Forty-five patients with parkinsonism were carefully matched for age and sex with 45 chronically disabled control patients with a significantly more severe grade of physical handicap. Depression was measured by the Hamilton Rating Scale, and it was found that the parkinsonian group was very significantly more depressed than the control group (p < 0.0001). Depression scores in both groups were unaffected by the patient's sex or by the severity of the disability. Analysis of the individual ratings of the Hamilton Scale showed that parkinsonian patients had significantly higher scores on items relating to suicide, work and interests, retardation, psychic anxiety, general somatic symptoms, and loss of insight. It was concluded that patients with parkinsonism suffer a degree of depression which cannot be solely a reaction to the stress of physical disability. This finding is discussed with reference to the monoamine hypothesis of depressive illness.

During the fiscal year 1 April 1972 to 31 March 1973, 22,210 ECT treatments in 3,438 series were given in Denmark (6.46 treatments per series). Indications for treatment were: endogenous depression, acute delirium, mania, hysterical psychosis, reactive depression and schizophrenia. Unilateral ECT was used in more than half of the departments concerned. Two treatments were given weekly. The types of apparatus and anaesthesia techniques used are described. One death, which had questionable relation to the ECT, was reported, and other complications were few and mild. The advantages of ECT compared to tricyclic antidepressants are described, including the higher percentage of remissions or improvements in the treatment of endogenous depressions (about 80 per cent for ECT compared to about 60 per cent for tricyclic antidepressants). Little risk was found in out-patient administration of ECT. With present techniques and unilateral placement of electrodes out-patient ECT may be recommended for wider use than before.

There are 22 specialized in-patient units for the treatment of alcoholism, all headed by consultant psychiatrists. Recently appointments to two inpatient units took some time to fill, presumably because of lack of suitable applicants. This, together with the current planning or building of further units, indicates a need for more training to provide sufficient consultants now. If, however, the Department of Health and Social Security’s policy of developing a District service for alcoholics and drug addicts based on a consultant psychiatrist taking special responsibility for these problems at District level is to be established, the need for more training is still further emphasized.

When Sir Aubrey Lewis died, psychiatry lost a major figure. He will surely rank with the great men of the past whose work he knew so well and would have judged substantial and enduring. The present assessment, written a few months after his death, can only attempt a preliminary evaluation of the work of a man who for more than twenty years was the dominant figure in British psychiatry.

Four patients with systemic lupus erythematosus (SLE) are described in whom there were major psychiatric complications. Two of these patients had cerebral lupus with psychiatric manifestations of the disease together with other features of disease activity and responding to treatment with high dose steroids. The first of these had had a ten-year history of recurrent episodes of depression before other features of the disease became evident; in the second patient recurrent psychotic episodes occurred after the onset of typical multi-system disease. The third patient had had a minor cerebro-vascular accident four years before other features of SLE became manifest, and cerebral deterioration later on in her life was probably due to hypertensive cerebro-vascular disease secondary to the renal disease of SLE. The fourth patient, a young man, had had recurrent episodes of depression and aggressive behaviour for several years and committed suicide at the age of 33.

We investigated the psychological status of Crohn's disease patients because 10 such patients had been referred to our psychiatric out-patient department over a period of six years, whereas if there were no association between the disease and psychiatric morbidity, the expected referral rate would be one case in 20 to 100 years. We found an association between episodes of psychiatric and physical symptoms in the case histories. We administered the Eysenck Personality Inventory and the Manifest Anxiety Scale to 28 out-patients with Crohn's disease (8 psychiatrically and 20 non-psychiatrically referred), 17 with chronic non-psychosomatic medical diseases, 43 with psychosomatic diseases and 100 with neurosis. Crohn's disease patients were significantly more anxious, neurotic and introverted than both the test norms and the non-psychosomatic medical out-patients and did not differ appreciably from the psychosomatic patients in these respects.

