Many surveys have been made of the course of schizophrenia, with results which may vary with diagnostic criteria, source and possible selection of patients, hospital admission and discharge policy (and facilities), and many other factors. The time scale is of particular relevance in view of the sometimes life-long course of the condition. Short-term studies thus have limitations to their value, and long-term surveys present problems, such as changes in fashions of diagnosis and management, which may affect their relevance at the time of publication. At present, there is much discussion of the relative roles of general hospital psychiatric units, mental hospitals and community care in the management of schizophrenia, and these organizational aspects are closely bound up and indeed are sometimes confused with the clinical course of the illness.

It has been shown by Knobloch and Pasamanick that a disproportionate number of oligophrenics are born during the first months of the year. This appears to be true mainly in warmer climates and is supposed to be related to nutritional problems which arise when the most sensitive weeks of pregnancy coincide with the unpleasantly warm summer months. Such findings have led to a revival of the interest in the monthly birth distribution of schizophrenics. There is some evidence that this pattern actually differs from that of the general population, and para-natal complications could be the explanation.

Since the implementation in April 1968 of the 1967 Dangerous Drugs Act, it has been illegal for any doctors except those working in drug centres to prescribe heroin. With the consequent introduction of the methadone maintenance clinics there has been a definite change in the overall pattern of addiction, largely governed by drug availability. It is difficult to estimate the extent of dependence on, or misuse of, barbiturates, but it is likely that the figure for the United Kingdom may be in the order of 150 to 250 per 100,000 (Bewley, 1970). In a recent study of sedative abuse, Mitcheson et al. (1970) found that 95 per cent of the heroin addicts interviewed had used sedatives.

A substantial part of Freud's (1925, orig. 1905; 1926, orig. 1922) theorizing on the causes of male homosexuality was the assumption of a fear of the female genitals, and according to Radó (1969) “fear of the genitals of the opposite sex is the basic dynamic of the individual who wants a sexual relationship with a member of the same sex”. Radó's stress on the phobic component in the causation of male homosexuality is shared by many theorists and practising clinicians.

The enzyme creatine kinase (CK) is present in high concentration in skeletal and cardíac muscle and brain tissue (Dawson and Fine, 1967). Raised serum levels of the enzyme occur in skeletal muscle disease, following myocardial infarction and in hypothyroidism. Raised levels have also been demonstrated in acute cerebral disease (Acheson et al., 1965), but earlier suggestions that this might be due to leakage of enzyme from brain tissue have not been confirmed by isoenzyme separation studies (Dubo et al., 1967), which have shown that the excess enzyme came from striated muscle. Raised serum CK levels associated with acute psychosis have also been reported (Bengzon et al., 1966; Meitzer et al., 1969; Coffey et al., 1970; and Gosling et al., 1972). This has led to the suggestion that serum CK estimation could be used in the differential diagnosis of psychiatric patients (Meltzer et al., 1970; Gosling et al., 1972). Meitzer (1969) has also claimed that the biochemical abnormality reflects ‘a basic patho-physiological process common to the acute psychoses'.

The study of the victims of violent criminal offences and the study of female criminality are both poorly documented areas which are currently attracting a larger share of attention. Investigations into the relationship between the victim and offender and descriptions of the victims of fatal offences have appeared intermittently over the years (East, 1936; von Hentig, 1948; Wolfgang, 1957; Morris and Blom-Cooper, 1964; Gibson and Klein, 1969), but in most of these cases the information is peripheral to the main interests of the researchers and the studies are confined to victims of homicide. This report describes the victims of mentally disordered violent female offenders who were patients in the Special Hospitals, and includes victims of murder, manslaughter, attempted murder and wounding.

Multiple tics appear in the population with a frequency estimated at from 1 in 1,000 child psychiatric out-patients (Lucas et al., 1967) to 1 in 12,500 out-patients (Ascher, 1948). The incidence of XYY karyotype is about 1.24 per thousand males (Nielsen and Christensen, 1974). The occurrence of multiple tics with vocalization in a patient with the XYY chromosome constitution strongly suggests that the extra chromosome promotes neurological abnormality.

It is over a year since the conference on ‘The Responsibilities and Role of the Doctor in the Care of the Mentally Handicapped’ was held, at which Sir George Godber delivered the opening address published in the Journal for December 1973 (pp. 617–20).

The current status of the psychotherapy of obsessive-compulsive conditions is somewhat confusing. For many years the condition has been regarded as resistant to psychotherapeutic intervention, but recently some success has been claimed by both behaviour therapists (for example Boulougouris et al., 1971; Rackensperger and Feinberg, 1972) and psychodynamic therapists (for example Barnett, 1972; Suess, 1972). The confusion arises because despite the plethora of published work we seem little closer to an understanding of why the techniques have worked.

The object of this paper is to consider the proposition that some kinds of critical change in a person's life experience bring about a change in his sense of identity which is not subjectively recognized and acknowledged until between one and two years after the critical event or initiation of the critical change.

