In 1970 we studied the phenomenon of rejection in two units of a psychiatric rehabilitation hospital (Morgan and Cheadle, 1972). The study concluded that 20 patients out of a sample of 110 were rejected to some degree by some members of staff. The method employed to determine this was to ask all members of staff to name the patients who they considered fitted into certain categories. Ten of these categories indicated desirable behaviour such as helpful, co-operative or appreciative; the other ten were of an undesirable nature such as lazy, untrustworthy or attention seeking. The questionnaire used was published as the Appendix to our previous paper. If a staff member placed a patient into more undesirable than desirable categories he was considered as rejecting that patient. If more staff rejected a patient than accepted him, the patient was considered to be a reject.

An analysis of recently published family history data on rapid eye movement (REM) narcolepsy was undertaken to determine the goodness-of-fit of a multifactorial (MF) model of inheritance. The analysis revealed that a two-threshold MF model can successfully account for the prevalence of REM narcolepsy and other disorders of excessive sleep (DES) observed in the first-degree relatives of the REM narcoleptic probands studied.

In a group of British-born primiparous women, admission of a separation experience from parents in childhood was found to be associated with unmarried status, teenage pregnancy, having had psychiatric treatment, housing problems and a high score on a ‘Malaise’ inventory. Within the separated group the unmarried and teenage status were associated only with separations occurring in the context of a disrupted childhood, but were not related to the age of the separations. The Malaise score, however, was raised both for disrupted separations and for those occurring below the age of 5. It is noted that the factors associated with the separation in the mothers are those which have been found to be more common in the mothers of children with behaviour disorders.

Two cases of chronic monosymptomatic psychogenic eye pain with abnormal illness behaviour are presented. Both failed to respond to a wide variety of treatments, and despite the accepted low suicidal risk in hypochondriasis both killed themselves. The origin, prognosis and therapy of such behaviour are discussed in this context.

The study dealt with the level of and diurnal alterations in the concentration of tryptophan, free tryptophan and tyrosine in the blood plasma of 20 inhibited depression patients and 10 healthy controls.

The results suggested that there was no distinct relationship between either the total plasma tryptophan or plasma tyrosine level and depression. On the other hand, the free plasma tryptophan level was, at all the times of day at which measurements were made, either significantly or almost significantly higher in the patients than in the controls. It was further found that the results of measurement were related to the patients’ clinical improvement, as measured by the Hamilton test, in such a way that after four weeks of treatment the free plasma tryptophan level in ‘poorly improved’ patients continued to be significantly higher in comparison with the controls, whereas the values for the ‘well improved’ patient group did not differ greatly from the corresponding values for the control group any longer.

It may be hypothesized that the rise in the free plasma tryptophan in depressive patients might represent an effort made by the peripheral body to compensate for the slowed-up serotonin metabolism of the brain, whereby the tryptophan mobilized from the periphery would serve as a sort of ‘endogenous antidepressant’ provided by the organism itself.

Although a number of studies have suggested that hostility and drug dependence may be related, there are few systematic studies of this issue. Using the Hostility and Direction of Hostility Questionnaire, the present study compares several drug-dependent groups of patients. Results showed that the intravenous in-patient group was more hostile on several variables than their out-patient counterparts, and also more hostile than an oral in-patient group. Barbiturate abusers were found to have high levels of hostility; amphetamine abusers were the least hostile group, and narcotic dependent patients were intermediate between the two. Correlations between scales of the HDHQ, were all positive, and most were both high and statistically significant, suggesting that hostility represents a relatively generalized trait in drug-dependent subjects. The results are discussed both in terms of patient selection factors—the differential pressures on different types of patients, and in terms of direct drug effects. It is suggested that the hostility of drug-dependent patients may represent an important problem of personal functioning and may require special attention in treatment programmes.

Sixty-five patients primarily referred for erectile impotence were investigated and treated in a psychiatric out-patient department. Information was obtained from patients and wherever possible from their partners. Subjects were treated either with chemotherapy or with a modified form of Masters and Johnson's technique. A controlled group were not given any specific treatment. Results indicated that neither chemotherapy or behaviour modification (modified Masters and Johnson's technique) were in any way superior to no treatment. The prognosis was related to the clinical features of the subjects rather than to the form of treatment. Subjects in whom impotence was caused by a specific psychological or physical trauma showed a much better prognosis than those who had an insidious decline in sexual potency without any discernible psychological or physical factors. The decline in these latter subjects with a very poor prognosis was possibly due to inherent physiological factors.

Are research interview techniques adequate in assessing signs and symptoms? This question is investigated by obtaining two sets of interview schedule ratings on 49 patients, one by a research psychiatrist applying the interview and one by the patient's psychiatrist using all available information. The latter was considered a clinical standard with which a cross-sectional research interview could be contrasted.

These two data sets were subjected to several types of analysis commonly undertaken with research interview ratings. Results indicated that the research interview adequately represents symptom data, but is seriously lacking in the assessment of observed behaviour. The effect of this difference depends on the goals of the study and the nature of the data analysis. If overall group findings are desired, or if analysis relies primarily on symptom data, results with a research interview may be similar to results based on a far more extensive evaluation. On the other hand, if conclusions are to be drawn on individual patients, or if data analysis relies heavily on observed behaviour, then data derived from research interviews are questionable.

