There are in the eyes of the world different sorts of ‘good’ psychiatrists. It depends who is making the judgement; it depends what is asked of the psychiatrist, what role he is expected to take and how successfully he has measured up to it. One would expect that the qualities of a doctor would be judged to a very large degree by his capacity to treat patients. This is what his long period of undergraduate and postgraduate training and education is about. Recently this concept of the doctor, and particularly that of consultant psychiatrist, has been challenged. The expectation that in the future he will continue to treat patients personally seems to be doubted. I wish to make my own attitude clear at the outset. The psychiatrist in my view is a physician in psychological medicine—a clinician—which means that his business and his professionalism are the personal care of patients. He is now called upon to do much more than this, and the reasons are several and complex. But the old view of a psychiatrist as physician may be lost if he accepts only the role of administrator, PR man, member of a multiprofessional team with far-ranging, ubiquitous responsibilities.

A matched controlled study of 84 depressed women confirms the findings of Brown et al, that loss of mother before 11, three or more children at home under 14 years of age, lack of a confiding marital relationship and lack of employment may be vulnerability factors predisposing to depression in working-class women.

Four hundred patients aged at least 17 who came to Casualty in one year after deliberately poisoning themselves were randomly assigned between an Experimental social work service (task-centred casework) and a Control (Routine) follow-up service. 139 patients were excluded from the trial, most of whom were already in continuing psychiatric treatment. After one year there was no difference in the proportions of E and C patients who repeated self-poisoning (about 14 per cent), but significantly more of the excluded group had repeated (36 per cent). A random half of the trial patients were re-interviewed four months after admission. Both E and C groups had improved to a significant extent on measures of depressed mood and of social problems. E patients showed more change in social problems and were more satisfied with the service they had received.

Forty alcoholics and 40 controls were compared on tests of frontal lobe functions, abstracting ability, and verbal and picture memory. Alcoholics were inferior to controls, and heavy drinkers poorer than moderate ones (life-time alcohol consumption) on picture memory and a verbal fluency test of frontal lobe functions. Verbal memory and abstracting ability were not significantly impaired. Although this pattern may indicate that frontal and right temporal areas of the brain are particularly vulnerable to the effects of chronic alcoholism, the possibility that it may merely reflect general sensitivity of the tests to brain damage cannot be ruled out.

Since 1804 there have been twelve case reports of patients with mood disorders showing a regular periodicity of 48 hours, eight bipolar and four unipolar. This paper describes an additional patient, a 57-year-old man with a 48-hour unipolar cycle. Although his 24-hour serum Cortisol pattern was abnormal, there were few clear-cut biological abnormalities. Possible mechanisms are discussed, and comparisons made with previous reports of similar patients.

The prevalence of age disorientation was estimated in the population of patients with a diagnosis of schizophrenia in a large mental hospital. Of these 357 patients 25 per cent demonstrated age disorientation, defined as a five-year discrepancy between true and subjective age, and 11 per cent of the population believed themselves to be within five years of the age they were at admission, although they were a mean 28.9 years older. Age-disorientated patients differed from the age-orientated in being significantly older. However, when age-matched, they were younger at first admission and had a longer duration of stay than patients with a diagnosis of schizophrenia without age-disorientation. Age-disorientation may thus be a feature of a type of schizophrenic illness of early onset and poor prognosis.

In an interview survey of temporal orientation in chronic schizophrenia, patients with age disorientation (n = 77) were much less likely than patients without age disorientation (n = 222) to be able to give correct answers to simple questions about dates and the passage of time (e.g. their date of birth, the present year and the duration of their hospital stay). The age disorientated systematically underestimate the present year and their duration of hospital stay; in individual patients the errors they make are consistent with their concept of their own age. ‘Time stands still’ for these patients.

However, there are patients in whom an incorrect appreciation of their own age co-exists with correct awareness of the present year. Between these patients and those for whom subjective time stands still, there appears to be a continuum of increasing temporal disorientation. This dimension may be a clinical correlate of intellectual impairment.

Serum calcium and magnesium were studied in drug-free and neuroleptic-treated schizophrenic patients. Calcium and magnesium were not significantly different in 31 unmedicated schizophrenic patients compared with normal controls. Serum calcium was altered, however, in two subgroups: (1) Patients who remitted after neuroleptic withdrawal were significantly lower in calcium than those who did not remit; (2) catatonic schizophrenic patients appeared to have an increased calcium at the onset of catatonic stupor.

