be considered an important aspect of treatment for the majority of obese patients in psychiatric hospitals regardless of the cause of obesity.

Personality variables and psychiatric symptoms were each assessed by inventory in 42 patients with anorexia nervosa: as in-patients initially, and during a three-year follow up. The results were used to distinguish primary from secondary cases and to monitor the clinical progress of the disorder.

In an article entitled ‘The Nasal Drop Addict’, Jarvis (1969) wrote, “Every rhinologist from time to time sees patients who are using decongestant drops every few hours in an effort to obtain a clear nasal airway”. Yet few reports have appeared in the medical literature.