The received version of the history of the care of the insane consists largely of myth and folklore, tempered by a strong dash of wilful ignorance, and is capable of absorbing any number of incongruous features. It runs roughly as follows, give or take a century or two here or there (which is about the accepted level of precision): from the dawn of history, or just before, or just after, until about the middle of the nineteenth century, nothing happened at all: or (depending on where you received your version) the mentally disordered were indiscriminately exorcised, or burnt, or left to wander at will, or chained up and beaten, or all four. From the middle of the nineteenth century they were all rounded up and driven into enormous asylums (where, according to a subtle sociological variation, mental illness was invented) and were left to vegetate until the 1950s. Around 1960 dawned the enlightenment, and it was suddenly revealed that everything that had ever happened before—whatever it was—was completely wrong, and probably intentionally malicious too: and over the years following there were gradually also revealed a number of brand-new ways of putting it right, all different and mutually incompatible (not to mention expensive), and revealed respectively to different Departments of State, working parties, committees and unions—or sometimes successively to the same one.

Sixty parasuicide patients admitted to medical wards were assessed by social workers prior to routine psychiatric assessment. Both disciplines completed a rating schedule. The social workers' and psychiatrists' rating schedule responses were compared, and their decisions were examined against further information obtained by a research psychiatrist, which included standardized mental state assessment. Overall the results show that social workers can safely and reliably assess these patients, but they are more cautious. A management approach involving social workers as assessors of parasuicide patients is discussed.

By means of a twin study an attempt was made to throw light upon the aetiology and nosology of phobic fears. Factor analyses revealed five factors, namely separation fears, animal fears, mutilation fears, social fears and nature fears. The study demonstrated that, apart from separation fears, genetic factors play a part in the strength as well as content of phobic fears. Environmental factors, affecting the development of dependence, reserve and neurotic traits generally, seemed also to be of some importance. It was further demonstrated that phobic fears were related to emotional and social adjustment and this was true to an even greater extent for separation fears.

Seventy agoraphobic out-patients were followed up prospectively for four years after treatment; the improvements manifested during treatment were found to be maintained and partly augmented. At the end of follow-up, 75 per cent of the patients had improved on the main phobia. No clear relationship was found between external control, social anxiety, depression and duration of the complaint at the beginning of treatment on the one hand and the results at follow-up on the other. The disorders remained phobic, no other neurotic symptoms having developed during the follow-up period.

A suggestion that schizophrenic speech may be harder to understand than normal speech was tested by a technique of reconstruction. Ten schizophrenic and ten normal passages were typed onto cards, one sentence per card. Each passage was then presented with the sentences in random order, and students were asked to reconstruct what they believed was the original order. Fewer correct strings of three or more sentences were achieved for the schizophrenic material than the normal material. It is concluded that there is a detectable abnormality in the structure of schizophrenic speech, but that it stems from the relationship between sentences rather than the content of individual sentences.

Monoamine oxidase (MAO) levels in plasma, platelets, lymphocytes and granulocytes have been compared in schizophrenics and controls using three substrates. No significant difference was found between MAO levels in controls and the schizophrenic group as a whole, but platelets and lymphocytes of the latter (tyramine or benzylamine substrate) showed greater variation and in some cases higher values than controls, irrespective of treatment. Schizophrenics who experienced auditory hallucinations had significantly lower MAO levels in lymphocytes and platelets than those who did not.

A study was made of platelet monoamine oxidase (MAO) activity in non-medicated, newly-admitted schizophrenics and institutionalized chronic schizophrenics both on and off medication. These patients were compared to two control groups: normal subjects and brain-damaged institutionalized patients. No relationship was found between platelet MAO activity and the severity or duration of illness, duration of psychotropic medication, presence of auditory hallucinations or institutionalization. Mean platelet MAO activity did not differ significantly between the schizophrenic subgroups and control groups. Thirty-one patients studied before and after treatment with phenothiazines showed no significant change in platelet MAO activity. The findings did not indicate a relationship between schizophrenia, its treatment or outcome and platelet MAO activity.

