The concepts of ‘borderline’ and ‘borderline schizophrenia’ remain a confusing area in psychiatry. In its functional use, the word ‘borderline’ refers to a hypothesized level of functioning on a continuum which extends from normality to psychosis, e.g. borderline personality organization. In the phenomenological use ‘borderline’ qualifies a psychiatric diagnosis, referring to a milder form of the disease process, e.g. borderline schizophrenia. In this paper we attempted to define and validate the concept of borderline schizophrenia using case records from the Danish Adoption study with this diagnosis and rating the cases on a new instrument: the Symptom Schedule for the Diagnosis of Borderline Schizophrenia, found reliable, and discriminating cases of borderline schizophrenia from cases of neurosis and personality disorder.

Plasma levels of antidepressant drugs were measured in 17 depressed patients at roughly monthly intervals over follow-up periods of three to 26 months. Good results in seven were associated with small fluctuations in level from visit to visit, while big fluctuations were associated with poor outcome. Such fluctuations were probably from poor compliance or drug interaction from self-medication. Severe side effects and cardiotoxicity were associated with high levels.

The excretion of N,N,-dimethlytryptamine (DMT) has been measured in longitudinal studies of five patients with schizophrenic illnesses and in four patients with rapidly or slowly cycling manic-depressive illness. The excretion of DMT was frequently raised in patients when they were psychotic but was usually normal when they had recovered. However, rapid changes in the severity of illness or sudden switches from one mood state to another were not accompanied by changes in the excretion of DMT. These findings contrast with the immediate hallucinogenic effects of an injection of DMT, and suggest that the extracerebral production of DMT (as measured by its urinary excretion) does not provoke the experience of hallucinations in psychotic patients.

A group of outpatients scheduled for hearing evaluation were screened for psychiatric morbidity using the General Health Questionnaire (GHQ-30). There was an association between objective hearing loss and elevated GHQ-30 score. An association was also found between the presence of tinnitus and vestibular symptoms and elevated GHQ-30 score.

The Survey Psychiatric Assessment Schedule (SPAS) was used in a survey of elderly people living at home and in institutions to examine its reliability in determining mental state. A psychiatrist assessed the same subjects using the Geriatric Mental State Schedule (GMSS) and classified psychiatric disorder into three broad groups: organic disorders, schizophrenia and paranoid disorders, and affective disorders and psychoneuroses. The agreement between the psychiatrist's classification of mental state and the classification derived from SPAS was found to be satisfactory for organic disorders and less satisfactory for functional disorders. The limitations of this method of identifying psychiatric illness are examined.

It has been suggested that reversal of stress-induced tachycardia by beta-adrenergic blockade might be of benefit in the treatment of phobias. This was tested in a double-blind cross-over trial by exposing 22 female volunteers with spider or snake phobias to their phobic object 1 ½ hours after administration of either tolamolol 200 mg, diazepam 10 mg or placebo. Although tolamolol abolished the stress-induced tachycardia, it had no beneficial behavioural or subjective effects. In contrast, diazepam, which had no significant effect on heart rate, improved behavioural performance. Subjective measures were more influenced by order effect than by medication.

Concentrations of noradrenaline (NA), homovanillic acid, 5-hydroxyindoleacetic acid and cyclic nucleotides were determined in lumbar cerebrospinal fluid (CSF) from acute and chronic schizophrenics and various groups of psychiatric and non-psychiatric control subjects. Statistically significant increases in NA and cyclic adenosine monophosphate were found in CSF from chronic schizophrenics compared to all other groups. These results were shown by statistical analyses to be unrelated to medication. They may be interpreted as evidence for noradrenergic overactivity as a possible primary abnormality in chronic schizophrenia.

A survey was made of demographic and social characteristics of patients referred to a Student Health psychiatrist over a two year period. These patients were compared with a group attending Student Health physicians. Significantly over-represented in the psychiatric group were: medical and dental students; students who had repeated an academic year; students over 30 years of age; Roman Catholic students; and students who were totally financially dependent on their parents. Findings by others suggesting that first-year and female students would be over-represented in the psychiatric group were not borne out.

No benefit attributable to propranolol (1000 mg/day) could be detected in a trial lasting at least 22 weeks, 6 weeks of which was double-blind placebo-controlled, in 5 chronic schizophrenic patients. The mean propranolol CSF/plasma ratio was 0.08, and there was good agreement between CSF and free plasma propranolol levels. Basal plasma prolactin was slightly but insignificantly reduced by propranolol, and metoclopramide-stimulated prolactin release was unaffected. Propranolol was associated with a significant temporary increase in HVA, a non-significant rise in 5-HIAA and a significant decrease in MHPG, in the lumbar cerebrospinal fluid of 4 patients.

The files of a narrowly defined group of schizophrenic patients, admitted to hospital for the first time in their lives in 1963, and who were representative of cases from a large un-selected population, were examined for Schneider's first-rank symptoms. Forty-three such patients were followed-up in 1977. Using stepwise regression, it was found that Schneider's first-rank symptoms relate to outcome such that they can ‘explain’ from 17 per cent to 26 per cent of the variance on four outcome measures. The presence of some first-rank symptoms correlated positively with good outcome, others negatively, whilst some correlated differently with different outcome measures. Thus, assessment of only the presence, absence or number of first-rank symptoms is unlikely to relate to outcome.

