Mental retardation may be associated with a number of environmental factors such as undernutrition, lead poisoning or exposure to neuroactive drugs during a critical period of brain development. Possible biochemical mechanisms operating in these various conditions and in animal models are reviewed in relation to the vulnerable period hypothesis. Small brains are common in the mentally retarded, and this may be related to a developmental abnormality particularly at the level of the synapse.

SUMMARY The paper describes a two-month period of study in four bipolar manic-depressive patients in a metabolic ward. Plasma renin activity, packed cell volume, plasma sodium and potassium were determined at intervals. Twenty-four-hour urinary sodium, potassium and creatinine were also estimated daily. Aldosterone production rate was measured on two occasions for each patient. Three of the patients showed at least one episode each of mania and depression during the study, while the fourth patient, who was receiving prophylactic lithium throughout, had one ten-day depressive episode but was otherwise normal.

No obvious relationship between mood and plasma renin activity was observed, but the group showed a high resting renin activity, a blunted renin response to posture, and inappropriate aldosterone production rates for the renin activity found.

It is postulated that a primary defect in the aldosterone-renin system may be present in bipolar manic-depressive psychosis.

SUMMARY The corticosteroid response to methylamphetamine was lower in ten patients when they were depressed than when they were recovered (P < ·026). The growth hormone responses to the same injection in the depressed and recovered states were not significantly different. This pattern of responses is seen in normal subjects after blockade of alpha adrenergic receptors. These findings may indicate a functional deficiency of noradrenaline at alpha adrenergic receptors in these patients during the time they are depressed.

A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

During a ten year study, 10 per cent of patients at a general hospital in-patient unit had unsolved diagnostic problems at the time of discharge from hospital. These 132 cases were designated ‘uncertain’ and were followed up. Eighty-three patients were ultimately diagnosed, and 300 consecutive in-patients discharged from the same unit with a definite diagnosis were also studied. The clinical features and diagnoses of the two groups were compared. Special features associated with uncertainty were: a presenting complaint of pain; apathy without apparent mental or physical cause; hallucinosis or major paranoid symptoms without other good evidence of psychosis. Age was found to be relevant; compared with patients receiving confident diagnoses, those with uncertain diagnosis due to depressive psychosis were more often younger, while those due to neurosis or personality disorder tended to be older. Atypical psychotic depression was the condition most commonly associated with diagnostic doubt.

Fifty-one out-patients with social skills deficits (two-thirds men) completed ten weekly sessions of 75-minute group treatment; 44 were followed up for a mean of 16 months. Random assignment was to one of three conditions: (1) Cohesive group discussion; (2) Modelling and role-rehearsal; or (3) Modelling and role-rehearsal+daily social homework.

All three treatment conditions produced significant but incomplete improvement at the end of treatment and follow-up. The two role-rehearsal conditions were significantly superior to group discussion on several measures. Patients who completed daily social homework assignments did significantly better than patients who completed control homework. Alcohol and drug abuse patients usually dropped out. Schizophrenic patients in remission had lost their improvement at follow-up. Patients with other diagnoses retained their gains to 16-month follow-up.

Social anxiety was found to be the most common complaint in a sample of psychiatric patients reporting social interaction difficulties. High social anxiety was shown to be associated with impairments to social behaviour in socially anxious psychiatric patients and non-psychiatric volunteers. A comparison was made of systematic desensitization and a form of social skills training in the treatment of social interaction difficulties associated with high social anxiety. This indicated that while both therapies were effective in the reduction of social anxiety, the training programme was the more effective in reducing problem behaviour, but desensitization appeared to lead to a wider generalization of improvement as indicated by increases in social participation.

This paper presents a well-documented case of monozygotic male twins concordant for infantile autism, with a twelve-year follow-up. Assessments include birth records, laboratory studies, physical measurements, psychometrics and quantifiable behavioural ratings by independent raters using multiple scales. Possible aetiological factors of infantile autism, as well as outcome are discussed.

Attitudes to the treatment of the pre-school child today stem very largely from the mainstream traditions in classical child psychiatry, the most powerful of which is still probably psychoanalysis. Recent articles (e.g. Freud, 1966; Frommer, 1967; Bentovim and Boston, 1973) describing treatment units for very young children exemplify very clearly the influence of these traditions and illustrate the difficulty of breaking new ground in conceptualizing treatment procedures. It will be the purpose of this paper to take issue with such traditions, and to argue that it is time for a new look at pre-school child psychiatry.

Parasuicide is not a single syndrome. Subtypes at present recognized are based largely on clinically derived stereotypes. When considering a series of patients, the clinician is unable to handle more than a few attributes at a time. This paper describes the application of three very different clustering algorithms to a material of 350 treated parasuicide patients. Mathematically, three types emerge. Clinically, two of these are interpretable and make sense. The types established are: I (n = 107) a group not characterized by any of the variables we examined; this group is a puzzle, mainly because the reasons for the parasuicidal act are not clear. II (n = 132) a depressed, alienated group with high life-endangerment. III (n = 111) a group whose act was highly operant: they felt alienated and were angry with others. These groups did not differ significantly on demographic variables. The usefulness of this typology, particularly for management, after-care and prevention, has now to be assessed.