This paper reviews explanations of sex differences in mental hospital admission rates, taking account of age and marital status effects. Six propositions derived from the review are tested on data from a nationwide community survey of 259 respondents, using a standardized symptom check list.

Women report more psychological symptoms than men, but this is unrelated to marital status. It is suggested that being married acts to keep a potential patient out of hospital rather than to reduce symptoms. Whether or not a woman is in paid employment outside the home is a major predictor of symptom levels, especially in depression. Women with unemployed husbands are also particularly likely to report high levels of depression. However, there is no reciprocal effect of wives' employment status on the psychological well-being of their husbands.

A raised blood sugar level no more defines a single entity than does a raised bilirubin or a low haemoglobin. Diabetes is a heterogenous group of disorders whose only common factor is hyperglycaemia (Tattersall et al, 1980). The classification of diabetes is being revised, although the changes are of more relevance to epidemiologists than clinicians. Previous standards of normal glucose tolerance were set too low, so that some people were labelled diabetic who had no symptoms and have proved on follow-up not to be at risk of developing complications such as retinopathy (i.e. they had a non-disease). Epidemiological evidence suggests that the cut-off point for ‘true’ diabetes (i.e. a condition which leads to complications and shortening of life span) is a blood glucose level two hours after a 50 G oral glucose load of 11.1 mMol/L (National Diabetes Data Group, 1979). This corresponds to a fasting blood glucose level of 7 mMol/L or below. Hence, a single blood glucose value, either in the fasting state or two hours after a 50 G glucose load, is enough to diagnose diabetes and glucose tolerance tests should hardly ever be necessary.

Depression assessed by clinical examination and Hamilton rating scale was found in half of 37 untreated new acute schizophrenics, and in about a third of chronic schizophrenics who relapsed whether treated with depot injections (89) or not (79). A significant part of depressive illness in schizophrenics is thus not drug-related. However, depression was commoner in those on higher doses of depot neuroleptic (P <.05) or who showed extrapyramidal side effects (P <.001), suggesting that drugs can play a part. Patients maintained in remission on moderate doses of depot drug had the lowest prevalence of depression.

Acute schizophrenics, chronic schizophrenics, psychiatric controls and patients with a depressive illness were asked to judge which of two faces in photographs was the more friendly. Acute schizophrenics disagreed significantly with the other three groups of subjects whilst agreeing with them on a control task of perceptual judgement involving colours. In a second experiment a new group of acute schizophrenics disagreed with remitted psychotics and psychotic depressives in judging friendliness and meanness but agreed with these control groups in judging age of the faces. The findings are presented as a potentially fruitful area for research on psychological deficits in schizophrenia.

The diagnoses given to samples of 1,000 first admissions to English mental hospitals in 1977 and 1980 were compared in order to find out how much influence the 9th revision of the International Classification and its glossary had had on the diagnostic habits of English psychiatrists since its introduction in January 1979. Although the differences between 1977 and 1980 diagnoses were modest they were greater than those found in an earlier comparison of 1968 and 1971 diagnoses, before and after the introduction of the 8th revision. Comparison of all four sets of diagnoses, from 1968 to 1980, revealed some serial changes in the categorization of depressive illnesses and a slowly increasing familiarity with the ICD. Although a higher proportion of diagnoses used the nomenclature of the ICD in 1980 than in previous years, this was mainly because the ICD had adapted itself to the habits of English psychiatrists rather than the other way about.

Little work has been done to determine objective, reliable differences in formal characteristics of the actual utterances of thought-disordered and non-thought-disordered subjects. The type-token ratio (TTR), a quantitative measure of repetition in language, correlated highly with clinical judgments of thought disorder when spoken language was examined, and statistically differentiated thought-disordered from non-thought-disordered schizophrenics and psychiatric and normal controls. Elicited and spontaneous motor abnormalities were associated with reduced TTRs both in schizophrenics and in affective subjects with motor disturbance. The TTR is a reliable, objective indicator of language deviance and thought disorder, and strongly associated with motor disturbances.

A two-year follow-up study was conducted, mainly from case notes, of patients who had originally taken part in a study of the influence of relatives' expressed emotion on schizophrenic relapse. It was found that in the two years following discharge from hospital patients from high expressed emotion homes had a significantly greater relapse rate than those from low expressed emotion homes.

The prophylactic effect of maintenance drugs was no longer evident for patients from high expressed emotion homes at the two-year follow-up. By contrast, a significant protective effect of maintenance therapy emerged for patients from low expressed emotion homes.

The interpretation of these findings is discussed.

Thirty-eight depressed patients who were treated with ECT were randomly assigned to receive lithium therapy or identical-looking placebo tablets for one year after clinical recovery in a double-blind trial. The patients who received placebo tablets spent an average of 7.8 weeks with an episode of depression (either as in-patients or day-patients) during the year. In comparison, patients who received lithium spent on average 1.7 weeks with an episode (P <0.02). The trial confirms the high rate of relapses after ECT and suggests that lithium considerably reduces this morbidity. It is suggested that ECT without continuation therapy is not a satisfactory treatment of depressive illness.