Individuals potentially at risk for psychiatric disorders were identified by screening 375 college student volunteers for low platelet monoamine oxidase (MAO) activity levels. The lower and upper 10 per cent in MAO activity were administered a personal and family history interview, psychological tests and average evoked response (AER) electroencephalographic procedures. Results indicated that low MAO males and females were socially more active, had more psychiatric contact, and had relatives who were psychiatric-ally more disturbed than high MAO subjects. Low MAO males had more convictions, experimented more with illegal drugs and had elevated scores on the MMPI. AER criteria further defined a high risk group of low MAO-AER augmenters which had more suicides among their relatives and higher scores on the schizophrenia scale of the MMPI.

The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample.

Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change.

The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

Fifty depressed in-patients at two psychiatric units, one in Italy the other in England, were treated with clomipramine, either orally, or intravenously and orally. A comparison of clinical response with plasma levels of clomipramine and its metabolite, desmethylclomipramine, showed clear relationships especially in the case of desmethylclomipramine. In the intravenously-treated group this was linear, in the orally-treated group it was curvilinear. Plasma levels of desmethylclomipramine and administered clomipramine correlate highly.

These findings, together with the fact that significant clinical improvement was observed in only 55 per cent of the patients, suggest that titration of the administered dose to obtain more effective plasma levels of the metabolite might improve the clinical response to the drug in some patients.

Two hundred and sixty three pregnant Ugandan women and 89 non-pregnant, non-puerperal women were interviewed using a semi-structured psychiatric questionnaire. Comparison of psychiatric morbidity between the control group and matched pregnant women showed an increased frequency of psychiatric morbidity in pregnant women. Separated pregnant women were particularly at risk. No association was found between antenatal psychiatric morbidity and age, gravidity, number of co-wives or the duration of the pregnancy.

Parents of fifty children attending a child guidance clinic (clinic parents) were studied and compared with the parents of non-referred children matched on relevant parameters (control parents). The clinic parents differed significantly from the control parents on certain variables: presence of psychiatric morbidity in clinic mothers, disciplinary techniques used, attitude towards their own children and the marital relationship. There were no significant differences between the parents of the two groups in their attitudes towards their own parents. Alcoholism and sociopathy were not common among clinic fathers.

A trial was carried out over twelve months of a method for monitoring the care of a large number of schizophrenic patients in the community. The method has been demonstrated to be practical in use, economical of resources and potentially relevant to a number of chronic disorders.

A sample of chronic schizophrenic patients from an urban community, living outside hospital, were reassessed on the Present State Examination one year after a first examination. During this time their use of psychiatric hospital services was recorded. One hundred and two patients had satisfactory interviews on both occasions. These could be divided into Heavy, Medium and Light users of services, the numbers being 8, 14 and 63 respectively, while 17 only saw their general practitioners or had no treatment. A ranking of the sample in terms of severity showed no correlation with use of these services; second PSE scores were not significantly different from the first. Heavy and Medium users of hospital services were in contact with Social Services to a significantly greater extent than other patients.

The predictive value of the NOSIE, a ward behaviour rating scale, was investigated in a group of long-stay patients. After a follow-up period of 3 ½ years, it was found that all NOSIE scales differentiated continuing in-patients from those discharged. Regression analysis showed that age and florid psychoticism carried most predictive weight. These findings and the value of reliable rating scales for rehabilitation purposes are discussed.

Five experimental incentive conditions were compared with a control condition in terms of their effect on work performance. Each of the six groups studied had a standard four-week baseline period (Block 1) consisting of an attendance payment, followed by a four-week experimental period (Block 2). Whereas all patients in the Control and Feedback groups produced less during Block 2, only two patients in the remaining four groups failed to improve. An analysis of variance indicated that Social Reinforcement, Piece Rate, Piece Rate plus Social Reinforcement, and Pay Increase plus Social Reinforcement were significantly superior to the Control and Feedback conditions.

Psychiatric investigation of 342 patients attending a urological clinic during one year showed a wide spectrum of problems. Patients with lower urinary tract complaints scored higher on the Hamilton Scale than those with upper tract complaints.