The problem of assessing outcome in psychotherapy is considered by examining the experiment conducted by Bloch et al (1977). The experimental design and statistical considerations in investigating psychotherapy outcome are briefly examined. It is argued that attention should be directed towards assessing the severity of patients problems rather than improvement after treatment.

Concentrations of plasma amino acids in nine patients with Huntington's chorea and nine control patients were studied while diet and drug therapy were controlled. Significantly low values for threonine, alanine, isoleucine, leucine, lysine and histidine were found in the Huntington's chorea patients. However, since different investigators have failed to establish a consistent pattern of abnormality, it is considered that the findings are probably due to non-specific factors.

Ninety-nine cases of school phobia seen at a child guidance clinic over a period of twelve years were divided into acute and chronic groups and investigated in several ways. The results indicate that the children of both groups are more likely to be the eldest or youngest in the family. Acute school phobia is more likely to occur in youngest children with two or fewer siblings, and mothers tend to be older. It is most common in adolescence and seems often to be precipitated by stress. Chronic school phobia is likely to occur in a child from a larger family and with a younger mother. It is more common in social class V and in children of mentally ill parents. Implications for treatment are discussed.

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

Nortriptyline plasma levels and the incidence and severity of the common subjective side effects of the tricyclic antidepressants were determined in 26 patients during six weeks of treatment with nortriptyline. The total corrected (treatment minus pre-treatment) score of the eight side effects most independent of the severity of depression correlated (0 · 60) with the nortriptyline plasma level. Increased perspiration (o · 59) and dry mouth (o · 54) were the individual corrected side effects which most consistently correlated with the plasma level. These subjective side effects may serve as clinically useful guides to dosage adjustments during treatment, though their value is limited by the magnitude of the correlations and the need to correct for their presence prior to treatment.

Undetermined and accidental poisoning deaths in England and Wales between 1968 and 1974 did not show the same pattern of seasonal variation as suicides by poisoning.

This paper deals with the early results and problems of establishing and developing a regional training programme in psychotherapy, using peripatetic senior lecturers. The difficulties of a psychoanalytic approach to psychotherapy in mental hospitals are discussed, and a model of psychotherapy more suitable for general application in mental hospitals and district general hospital psychiatric units is proposed.

The reporting of suicide inquests by a provincial evening paper has been examined. Inquests on violent and youthful suicides were given more reports, larger reports and more eye-catching headlines.

It is known that official suicide statistics underestimate the incidence of suicide, but it is not clear whether the extent of under-reporting remains constant. An examination of coroners' records in Dublin from 1900 to 1904 and comparison with a similar series in 1964–68 suggests that the underestimation was of similar proportions in both series. It is suggested, therefore, that official suicide statistics are likely to reflect valid temporal changes in suicide and are therefore of value for the study of socio-economic influences on trends in suicide frequency.

Legal findings of unfitness to stand trial are returned ten times more frequently in Scotland than in England and Wales. Sixty-five patients in the State Hospital who had been found insane in bar of trial were compared with a control group of 64 offender patients. They showed a significantly greater incidence of homicidal crimes and diagnoses of psychotic disorders, 19 per cent of which later proved to be unstable. They had also been detained longer at the State Hospital. These findings are discussed and particular reference is made to the tendency for psychotic offenders to be almost automatically regarded as unfit to plead. A brief comparison is made with the situation in England, and some modifications in forensic psychiatric procedure are suggested.

Thirty-two school-phobic youngsters of mean age 13 years were randomly allocated to two treatment groups after stratifying for sex. Length of in-patient management in a psychiatric hospital unit for young adolescents was evaluated. One group was admitted for three months and the other for six. Care was taken to ensure that cases had been fairly distributed between the groups by comparing them on a variety of clinical features. Follow-up assessments were carried out in a reliable fashion at six months, one year and two years after discharge. Outcome, overall, was similar to that found in a previous follow-up study for the same unit, in that symptoms of emotional disturbance and social impairment tended to persist in a considerable proportion of cases over the period of review. Length of stay in hospital did not affect outcome as far as the boys were concerned; the findings in relation to the girls was less certain and it seems likely that longer in-patient treatment improves outcome in school-phobic girls.

One-hundred female nurses at a psychiatric hospital were interviewed in an attempt to assess the overall frequency of having been the victim of indecent exposure and to describe it as experienced by the victim.

Forty-four of the subjects had been victims of indecent exposure, one-third of these on two or more occasions.

The attitudes of those who had been victims were no different from the attitudes of those who had not. One-third of all incidents had not been disclosed to anyone. In over one-fifth of the episodes the reaction of the family and friends in whom the victim confided had been more distressing to the victim than the episode itself.

This paper brings up to date a 1970 study of suicide attempters coming to a major emergency room in an United States urban community and reviews international trends in suicide attempts. Results of the study and the review of the international literature indicate that the high rates of suicide attempts that were observed in 1970 are continuing into 1975. The incidence of suicide attempts continues to be a public health problem primarily among young women. Pill ingestion, usually barbiturates and psychotropic drugs, continues to be the most common method used.

This paper presents work that formed the basis of a fourth-year project at Southampton University Medical School. Thirty patients were seen prior to their first psychiatric consultation and asked about their hopes, fears and expectations. Twenty-five were seen subsequently.

The study, which is largely descriptive, shows that many patients have unrealistic expectations about various aspects of the interview, and afterwards many are dissatisfied with its outcome. The paper discusses these findings and makes some tentative recommendations.

A group of psychiatric patients were operationally defined as ‘hysterics’ by their reliance on the perceptual defence mechanism of repression, as disclosed in a valid psychological test. Most of them had dependency conflicts. Only half of them, almost exclusively female, had received the clinical diagnosis hysteria, the diagnosis being apparently founded on bodily complaints, overt aggression, and absence of depressive mood and anxiety. Lack of these characteristics in patients resorting to repression and with dependency conflicts results in diagnostic uncertainty. Clinical and test data justified the separation from operationally defined hysterics of three small subgroups: one with brain dysfunction, one with regressive psychosis, and one with non-regressive schizophrenia. Relevant diagnostic clues in the psychological tests and in the clinical picture are discussed.

The use for hallucinogenic purposes of an indigenous mushroom, Psilocybe semilanceata indigenous to Britain is reported in three patients. Typical psychedelic, transient psychotic and more prolonged schizophrenia-like states were seen, with sympathomimetic signs noted in two cases, in one being prolonged. Enquiry about such mushroom abuse should be considered in individuals presenting to medical or psychiatric emergency clinics.

A lower incidence of attempted suicide was found for Oxford University students than for other persons of the same age in Oxford City. This may be due to social class differences. Characteristics of the student attempters are reported. On the other hand, the rates for completed suicides of students, over a recent ten-year period, were in excess of those for the rest of their age group.

A variant of the Capgras syndrome is described in a 43-year-old woman who had vitiligo and multinodular goitre. The unusual feature of the case was that the patient not only misidentified members of her own family but also claimed that she herself had been replaced by a double.

The results of a follow-up study of schizophrenics attending a centre in North West India are reported. The relevant literature is reviewed, The results were compared with two well-known studies, one from the United Kingdom and the other from Mauritius. The evidence presented suggests that the course taken by schizophrenia in a newly-developed city and its neighbourhood in this part of India is similar to the one seen in the Western world. This study does not support the view that chronicity of schizophrenia in non-European, non-white populations is different, at least in an urban setting.