The ages of 87 patients attending an open out-patient group in a general hospital psychiatric out-patient department are analysed in relation to persistence with treatment. A highly significant correlation (p <.001) is obtained between increasing age and continued attendance, and a significantly greater number are found to attend for six months or more in the age-range 37–47 than at other ages. In a sub-group of 35 patients, all of whom had attended more than four sessions and had returned a questionnaire, significant correlations are obtained between age and symptomatic improvement (p < .05) and between continued attendance and improvement in interpersonal relationships (P < .05).

To study looseness of associations and other theoretically relevant variables of speech pathology, 51 acute psychiatric patients, including 26 schizophrenics, were studied at the acute phase of their disorder by means of a free verbalization interview. The results on these 51 patients during the acute period were.

1. 1. There were clear differences between the schizophrenic patient group and the control patient group, the overall index of deviant verbalizations being significant at the .001 el.

2. 2. Many types of looseness were found in non-schizophrenic patients as well as in schizophrenics. Except at the very mildest levels, however, the variants of overt looseness were strikingly more frequent in occurrence and severe in degree in the schizophrenic group (p < .01).

3. 3. Gaps in communication, vagueness of ideas and blocking, though present to some degree in our control group, were much more common in the schizophrenic sample (p < .001).

4. 4. In the control group of patients, private meanings (including neologisms), repetition and perseveration were extremely rare, and current delusional thinking virtually non-existent. Private meanings and current delusional thinking were conspicuously present in the schizophrenic sample; repetition and perseveration were present to a mild degree in this acute schizophrenic sample.

5. 5. Schizophrenic patients tend to show more looseness of associations when faced with a request to talk about topics not related to their illness.

Comparative studies of first admission rates to psychiatric hospitals have revealed significant differences in the rates of diagnoses of functional psychoses between the United Kingdom and the United States of America.

The present study examined the diagnoses of indigenous patients born between 1921 and 1955 and first admitted to hospitals in New South Wales, Australia, and England and Wales. Admission rates for mania were in striking agreement. The rate in New South Wales for schizophrenia was slighdy higher and for psychotic depression considerably less than in England and Wales.

A similar trend in diagnostic dissonance would appear to exist between England and Wales and New South Wales as between England and Wales and the United States for schizophrenia and psychotic depression, but this is considerably less in degree.

Five-hundred women electing salpingectomy for contraception and their husbands were studied by means of structured interviews and questionnaires over periods of three months to two years, beginning before surgery. The post-operative follow-up was completed for 374 couples. The subject's condition was compared before and after operation for emergence of any symptoms, and whether there was any significant difference in frequency of intercourse or other sexual behaviour, changes in sexual functioning, emotional adjustment and marital satisfaction. There was evidence of adverse psychological and sexual changes but these were apparently of a mild nature. Eighty-three per cent of the subjects complained of various symptoms, presumably of psychological origin; in 65 per cent sexual desire had declined, and 29 per cent had not resumed intercourse. The mean score of psychiatric symptoms based on clinical ratings rose from 0.38 before to 4.35 after operation, which is statistically highly significant. Paradoxically satisfaction with the operation was expressed by 92 per cent of the subjects.

Thirty years ago it was suggested that the apparently higher incidence of manic-depressive illness in women might be due to X-linked heredity. The hypothesis was undermined by subsequent reports of the frequent occurrence of father to son transmission. Winokur and his associates recently revived it, providing data which indicated that such transmission is absent or rare in the bipolar form of the illness. Additional support has come from linkage studies with known genetic markers located on the X chromosome. The present study, based on the 400 parents of 100 male and 100 female bipolar manic-depressive probands, failed to discover a lack of father-son compared to other affected parent-child pairs. This finding, together with a review of the literature, would indicate that it is premature to invoke X-linked heredity as a general explanation for bipolar manic-depressive illness, though there is mounting evidence that it may account for the illness in some family pedigrees.

In all the contemporary discussion on drug misuse little attention has been paid to the use and abuse of minor analgesics. Over the past 30 years there has been a huge increase in the consumption of aspirin, phenacetin and codeine throughout the world, but only recently have clinicians fully awakened to the extent of the pathology which results from analgesic abuse. Analgesic-induced renal disease was first described in Switzerland in 1953 and for several years was thought to be confined to that country. However, increasing numbers of cases were reported from other countries throughout the 1960s, and eventually it was established that analgesic nephropathy was common in Britain (reviewed by Murray, 1974). Phenacetin was widely blamed for the nephrotoxicity, since it was the common constituent of nearly all the mixtures held to cause kidney damage, and consequently as from September 1974 phenacetin became available only on a doctor's prescription in Britain. The excessive ingestion of other common analgesics is not without risk. Paracetamol in overdosage may result in profound liver damage, while it is well known that aspirin may cause anaemia, gastro-intestinal haemorrhage and peptic ulceration.

