Environmentalists have long attempted to demonstrate relationships between various deficiencies in upbringing and adult mental illness. Early parent death is one of the most obvious and one of the most easily measured of such deficiencies, and many investigators have been tempted to the deceptively simple task of comparing the incidence of early parent death in patients and the general population. That there is so little agreement in the findings of the now considerable number of studies is a reflection of the methodological pitfalls which exist.

The aim of this study was to examine the relationships between side effects occurring in the first two months of treatment with a contraceptive pill and questionnaire-assessed neuroticism. Because the side effects of contraceptive pills are now widely known, doctors' and patients' expectations could be a significant influence in reporting side effects. In order to control for these non-pharmacological variables we therefore designed a double blind trial of a contraceptive and an inert pill involving an intensive study of a small group of patients. It was assumed that neurotic patients were more likely to report side effects, but that if the degree of neuroticism could be controlled, any significant differences in reports of side effects would be due to the active substance.

The possibility of abnormalities in carbohydrate metabolism in schizophrenia has been stressed by many authors (Mann 1925, Freeman et al., 1943, Braceland et al., 1945, Morgan and Pilgrim 1952, Henneman et al., 1954, Moya et al., 1958, Lingjaerde and Skaug 1959). As there is a close relation between lipid metabolism (in terms of plasma free fatty acids, FFA) and glucose metabolism Mueller (1961, 1962) tested the FFA-response to insulin-induced hypoglycaemia in chronic schizophrenic patients. He found that schizophrenics showed less reduction in FFA-values than healthy controls, in some cases even an increase. Results were later presented which tend to confirm Mueller's data (van Sickle et al., 1966). Interest was focused on increased sympathetic activity in the patients, and infusion experiments with epinephrine (van Sickle et al., 1966) and norepinephrine (Cardon and Mueller 1964) were performed without producing conclusive results.

Studies of the relation between birth rank and schizophrenia (or any other disorder of adults) have hitherto been based on the assumption that, for a null hypothesis, cases will be randomly distributed among the birth ranks. In other words, if the distribution of cases is found to depart significantly from random (i.e. from equal numbers in each birth rank for each sibship size) then an association between birth rank and the disorder is held to have been demonstrated. However, we have recently shown, both from theoretical considerations (Price and Hare, 1969) and from the study of a large sample of psychiatric patients (Hare and Price, 1969b), that birth-rank distribution may depart very significantly from random because of bias arising from changes in the birth rate of the general population. The amount and direction of this bias will depend both on the changes in family size and on the number of families being started during the period of time when the patients (or any other population sample) and their siblings were born. The amount of bias is thus likely to be different in geographically different populations or in the same population at different periods of time.

Reaction to the death of a closely related person is characterized by a period of shocked disbelief, a period of acceptance and suffering, during which time the libidinal attachment to the internalized object is gradually withdrawn, and a prolonged period of readjustment. The first two phases usually last a number of months and correspond to the state of acute grief described by Lindemann (1944), Wretmark (1959) and Parkes (1965). The third phase involves the adjustment to a life without the lost person and in some individuals may persist for a number of years.

Lithium was first successfully used in the treatment of mania by Cade (1949), and its efficacy in reducing mania was confirmed in double-blind trials by Schou et al. (1954) and Maggs (1963).

This study was conducted at an out-patient clinic employing group therapy techniques, where some workers felt that a balance between frequent participators and more silent members was advantageous to the group as a whole. As Taylor (1961) has observed, frequent speakers tend to withdraw from groups if not given enough scope for participation. Very silent members sometimes have difficulty in establishing themselves at all, yet the lack of even one active member may lead to a decline in group morale, hence in motivation to continue treatment.

The Henderson Hospital is a 68 bed unit for the in-patient treatment of young people of both sexes who are described as psychopaths, sociopaths, personality disorders or character disorders. Treatment is by means of a Therapeutic Community, and prospective patients are referred by external psychiatrists with no working commitment in the hospital, by prison medical officers and sometimes by Probation Officers and other social workers with the medical backing of a general practitioner. All prospective patients are seen at a group interview and on the basis of this will be selected for admission or not.

Behavioural symptoms suggestive of the so-called functional psychiatric disorders are often observed during the course of sub-acute or chronic encephalitides, particularly sub-acute sclerosing panencephalitis. This has been regarded as an invariably fatal neurological illness, but Cobb et al. (1) have recently presented two non-fatal cases and have drawn attention to rare scattered reports of others, some with behavioural disorders. We have therefore made a survey of cases of sub-acute encephalitis at the Yale-New Haven Hospital, especially noting their behavioural aspects.