Patients treated with pimozide were found to have a significant decrease in both calcium and magnesium compared with their drug-free values. These same patients showed a similar decrease in both electrolytes during treatment with fluphenazine, a structurally different neuroleptic drug.

In a retrospective study, there were clearly abnormal laboratory findings in 4.8 per cent of 4,994 adults who attended for psychiatric evaluation at a mental hygiene clinic. In particular high fasting blood sugars, abnormal blood counts, eosinophilia, VDRL and abnormalities of chest X-ray or urinalysis were found. Just under half of these abnormalities led to further medical follow-up. Old and young, schizophrenic and neurotic were equally likely to be followed up, but tests which were clinically not alarming might be ignored. The implications are discussed.

The effects of videotape feedback on patients' self-perception were assessed in a study which was a partial replication of an investigation reported by Griffiths and Hinkson (1973). Subjects were randomly allocated to one of three groups. After a semi-structured interview, they were either (1) shown a videotape of the interview, or (2) shown a videotape of another person being interviewed, or (3) engaged in other activities not involving videotape. Patients' self-ratings indicated that videotape feedback has immediate effects on self-assessments of social ease and physical attractiveness. Feedback produced changes in ratings of social ease, but individuals differed in the direction of the change (i.e. whether social ease was ‘better’ or ‘worse’). The direction of the change was predicted by a questionnaire measure of response style. Feedback also tended to make patients rate themselves as less attractive in the eyes of other people. All changes were, however, temporary and had disappeared at a two-week follow-up.

The results are generally consistent with those reported by Griffiths and Hinkson in that they indicate temporary and specific changes in response to videotape feedback. The implications of the results are discussed.

Two drug trials in schizoaffective patients are reported. Nineteen ‘schizomanic’ patients were treated for one month, on a double blind basis, with chlorpromazine or lithium and 41 ‘schizodepressive’ patients with amitriptyline, chlorpromazine or both.

In the schizodepressive patients there was a trend to a better response to chlorpromazine, but drug response generally was poor, only 20 per cent of patients recovering within the month. In the schizomanic patients lithium seemed as effective as chlorpromazine, which supports the view that these patients were suffering from a variant of mania.

A therapeutic trial with chlorpromazine was conducted with a homogeneous (for age and sex) group of recently admitted schizophrenic patients. Extrapyramidal effects were measured through quantitative analysis of digital tremor, after four days of fixed-dose treatment. Assessment of treatment efficacy was based on Brief Psychiatric Rating Scale ratings, done at the end of four weeks' treatment. Those patients whose tremor was least affected by drug were most likely to benefit from the treatment. Implications of this negative correlation for our understanding of the neuroleptic hypothesis and the closely associated dopamine hypothesis of schizophrenia are discussed.

The Delusions-Symptoms-States Inventory (DSSI) was administered to 33 chronic non-paranoid schizophrenic patients resident on long-stay wards. It was found that the vast majority of cases (81 per cent) produced symptom patterns conforming to the hierarchy of classes of personal illness model, but with a radically different distribution among the classes from that in acutely ill patients. Within the model a half of the patients were allotted to the two lowest classes—Class 0 (Symptom-free) and Class 1 (Dysthymic States). When each set of items was considered separately and independently of the model, it was found that a half of the group professed to have recently experienced delusions. Affective states and depressive symptoms were reported by over a third of the patients.

Response to a token economy was assessed in male chronic schizophrenic in-patients who were given, in a double-blind cross-over trial, pimozide (up to 20 mg daily) or chlorpromazine (up to 1,000 mg daily), each for three months. After six months there was little change in the patients' mental state, but general ward behaviour and token-rewarded target behaviours improved significantly. There were no statistically significant between-drug differences, but the trend was that general ward behaviour, but not token-rewarded behaviour, improved more on pimozide. The patients who showed initiative and cooperated best with staff were those whose token-rewarded behaviour was most satisfactory.

I am not a historian, a mere dabbler in history, but the figures of the past have always intrigued me. Psychiatry lives in the shadow of the 19th century, both in terms of its architecture and of its theories. It is not too difficult to give oneself déjà vu feelings about psychiatry, and to see its ‘progress' as a circular tour. But what of it ? In that way we revisit all sorts of old friends, provided we meet them as they really were, and not as dusty images, mouldering statues, ancient deities or foolish fond old men.