A study to test the relationship between body build and mental illness, conducted in Royal Park Psychiatric Hospital, Melbourne, is described. The Rees-Eysenck body index (REBI) and androgyny score (AGS) were determined for 225 male patients and 24 normals. As age increases, there is a decreasing trend in the scores for these two indices. There were no significant differences between the various diagnostic groups and the normal group for the AGS. But the difference between the non-paranoid schizophrenic group and paranoid schizophrenic group in REBI was significant.

To bring to light the particular circumstances which from the outset weigh against the prospect of a successful result of sex reassignment the authors describe five male cases of transsexualism all of whom subsequently regretted the measure taken for sex reassignment. The number of factors suspected to be prognostically unfavourable was to a statistically significant degree more common among five ‘repentant’ cases than among nine cases with favourable outcome. It was also evident that the patients with unfavourable outcome were considerably older when they first sought help with the aim of obtaining sex reassignment. The results suggest that the more of such factors there are present in a particular case the stronger are the reasons for restraint in embarking upon a course of active intervention.

The addiction and conviction status of 60 male patients, examined at a London drug clinic in 1970 was reassessed at four-year follow-up. Forty-three per cent had become abstinent, 23 per cent remained dependent and 15 per cent had died. Ninety-seven per cent had received a court conviction and 73 per cent were convicted during follow-up. A prognostic assessment was determined in combined terms of continued addiction and continued delinquency. Poor outcome related to a lack of educational attainment, earlier first conviction and regular opiate use on arrival, and was associated during follow-up with an irregular clinic attendance beyond one year, drug conviction and death. Good outcome related to an absence of parental loss and later first conviction, and was associated during follow-up with discharge within one year without hospital admission. Analysis of the data indicates the value of combining forensic information with drug history in prognostic assessment.

A prospective follow-up of schizophrenic patients treated with depot neuroleptic injections demonstrated the variability of the prevalence rate of morbidity from drug-induced extrapyramidal symptoms. Factors influencing this morbidity are discussed. This study suggests that the need for the treatment of drug-induced symptoms by the use of antiparkinsonian drugs is less than commonly accepted. It is suggested that our psychological set to the problem of drug-induced side-effects requires revision, and in particular that the prescription of anticholinergic drugs needs justification.

Attitudes towards self-poisoning were investigated in 80 psychiatric patients, half of whom themselves had previously taken overdoses. They were asked to comment about self-poisoners in general, and on four specific cases in particular. In addition to motives spontaneously suggested they were asked to choose from a list of alternative motives in explaining each case.

The subjects who had previously taken overdoses differed from the rest in seeing such behaviour as more often due to a disturbed state of mind and less often an expression of hostility. Both groups tended to see self-poisoners as mentally ill; and, unless they were offered a ‘vocabulary’ of goal-directed motives, they tended to see the behaviour as a reaction to events (i.e. expressive) rather than goal-oriented (i.e. Insteurnental). The implications of these findings are discussed.

This paper confirms previous findings that the incidence of suicide in England and Wales is greater than that in Eire, but shows that the incidence in 1968–70 was only twice as high, and not four times as stated in the official statistics.

Classifications given to self-inflicted deaths between 1959 and 1972 by a coroner and his deputy were compared for differences in the use of the suicide, accident, and open verdict definitions. The coroners varied in their use of the open verdict and the suicide verdict for poisoning cases but not for deaths from other causes.

This paper is concerned with the evaluation of the Hilton Drinking Behaviour Questionnaire (HDBQ), which is based on the proposition that although there are wide variations in the types of problems caused by alcohol abuse there are certain symptoms which are generally considered to indicate ‘alcoholism’. Also that there is an identifiable pattern of symptom development in the acquisition of dependence.

The HDBQ proved to be a unidim.ensional scale which was valid and reliable as a m.easure of alcoholfsm, All items significantly discritninated between the alcoholic and control groups, and total scores correlated highly with those on the Alcadd test and with quantity-frequency measures of drinking. The theoretical and clinical implication of the results are discussed.

It has been suggested that cerebral noradrenaline turnover in patients can be assessed from the excretion in urine of 3-methoxy-4-hydroxyphenylethylene glycol (MOPEG). Studies were therefore made on the effects of mild exercise on the excretion of the conjugates of MOPEG as this might complicate interpretation. Changes are produced, but there are individual differences between subjects.

Physical fitness was also studied and, although it could not be shown to be the factor explaining differences between different patients, nevertheless it is probably a factor influencing the levels of MOPEG excreted.

The study of the distribution of free MOPEG and its sulphate conjugate in a human brain also raised doubts about the proportions which could have a cerebral origin.

The observations suggest the need for caution in using MOPEG excretion to detect abnormal amine changes in brain. They do not, however, conclusively refute the hypothesis that MOPEG sulphate in urine significantly reflects cerebral noradrenaline activity.

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.

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.

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 size and utilization of the primary group (those with whom one has interaction and commitment) was examined in 50 patients with non-psychotic psychiatric disorder and 50 matched controls. The hypotheses tested were that the patients would have a smaller size of primary group, less contact with its members and an inferior affective quality of interaction with it; and that this deficiency would be most marked in transactions with the principal attachment figure. Patients were found to spend the same amount of time as normals with their primary group, but proportionately more of that time was affectively unpleasant. They had fewer good friends and fewer contacts with persons outside the household. They had fewer attachment figures, almost one half of them reporting that either they had only one, or that they had had no recent contact with those alternatives that did exist. The majority of patients considered that their principal attachment figures gave them insufficient support. The complexity of interpreting these data is discussed.

In a transcultural setting, psychiatric diagnosis is often impeded by language and cultural barriers. A greater reliance on observed or reported behaviour than on the self-reporting of subjective discomfort may thus be expected, and this could result in the low prevalence of reported anxiety and depression in many transcultural psychiatric surveys. The language of the Pintupi Aborigines of Central Australia, until recently palaeolithic hunter-gatherers, is seen to contain lexical categories for anxiety and depression. This attests not only to their capacity to experience such affects, but also to their ability to express them verbally. The implications of this finding for psychiatric diagnosis are discussed.

A two-year follow-up inquiry was made of the residuum of a cohort formed by all senior registrars in general psychiatry in post in late 1974. Of the original 155, nearly half are in permanent posts, but only three-quarters of these are in general psychiatry in the United Kingdom. Twelve have already emigrated.