Thirty-two school-phobic youngsters of mean age 13 years were randomly allocated to two treatment groups after stratifying for sex. Length of in-patient management in a psychiatric hospital unit for young adolescents was evaluated. One group was admitted for three months and the other for six. Care was taken to ensure that cases had been fairly distributed between the groups by comparing them on a variety of clinical features. Follow-up assessments were carried out in a reliable fashion at six months, one year and two years after discharge. Outcome, overall, was similar to that found in a previous follow-up study for the same unit, in that symptoms of emotional disturbance and social impairment tended to persist in a considerable proportion of cases over the period of review. Length of stay in hospital did not affect outcome as far as the boys were concerned; the findings in relation to the girls was less certain and it seems likely that longer in-patient treatment improves outcome in school-phobic girls.

One-hundred female nurses at a psychiatric hospital were interviewed in an attempt to assess the overall frequency of having been the victim of indecent exposure and to describe it as experienced by the victim.

Forty-four of the subjects had been victims of indecent exposure, one-third of these on two or more occasions.

The attitudes of those who had been victims were no different from the attitudes of those who had not. One-third of all incidents had not been disclosed to anyone. In over one-fifth of the episodes the reaction of the family and friends in whom the victim confided had been more distressing to the victim than the episode itself.

This paper brings up to date a 1970 study of suicide attempters coming to a major emergency room in an United States urban community and reviews international trends in suicide attempts. Results of the study and the review of the international literature indicate that the high rates of suicide attempts that were observed in 1970 are continuing into 1975. The incidence of suicide attempts continues to be a public health problem primarily among young women. Pill ingestion, usually barbiturates and psychotropic drugs, continues to be the most common method used.

This paper presents work that formed the basis of a fourth-year project at Southampton University Medical School. Thirty patients were seen prior to their first psychiatric consultation and asked about their hopes, fears and expectations. Twenty-five were seen subsequently.

The study, which is largely descriptive, shows that many patients have unrealistic expectations about various aspects of the interview, and afterwards many are dissatisfied with its outcome. The paper discusses these findings and makes some tentative recommendations.

A group of psychiatric patients were operationally defined as ‘hysterics’ by their reliance on the perceptual defence mechanism of repression, as disclosed in a valid psychological test. Most of them had dependency conflicts. Only half of them, almost exclusively female, had received the clinical diagnosis hysteria, the diagnosis being apparently founded on bodily complaints, overt aggression, and absence of depressive mood and anxiety. Lack of these characteristics in patients resorting to repression and with dependency conflicts results in diagnostic uncertainty. Clinical and test data justified the separation from operationally defined hysterics of three small subgroups: one with brain dysfunction, one with regressive psychosis, and one with non-regressive schizophrenia. Relevant diagnostic clues in the psychological tests and in the clinical picture are discussed.

A lower incidence of attempted suicide was found for Oxford University students than for other persons of the same age in Oxford City. This may be due to social class differences. Characteristics of the student attempters are reported. On the other hand, the rates for completed suicides of students, over a recent ten-year period, were in excess of those for the rest of their age group.

The use for hallucinogenic purposes of an indigenous mushroom, Psilocybe semilanceata indigenous to Britain is reported in three patients. Typical psychedelic, transient psychotic and more prolonged schizophrenia-like states were seen, with sympathomimetic signs noted in two cases, in one being prolonged. Enquiry about such mushroom abuse should be considered in individuals presenting to medical or psychiatric emergency clinics.

A variant of the Capgras syndrome is described in a 43-year-old woman who had vitiligo and multinodular goitre. The unusual feature of the case was that the patient not only misidentified members of her own family but also claimed that she herself had been replaced by a double.

The results of a follow-up study of schizophrenics attending a centre in North West India are reported. The relevant literature is reviewed, The results were compared with two well-known studies, one from the United Kingdom and the other from Mauritius. The evidence presented suggests that the course taken by schizophrenia in a newly-developed city and its neighbourhood in this part of India is similar to the one seen in the Western world. This study does not support the view that chronicity of schizophrenia in non-European, non-white populations is different, at least in an urban setting.

On Tuesday 10 June 1975 G.M.B. was convicted at Bristol Crown Court of the murder of a young woman and sentenced to imprisonment for life.

The size and utilization of the primary group (those with whom one has interaction and commitment) was examined in 50 patients with non-psychotic psychiatric disorder and 50 matched controls. The hypotheses tested were that the patients would have a smaller size of primary group, less contact with its members and an inferior affective quality of interaction with it; and that this deficiency would be most marked in transactions with the principal attachment figure. Patients were found to spend the same amount of time as normals with their primary group, but proportionately more of that time was affectively unpleasant. They had fewer good friends and fewer contacts with persons outside the household. They had fewer attachment figures, almost one half of them reporting that either they had only one, or that they had had no recent contact with those alternatives that did exist. The majority of patients considered that their principal attachment figures gave them insufficient support. The complexity of interpreting these data is discussed.

This case report augments a paper published in 1971 (Gunn and Fenton) in which it was indicated that automatic behaviour is a rare explanation for the crimes of epileptic patients. It was claimed that although two possible ‘automatic’ crimes were committed by two epileptic patients among the 46 male epileptics at Broadmoor there were no such crimes committed by any of the 158 male epileptic prisoners who came into a national sample. Since then it has become clear that one man serving life imprisonment, excluded from the epileptic prisoner sample in 1967 because of a doubt about his diagnosis, is definitely epileptic and probably killed his wife during an epileptic attack or its immediate sequela.

A group of 30 manic and hypomanic patients was assessed on the Delusions-Symptoms-States Inventory and did not appear to conform well to Foulds' and Bedford's hierarchy model. Failure to fit the hierarchy was caused by lack of scores in the Neurotic Symptom Class. The relationship between delusions of Grandeur and state of Elation, which was found to be inclusive and non-reflexive, did, however, support the hierarchy model.

Two measures of extraversion were administered routinely to a group of drug dependent offenders, on admission, after six months and after one year's treatment in a therapeutic community. On admission the sample was relatively introverted. During the treatment there was a progressive move towards extraversion, and after one year's residence there was a significant change in the direction of extraversion. It is suggested that this change constitutes an important factor in the success of this type of treatment.

In a transcultural setting, psychiatric diagnosis is often impeded by language and cultural barriers. A greater reliance on observed or reported behaviour than on the self-reporting of subjective discomfort may thus be expected, and this could result in the low prevalence of reported anxiety and depression in many transcultural psychiatric surveys. The language of the Pintupi Aborigines of Central Australia, until recently palaeolithic hunter-gatherers, is seen to contain lexical categories for anxiety and depression. This attests not only to their capacity to experience such affects, but also to their ability to express them verbally. The implications of this finding for psychiatric diagnosis are discussed.

Analysis of medical students' formulations and replies to clinical problems indicates difficulty in deciding on the nature and organization of treatment. A programme describing a problem-solving approach was devised, and students taught in this way were shown to be significantly more able to formulate organized treatment plans with more precise aims. It is suggested that problem-solving methods are likely to be much more effective than conventional teaching of psychiatry.