We report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.

One hundred and ten young women aged 18 to 30 years who had attempted suicide by drug overdose were divided into three groups on the basis of the physical threat to life of their suicide attempt. Young women whose suicide attempts resulted in the greatest risk to life were more often unmarried or not in a de facto relationship; reported little use of alcohol; had had recent contact with a psychiatrist; had taken more than 20 tablets or capsules, most often antidepressants; and had a high degree of suicidal intent and hopelessness. Furthermore, there were trends for them to be of high socio-economic status; to have had less history of violence, both used and sustained; to more often demonstrate schizoid personality traits; and to report less death anxiety.

Five hundred patients who had completed a suicide intent scale after self injury were followed up over five years. Seven definite and six doubtful suicides occurred. The future suicides tended to have high scores on the scale for their original self injury episodes and had very high scores for the penultimate self injury before suicide. Discussion centres on the small number of suicides ascertained and on the use of the scale as a suicide predictor. A group of very high risk patients was identified by repeated use of the scale, and the suggestion is made that the scale might be used as part of a suicide prevention programme.

Forty-one subjects from an earlier study, who had undergone computed tomography (CT) during their in-patient care for affective disorder, were followed up clinically for a minimum of one year. Mortality at two years was also determined, and comparisons made with 50 age-matched controls. Those with affective disorder showed a higher mortality than controls, but the difference just failed to reach significance. Within the affective group, however, mortality was significantly higher in patients who had previously shown ventricular enlargement on CT, confirming our earlier suggestion that these patients might have constituted a distinct subgroup. Failure of the affective group to improve performance on a simple cognitive test at follow-up was related to persisting depression. These and other findings are discussed.

Platelet MAO activity was assessed in 35 schizophrenics during a trial of the isomers of flupenthixol. Enzyme activity was unrelated to severity of symptoms, the presence of delusions, hallucinations or thought disorder or to negative symptoms. In a few patients MAO activity fluctuated widely with time, but in the group of patients on medication there was a slow decrease in enzyme activity which was significant after 28 days of treatment. Enzyme activity after 14 days' drug treatment was still correlated with activity before treatment, but after 28 days this significant correlation disappeared. Slow effects of neuroleptic drugs on platelet MAO activity may explain previous findings of reduced activity of the enzyme in schizophrenia.

Fifty-three hospitalized chronic schizophrenic patients were treated with either propranolol, chlorpromazine or placebo in a double-blind randomized trial for up to three months. Propranolol in a usual dose of 640 mg/day, produced marked cardiovascular effects but no improvement in schizophrenic symptomatology relative to placebo. The effects of chlorpromazine were small and inconsistent.

We used the Wechsler Adult Itelligence Scale (WAIS) to study a sample of patients with affective disorder (N = 52), schizophrenia (N = 17) and organic brain disease (N = 8). Schizophrenic patients had lower verbal, performance and full-scale IQs than patients with affective disorder, but were no different from those with organic brain disease. An individual WAIS subscale analysis showed that, compared with affectives, schizophrenics had relatively poorer performance on language than non-language tasks.

These differences were independent of age, sex, handedness, educational level or drug administration and are consistent with a variety of studies demonstrating significant cerebral dysfunction in carefully diagnosed schizophrenic patients.

In the past, birthplace has frequently been omitted in completing the Sheet, but in 1976, over 91 per cent of all first admissions to psychiatric hospitals in South-East England were analysed by birthplace, sex, age-group and marital status. First admissions for schizophrenia were five times the expected number for immigrants from New Commonwealth America (the West Indies), four times the expected number for immigrants from New Commonwealth Africa (mostly ethnic Asians) and three times the expected number from India. Immigrants from Pakistan and the remaining New Commonwealth Asian countries did not show a significantly higher than expected number of admissions for schizophrenia, and their first admissions for alcoholic psychosis and alcoholism, psychoneuroses and personality and behaviour disorders were significantly fewer than expected. First admissions for schizophrenia were also significantly more than expected among immigrants from Ireland, Germany and Poland, but not from Italy.

A total of 150 psychiatric patients—schizophrenics, affective psychotics and neurotics—were compared with 150 normal controls for handedness. Schizophrenics were significantly more likely to be non-dextrals (i.e. not completely right handed) than controls. Affective psychotics and neurotics were not significantly different from controls.

One hundred and sixty Scottish psychiatrists complete a questionnaire eliciting the extent of their use of the term ‘borderline patient’ and the factors affecting this. The term was used by 27.5 per cent, the majority of whom felt that it ought to be included in current diagnostic classification systems. There was, however, general dissatisfaction with the vagueness of current definitions of the term and a confusing use of numerous diagnostic labels.

Use of the term was not related to status, geographical location, or familiarity with American psychiatric literature. The practice of psychodynamically-oriented psychotherapy and extended working contact with psychiatry in North America were found significantly to increase its use.