This paper presents a well-documented case of monozygotic male twins concordant for infantile autism, with a twelve-year follow-up. Assessments include birth records, laboratory studies, physical measurements, psychometrics and quantifiable behavioural ratings by independent raters using multiple scales. Possible aetiological factors of infantile autism, as well as outcome are discussed.

Seventy-eight depressives were assessed on the Delusions-Symptoms-States Inventory. The results supported Foulds' and Bedford's hierarchy model, in that nearly all patients fitted this model, and the relationship between delusions of Contrition and state of Depression was found to be an inclusive, non-reflexive one. Suggestions are made for extensions to this study.

The psychological function of the social network is considered in terms of attachment theory. Social bonds are proposed as essential for obtaining a commodity commonly but unsatisfactorily referred to as support. Requirements for this complex commodity can be discerned in a wide range of contexts. Examples considered are the evolutionary origin of the social network itself, the concept of psychosocial supplies, the distribution of neurosis in Western and non-Western populations, the use of medical consultations, psychotherapy and habitual responses to adversity or disaster. In these and other contexts, it is apparent that individuals have, quite simply, a requirement for affectively positive interaction with others. Under stressful conditions this interaction is called ‘support’. When support is lacking there is evidence that psychiatric and perhaps medical morbidity rates increase. For research, the objective must now be to determine whether depleted primary group interaction is causally related to morbidity, or whether it is only an associated or a secondary factor in aetiology, or indeed wholly unrelated. Elucidating more precisely why people need people constitutes an important new task for social psychiatry.

Middlewood Psychiatric Hospital, Sheffield, has recently provided facilities for the admission of babies with mothers suffering from psychiatric illness. The venture was sufficiently novel and noteworthy to receive mention in national newspapers, and one gathers that medical and nursing staff are pleased and encouraged by their experiences with their first few mother-infant pairs.

A survey of relatives' experience of coroners' inquests on suicides is reported. The survey was conducted shortly after the inquest and gave results similar to those of a survey which took place some years after the relevant inquests. Both surveys show that the inquest aggravates the distress resulting from bereavement by suicide. Implementing the Brodrick Report and preventing the publication of inquest reports in the press would relieve some of this additional distress.

To test the Foulds and Bedford hierarchical model of personal illness, the Delusions-Symptoms-States Inventory (DSSI) was administered to 100 psychiatric in-patients. Ninety-six had symptom patterns compatible with the hierarchy. This is significantly more than expected on the basis merely of the number of DSSI items affirmed, and overall the results support the model.

The psychiatric tutors in the South West Thames Region recently got it into their heads that as no one had ever taught them anything about how to teach it was high time they explored the possibilities. This idea, backed by Professor Dick, the Postgraduate Dean, roughly coincided with the appointment of John Heron as Assistant Director of Medical Education to the Postgraduate Federation. He has been known for years, while working at Surrey University, as an advanced educationalist alarmingly inclined to the use of encounter group methods. Undaunted, the tutors sent out a reconnaissance party, then digested a provisional programme in the form of a contract which talked of facilitative and cognitive learning, the need to study the relationship between teacher and taught, to forego the idea that teachers are born and not made, to accept that techniques of teaching do not take you far unless the relationships are right, and hence the need for group experience and some personal disclosure.

The excess incidence of schizophrenia reported from Ireland may partly be due to the unusual distribution of the Irish population by maternal age at birth.

A psychiatric investigation on 56 cases of male transsexuals in Singapore revealed a prevalence of 1 in 25,000. Eighty-two per cent were prostitutes and 83 per cent had completed secondary education. All were unmarried, and 35 per cent were co-habiting with men. Fifty-eight per cent had felt they were females before the age of 5, 65 per cent cross-dressed before the age of 10, and by the age of 20, 57 per cent were completely cross-dressed of whom 73 per cent were receiving female sex hormones. Their mean IQ was 105. Thirty-two (58 per cent) underwent sexual reassignment surgery. There was no report of psychiatric complications. It was concluded that transsexualism as described by different authors may not refer to the same condition. Aetiologically, these cases did not appear to be determined by early childhood experience.

Attitudes to the treatment of the pre-school child today stem very largely from the mainstream traditions in classical child psychiatry, the most powerful of which is still probably psychoanalysis. Recent articles (e.g. Freud, 1966; Frommer, 1967; Bentovim and Boston, 1973) describing treatment units for very young children exemplify very clearly the influence of these traditions and illustrate the difficulty of breaking new ground in conceptualizing treatment procedures. It will be the purpose of this paper to take issue with such traditions, and to argue that it is time for a new look at pre-school child psychiatry.

Junior schoolchildren were screened for high risk of emotional and educational disorder. The information was gathered from the school, using standard and objective tests. The multiple criterion screen employed, comprised: (a) classroom behaviour scale (Rutter B Scale), rated by teachers; (b) sociometric tests; choice of companions by classmates. From these, lack of positive choices was taken as a measure of isolation and a high rate of negative choices, as a measure of rejection; (c) Reading quotient of 75 or below on the Young Reading Test; (d) Absence from school for reasons considered by teachers to be trivial.

The number of cases identified by the screening was found to be 322 children per thousand. They may be seen as representing a high risk rate.

Using extreme scores as indicative of high risk, approximately 17 per cent of children were identified on the basis of the behaviour test; 12 per cent by the reading test; 9 per cent by the isolation test; 8 per cent by the rejection test and 3 per cent by the absenteeism test. Seventy per cent of the identified children were rated clinically as disturbed. Absenteeism identified the smallest percentage of cases and made the smallest independent contribution to identification. Isolation was not impressively related to neurotic or antisocial beha viour. The three important criteria, therefore, were behaviour, rejection and reading.

Corrected disturbance rates for our population of 7-8-year-old children, including those not identified by the screen, were 6-8 per cent markedly maladjusted and 33.7 per cent somewhat maladjusted.

An account is given of impressions and observations collected during three weeks in November 1975 which the writer spent with two of his chronic schizophrenic patients in a purpose-built isolation unit inside which it was impossible to have any idea of the real time.

This experience gave the observer an unusually close view of schizophrenic and institutional behaviour and some insight into the natural outcome of staff-patient interaction.