Successively admitted neurotic and non-neurotic depressives were compared with respect to stressful life events experienced in the 6 months before the onset of the illness. Almost equal proportions of neurotics and non-neurotics had experienced a single stressful event. Significantly more neurotics than non-neurotics had suffered multiple stressful events. An analysis of the multiple events revealed that many were related and involved a single calamity. For multiple unrelated stressful events no significant difference was found between neurotic and non-neurotic depressions.

In an earlier paper we found that a model of depression developed on a sample of women in a London population was confirmed in a female population in the Outer Hebrides. Differences in the rates of onset and chronic cases between the two populations, however, suggested that the Scottish women might be more likely to become depressed after the death or intimation of death of close relatives; furthermore, it seemed that such depressions were more likely to remain chronic in the Scottish islands than in London, and to contain a strong anxiety component. This difference is discussed in the light of socio-cultural differences between the two populations, particularly in terms which relate family structure, marital position and contact with relatives to affective disorder in terms of theories of attachment.

A domiciliary survey (sample size circa 6000) was conducted in areas of different aircraft noise exposure affected by London (Heathrow) Airport. Respondents were urban dwellers aged 16+. Their use of medicines, general practitioner services, hospital facilities and community services were investigated in relation both to the level of aircraft noise and to the degree of annoyance it causes. None of the indicators showed higher uptake in the high noise areas. The relationships between health indicators, noise and annoyance were not uniform. In areas exposed to high noise the use of non-prescribed drugs was significantly higher among ‘very annoyed’ than among ‘less annoyed’ respondents. The uptake of psychotropic drugs, and the use of general practice and out-patient services, tended to increase with increasing annoyance both in high- and low-noise areas, but the differences were not in all cases statistically significant. Parallels were drawn between these results and those of earlier analyses of the same survey related to the prevalence of acute and chronic symptoms. Suggestions for the analysis and interpretation of health effects of noise are put forward.

Subjects who were initially free of psychological symptoms completed life event and symptom measures on 3 subsequent occasions 4 months apart. As expected, an association was found between symptoms and life events reported as occurring in the previous 4 months. A path analysis model was then constructed. The association between symptoms and events of the previous 4 months remained, but in neither panel did events reported as occurring more than 4 months previously predict symptoms.

This study examines the role that clinical and social factors play in compulsory admissions to hospital in a London borough. 150 patients compulsorily admitted under a Section of the Mental Health Act 1959 were compared with 100 informally admitted patients. Significant differences in social-demographic and clinical characteristics are described as well as differences in outcome on follow-up. A long-term unwillingness on the part of the compulsory patients to engage in follow-up services was evident. These differences still held when the compulsory patients were compared with a group of informal patients matched for age, sex and diagnosis. Patients referred by the police and admitted under Section 136 of the Mental Health Act showed those features associated with compulsory admission in general to the most severe degree.

Assessment of the relationship of life events to minor and major affective illness is beset by several methodological problems. The reliability and validity of measures is not entirely satisfactory. When the stress concept used is that of ‘threat’ or ‘emotional distress’ it becomes of crucial importance to define clearly the criterion variable: in particular, it is necessary to distinguish normal distress responses from depressive illness. In those studies using general practice or hospital patients it is important to determine whether life events provoke depressive illness or some illness behaviour such as service utilization. Because of these problems it is still not certain that life events cause depressive illness.

In a study of domiciliary and out-patient treatment of self-poisoning patients, using a brief problem-orientated approach, it was found that domiciliary treatment resulted in much higher attendance rates but no difference in outcome. Patients who completed out-patient treatment had a better outcome than those who failed to attend treatment sessions. Completion of out-patient treatment was more frequent among higher social class patients. Domiciliary treatment may be more appropriate in some cases for married patients and for those of lower social class. Medical and non-medical staff proved to be equally effective therapists. Future research should be concerned with evaluation of alternative methods of provision of help and further identification of patients who are most likely to benefit from treatment.

The notions of loss and danger are briefly described. Two groups of raters in London and Canberra were shown to be reliable in rating the degree of loss and the degree of danger associated with a sample of life events previously rated as ‘severe’ on a contextual measure of long-term threat. The life events were reported by 164 young women attending a general practitioner in London. The women were interviewed by a psychiatrist using the Present State Examination. Their psychiatric symptoms were rated by a team of raters who were ignorant of the life events reported by the young women. Three types of cases of psychiatric disorder of recent onset were diagnosed: depression, anxiety, and mixed depression/anxiety. The frequency of life events reported by these three types of cases as occurring in the year before the onset of their disorder was compared with the frequency of events in the same time period reported by a group of women without severe psychiatric disorder. The results were used to argue that severe loss was a causal agent in the onset of depressive disorder and severe danger was a causal agent in the onset of anxiety states in this sample. Cases of mixed depression/anxiety were more likely to report both a severe loss and a severe danger before onset. This supported the argument for recognizing a distinct group of mixed disorders in the classification of depressive illnesses.

Family genetic data, based on standardized and independent diagnostic procedures of index and secondary cases, confirmed the dichotomy between schizophrenias and affective disorders. The classical schizophrenic subtypes exhibited a significant tendency towards homotypia among their secondary cases. The genetic evidence did not support the monopolar–bipolar subdivision of affective disorder. Schizo-affective disorders impinged on the clear-cut schizophrenic and affective psychotic disorders and there was no homotypical tendency among the relatives of index cases with this diagnosis.

