This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.

One hundred and fifty-three completed questionnaires received from families with a history of Huntington's chorea were analysed to discover their attitudes towards the disease. Of special interest were: (a) how and when they were first informed about their illness; (b) what effects the knowledge of the hereditary aspects of the disease had on them and on their children; and (c) their reaction to a possible future predictive test

Analysis of DHSS statistics from the Mental Health Enquiry for 1975 indicates that, contrary to some predictions, district general hospital psychiatric units (DGHU) are assuming a proportionate share of the burden of hospital care for most groups of mentally ill individuals. Comparisons of admissions to mental illness hospitals and DGHUs indicate no major differences in most categories of patient characteristics (age, sex, order of admission and diagnosis); where differences do exist, they appear to be decreasing. Concern that DGHUs might ‘cream off’ patients with less serious illnesses, with a resultant ‘two-tier’ system of mental hospital care, would thus appear to be unwarranted.

The reliability of Brown's contextual measure of threat is assessed and found to be highly satisfactory. Previously inexperienced raters achieve highly reliable ratings after only brief training. The implications for the concept of the threat of life events are discussed.

Two hundred and eighty-two schizophrenics discharged from St John's Hospital, Stone, were followed-up. The reliability of the diagnosis was measured by the extent of agreement among the hospital clinicians. The number of readmissions and the time spent in hospital were ascertained and correlated with the sex, civil state and age at first admission of the subjects.

It was found that a higher proportion of males than of females was readmitted; that the proportion of single persons among male schizophrenics is higher than among comparable age groups in the general population; that single males are more frequently admitted than single females; that the peak age of first admission for males is 10 years earlier than for females and that men whose age at first admission is below the median are more frequently readmitted than those whose age at first admission is above it.

Women are more frequently married than men at the onset of schizophrenia, giving rise to the suggestion that marriage has a protective effect in schizophrenia. This hypothesis was not supported by our findings. The bearing of these findings on the course, genetics and marital handicap of schizophrenia is discussed.

This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: ‘conspicuous morbidity’ by the doctor's own assessments, and ‘probable prevalence’ by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was +0·36, but the range was very wide (0·09–0·60).

The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death.

The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67 % of the variance of correlation coefficient mainly in terms of 2 dimensions: ‘interest and concern’ and ‘conservatism’. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.

The Leyton Obsessional Inventory gives both an indication of the range of obsessional symptoms present and the degree of resistance and interference associated with each symptom. A new method is described in which the covariation of resistance and interference is represented in the form of a matrix. The results, using this method, can give a unique picture of the quality of the patient's symptoms from the clinical standpoint and provide useful guidelines for treatment and follow up. Automatic data-processing is offered for the convenience of clinicians and researchers wishing to utilize the test in this form.

The reliability of 26 items from the ninth edition of the Present State Examination (PSE) was assessed using both the conventional categorical scales and separately constructed analogue scales. Reliability was also calculated when the analogue responses were rescaled down to 2, 3 and 4 categories. The levels of inter-rater agreement obtained were comparable to those achieved in previous studies of PSE reliability, although as expected the levels of agreement on audiotapes were greater than those for independent interviews performed on the same day. These levels were not significantly affected by any of the changes in scale format, but there were apparent differences in reliability depending on the statistics used. In selecting or constructing a psychiatric rating scale, the question of reliability should not influence the choice of a categorical or continuous scale, or the number of scored points in the scale.

A neighbourhood health centre in the US is compared with the mental health services in an area of the UK.

Patients with severe, but long-standing psychiatric illnesses, or patients with transient emotional problems are likely to be treated by a general practitioner in London and by non-medical mental health specialists in Boston. These patients receive more overall care, more specialist, non-medical care but make as many visits to a medical provider, other than a psychiatrist, in Boston as they do in London. Psychiatrists see more acutely ill patients for a shorter time than non-medical specialists in both places, and in both Boston and London there is a highly selective referral process which results in psychiatrists from both areas seeing approximately the same proportion of the population of their catchment areas.

The integration of these findings with community attitudes in planning services is discussed.

Alzheimer's disease confirmed by histological examination is described for the first time in identical twin brothers who both died at the age of 38 years. Their mother died of a dementing illness at the age of 42 years and her brain was atrophied at post mortem.

Referral rates to psychiatric services in North-East Scotland by 147 individual urban and rural general practitioners were calculated. Among city doctors, the greater the number of years since qualification the more patients were referred. Single-handed city doctors also had very high referral rates. Subsequent interviews were conducted with 76 general practitioners. Topics covered included reasons for referral to psychiatric services. Psychotics, severely depressed patients, alcoholics and violent patients were the most frequently referred groups.

