Immunoglobulins, IgG, IgA and IgM were quantified in cerebrospinal fluid (CSF) and plasma from chronic schizophrenic patients and controls using an immunofluorescent antibody technique. A generalized reduction in immunoglobulin levels was observed in the schizophrenic patients compared with controls. While this study supports other reports of abnormal immune functioning in schizophrenia, it failed to replicate previous findings of elevations in CSF IgG and elevations in serum IgA. The aetiology and significance of these findings are hypothesized but remain elusive.

The incidence of physical symptoms in depression was studied in 51 drug-free patients and in an age and sex-matched control group. Mean symptom intensity and number of symptoms were significantly higher in the patient than in the control group. The subjects' personality structure and relationships between their symptoms and degrees of depression and anxiety were examined using the Eysenck Personality Inventory (EPI), the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory, respectively. Of the variables studied, only the N score of the EPI was shown to influence the symptoms significantly. The effect of such non-specific factors as age, gender, use of alcohol, coffee, tea, and cigarettes was also evaluated and found to be minimal.

Ten hospitalized chronic schizophrenic patients were given chlorpromazine alone and chlorpromazine plus high dose propranolol in two 7-week treatment periods according to a randomized crossover design. In the six patients who completed the whole study, plasma levels of chlorpromazine and chlorpromazine sulphoxide, total serum levels of neuroleptic and serum levels of prolactin were consistently and significantly elevated during treatment with chlorpromazine plus propranolol relative to levels during treatment with chlorpromazine alone. These effects are sufficient to explain previously reported clinical improvement in schizophrenic patients given propranolol in addition to neuroleptics.

Patients conforming to the Feighner criteria for schizophrenia who had been discharged from hospital were traced after 5–9 years. They were assessed in terms of mental state and cognitive, behavioural and neurological functioning; the results of these assessments were related to information obtained from casenotes. The findings of this study of 120 discharged patients were compared with those of an earlier study of 510 in-patients with schizophrenia. When factors of age and duration of illness were taken into account there was no difference between the two groups in terms of positive or negative schizophrenic features or behavioural performance, although the in-patients performed less well on cognitive tests. This study indicates that the deficits of chronic schizophrenia are an integral feature of the disease: process, and that any effects of institutionalisation are relatively small.

Similarities between language disorders in aphasia and formal thought disorder in schizophrenia are explored in 24 schizophrenic, 5 manic and 5 depressed psychiatric in-patients, and 28 normal controls. Eight sub-tests from the Boston Diagnostic Aphasia Examination, a picture naming test and the Token Test were administered. Schizophrenics with formal thought disorder showed significant abnormalities compared to all other groups, particularly on the Token Test and the repetition of phrases test. These deficits are suggestive of language comprehension and repetition dysfunctions in a substantial minority of rigorously defined schizophrenics.

The plasma prolactin (PRL) response to haloperidol 2 or 4 mg i.m. was studied in 18 schizophrenic men during their routine treatment with neuroleptic drugs. A substantial rise of the PRL level above the treatment baseline occurred in all but four of the 20 tests showing that the PRL elevation induced by treatment was not maximal. The challenge was ineffective only in patients receiving very high daily doses of medication. The increment was inversely correlated to the daily dose of medication but unrelated to plasma haloperidol concentrations during the test. Chronic schizophrenics who were receiving long term treatment and had low basal PRL levels did not show tolerance to the prolactin stimulating effect of haloperidol. That prolactin rose during the test in patients who had improved during their current treatment indicates that the degree of dopamine receptor blockade required for therapeutic effects is below that which produces a maximal PRL response.

Although auditory hallucinations in schizophrenic patients are usually thought to be private events, several early writers observed vocalizations concurrent with hallucinations. The content of such vocalizations corresponded to what the voices were reported to have said. A schizophrenic patient is described whose whispers were increased to an intelligible level by the use of auditory feedback. This has implications for the self-control of hallucinations, and for neurological theories of verbal hallucinations.

Individuals who speak one or more languages in addition to English comprise a small but important proportion of the general population of this country. In most clinical situations, provided verbal communication is adequate, proficiency in a second language has little medical relevance. Studies of neuropsychiatric disorder in bilinguals and polyglots have, however, demonstrated that their cerebral organization and utilization of language is different to that observed in monolinguals. Such differences have important implications in the clinical presentation and management of neuropsychiatric illness in bilingual patients.

The validity of the concept of situational (i.e. reactive) depression as distinct from other major depressive subtypes is examined in terms of psychosocial stressors, personality features, current symptomatology, and clinical course and follow-up. Thirty-eight patients with a recent onset of situational major depressive disorder (i.e. the disorder developed after an event or in a situation the diagnostician deemed likely to have contributed to the episode at that time) were compared with 68 non-situational major depressive patients. These patients were participants in the clinical studies of the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression. No significant differences between the two groups were found in the total number, content areas, or other categorizations of life events, experienced prior to onset. Some statistically significant differences in current symptomatology and in clinical course and follow-up measures were obtained, but there were none in personality traits. Implications of these results in relation to previously published reports are discussed and caution is recommended in the use of the term situational depression until more definitive data become available.

A small (n = 20), double blind, controlled trial failed to show that propranolol has any beneficial effect in chronic schizophrenia.