One of the principal sources of error in data collected from structured interviews with respondents is the method of measurement or observation itself. In this paper the differential impact of each of a group of interviewers on the responses obtained in an epidemiological survey is examined. The effect is measured and its impact on the interpretation of individual responses, scale scores and model fitting is shown.

The aim of this paper is to explain and to stress the importance of mathematical models and, in particular, linear models in the field of psychiatric epidemiology. An awareness of linear models is essential in contemplating the use of statistics to analyse epidemiological survey data, and in many cases the appropriate linear model is by far the most effective way of summarizing such data.

The teaching of ‘clinical skills’ is generally held to be central to postgraduate training in psychiatry, but the term itself has so far escaped exact definition. In an effort to study some of the component clinical abilities, their inter-relationships, and the factors promoting their transmission, all junior psychiatrists at the Maudsley Hospital were surveyed for their views on the clinical training they had received. Three hundred and seventy three assessments on 43 units were made. Trainees perceived the academic instruction and advice on formulating cases which they had received as being quite unrelated to the quality of help with interview skills and instruction in practical management, but feedback from the consultant to the trainee on the latter's performance was necessary for a high standard of both academic and practical instruction. Encouragement to do research was transmitted independently of other clinical teaching. Over a 3-year period the standard of multidisciplinary teamwork appeared to improve, but there was a decline in the standard of academic instruction and in encouragement to do research. These overall differences were due to changes in the teaching staff, rather than alterations in teaching methods. Surveys such as this may help to define the goals of postgraduate clinical training, and also monitor the extent to which an institution is achieving these goals.

Inj. (Des-Tyr1)-γ-endorphin was used in a pilot study over a period of 12 days for the treatment of 11 schizophrenics and the assessments were carried out using standardized rating scales. Only 2 patients showed an improvement. Euphoria and excitement were observed in 3 patients. The findings are discussed in contrast to the earlier reports of a dramatic improvement with the compound.

A random sample of 800 men and women between the ages of 18 and 64 living in Camberwell, south-east London, were interviewed using a short form of the Present State Examination (PSE). The interviewers were from a professional Agency and had received a shortened version of the usual PSE training course. A further interview was sought one month later with all subjects who were above the threshold on the Index of Definition, and a sample of those below the threshold. At this interview the full PSE was administered by members of the MRC Social Psychiatry Unit. Forty-nine audiotapes of Agency interviews were available for the members of the MRC team to rate.

This paper reports the reliability between interviewers. Techniques of comparison were chosen which enabled interviewer reliability to be assessed, without making the assumption that individual subjects would display the same symptom levels over a period of one month.

There is strong evidence that at least 2 of the 8 Agency interviewers had thresholds that were lower than those of the MRC team for rating many of the common minor symptoms such as irritability, also the key symptom of depressed mood. At least 4 of the Agency interviewers, however, were rating in a similar manner to the MRC team. There was no marked tendency for thresholds to change over the 6-month period of interviewing.

In general, linguistic analyses have not proved useful to psychiatrists because of their complexity and their inability to differentiate between diagnostic groups. However, cohesion analyses of disordered speech seem to offer both a simple and potentially useful tool for clinical diagnosis. This study was designed to test whether psychiatrists can use the rudiments of this analysis in order to differentiate between two diagnostic groups, manics and schizophrenics.

The circumstances immediately surrounding compulsory admissions are examined. These circumstances can be seen largely to derive from the long-term psychiatric and social difficulties of patients described in Part I. A constellation of factors is identified which often limits any alternative to a compulsory admission. A number of recommendations are made based on these findings which are designed to diminish the need for compulsion in the future.

Urinary free cortisol was measured in 24 patients with primary depressive illness. The patients were classified according to their family history (Winokur's classification) and the Newcastle scale. There was a significant increase in urinary free cortisol (UFC) excretion in patients classified as endogenous on the Newcastle scale, but UFC excretion was normal in patients with neurotic depression. No significant relationship between urinary free cortisol and the Winokur classification was observed.

A standardized assessment of personality (SAP) based on interview with an informant has been developed to classify a patient's premorbid personality in clinical terms for use for research purposes in or out of a hospital setting. Three preliminary investigations of its use are reported. These indicate that an informant's account of personality can be rated reliably by psychiatrists and is consistent over time. The addition of two extra descriptive types to the schema of ICD Section 301, the anxious and the self-conscious personalities, is found to contribute usefully to a taxonomy of personality in two series of patients investigated with the SAP. Further investigations are indicated to determine the accuracy of an informant's account before epidemiological studies with this instrument can be considered.

Opiate-like neuropeptides, such as beta endorphin, have been implicated in the aetiology of schizophrenic symptoms; and the relief of some symptoms, particularly auditory hallucinations, has been reported after injection of naloxone. An opiate antagonist, naloxone 1·6 mg, and placebo were administered in a double-blind, crossover design to 13 constantly hallucinating schizophrenic patients. Naloxone was found to be no different from placebo in its effect.

The use of lithium-containing compounds has increased dramatically since their introduction into the pharmacopoeia in 1968. However, there is no evidence of more than transitory decreases in admissions to hospital with mania. Such admissions, particularly for female readmissions, have increased. Reasons for this are suggested.