Eighty-three consecutive patients with organic mental disorder were studied on their first admission to a psychiatric day hospital assessment unit in a general hospital. They were evaluated medically, psychiatrically and by social work, re-evaluated after 3 months, and again after 12 months or at death. The types of care, and the number of days in each setting, were recorded. Nearly three-quarters were dead or in institutions by 12 months: those initially living with spouses did worst, and those with their children did best, while those on their own became long-stay residents in institutions. Family support seemed the most important factor determining continued life in the community, and increased help to families from social services appeared to be needed. The value of earlier psychiatric diagnosis and earlier treatment of physical ills is also discussed.

A double-blind placebo-controlled trial of L-tryptophan, with pyridoxine and ascorbic acid, was carried out in 10 female patients suffering from mania.

In contrast to earlier studies led by Prange and Murphy, L-tryptophan was found to be no better than placebo.

Forty-five patients with obsessive-compulsive neurosis were given a specially devised structured interview with the aim of elucidating aspects of the phenomenology. Four main kinds of ritual were found to predominate: cleaning, avoiding, repeating and checking. A surprisingly large number of patients had little or no resistance to carrying out their rituals. The recognition of senselessness of a ritual was a more important criterion than that of resistance, but patients with predominantly repeating rituals did demonstrate resistance. It is proposed that a redefinition of obsessive-compulsive neurosis with less emphasis on resistance as a necessary condition may be appropriate.

The incidence and quantities of dimethyltryptamine and O-methyl-bufotenine were studied in the cerebrospinal fluid of patients suffering acute schizophrenic illnesses and in surgical and neurological control groups. Some schizophrenic patients have higher levels of both amines than do controls, though the differences in distribution did not reach statistical significance in the sample studied. The gas-chromatographic technique used is sensitive at the low picogram level.

The progress over one year of 25 children aged 2½ to 3½ years attending a psychiatric day centre was compared with that of 25 similarly disturbed 3-year-old children identified in a total population study. There were few differences in outcome, and those that were found did not particularly favour either group. Implications for the organization of treatment services are discussed in terms of the need to lay down clear objectives and to pursue systematic controlled evaluation.

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.

Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper ‘Better Services for the Mentally Handicapped’ will be sufficient.

A search was made of records available for 65 non-psychotic patients referred to a psychiatric day hospital. Assessments were made of whether they had shown various specified types of deviant social conduct, such detailed objective surveys of social conduct being regarded as superior to the use of concepts such as ‘psychopathic personality’. The correlational structures of the areas of deviance produced four factors, i.e. deviant family roles, poor social integration, violence, and a more heterogeneous antisocial behaviour factor.

The relationship was examined between areas of deviance and indices of the course and outcome of day hospital admission. The prognostic significance of social deviance was different for men and women; for example, only men showed a correlation between the number of areas of social deviance and the outcome of day hospital admissions. Violence and poor social integration showed no relation to outcome at all. It is suggested that there is no basis for excluding such patients from day hospitals on the assumption that they are less likely to be helped than other non-psychotic patients.

This paper describes a supported lodgings scheme as an alternative to group homes. It is pointed out that the County Council has a statutory duty to finance supported lodgings and that schizophrenics are ideally suited to such a scheme. Some short-stay, the majority of the ‘new’ non-demented long-stay, and a large number of the ‘old’ long-stay patients have been discharged by this means. Aftercare facilities were important, as nearly half attended the day centre and over one third were regularly visited in their lodgings by the community psychiatric nurses and social workers.

Gamma-aminobutyric acid (GABA) levels in the CSF were measured in 9 normal individuals, 17 drug-free schizophrenic patients and 10 of these same schizophrenic patients after neuroleptic treatment. There was no significant difference between CSF level of GABA in the control group compared to those in schizophrenic patients; however, 6 of the 7 lowest GABA levels were from schizophrenic patients. There was a significant decline of 12 per cent in mean GABA levels in the CSF after a mean of two months of neuroleptic treatment.

Nine depressed patients received ECT to the dominant (left) side along with nine matched depressed patients who received ECT to the non-dominant (right) side. Neuropsychological tests showed that the right hemispheric functions were more frequently abnormal as compared to left hemispheric (dominant) functions in the pre-ECT tests. ECTs delivered to either the right or left side improved right hemispheric functions when the depression was ameliorated. This study indicates that in depression right hemispheric functions are initially disturbed and ECT, instead of being deleterious to these functions, tends to improve them.

Fifty cases of Korsakov's syndrome and 13 of ‘alcoholic dementia’ were identified from hospital records with the aim of examining the claim of each to be regarded as a clinical entity. Korsakov's syndrome, as diagnosed, was not homogeneous and comprised two groups. One resembled cases labelled as ‘alcoholic dementia’: the onset was gradual, the patients were older women with poorer intellectual functioning and there was a better outcome. The other group conformed to the conventional notion of Korsakov's syndrome, with preservation of intellect and a poor outcome. The combined group of gradual-onset cases and ‘alcoholic dementia’ was not entirely homogeneous. Within it were patients with ‘accelerated psychological deterioration’, others with Korsakov's syndrome superimposed on this pre-existing psychological deficit, and some with subacute confusional states.

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.

An extensive psychometric test battery was administered to 125 children with a reading disability, to their parents and siblings, and to members of 125 matched control families (N = 1,044). In addition to expected differences in spelling and reading, probands obtained significantly (P ≤ · 01) lower scores than controls on tests of other cognitive abilities. Manifold deficits were also found in siblings and parents of probands, conclusively demonstrating the familial (genetic and/or common-family environmental) nature of the disorder.

The HLA (Human Leucocyte Antigen) types A and B were studied in 80 patients diagnosed as schizophrenic. There was an increased incidence of HLA-BW5 and a decrease in HLA-AW29 and HLA-BW17 as compared with healthy controls. In the sub-group of patients exhibiting Schneider's first-rank symptoms there was an increased incidence of HLA-A1 with a decrease in HLA-A2 and HLA-BW17.

Among 84 adoptees, 18 years of age and older, separated at birth from their biological parents and without further contact with them, alcoholism was found more frequently in those whose relatives included an individual with alcoholism or in whom heavy drinking had been noted. Adoptee alcoholism did not correlate with any other diagnosis in a biological parent.

Childhood socialized conduct disorder was significantly higher in those adoptees who later received a diagnosis of alcoholism or suspected alcoholism, and was positively, but not significantly, related to heavy drinking or alcoholism in parents.

Age of adoptee, time spent in foster care, age of biological mother at the time of the birth, socio-economic status of adoptive home, psychopathology other than alcoholism in the biological background, and psychiatric or behavioural problems in the adoptive family (parents or sibs) were all unrelated to adult alcoholism in the adoptee.