Twenty-two female patients with anorexia nervosa were assessed by means of objective personality testing. The EPI, Leyton Obsessional Inventory, Cattell's 16 PF and Raven's Matrices were used for this purpose. The personality profile that emerged was of a highly neurotic and introverted person with moderately severe obsessional features and average intelligence.

The title of this paper is intended to act as a reminder of the epochal work of Hartog and Rhodes, An Examination of Examinations and An Examination of Examiners, first published in 1935. It will be worth while to refer to some of the details. They took several essay answers to examination questions, typed them out and handed them out for marking to a number of examiners. The wide range of marks sometimes given to the same answer was astonishing; from distinction to failure. Six months later they gave the same answer to the same examiners and asked them to mark them. The discrepancies between the marks given on the two occasions by the same examiner were equally large and equally astonishing. In one part of their investigations they had written out a model essay to provide the examiners with a standard; by accident, this essay was included with all the others and was marked by the examiners in the same way and with the same results. This work may be regarded as being a watershed in the history of the technique of examinations, but its significance has penetrated very little into the consciousness of the academic world. As for medical examinations, it was only when Hartog and Rhodes’s work was repeated and their findings rediscovered after World War II that they began to have any influence.

A psychiatric condition disabling to persons in the fifth and sixth decades is described. Approximately 51 per cent of nearly 1,000 Social Security Disability applicants sampled presented a wide variety of somatic and psychological complaints, but no severe psychiatric disorder. This group is characterized by inability to continue gainful employment. Commencement of full-time employment before age 16 years (59 per cent) and level of education were the only significant differences between this group and psychotic applicants; another 33 per cent began full-time work before age 20 years. 88.5 per cent of the families of these persons remained intact until after they began work. Apparently, being thrust into the responsibilities of adulthood earlier than their peers contributed to the early disability.

Fifty-four patients suffering from a variety of psychotic states were graded by their degree of psychomotor activity. Serum creatine Phosphokinase (CPK) levels were found to be related to the degree of psychomotor activity, irrespective of the diagnostic category. Retarded and withdrawn patients had normal serum CPK, but on their return to normal psychomotor activity the CPK levels tended to rise transiently. It appears that unphysiological motor activity has a more direct relationship to the rise of serum CPK than motor activity per se.

This investigation is an attempt to test the common supposition that postpartum emotional disturbance is related to hormone changes. A group of 27 normal pregnant women were assessed three times before delivery and sixteen times in the six weeks following delivery. During the first two interviews baseline data on personality and other personal variables were obtained. On each occasion blood was taken and three measures of clinical status and mood were completed. Plasma LH, FSH, total oestrogen and progesterone results are presented in detail and the results of prolactin assays mentioned more briefly. An attempt to correlate hormone findings and clinical findings is described. This failed to produce any strong evidence that hormones are related to mood at this time, although hormone changes were correlated weakly with a few specific symptoms. Some of the unexpected clinical findings and technical difficulties of the study are discussed, with special reference to possible further research in this area.

Better Services for the Mentally Handicapped (1971) forecasts a diminution in the number of beds in hospitals for mental handicap. It can be achieved only by the admission of fewer new long-stay patients. This paper considers 50 new long-stay cases admitted to a hospital for mentally handicapped in the five years 1970 to 1974. Of these admissions 42 per cent were children, and of all the admissions 54 per cent had Wechsler intelligence quotients under 25. Further, 62 per cent of the admissions were for behaviour problems and 38 per cent were for physical infirmity and helplessness. It is concluded that there are some mentally handicapped people who have problems with which only a hospital can cope. The high nursing dependency and the profound mental retardation of a majority of the new long-stay patients present a formidable challenge.

The efficacy and side effects of 10 mg of nitrazepam and 25 mg of thioridazine as sleeping aids were measured in 20 psychogeriatric in-patients during the 14th night and morning of drug administration. The trial used a double blind, cross-over design. The effect of nitrazepam was slightly faster than that of thioridazine. After thioridazine, but not after nitrazepam, the patients slept significantly longer than after placebo. Nitrazepam, but not thioridazine, significantly impaired patients' abilities to move and to conduct everyday activities. It is concluded that thioridazine is a suitable sleeping aid for psychogeriatric patients, but that nitrazepam should be avoided.

