This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.

As the first phase of a project designed to institute controlled drinking as a therapeutic goal for alcoholics, it was decided to recruit volunteers who were dissatisfied with their present mode of drinking but who had not previously sought help. This was done by requesting them to phone a private number. When these volunteers had been recruited it was proposed to modify their drinking habits to their own requirements, using non-averse training, drinking practice and ongoing group psychotherapy. This project however has not been implemented because of a paucity of volunteers. The methods of recruitment are listed and those drinkers who volunteered are described. The reasons for the low rate of response are discussed.

Reported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising.

Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die be replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy.

On October 3 1975, an ecumenical service was held between the Royal College of Psychiatrists, the Royal College of General Practitioners, the Association of Directors of Social Services and the Department of Health and Social Security.

This study is a replication and extension of past work carried out by Brown, Birley and Wing (1972) concerning the influence of family life on the course of schizophrenia. In the original research the index of emotion expressed by a key relative about the patient at the time of key admission proved to be the best single predictor of symptomatic relapse in the nine months after discharge from hospital. In the present study this main finding of Brown et al has been replicated for two clinically different groups of psychiatric patients. The expressed emotion of the relative again seems to be associated with relapse independently of all other social and clinical factors investigated. In addition, important additive effects between various social influences and pharmacological treatments have been revealed which make it possible to predict relapse patterns in schizophrenia with considerable precision. The patterns of these relationships with relapse are different for the two clinical groups studied, patients with schizophrenic psychosis and with depressive neurosis.

From an original cohort of 471 admissions of male schizophrenics (260 individuals) to Leverndale Hospital, Glasgow, in the years 1967–70 inclusive, 39 patients were found who in December 1973 had become long-term residents by virtue of over three years' stay. These patients were followed up two years later, when it was found that 33 remained. Three had died and two had been discharged, though one was later admitted elsewhere. Those remaining had an average age of 45.4 years, and an average duration of illness of 15 years. The patients are considered in terms of their clinical state, management problems, accommodation, occupational grade, and social circumstances. It is concluded that they represent a hard core and that very few of them are likely to be suitable for such alternative forms of care as are at present available.

The effects of tricyclic antidepressants on the heart are reviewed. Statistically significant increases in heart rate and in atrioventricular conduction times were found following the administration of tricyclic drugs to 32 depressed patients. The method of His bundle electrocardiography was used to study atrioventricular conduction in ambulant patients and in patients admitted after an overdose of tricyclic antidepressant drugs. Distal conduction defects were frequently found in patients following tricyclic overdosage, but these were not seen with doxepin overdosage. Impaired distal conduction was also found in occasional patients on therapeutic doses of tricyclic drugs. Some animal experiments giving similar results to the above clinical findings are also described. The clinical implications of these findings are discussed.

Monoamine oxidase (MAO) is an important enzyme in the catabolism of brain biogenic amines. Platelet MAO has been reported to be moderately reduced in manic-depressive patients and markedly reduced in schizophrenic patients. This enzyme's activity has been shown to be under a large degree of genetic control and has been proposed as a ‘genetic marker’ in schizophrenia. A transcultural replication of the finding of low platelet MAO in schizophrenia and manic-depressive illness was carried out at the Jerusalem Mental Health Centre. Manic-depressive patients were found to have higher platelet MAO activity than schizophrenic patients, as reported previously, but control individuals were as low as the schizophrenic patients. It is unlikely that platelet MAO activity is a transculturally-valid marker for schizophrenia.

There are approximately 50,000 mentally handicapped patients in hospitals, the majority of whom have no prospect of being able to live in the community, by virtue of their disability and/or lack of appropriate facilities outside hospital. It is clear that hospitals must remain responsible for this group for the forseeable future and hence their resources must not be reduced. Indeed, the standards in these existing hospitals must not only be maintained, but improved.

Old people with mental disorders tend to be looked on with the same affection as nettles. Viewed en masse they may not be beautiful, examined as individuals initial interest may be diminished by lingering discomfort.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets.

Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.

The chemical structure of a neuroleptic does not reliably predict the exact profile of its therapeutic action. We considered the question whether the biochemical action of a neuroleptic, and specifically the ratio between DA-receptor block and NA-receptor block, might have a higher predictive value in this respect. In this context we carried out a double-blind study of the therapeutic value of clozapine and perphenazine in acute psychoses of varying symptomatology and aetiology. There are strong indications that clozapine has only a slight inhibitory effect on transmission in central DA-ergic neurons, but markedly inhibits transmission in central NA-ergic neurons, and that the reverse applies to perphenazine. In view of these data we expected perphenazine to be a stronger antipsychotic and a weaker sedative than clozapine, and vice versa. The plausibility of this hypothesis was demonstrated. Partly also on the basis of earlier research, we concluded that the biochemical action of a neuroleptic is a more faithful predictor of its therapeutic action profile than the chemical structure.