Steinberg et al. (11) have recently described, in a case report in this Journal, a combination of manic psychosis in the course of and following an influenza infection with high levels of complement fixing (CF) antibody titre, with a view to encouraging further research-work in this direction. Following their suggestions, we should like to describe a similar observation. At the same time, we will take the opportunity to make some critical remarks on the comments made by Steinberg et al. as to the correlation between the specificity of an exogenic noxious agent and a mental reaction, since, in our opinion, it might lead to a certain misunderstanding to talk about a direct or even specific relationship between influenza infection and manic psychosis.

The Royal College of Psychiatrists welcomes this opportunity to give evidence to the Committee and notes its terms of reference:

(A) to consider to what extent and on what criteria the law should recognize mental disorder or abnormality in a person accused of a criminal offence as a factor affecting his liability to be tried or convicted and his disposal;

(B) to consider what, if any, changes are necessary in the powers, procedure and facilities relating to the provision of appropriate treatment, in prison, hospital or the community, for offenders suffering from mental disorder or abnormality, and to their discharge and after-care; and to make recommendations.

Lader and Wing (1965) compared amylobarbitone sodium and chlordiazepoxide as daytime sedative drugs in anxious patients. Using a formal bioassay technique they found that 65 mg. of amylobarbitone sodium was equivalent to 9 mg. of chlordiazepoxide. Essential differences in the physiological and clinical actions of the drugs were not demonstrated, and the incidence of side effects, including drowsiness, was similar in each case.

Stammering has been defined as an interruption in the normal rhythm of speech of such a frequency and abnormality as to attract attention, interfere with communication or cause distress to a stammerer or his audience (Bloodstein, 1960).

Whereas there are many reports from Western societies on the prevalence of psychiatric disorders few systematic studies are available for a culture such as the Indian. Certain efforts in this direction have been made recently, and a few reports have emerged. Dube (1970), in a psychiatric survey conducted in Agra City and its suburban areas found a period prevalence of 18 per 1,000. In a study of 184 families of a rural community in India, Elnaggar et al. (1971) observed a prevalence rate of 27 per 1,000. In a study of 300 urban families, Sethi et al. (1967) found a psychiatric morbidity rate of 72 per 1,000 whereas this rate was only 39 per 1,000 in a surveyed population of 500 rural families (Sethi et al., 1972a). We also observed (Sethi et al., 1972b) that psychiatric disorders were commoner in the migrant families. The present study was undertaken to estimate the extent of mental illness in an urban society in India and to find out the relevant variables associated with various psychiatric disorders.

It is generally accepted that in mammalian evolution from rodents to primates, including man, aggressiveness, and more particularly intra-species aggression related to the assertion of dominance in the social hierarchy of the group, is a characteristic of the male (Gray, 1971). There is also an increasing body of evidence which shows that mammalian behaviour patterns are basically female and that male patterns are determined by the action of the sex hormone testosterone on neural structures during critical phases of intra-uterine development (Seymour Levine, 1966). Ounsted and Taylor (1972) have proposed that the X chromosome is sexually neutral, essentially equivalent to an autosome, and that its role in sexual differentiation lies in that it maintains ovarian function in the female. The Y chromosome is sex-determining by causing potential autosomal and X-coded information to become manifest in the phenotype. This is achieved in part by determining the development of foetal testosterone during a critical phase of foetal life. In the absence of testosterone the fundamental female morphology would be established in either sex.

The Tavistock conference model of Group Relations Training, described in some depth by Rioch (1970) and O'Conner (1971), provides participants with a focus on the problems of leadership and authority as they develop and emerge in a variety of relatively unstructured group contexts within a time-limited laboratory setting. The major conference experience involves participation in ‘here and now’ groups with the use of staff in a consultative role, i.e. the staff function being to focus exclusively on the covert or unconscious processes in the group. So the usual consultant role involves no comments to individuals but a rigorous focus on the dynamics of the group as a whole; a role which has been described in more clinical settings by Bion (1968), Coffey (1966) and Ezriel (1950). ‘One of the major aims of the conferences is to contribute to people's ability to form serious work groups committed to the performance of clearly defined tasks …. A second major aim … is the development of more responsible leadership and fellowship in group life’ (Rioch, 1970, p. 347).

Studies in Great Britain concerning intentional self-harm in adolescents have been few (Haldane and Haider, 1967; Leese, 1969). Such behaviour amongst teenagers is now common, and usually takes the form of self-poisoning with drugs; in fact it is probably becoming commoner, although the reasons for this are not altogether clear. The present survey concerns 50 consecutive patients aged between 14 and 19 years, admitted to the General Hospital, Birmingham, following self-harm behaviour in 1970 and 1971. The lower age limit for the group was determined by hospital admission policy, since children under 14 are admitted elsewhere in the city. All the patients had taken drug overdoses, and none had used other methods of self-harm, such as wrist-slashing. All cases classified as intoxication or poisoning within these age limits admitted to the hospital during the relevant period were scrutinized, and care was taken to make sure that no cases of intentional self-harm were being overlooked amongst so-called accidental poisoning. All patients in the intentional self-poisoning group were interviewed by the psychiatrist within 24 hours of regaining full consciousness. Information was obtained in a standard form covering specific aspects of the history. The parents (when available and willing) were seen either by medical staff or by a social worker in an open-ended interview. The Eysenck Personality Inventory (EPI) and Raven's Progressive Matrices test were administered by the psychiatrist at a later date, when all drug effects had worn off.

The introduction of techniques for the measurement of the serum concentrations of anticonvulsant drugs has opened up new opportunities of studying epilepsy in many of its aspects. Until the present time authors have studied variations in, and factors effecting, the metabolism of the drugs, and the relationship of serum drug concentrations to seizure control and well known side effects (see Woodbury, Penry and Schmidt, 1972). In this paper we report some preliminary observations on drug concentrations in patients with and without marked changes in their mental state.

Numerous studies of the reliability of psychiatric diagnosis have been published in the last twenty years, but most have been based either on a comparison of the diagnoses made by two or more raters at a single joint interview, or separate interviews a few days apart (the observer agreement model), or on a comparison of the overall spectrum of diagnoses assigned to two comparable series of patients (the frequency agreement model). Comparisons between the diagnoses assigned to patients on successive admissions, or at other widely separated points in time (the consistency or stability model), have been carried out less often, in spite of the fact that the usefulness of our diagnostic categories is just as dependent on temporal stability as on reliability in an observer agreement situation.

Stammering has been and still is one of the most challenging disorders in psychiatry. It may be the result of constitutional or neurological differences (Karlin, 1950; Boland, 1951), of delayed auditory feed-back (Lee, 1951), of neurosis or of a learned response (Wischuer, 1950, 1952). Schmoigl et al. (1967) studied 50 cases of stammering and found abnormalities in 70 per cent of cases. The possibility of organicity in stammering tempted us to make EEG studies in Egyptian stammerers.