In 1963–4 the Oxford University Penal Research Unit managed to collect information about 90 per cent of the offender-patients who were admitted to N.H.S. and Special Hospitals under hospital orders made by criminal courts: this cohort has been described in Crime and Insanity, Vol. II, by Walker and McCabe (1973). One of the by-products of the follow-up of these offender-patients was a rough and ready scoring system for predicting reconvictions (within a two-year follow-up) of 456 offender-patients who were allowed to leave hospital within a year of admission. A prediction system can be used to assist human decision-making (though it should not be a substitute for it)∗ and can also be used to assess the efficacy of measures—such as after-care—by seeing whether individuals with equal predicted reconviction-rates do better with than without the measure (Mannheim and Wilkins, 1955).

The role of a broad range of life events, especially those viewed as stressful, in the genesis of somatic illnesses or psychiatric disturbances is a subject of considerable interest. Recently attempts have been made to develop quantitative measures of life events and to explore the relationship between the ‘amount’ of life events and/or stress and illness in a general population (Rahe et al., 1968; Rahe et al., 1970): for example, The Social Readjustment Rating Questionnaire (SRRQ) (Holmes and Rahe, 1967). In the development of this scale a list of 43 life events was presented to a sample of 394 subjects. Marriage was arbitrarily assigned a value of 500, and the subjects were asked to compare the amount of relative readjustment they would anticipate from the other events. Means and item rankings (Masuda and Holmes, 1967) have been reported to be relatively consistent in groups of different age, sex, marital status, education, social class, generation American, religion, race and cultural background (Holmes and Rahe, 1967). These findings have been found reliable with patients on our unit and in a group of medical students (Mendels and Weinstein, 1972). Paykel et al. (1971) performed a study of weightings of a list of life events and obtained weights which were highly significantly correlated for the 14 items that were identical to those found on the SRRQ. They tested a mixed group of psychiatric patients and found that in general those events defined as ‘exits’ were scaled high, whereas events defined as ‘entrances’ had lower values.

Recently, though the value of lithium salts has been supported by a number of careful studies (1–6), it has become increasingly evident that as a preventive of affective and schizoaffective psychoses the use of lithium is far from being universally effective and that it does not always lead to a complete disappearance of phases and attacks (7–8). The most generally held view (9–13) of lithium as a prophylactic drug is that it is of most value in preventing the recurrent affective attacks of patients with manic-depressive psychosis and cyclothymia.

Hoenig (1967) has recently and comprehensively summarized the extensive literature on the prognosis of schizophrenia. In a section on existing prognostic tests he criticizes the vagueness of the items to be scored, the variety of prognostic criteria and the low validity of the resulting scales. The present paper describes an attempt to devise a new prognostic test, using material which was originally collected in order to study the cost of rehabilitation.

Several surveys of mental illness in husband-wife pairs have all concluded that sick couples occur in the general population with a frequency significantly in excess of the number to be expected by chance (Penrose, 1944; Gregory, 1959; Kreitman, 1962; Ryle and Hamilton, 1962; Pond et al., 1963; Nielsen, 1964). The statistical methods employed in such investigations have been criticized by Hall et al. (1971), but these authors' arguments appear to suggest that the relative excess of conjoint illness has, if anything, been under-estimated.

Considering their potential contribution to the community, the growth of clinical services in relation to the specialized mental health problems of students in higher education has been haphazard. Although most universities have developed or are on the way to developing comprehensive health services on the lines recommended in the report of the Royal College of Physicians (1966), services in the non-university sector are often less than adequate. This report accepted as established that about 5 per cent of students have psychological disorders which cause serious distress, and a further 10 to 20 per cent have less severe though handicapping disorders. It was accepted that special provision would need to be made for these mental health problems, as part of the range of preventive and treatment activities relevant to a College community.

In a previous paper (Morrice, 1973a) an account was given of a day hospital run as a therapeutic community. Emphasis was laid upon the way staff had learned to diagnose and treat patients not only according to conventional labels but also in terms of their disturbed social relationships—so-called social diagnosis and social prescription. At that time also an attempt was begun to identify life events which appeared to have precipitated the patients’ referral to psychiatric care. This paper considers the data derived from 266 consecutive admissions to the day hospital. Information obtained in each case was discussed by the staff group and noted on a standard form (Fig. 1) according to agreed principles.

Despite the popularity of the Beck Depression Inventory (Beck et al., 1961), only Salkind (1969) has attempted to validate this instrument for a general practice population. For some purposes, particularly clinical research, measurement of change in a depressive mood is more important than an absolute measure. So far only Little and McPhail (1973) have considered this aspect of use.

Several surveys (Carstairs and Bruhn, 1962; Shepherd et al., 1966; and Johnson, 1973a) have demonstrated that the treatment of psychiatric disorders in general practice consists principally of prescribing drugs, with relatively little use of social agencies and psychotherapy. Although Shepherd et al. (1966) comment that the treatment is often haphazard and inadequate, the published surveys of general practice give little specific information about the prescribing habits of doctors. The present author surveyed the prescribing habits of general practitioners in the treatment of depression in the belief that it is necessary to have this information in order to evaluate the need for education in this clinical expertise, and also to act as a comparison for other surveys which will undoubtedly be carried out in the future to test the effectiveness of the current expansion of undergraduate teaching in psychiatry.