A rational approach to the use of monoamine oxidase inhibitors (MAOIs) is outlined. Patients suitable for treatment cannot be classified adequately using conventional diagnostic labels. They include those with primary symptoms of hypochondriasis, agoraphobia and social phobias, irritability, somatic anxiety and anergia; those with primary depressed mood, guilt, ideas of reference and personality disorders seldom respond. There is great variation in the interval between the first administration of these drugs and clinical response, and this may account for the inconsistencies in published trials. The type of drug and its dose may affect rate of response, as may biochemical factors, including acetylator and monoamine oxidase status. To obtain maximum benefit, a course of therapy with MAOIs should last for several months.

This study investigates the reasons people give for taking overdoses of drugs. A representative sample of 128 subjects were interviewed immediately after their recovery from an overdose. During the interview they were given alternative reasons for taking overdoses and asked to choose any that applied to them. Spontaneous comments about suicidal intent were also recorded. Of the subjects, 44 per cent indicated that they had wanted to die. On the basis of their choices 33 per cent were ‘seeking help’, 42 per cent ‘escaping from the situation’, 52 per cent ‘obtaining relief from a terrible state of mind’ and 19 per cent ‘trying to influence someone’. The association between these various reasons and other expected effects or feelings associated with the act were examined by means of multidimensional scaling analysis. In addition, the characteristics of those expressing suicidal intent and other reasons were studied, together with such consequences as toxic effects and psychiatric after-care. The possibility is discussed that a large proportion of those indicating suicidal intent do so either to gain social acceptability for their act or to influence helping agencies.

The statistical method of autocorrelation, commonly used in econometrics and engineering, was applied to the daily mood scores of ten depressive hospital in-patients. The analyses made possible the quantification of two aspects of the longitudinal course of individual patients' psychopathology, the degree of day-to-day stability and the degree of periodicity in mood. Quantification of the degree of day-to-day mood stability yielded wide variations between patients and suggested that patients might be usefully categorized in terms of this characteristic. Mood stability during periods of severe depression was found to be less pronounced than during periods of relatively moderate depression. Furthermore, the existence of ‘mini-cycles', cyclical fluctuations in mood of one to two weeks' duration occurring during the course of depressive episodes, was demonstrated in three cases.

Binet created the psychology of mental deficiency and incidentally the concept of intelligence which for many years has been a central issue in both psychology and education. He was primarily concerned with learning difficulties in children and it is a wry paradox that his development of the notion of intelligence has proved such a barrier to the study of the learning process. Intelligence for Binet was a summary term which stood in place of all the component elements of learning weakness which he noticed and assessed. His successors such as Spearman (1923), Burt (1937), Vernon (1950) and Jensen (1975) tend to use the term in an explanatory fashion although it is doubtful whether ‘intelligence’ explains ‘mental age’ or ‘mental deficiency’ except as a descriptive cross-reference.

The results from a prospective follow-up study of a group of schizophrenic patients suggest that a significant proportion (41 per cent) are likely to relapse during a two-year period despite the prescription of long-acting injectable neuroleptic drugs. Some will relapse because of a failure of the regime, but others (32–37 per cent) because the pharmacological protection of these drugs would appear to be less effective in certain patients. Even with the major advantages of the long-acting injectable neuroleptics over oral medication, the schizophrenic patient population remains a group with a high incidence of psychiatric and social morbidity which continues to require the full resources of both the hospital and community services.

Whether the existing law affords adequate protection to children and young persons against sexual acts committed against them or other indecent conduct; whether the method by which this protection is given is satisfactory; and, in particular, whether any changes are desirable in the law relating to indecent assault and the legal presumption that a child under the age of consent (at present 16) is deemed to be incapable of consenting to sexual acts.

The protective function of the law has always favoured the weak, vulnerable and immature, particularly against those in a position of trust. Children are by their very nature easily influenced by adults, either for good or for evil, and the effects of abuse of this trust can be far-reaching. There are, of course, situations in which the child is aware of the adult’s misbehaviour, but in such circumstances the child’s irresponsibility is rightly assumed whereas that of the adult is particularly culpable.