The following report is about the procedure which was developed to involve school young people with mental hospital personnel, and the transactions between people in multiple organizations involved with this are described. Youth volunteers working in a mental hospital were making some sort of impact which seemed worth looking at in more detail with the various people involved to seek meaning in a phenomenon. The working relationship of a hospital-based Voluntary Services Organizer (J.L.) and a Consultant Psychiatrist (T.L.) is portrayed.

Dermatoglyphic patterns, especially fingerprints, have long been of interest to researchers in the genetics of schizophrenia, but results of investigations have been inconsistent. Rosner and Steinberg (4) published the first dermatoglyphic study of Negro male schizophrenics, comparing finger and palm prints of 207 patients at Virginia State Hospital with those of 105 healthy Negro males from the National Institute of Neurological Diseases and Blindness Perinatal Study. This is the second report on the dermatoglyphics of Negro male schizophrenics.

Amitriptyline is a widely used antidepressant and its effectiveness has been shown, e.g. in comparison with imipramine in double blind trial (Burt et al., 1962; Hordern et al., 1963, 1964). A disadvantage of currently prescribed tricyclic antidepressants is the necessity for administering the drug three times a day. It has been shown that general medical and in particular psychiatric patients fail to take their medication either in the prescribed dose or at all (Benstead and Theobald, 1952; Haler, 1952; Park and Lipman, 1964; Parkes et al., 1962; Porter, 1969). This failure rate may be as high as 50 per cent (Dixon et al., 1957; Willcox et al., 1965). Even in psychiatric in-patient studies there was still a high failure rate in taking prescribed psychiatric drugs (Hare and Willcox, 1967). A regimen consisting of a single daily dose is more reliably taken than one consisting of thrice daily dosage (Coppen et al., 1969; General Practitioner Clinical Trial 1970).

Paternal incest has been known and recorded in all periods of history and in all types of civilization. It seems to be a universal phenomenon which does not recognize any historical, geographical, racial or social boundaries: it was practised by royal families in classical Egypt, Greece, Peru and Japan; it occurred among some ruling families in mediaeval Europe; nowadays it has been reported in most industrial countries of Europe and America, as well as in the remote islands of Polynesia. Incest seems to exist everywhere, in spite of the fact that it is regarded as taboo in many primitive societies (Cooper, 1932; Freud, 1919; Walker, 1940), and is condemned in all Western societies, both by the Church, which regards it as a serious 'sin’ and by the Law, which makes it an indictable offence.

Retardation, i.e. abnormal slowness in performing mental and/or motor tasks, is frequently noted as being a prominent feature of schizophrenia. While some writers describe it as being merely one of the several clinical signs and symptoms of schizophrenia, others suggest that retardation has a causative role, and is a basic disorder underlying antisociability and withdrawal from reality (Babcock, 1933), intellectual deficit (Shapiro and Nelson, 1955), affective flattening (Harris and Metcalfe, 1956), thought-process disorder (e.g. Yates, 1966), and other disorders.

In 1963 Coppen and Shaw reported that patients with manic-depressive psychosis showed, on clinical recovery, a significant decrease in exchangeable sodium, and in residual sodium (exchangeable minus extracellular sodium), presumed intracellular, per litre of body water. Coppen, Shaw, Malleson and Costain (1966) found a similar type of shift in mania but the deviation from normal was, on average, more extreme. Although low and high sodium diets had no effects on the distribution of sodium in manic-depressive psychotics, the administration of spironolactone resulted in a significant reduction of residual sodium (Coppen, 1970). The possible involvement of aldosterone in these changes led Jenner et al. (1967) to examine aldosterone excretion in a 48-hour cycle patient and Murphy, Goodwin and Bunney (1969) to examine groups of manic and depressed patients. Murphy et al. found lower rates of excretion of aldosterone in depression than in mania, but Jenner et al. found the opposite.

A sedative or tranquillizing effect may be important in the treatment of mild depressive illness not requiring admission to hospital or ECT (Wheatley, 1969), and Hare et al. (1962, 1964) have suggested that antidepressant drugs may exert their effect by virtue of their sedative action. Other workers also have found similar effects from antidepressant drugs and tranquillizers (Overall et al., 1964; Paykel, 1969).

A survey has already been presented (British Journal of Psychiatry, November 1971) of all patients seen by the senior psychiatric staff of Leverndale Hospital and the Victoria Infirmary, Glasgow, with a view to termination of pregnancy for the period of two years following the implementation of the Abortion Act, i.e. from April 1968 to April 1970. During this time 116 patients were seen, of whom 71·5 per cent were recommended for termination. Follow-up of cases not so recommended showed that one-third obtained abortion elsewhere; the rest apparently made a reasonable adjustment to their situation.

Recently several communications have been published implicating impaired 3′5′ cyclic adenosine monophosphate (cyclic AMP) metabolism as a causal factor in affective disorders (1, 3, 7, 8, 9, 11). In particular, the urinary excretion of cyclic AMP in manic patients is reported to be increased compared with that of normal subjects, whereas in depressed patients a decreased excretion has been observed (1, 7, 8, 9). These findings form the basis of a theory explaining the systemic and mental symptoms of affective disorders (1).

The last decade has seen a shift in the emphasis of research into student problems and student performance. On the psychological side there has been a move away from somewhat static concepts of personality measurement and intellectual assessment, and the concomitant preoccupation with prediction and selection, towards a more interactive approach in which individual aspects are related to academic and social processes (e.g. Sanford, 1962; Lavin, 1965; Wankowski, 1969). On the mental health side there has been a shift from 'syndrome identification’ towards a more dynamic appraisal of personal and social forces and their interaction (Grant, 1969; Ryle, 1969; Lucas and Linken, (1970).

In order to try to overcome the common clinical experience of patients who do not take the drugs prescribed for them (Wilcox et al., 1965) a sustained release form of amitriptyline (Lentizol) has recently been made available. This trial was undertaken to test the efficacy of this formulation given once daily at night compared to standard amitriptyline given thrice daily.

The patient, C, was a 33-year-old woman who attended hospital complaining of depression, inability to sleep, and weakness of hands and legs. This had been going on for 4 to 5 weeks. She had been suffering from ‘writer's cramp’ five years previously but this had been satisfactorily treated with drugs.

Psychiatric Social Work as a profession with its tradition, training and culture rooted in the Hospital Service, will in all probability soon cease to exist. It would appear that the imminent decease of this profession is not generally known or understood. This account, an expression of much personal regret, is also an attempt to give a background to the current situation. It pays tribute to the medical profession, without whom the Psychiatric Social Workers would never have acquired their specialization and expertise. It has been in hospitals and other allied settings that the Psychiatric Social Workers have practised their professional skills and had the opportunities to keep abreast of clinical progress and new approaches to mental health, so essential to teaching new generations.

During the current financial year the Department of Health and Social Security is supporting research in mental illness to the extent of rather more than £140,000. Expenditure by the Department is 50 per cent greater this year than last, and it is likely to continue to increase over the next few years.

The main Government agency for the advancement of medical research is the Medical Research Council. Very broadly, the research the Council supports is essentially basic research, whereas the research supported by the Department is mainly service orientated.

Among patients admitted to psychiatric hospitals are some who are discharged undiagnosed. It can be expected that psychiatric patients, as patients in other medical specialties, who do not meet the criteria for any of the established diagnostic groups, will be considered as undiagnosed until the course of their illness and clinical picture makes the diagnosis evident. The undiagnosed patients are a diagnostic and therapeutic challenge. Because in a space of five years, 256 patients left undiagnosed, it was felt that this group merited investigation.