This preliminary study investigates the effect on patients' performance of a set time off, in the form of a short holiday, from a strict reinforcement (token economy) regime.

Assessment was by the patients' mean token earnings before and after the holiday and their self-care and work performance throughout. The results suggest that a holiday from a token economy has beneficial effects for patients.

As a contribution to an international pool, chromosomal analysis was carried out on 30 women with anorexia nervosa. The stimulus for this study was that during the last decade nine cases have been described of coincidence between Turner's syndrome and anorexia nervosa. Of the 30 women here examined, all had normal chromosomal constitution.

The coroner's records of no accidental deaths resulting from poisoning, drowning and falling were examined for evidence of mental illness. Sixty per cent were classified as mentally ill before they died, depression, drug dependence and alcoholism accounting for over three-quarters of the diagnoses. Deaths given accident verdicts should be included in the study of the mortality of the mentally ill.

The difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation, method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.

A speculative hypothesis is presented which links the late development of modern concepts of schizophrenia with social and familial effects of industrialization. It is suggested that the social and family structures found historically in pre-industrial societies and currently in developing countries exert a comparatively benign effect upon patients with schizophrenia, and that these effects are lost during and after industrialization. Thus the severe and chronic forms of the illness became prominent and therefore recognized in the segregated institutions of Europe in the latter part of the nineteenth century.

Possible mechanisms are examined by which industrialization could influence the structure of communities and families and the development of individuals to produce the postulated changes in the individual's response to the schizophrenic illness. It is suggested that three major areas of interest for the identification of these mechanisms are (i) the rapid increase in size of towns and communities, (ii) changes in perinatal and infant mortality and morbidity, and (iii) changes in family structure. Some ways of testing the hypothesis and its implications are outlined.

From a sample of psychiatric referrals who had completed the MMPI the following three groups, matched for age and sex, were derived: 42 patients with a history of a serious suicide attempt, 42 patients with a history of a non-serious attempt, and 126 patients who had neither attempted nor contemplated suicide. Non-serious suicide attempters were shown to be the most deviant group and differed to a significant extent from each of the other two groups on the Dependency, Hostility and Unconventionality scales. Male non-serious attempters showed the most disturbed personality profile. This implies that there is, for males, a higher personality threshold for making a non-serious attempt, which may account for the fact that suicide attempts, most of which are non-serious, are commoner among females.

All new female indigenous Zambian patients (180) admitted to Chainama Hills Hospital from 1 June 1974 to 31 May 1975 were seen by the authors and given a firm diagnosis before they were started on treatment. The diagnostic classification of these patients was compared to that of a similar group of patients (163) admitted to the same hospital from 1 June 1973 to 31 May 1974. Forty-two per cent of the patients in 1974/75 were given a diagnosis of depression as compared to 26 per cent in 1973/74; 14 per cent of those in 1974/75 had a diagnosis of schizophrenia as compared to 21 per cent in 1973/74, and 3 per cent of the patients in 1974/75 fell into the group of ‘not yet diagnosed’ as opposed to 27 per cent in 1973/74. The ‘acute transient psychoses' were noted for their relative rarity in the two groups. A plea is made for all psychiatrists working in Africa to give diagnosis the importance it deserves.

In the past few years the overseas doctor working in the National Health Service has been surveyed, discussed, exposed and sometimes adversely criticized in reports and in the press. Realizing the seriousness of this situation in order to attempt a remedy the Royal College has set up a working party in the form of the Overseas Trainees Sub-Committee.

The programme in an intensive rehabilitation unit in a large psychiatric hospital is described. Features include the use of non-medical staff as primary therapists, the use of a mini-bus to facilitate regular visits by patients to their home areas, the inclusion of the mini-bus driver on weekly staff conferences, the use of sociodrama, the re-organization of hospital money payments to patients, the promotion of relations with community-based facilities through occasional ‘teach-in’ days, and a special liaison social worker providing intensive follow-up after discharge. Rehabilitation was prolonged (average stay about one year) and about half of those selected for rehabilitation from the long-stay wards were discharged. Follow-up showed that these patients benefited from discharge, in spite of a relatively high incidence of psychopathology and of social problems. Those transferred back to long-stay wards showed increased institutionalization.

Correlations between the ratio of erythrocyte to plasma lithium (Le/Lp) and clinical status have been reported by some authors and disputed by others. Examination of the literature on Le/Lp and erythrocyte physiology suggests that Le/Lp is determined by peripheral pharmacokinetic parameters and has no direct relationship to central pathophysiology. Because of this, and because of inconsistencies between studies reporting correlations of the ratio with clinical status, such correlations probably cannot illuminate either the pathophysiology of affective illness or the mode of action of lithium.

A double-blind, cross-over trial of the effectiveness of piribedil, procyclidine and placebo in the control of parkinsonism induced by fluphenazine decanoate was conducted in sixteen cases of chronic schizophrenia. Procyclidine was shown to be more effective and piribedil less effective than the placebo. Piribedil produced a number of unpleasant effects, including headache, vomiting and malaise.