The content analysis was made of special thirty minute discussions between each of 30 acute male schizophrenics and their parents to determine features of parental personality. All patients were discharged, but after 2 years 13 of them had been readmitted. Compared with those not readmitted their fathers expressed more outward-directed hostility and hostility projected on to others, and their mothers expressed more inward-directed hostility as well as guilt anxiety and shame anxiety. Both parents were emotionally more unstable during the course of the discussion. The emotional interaction between mothers and sons was of symmetrical type (whereas it was complementary between mothers and sons who had not been readmitted).

Animal studies of alcohol intake can be divided into two groups based on the methodology. General findings of each group will be reviewed especially as they relate to current areas of research interest. Some implications of research findings for theories of alcoholism and drug addiction will be mentioned.

The anticonvulsant treatment of epilepsy associated with psychological disorders is reviewed in the light of modern knowledge of the clinical pharmacology and adverse mental effects of the drugs. Careful monitoring of individual drug therapy from the onset of treatment improves compliance and seizure control and avoids unnecessary and harmful polypharmacy, and some of the neurological and psychosocial problems of chronic epilepsy. In chronic patients on polypharmacy cautious rationalization may improve mental function but can be hazardous due to withdrawal seizures. A clearer perception of the limits of anticonvulsant therapy will allow more attention to appropriate psychosocial measures.

This paper reviews ideas about depression and mourning from various quarters, particularly from psychoanalytic writings, from the work of George Brown on the social origins of depression and from some of the work in behavioural psychotherapy on guided mourning. Its essence is foreshadowed in a statement of Winnicott's: “If in an individual the depressive position has been achieved and fully established, then the reaction to loss is grief, or sadness. Where there is some degree of failure at the depressive position the result of loss is depression”.

Few psychiatrists now take a lively interest in the social sciences, and few social scientists listen to what psychiatrists have to say. For the handful who do, the widening gap between the two fields of knowledge is regrettable, for we have much to learn from each other. The gap seems to have grown for two reasons: psychiatrists, increasingly occupied with pharmacotherapy, have drawn closer to general medicine, and there is comparatively little interest in the social therapies which seemed to offer so much promise back in the 1950s. The open-door system was a success, and so was the idea of community care, even if the practice left much to be desired. Incidentally, these developments destroyed many of the interesting experiments in group dynamics which were at one time a feature of mental hospital life. Social workers, once seen as allies, went off on their own in the new, powerful and largely incomprehensible Social Services Departments, where they had many other tasks to occupy them. Sociologists became shrill and hostile. Many psychiatrists ceased to read sociology after the publication of Goffman's Asylums (Goffman, 1961) because it seemed that sociology was off on some kind of egotrip which was deeply antithetical to their own professional experience. People who talked about “madness” instead of “mental illness”, rejected diagnosis as labelling, and regarded mental patients as victims of a capitalist plot were (and are) difficult to talk to. One of the distinguishing features of mental health reform over the past 200 years has been its apolitical nature—people of all political views could agree on what seemed essentially a matter of common humanity. Suddenly it became highly politicized, both in theoretical terms, since the new analysis was basically neo-Marxist, and in the action of pressure groups in the Civil Liberties lobby. Confused by the Right to Treatment, the Right to Refuse Treatment, the Right to Information and the Right to Confidentiality, most psychiatrists have (wisely in the circumstances) kept their heads down and got on with the job.

This paper defines and tests a typology of addicts defined through assessment of the sequence of three types of key events: (a) traumatic childhood events such as death of a parent or child abuse; (b) onset of regular delinquent activity; and (c) initiation of illicit drug use. By evaluating the sequence of these events three groups are defined: (a) an initial childhood trauma group; (b) an early delinquency group; and (c) an initial drug use group. Data derived from a sample of treated opiate addicts are used to define and differentiate these three groups.

Using structured psychiatric interviews, we searched for differences between depressed patients with bipolar affective disorder, and with other types of depression. The patients were taken from 2 large series, collected in London and Chicago. Some differences were found, but few more than would be expected by chance, in view of the large number of variables examined. The possible reasons for this failure are discussed. They include contamination of the groups, and the insensitivity of structured mental state inventories.

Addicts who use illicit drugs despite receiving a maintenance prescription present a difficult management problem for drug dependence clinics. This study looks at a small group of such addicts and at their response to the provision of a temporary increase in their prescribed opiates. The results indicate that this increase led to a reduction in illicit drug use and to improvements in social functioning. These and other findings are discussed. It is suggested that clinics should be more prepared to consider such temporary increases, but the need for careful monitoring and for the involvement of more than one member of the treatment team is stressed.

It is proposed that some cases of depressive illness in cancer patients may be caused by immunological interference with the activity of serotonin, one of the neurotransmitters thought to be implicated in depression. This interference could be mediated in two ways. Antibody induced against a protein released from cancer cells could, on the basis of cross-reactivity with CNS tissue, bind to receptors for serotonin and block them. Such primary antibodies could stimulate the production of anti-idiotypic antibodies, which would act as an alternative receptor for serotonin and reduce its synaptic availability.