A follow-up study is reported of a consecutive series of 360 women who underwent termination of first trimester pregnancies by vacuum aspiration. Each patient received brief counselling before termination. Follow-up examinations were carried out by means of detailed, structured interviews at three months and between 15 months and two years (mean: 18 months) after termination. Outcome was assessed in terms of psychiatric symptoms, guilt feelings, and adjustment in marital and other interpersonal relationships, sexual responsiveness and work record. Compared with ratings of psychosocial adjustment before termination, significant improvement had occurred at follow-up in respect of psychiatric symptoms, guilt feelings and interpersonal and sexual adjustment; there was no significant change in marital adjustment. Adverse psychiatric and social sequelae were rare.

The paper is concerned with methodological problems relating to the scientific study of the effectiveness of Alcoholics Anonymous (AA). Studies of the effectiveness of AA fall into two categories—longitudinal and cross-sectional, and may be criticized on the basis of over-simple criteria of success.

The particular problems of the requirement for control groups in studies of effectiveness are pointed out. The problems arising out of the whole process of affiliation and disaffiliation and their implications for scientific study are discussed. The requirement for sound statistical analysis is stressed, and inadequacies in the techniques of follow-up are indicated.

The studies which have some bearing on AA as a treatment facility are reviewed. These include multivariate studies involving AA attendance as one factor, studies in which AA was the main variable in a hospital programme, and longitudinal studies of AA from within the organization. Particular difficulties in using cross-sectional surveys for the purpose of estimating efficacy are pointed out.

The conclusion reached is that because of the methodological difficulties the totality of these studies does not add significantly to the knowledge concerning AA which we possess from clinical experience. Moreover, without a change in the unusual characteristics of AA when considered as a treatment facility it seems unlikely to be possible to assess its effectiveness in a scientific manner.

A double-blind prospective study was carried out comparing the prophylactic effect of maprotiline and lithium carbonate over a period of one year in patients suffering from recurrent affective disorders. The average Affective Morbidity Index was lower, but not significantly so, in patients treated with lithium. A further analysis, based on dividing patients into those with no affective morbidity and those who showed some affective morbidity during the study, demonstrated lithium carbonate to be significantly superior to maprotiline both in the group as a whole and in unipolar depressives. A correlation between high plasma maprotiline concentration and low morbidity was observed and was in line with an earlier report. A highly significant negative correlation (r = −0.97; p < 0.001) was found between plasma maprotiline concentration and body weight. Although the results showed lithium carbonate to be superior to maprotiline in the study, it should be emphasized that the plasma levels of lithium were constantly monitored and maintained at what is considered to be its optimum concentration, whereas the maprotiline treated patients were kept on a fixed dosage regime irrespective of plasma levels.

The present investigation was intended principally as a concurrent validation study for a new self-report symptom inventory: the SCL-90. A sample of 209 ‘symptomatic volunteers' served as subjects and were administered both the SCL-90 and the MMPI prior to participation in clinical therapeutic drug trials. The MMPI was scored for the Wiggins content scales and the Tryon cluster scales in addition to the standard clinical scales. Comparisons of the nine primary symptom dimensions of the SCL-90 with the set of MMPI scales reflected very high convergent validity for the SCL-90. Peak correlations were observed with like constructs on eight of the nine scales, with secondary patterns of correlations showing high interpretative consistency.

A therapeutic group with eight members was studied, using psychometric tests, improvement ratings based on pre-treatment statements of patients' hopes, and of therapists' aims rated for achievement on the basis of post-treatment interviews, and two forms of repertory grid testing. The In-Group Grid yielded a number of measures relating to outcome and to aspects of the group process. Most patients improved by some criteria, and most measures of improvement intercorrelated positively but not, in most cases, highly. Few clear relations between process and outcome measures were demonstrated.

A hundred-and-twenty-five school phobic youngsters had been treated in a psychiatric in-patient unit for young adolescents of secondary school age over a seven-year period; a hundred of them were reviewed on average three years after discharge. About a third of cases were found to have improved little; they had persistent severe symptoms of emotional disturbance and continuing social impairment. Another third had improved appreciably and were affected by neurotic symptoms rather than social impairment. The remaining third had improved substantially or completely. School attendance difficulties had remained in about half of all cases. Subsequent difficulties in going to work were less pronounced. The best predictor of outcome was clinical state on discharge. High intelligence also emerged as a significant predictor of poor outcome. Five girls and a boy had already developed severe and persistent agoraphobic difficulties when reviewed. It was found that severe school phobia in early adolescence resembled adult affective disorders in some clinical features and in outcome.

A postal inquiry of all senior registrars in general psychiatry in the United Kingdom gave a nearly 90 per cent response rate. Between a quarter and a fifth of the respondents will not be pursuing general psychiatry at consultant level in this country, most of these opting for a psychiatric specialty. Nearly all the overseas graduates will probably remain in this country. Slightly fewer women than men are aiming for a consultancy in general psychiatry, the rest of the women proposing to switch to one of the specialties. Some of the implications of these findings are discussed, including a proposal for a yearly follow-up of the respondents.

Correlations were made between ratings on the Hamilton Rating Scale for depression and the Inventory for measuring depression devised by Beck. Satisfactory and significant correlations were observed in only two-thirds of the patients, and often very divergent results were found in the remaining third.

In a recent article, Everitt (1975) discussed several problems with multivariate techniques. However, two useful applications of multivariate techniques were not covered. The present paper describes the use of factor analysis to reduce a large array of outcome variables to a statistically manageable number, and multivariate analysis of variance to determine the relative effectiveness of several treatment regimes where a single outcome variable cannot be specified. It is concluded that the advantages of a multivariate approach outweigh the disadvantages, provided the researcher is careful in interpreting and reporting his results.