Sodium valproate given in doses of 750–3000 mg daily to eight schizophrenic patients produced a qualitatively similar increase in symptoms in five. CSF showed no significant change in γ-aminobutyric acid or methoxy hydroxyphenyl glycol, but homovanillic acid increased non-significantly in five patients.

In 1977, the University of Adelaide extended the psychiatric training of medical undergraduates to their 6th year. The four weeks course in psychiatry, for groups of no more than sixteen students at one time, was spent at an acute receiving unit of a psychiatric hospital and combined with a series of visits to a wide range of psychiatric subspecialties in the community. A systematic evaluation of the course showed that it was well received by students and by the preceptors who supervised students in the various hospitals and psychiatric units.

The perception by schizophrenic patients of stimuli with more than one feature (dimension) was investigated using psychiatric and non-psychiatric control groups. Indices of the ability (a) to make use of redundant stimulus cues, (b) to ‘screen out’ or filter irrelevant stimulus features, and (c) to scan the perceptual field for relevant stimulus features, indicated that only filtering was consistently poor in schizophrenia. It has been suggested that the schizophrenic patient may tend to perceive his environment in an undifferentiated holistic manner rather than in an analytic manner and the implication for the theory of left hemisphere pathology in schizophrenia is discussed. However, the performance of the schizophrenic subjects did not differ significantly from that of the group of depressed patients, which suggests that the selective attention deficits previously observed in schizophrenia are not specific to the disorder.

The revised Kendrick battery was used to assess level of cognitive functioning and subsequent cognitive change in a group of 40 long-stay elderly psychiatric patients. If it had been used for diagnosing organic dementia in this group, half would have been classified as dementing, although the clinical evidence was against such a diagnosis. It may therefore misclassify individuals who are functioning at a low cognitive level for other reasons. Alternative assessment procedures are now available for use with the elderly.

In a series of fifteen aggressive mentally subnormal patients treated with lithium carbonate, there was an improvement in aggressive behaviour in eleven cases, three patients showed no change and one patient became worse during lithium treatment. The response to lithium therapy was assessed by clinical observation and retrospective analysis of daily ward reports. Treatment had to be discontinued in one patient who developed tardive dyskinesia, but otherwise side effects were not a problem.

Some research indicates that thought-disordered schizophrenics produce language utterances that are less predictable than those of non-thought-disordered schizophrenics and controls. We examined the hypothesis that thought-disordered schizophrenics would have a parallel deficiency in the ability to use the predictabilities provided by contextual constraint to improve recall of heard language passages. Subjects were seventeen schizophrenics, ten normal controls, and twelve psychiatric controls, evaluated by standardized psychiatric interview and diagnosed according to research criteria. The data obtained supported the hypothesis and non-thought-disordered schizophrenics performed similarly to controls in the experimental task.

Failure to classify schizophrenic subjects on the dimension of thought disorder may result in misleading comparisons of general samples of schizophrenics with controls on tasks requiring language perception and production.

The stereotype of the older male homosexual is one of disengagement from the homosexual world, loneliness, rejection, depression and unhappiness. This typical picture of the ageing homosexual is not supported by the findings from 478 homosexual men in Australia with diverse backgrounds. There are no age differences in psychological well-being and involvement in the gay community. The older homosexual does believe he has less control for his sexual orientation and attempts to hide his homosexuality more than his younger counterparts. These latter findings appear to be generational differences. Implications for professionals working with homosexuals and their parents are briefly discussed.

The mental states of 23 epileptic psychotic patients and 10 patients with process schizophrenia were compared, using the Present State Examination. The epileptics displayed marked heterogeneity of psychiatric diagnoses. Disturbances of affect underlying the psychosis or presenting as manic-depressive psychosis were frequent and independent of the type of epilepsy. Schizophrenic psychosis, classified with psychopathological criteria similar to those used in the non-epileptic schizophrenic group, was significantly associated with temporal lobe epilepsy. Psychoses other than schizophrenia, however, were present in 5 out of 16 patients with temporal lobe epilepsy. These results support a relationship between schizophrenic symptoms and temporal lobe pathology and emphasize the need to use reproducible methods of diagnosis in psychiatric research.

Validity and reliability studies of a method of assessment of the elderly mentally ill by nurses are presented. The method has the advantages of being brief, meaningful and structured into three areas which provide useful distinctions for nursing: Orientation, Behaviour, and Physical Capacity. Applications of the scales are discussed.

A randomized controlled trial of brief hospital admission failed to show any difference on clinical measures when compared with standard admission for all psychiatric patients admitted from a catchment area over one year. Psychotic and neurotic symptoms were examined separately and together, using the Present State Examination (PSE) a week after admission and three months later. Clinical outcome was not related to length of stay in hospital or psychiatric diagnosis. This study shows how the PSE can be used to measure change in clinical state for a heterogenous group of psychiatric patients.