A study is reported of a controlled trial of social intervention in the families of schizophrenic patients at high risk of relapse. The patients were selected for being in high contact with high Expressed Emotion relatives. All patients were maintained on neuroleptic drugs. One half of the 24 families were randomly assigned to routine out-patient care, while the other half received a package of social interventions. This comprised a programme of education about schizophrenia, a group for the relatives, and family sessions for relatives and patients.

The relapse rate in the control group was 50 per cent compared with nine per cent in the experimental group (P = 0.04). The stated aims of the therapeutic interventions were achieved in 73 per cent of experimental families. In these families, no patient relapsed. The results provide evidence for the causal role of relatives' expressed emotion (EE) in schizophrenic relapse, as well as for the therapeutic effectiveness of social intervention combined with drug treatment.

The inter-electrode resistance during ECT is shown to be very variable, a finding which invalidates the measurement of shocks in joules. With square wave pulses of selected current value the threshold for convulsion may be below 100 milliamperes or above 2,000 milliamperes. It is advisable to measure the current value during millisecond pulses with relatively long intervals between.

A sample of patients with puerperal mental illness requiring hospital admission were diagnosed retrospectively according to the criteria of DSM III. Comparisons were made with controls matched for diagnosis on a number of features of past history, symptoms, management and outcome. Puerperal illness was associated with more frequent puerperal and less frequent non-puerperal previous admissions, more frequent delusions and greater use of ECT.

A pair of identical twins for whom long-term follow-up information was available progressed concordantly from typical ‘affective illness' to process schizophrenia. We discuss a possible genetic basis for a certain form of schizophrenia which may present typical affective features in the initial phase of process schizophrenia.

This study investigated parental bonding patterns of hypochondriacal patients using the Parental Bonding Instrument. Hypochondriacal patients and a matched control group were drawn from in and out-patients of a psychiatric hospital. Maternal over-protection was found much more frequently (P <.005) in the hypochondriacal group than in the control group. This offers support for previous clinical observations on hypochondriacal patients. The implications of this and other findings of the study are discussed.

EEG monitored ECT was administered to 20 patients, 12 females and 8 males. One hundred and fifty-six treatments were given (mean 7.8 treatments/patient), and the relation between clinically observed seizures (COS) and the cerebral patterns of convulsions (EPC) was compared. If clinical observation alone had been used, restimulation would have been necessary in 43 per cent of the treatments, whereas restimulation actually was done in 9 per cent. Similarly, too violent convulsion patterns would have been ignored in 5 per cent of the treatments.

Previous studies attempting to support unipolar mania as an entity distinct from bipolar disorder, have produced conflicting results. The present study reports on a chart review of 247 patients admitted to the University of Iowa with a history of at least one manic episode; 87 of these had apparently never experienced a depression. A subgroup of 92 patients, who met DSM III diagnostic criteria and had a history of at least two episodes of affective disorder, were also examined. There were few clinically meaningful differences between patients with unipolar mania and bipolar disorder on demographic, symptomatic, or familial variables. An earlier report that unipolar manics were more likely to be male and have a family history of unipolar depression was not confirmed. Unipolar mania is not supported as a separate entity from bipolar disorder.

In a comparison between elderly depressed subjects and normal elderly people in the general population, an association was found between severe life events, major social difficulties, poor physical health and the onset of depression. Working class subjects within the general population had a higher incidence of depression and this appeared to be explained by their poorer health and greater social difficulties. Those elderly people who lacked a confiding relationship were more vulnerable to depression. Evidence is presented that the lack of a confidant was a reflection of life-long personality traits.

The modern conceptualization of paranoia depends largely on the work of Emil Kraepelin. After him, German psychiatry concentrated on detailed descriptions of psychopathology in paranoid states, but there were few diagnostic or therapeutic advances till lately. A revival of interest is apparent, but this may be stultified by inaccurate criteria for paranoid disorders in DSM III, whose influence, at least in North America, appears assured for a considerable time.

Plasma pancreatic polypeptide concentrations rise by 320±81 per cent following administration of electroconvulsive therapy. This rise is observed in the first ten minutes despite premedication of patients with 0.6 mg atropine. Pancreatic polypeptide release is dependent on cholinergic tone and is very sensitive to atropine. The dramatic rise in pancreative polypeptide observed following electroconvulsive therapy probably results from vagal stimulation and reflects insufficient atropine premedication.

Patients diagnosed as reactively or endogenously depressed were given electroconvulsive therapy (ECT). The endogenously depressed patients tended to respond to the treatment more quickly and favourably. Measures of age and severity of depression were as predictive as the classification into endogenous or reactive depression using the Newcastle rating scale. The degree of psychological stress ascertained and presumed to be operating did not contribute to the prediction of outcome.