Considerable interest is at present focused on the possibility of an association between mental illness in epileptics and metabolic abnormalities resulting from the anticonvulsant drugs they have been taking; in fact it has been suggested that these drug-induced abnormalities may be actually causative of the psychiatric disorders. For a good summary of this literature the interested reader is referred to Reynolds (1968).

Abnormalities in the EEG of schizophrenics were first described by Lemere (1936) who found schizophrenic EEGs had poor alpha waves. Earlier workers were more interested in frequency abnormalities and Davis (1941) found, from study of the frequencies, the more unstable the EEG in schizophrenia the more unstable the behaviour. This concept is well established and has been confirmed by Brazier (1962) and other workers. However, the study of the different frequencies has shed little or no light upon the aetiology of schizophrenia.

The importance of psychotherapy, as one of the commonest and most distinctive methods of treatment used by psychiatrists, is hardly disputed, although the definition, theoretical basis and effectiveness of its various forms are subject to much debate. In the present article we are concerned with psychotherapy only as a form of service available to N.H.S. patients. Our aims are: (1) to calculate the numbers of patients, living in an area with relatively good services, who are receiving two operationally-defined types of psychotherapy, (2) to estimate the numbers of local patients already attending out-patient clinics who might be referred to a specialized psychotherapy department if certain rules of selection were applied, and (3)to discuss the relevance, if any, of these data for planning local psychotherapy services. The limitations of the material will be obvious and the calculations crude, but they should be adequate to open the subject to realistic discussion.

Freud's Mourning and Melancholia (1917) stimulated much psychoanalytic speculation regarding the relationship between loss of a loved object and subsequent depression. Abraham (1924) considered ‘a severe injury to infantile narcissism brought about by successive disappointments in love’ to be an important factor in melancholia, and used the term ‘primal parathymia’ to describe the disagreeable experiences of childhood which give rise to adult depression. Klein (1940) related all states of depression and mourning in adults to a reawakening of the infant's struggle to make reparation to the mother he fears he has destroyed. She believed that adults who are prone to depression have never successfully worked through this earlier ‘depressive position’. Bowlby (i960) has likened adult grief and mourning to the reaction of children to separation from their mothers. He proposed the view (1961) that children are less capable of coping with death of a parent than adults and adopt the defensive mechanism of ego-splitting by which part of the ego still considers the parent to be alive. This imperfect resolution of the loss situation leads to a fixation on the lost parent and a tendency to react badly to further separations. Brown (1961), extending this theory, maintained that rejections in adult life are likely to release the repressed urges to recover the lost object, and to precipitate a depressive illness.

During the past twenty years, the unity of manic-depressive disease as defined by Kraepelin (1913) has been questioned by investigators who have presented clinical and genetic evidence that the disease is heterogeneous and contains at least two discrete groups (Leonhard, 1957; Perris, 1966). In one of these groups mania occurs and patients exhibit both manic and depressive phases during the course of their illness. This group has been designated bipolar by most investigators (Leonhard, 1957; Perris, 1966). In the other group there are only episodes of depression, and this has been designated the unipolar group by some (Perris, 1966) and corresponds largely to the ‘monopolar’ group of Leonhard (1957). In this paper we shall use the term unipolar throughout to designate an affective illness in which only depression occurs.

Gilles de la Tourette's syndrome has not been reported outside Europe and America, and all the patients reported have been of the white or negro races (Singer, 1963). Although the condition was described as early as in 1825 by Itard and later differentiated as a syndrome by Gilles de la Tourette (1885), and although the syndrome is an unusual condition with undetermined aetiology, treatment and prognosis (Eisenberg et al., 1959, Kelman, 1965), and Kinnier Wilson (1940) had given the syndrome ‘a sinister’ outlook characteristically ending in insanity, Fernando (1967) could find only 85 cases published in English literature as cases of the syndrome. He rejected 20 cases, and of the 65 ‘proven cases' 50 were from the United States, 13 from Britain, one each from Finland and Canada. Shapiro and Shapiro (1968) commented on the scarcity of the syndrome even in the Western culture. Extensive search in the literature has shown that Gilles de la Tourette's syndrome has not been reported in Asians. This paper presents a detailed report of the first case from India.

The results from a small series of persons suffering from alcoholism suggested that the amounts of water and electrolytes in their brains (obtained post mortem) differed from those of control and depressed individuals (Shaw, Frizel, Camps and White, 1969). Since publishing this work we have analysed brain tissue from a further series of alcoholic subjects, and in this paper we compare these findings with the original data from control and depressed groups.