A consecutive series of 90 admissions of functional patients was examined with the Present State Examination (PSE). Based primarily on PSE findings together with previously published diagnostic criteria, we identified 11 clear or index cases of schizophrenia, 12 of affective psychoses, and 12 of neurotic/personality disorders. All patients were given daily 2 analogue scales, one measuring mood and the other alertness. Among the index cases, the depressives were distinguished by low scores on both scales and the manics by high scores. There was little overlap in the distribution of the scores among the diagnostic groups, suggesting that these scales might be effective psychological markers of clear affective versus clear non-affective functional disorders.

Among the undiagnosed cases, those with low or high scores on both scales resembled index affectives phenomenologically, clinically, and demographically. The scores of the ‘affective-like’ patients overlapped little with those of the ‘non-affective-like’ patients. The scales therefore might be practical diagnostic aids.

A further case of anorexia nervosa with an associated urogenital malformation, namely hypospadias, is presented. The prevalence of urogenital abnormalities in patients with anorexia nervosa is much higher than expected on the basis of coincidence.

A relationship between anorexia nervosa and urogenital malformations has been suggested previously. We report a further case with certain unique features.

Seventy-nine junior psychiatrists at the Maudsley Hospital answered 16 biographical questions and a 68-item questionnaire measuring attitudes to the psychoanalytical, biological, social, behavioural, and anti-medical models of mental illness. The psychoanalytical model was the most clearly defined and its adherents the most dogmatic, while those supporting the social model were the most eclectic. Sex, social class, education and political sympathy proved a poor guide to the orientation of the respondent. Individuals who had decided on a career in psychiatry before entering medical school were the most critical of the biological model. Biologically minded psychiatrists were older and, in contrast to Kreitman's findings, there was a shift from a psychoanalytical to a biological preference with increasing psychiatric experience. The importance of scientific attitudes in psychiatry was endorsed by biologically and behaviourally inclined psychiatrists but denigrated by supporters of the analytical approach. Adherents of the psychoanalytical model had as many academic qualifications as the biologically inclined, but had fewer publications and were less active in research. It appears that interest in psychoanalysis is antipathetic to the development of scientific attitudes conducive to research.

The numbers of long-stay patients in Danish psychiatric hospitals were studied, based on information from the Danish cumulative psychiatric register and from the census studies of patients in Danish psychiatric hospitals, performed at 5-year intervals since 1957.

In 1977, 2079 (20%) of the in-patient population which had been admitted before 1957 were still in hospitals. This ‘old long-stay’ group has diminished exponentially, with an annual reduction of 7%.

During the period 1972–6, the number of patients who, on any given day, had been in-patients or attending as day-patients for more than 1 but less than 2 years (the ‘new long-stay’) varied between 847 and 1089: an average of 20 per 100000 total population. The ratio of in-patients to day-patients was approximately 4:1.

There is considerable difficulty in providing clinicians with statistics relating to their work which are both relevant in content and suitable in style. As a contribution towards the solution of the problem for psychiatrists, a new type of statistical feedback, the Hospital/National Comparison Tables, has been produced in Scotland. In these tables the work of individual hospitals is compared with the work of all other hospitals of the same type. These are critically examined, together with examples of analyses showing the uses to which the data can be put.

A distinction is drawn between ‘diagnostic decisions’ and ‘management (or treatment) decisions’, and a model for the process of making a management decision is suggested.

Evidence is reviewed which suggests that psychiatric diagnosis does not strongly predict treatment, and an extension of diagnosis, the problem oriented approach, is advocated.

The activity of platelet monoamine oxidase(MAO)was measured in 22 severely depressed patients before and after treatment with 45 mg and 60 mg phenelzine. The per cent inhibition of platelet MAO after both doses was not related to acetylator status.

Phenelzine, since it is a hydrazine derivative, is probably metabolized by polymorphic acetylation. Patients who were phenotypically slow acetylators have been reported to show a better clinical response (Johnstone & Marsh, 1973) and more side-effects (Evans et al. 1965) to a given dose of phenelzine than patients who were fast acetylators.

Twelve male children were diagnosed with psychological gender disturbances by 3 independent clinical psychologists using independent data sources focusing on behavioural deviance from normal comparison groups, on conventional psychological testing, and on parent report instruments which had been validated on normal comparison samples. These children received a paediatric evaluation consisting of a medical history, complete physical examination, chromosome analysis including 2 cells karyotyped and 15 counted, and sex chromatin studies. All gender disturbed boys were found to be normal genetically and physically with the exception of one subject with one undescended testicle.

Data derived from a psychiatric case-register are presented on the accumulation of new long-stay cases in Salford from 1967 to 1976. The analysis supports the general decline reported in an earlier shorter-term study except for the over 65s, where the trend was reversed. The implications of the findings are discussed.