In an attempt to clarify the intentional aspect of parasuicide, constructs in response to a supposed crisis were elicited from a group of overdose patients, using the standard method of contrasting elements. In this case the elements were presented as a list of 11 alternative behaviours (including overdose and suicide) possible in such a situation. Using 9 of the most common constructs obtained, a repertory grid was administered to a second group of overdose patients and by computer analysis consensus group grids were obtained for patients scoring high and low on the Beck suicidal intent scale. These consensus grids showed that the low intent group perceived an overdose (in comparison to other alternative behaviours) as similar to ‘being alone and crying’ and ‘getting drunk’ and construed it almost exclusively as an escape from tension. In contrast the high intent group perceived overdose and suicide in quite similar terms. The data indicated that an overdose may have a respite function for low suicidal intent patients.

Data from Chapman's anhedonia and perceptual aberration scales are presented for groups of schizophrenics and hospital staff control subjects. Differences between the two groups are found for both anhedonia scales and for the perceptual aberration scale, but the difference for physical anhedonia is only marginally significant. The anhedonia scales do not differentiate between the two groups sufficiently well to be useful diagnostically.

Anterior pituitary response to TRH 200 μg i.v. was studied in ten chronic schizophrenic patients during long-term neuroleptic treatment. Nine patients had normal prolactin (PRL) response as compared with controls but in one the response was blunted; one patient had an exaggerated response. Prolactin increment was higher following TRH than haloperidol challenge. No growth hormone (GH) response to TRH was found and TSH responses were comparable to controls.

The patterns of self-reported symptoms in 103 chronic psychiatric patients were examined using the Delusions-Symptoms-Sign Inventory (DSSI). The subjects were all those able to co-operate drawn from the total population of psychiatric patients in Leicestershire who had been in continuous in-patient or day-patient care for over one year. A majority reported dysthymic symptoms and some sort of delusions. Three-quarters produced patterns of response predicted by the hierarchy hypothesis of Foulds.

Four experimental interview styles, each recommended by experts in the field, were compared for their efficiency in eliciting factual information during the initial diagnostic interviews with the mothers of children referred to a psychiatric out-patient clinic. If encouraged to talk freely, mothers tended to mention most (but not all) key issues without the need for standardized questioning on a pre-determined range of topics. However, systematic questioning was essential in order to obtain good quality factual data. Better data were obtained when interviewers were sensitive and alert to factual cues and chose their probes with care. Clinically significant factual information, idiosyncratic to the family and outside the range of standard enquiry was common, but was obtained satisfactorily with all four styles. No one style was generally preferred by informants. The advantages of systematic questioning for obtaining factual information were not associated with any disadvantages with respect to the eliciting of emotions and feelings.

The present report is of the effect of variations of auditory input on hallucinatory experiences in seven schizophrenic patients. Nine experimental conditions, each of two minutes' duration, were compared with a control condition. At the end of each period subjects were required to rate the duration, loudness, and clarity of hallucinations during that time. Experimental conditions varied according to the amount of structure present in the material and in its attention-commanding properties. One condition required the active monitoring of material presented and resulted in the greatest decrease in hallucinatory experiences. For the passive conditions, findings were broadly consistent with predictions, indicating that it is not stimulation per se, but rather the extent to which structure is present and attended to, that is important in determining the occurrence of hallucinatory phenomena.

Eighty-five schizophrenic patients were found to have worse two-year follow-up outcome (history of remission, clinical course, improvement in psychotic symptoms, general treatment result) than 39 non-schizophrenic psychotic patients. The outcome of 36 schizophrenic patients with derealization at initial evaluation, especially when nine hebephrenics were excluded, was better than that of 49 schizophrenic patients without derealization but similar to that of 39 non-schizophrenic patients. The hebephrenics with derealization demonstrated similar outcomes to schizophrenic patients without derealization. In non-schizophrenic patients, derealization had no prognostic significance.

A longitudinal study of neurotic disorder in the community showed that half the cases identified at first interview had remitted one month later. Remission was significantly related to four variables: recency of onset and of peak of the disorder, the occurrence of recent threatening life events and the occurrence of subsequent ‘neutralizing’ life events. A neutralizing event was defined a priori as one which neutralized the impact of an earlier threatening life event or difficulty. One third of all remissions were caused by such an event. Remission of disorder was not significantly related to demographic variables, symptom severity, syndrome type, medical consultation or psychotropic drug prescription. The implications for neurotic disorder in the community are discussed, in particular its relation to life events and the favourable outcome in the absence of treatment.

Hormonal responses to apomorphine 0.005 and/or 0.01 mg/kg body weight were studied in 17 schizophrenic patients during their routine treatment with neuroleptic drugs. Plasma growth hormone (GH) rose in 9 of the 20 tests and in 4 of these GH peak exceeded 5 ng/ml. This preserved GH response to apomorphine was significantly but weakly associated with lower daily doses of neuroleptics. It was unrelated to the extrapyramidal side-effects, plasma prolactin (PRL) level, duration of treatment or its therapeutic effect.

In 13 of the 20 tests, plasma PRL declined by more than 20 per cent of the baseline level. This was similar to the fall in PRL observed after placebo in the group studied previously. The absolute decline in plasma PRL following apomorphine correlated positively with the baseline PRL concentration and was unrelated to the daily doses of neuroleptics or to any other variable considered.

The psychological and physiological features of 20 aircrew consecutively referred for treatment of anxiety symptoms when flying were compared with a matched control group of uncomplaining aircrew. There were no significant differences between the two groups on psychometric tests of personality, though there were differences in skin conductance; the phobics had a higher rate of spontaneous fluctuation, and habituated less to a repeated auditory tone. More of the phobic group worried about their wives and acknowledged childhood and other adulthood phobias; more had a family history of an episode perhaps best described as flying trauma. Many were on an overseas posting when symptoms presented. These few features could correctly classify 85 per cent of the subjects into the phobic or control group. This type of ‘phobic aircrew index’ now requires to be validated prospectively for its predictive value.