Plasma prolactin has been estimated in 69 psychiatric in-patients receiving either thioridazine (20–300 mg./day) or chlorpromazine (50–200 mg./day) or other phenothiazines. A homologous radioimmuno-assay was used which depends on an antiserum to human amniotic prolactin. Prolactin levels were significantly increased in these patients compared with control patients, and were dose related. Simultaneous estimation of growth hormone revealed normal levels.

Non-attenders at a psychiatric new-patient clinic were seen and interviewed six weeks after the missed appointment, as were a group of controls who did attend.

The non-attenders were more likely to have had frequent changes of occupation or belong to families where this was the case with the family breadwinner; a history of court conviction; and a history of previous psychiatric treatment. They were less likely to have improved since referral to the clinic; and to have a diagnosis of manic depressive psychosis, depressed type.

The findings are discussed. There appears to be some self-selection, the most treatable patients keeping their appointments.

In a factor-analytical study of depression across two cultures, African and European, certain similarities and important differences were found. Depression in African cultures presented principally as depressed mood, somatic symptoms and motor retardation. In European cultures depression presented with depressed mood, guilt, suicidal ideas, motor retardation or anxiety. Both groups lost interest in work and the environment.

Guilt and suicidal ideas and acts are uncommon in African sample, and appear to be culturally determined.

Many severely subnormal patients talk little to each other. In this experiment, three pairs of subjects were reinforced for talking to each other, and learned to do so quite quickly. Whether social speech would continue to occur without the benefit of external reinforcement was examined by observing the subjects through a one-way mirror in a bare interview room adjacent to the teaching room immediately after each training session. On some occasions untrained subjects were observed in the bare room with the trained subjects.

The reinforcement of social speech was demonstrated to be effective by the use of a reversal design (baseline, reinforcement, no reinforcement, reinforcement), where the rate of speech increased considerably when reinforcement was available but decreased when it was discontinued. Generalization of the increased social speech, however, was very poor and only significantly above baseline levels with the pair who seemed responsive to social as well as material reinforcement. The implications of this for training programmes are discussed.

Programmes of suicide prevention require for their planning accurate epidemiological surveys.

Doubt has been cast on the accuracy of many existing surveys because of the realization that suicide is under-reported and because of the lack of consistency in the procedure for suicide ascertainment.

Two studies are described in this paper which attempt to examine the problem.

The first is part of an international study supported by the World Health Organization. In it, Denmark and England are compared, and it is shown that there are striking differences in suicide ascertainment procedure between the two countries. Next, on a blind basis, coroners and their opposite numbers in Denmark examine a sample of each other's case records. It is found that the Danes consistently report more suicides than do the English coroners on the same case material; thus considerable doubt is cast on the supposed difference in suicide rates between the two countries.

In the second study, deaths by poisoning are examined for certain coroners' districts in England and Wales. It is shown that there is considerable variation from one district to another in the relative proportions of these deaths which achieve an accident, an open or a suicide verdict. This suggests that in England and Wales coroners may not be consistent in their suicide ascertainment criteria.

Hypotheses attempting to account for differences in suicide rate based on such epidemiological surveys should be viewed with great caution.

On 24 September 1975, at Stanley Royd Hospital, Wakefield, Professor Sir Martin Roth formally opened a Museum devoted to psychiatric history—an event so far unique in British psychiatry. The creation of the Museum was the outcome of two years of planning and work by the Yorkshire and Humberside Museum Service, the hospital staff and the first curator, Mr A. L. Ashworth.

In this study 368 patients were interviewed after they had attended the Bristol Royal Infirmary Accident and Emergency Department following a non-fatal act of deliberate self-harm. There were twice as many women (247) as men (121), and two thirds of the patients were in the 15–35 age group. Ninety-five per cent had taken a drug overdose, most commonly one or more of the tranquillizers, antidepressants, hypnotics or analgesics. Seventy-eight per cent had taken drugs prescribed by a doctor. Half the patients mentioned interpersonal conflict as a major precipitating factor in the episode. A psychiatric diagnosis was completed for all admitted patients, of whom 52 per cent were considered to be suffering from neurotic depression, 29 per cent from personality disorder, 12 per cent from functional psychosis and 10 per cent from alcohol addiction. Almost half had deliberately harmed themselves on a previous occasion. The series showed a greater than average incidence of unemployment, overcrowded living conditions, divorce and antisocial behaviour. The implications of these findings for the clinical management and prevention of non-fatal deliberate self-harm are discussed.