Catechol O-methyltransferase of lysed human red blood cells was assayed under optimal conditions, using saturating concentrations of the substrates, S-adenosyl-L-methionine and 3,4-dihydroxybenzoic acid. The mean enzyme activity found in 24 normal subjects was 29.2 nmol/hr/ml RBC. The mean activity in blood of 33 female unipolar depressives was not significantly different from normal. However, higher enzyme activities were observed in the blood of 11 schizophrenic patients (38.9 nmol/hr/ml RBC). Partially purified enzyme preparations from blood of normal and schizophrenic individuals were indistinguishable with respect to substrate specificities, isoelectric pH values, and ratios of the two O-methylated products. Therefore it is unlikely that any defect in O-methylation which may occur in schizophrenia can be attributed to a change in the intrinsic properties of erythrocyte catechol O-methyltransferase.

Two cases are presented in which treatment with lithium was complicated by thyrotoxicosis. The underlying physiological mechanisms are discussed.

Lithium suppresses thyroid function, so the early stages of thyrotoxicosis may be clinically undetectable. The symptoms and signs of thyrotoxicosis may be confused with the side effects of lithium, and if lithium is withdrawn severe rebound thyrotoxicity may occur. Furthermore, some of the side effects of lithium may be aggravated by thyrotoxicity.

These cases provide further evidence of the importance of routine screening of thyroid function before starting treatment with lithium.

A retrospective study of the records of 17,571 psychiatric patients who attended the out-patients department of Eginition Hospital in Athens during three two-year periods (1948–50, 1958–60 and 1969–71) revealed a statistically significant decrease in the frequency of patients diagnosed as suffering from hysteria, a statistically significant decrease in the relative frequency of patients with hysterical fits and with mental conversion symptoms, and a statistically significant increase in the relative frequency of patients with mixed conversion symptoms. The findings confirm the notion that hysteria is still a ‘woman's disease’, although a statistically significant increase in male participation was noted. The significance of the above findings for the understanding of certain aspects of hysteria is discussed.

We studied the relationship between side effects, clinical outcome and the drug plasma levels in 28 female depressed patients treated with protriptyline. After 3½ weeks treatment, patients with plasma levels within a median range (630 to 900 nmol/1) showed better responses to the drug than patients with plasma levels outside this range.

There were no statistically significant correlations between plasma levels and side effect scores or ‘corrected’ side effect scores (scores after subtracting pre-treatment values) for the group at any time after starting the treatment. But we found positive correlations between plasma levels and ‘corrected’ side effect scores for the neurotic subgroup after 14 and 21 days of treatment. Other correlations between plasma levels and side effect scores were non-significant.

Three-hundred-and-thirty cases of unnatural death, leading to 110 open verdicts, 110 verdicts of suicide and 11o of accident, from the Inner West London Coroner's District have been examined to see if particular coroner's officers or pathologists were associated with disproportionate numbers of suicide verdicts. No significant deviations from the expected numbers were found. Coroner's officers probably share common ideas about the features defining suicide, and so do pathologists.

In 1970 we studied the phenomenon of rejection in two units of a psychiatric rehabilitation hospital (Morgan and Cheadle, 1972). The study concluded that 20 patients out of a sample of 110 were rejected to some degree by some members of staff. The method employed to determine this was to ask all members of staff to name the patients who they considered fitted into certain categories. Ten of these categories indicated desirable behaviour such as helpful, co-operative or appreciative; the other ten were of an undesirable nature such as lazy, untrustworthy or attention seeking. The questionnaire used was published as the Appendix to our previous paper. If a staff member placed a patient into more undesirable than desirable categories he was considered as rejecting that patient. If more staff rejected a patient than accepted him, the patient was considered to be a reject.