Despite dramatic clinical improvement in about one-third of a group of severely depressed, medication-resistant patients one year after modified leucotomy, their relative decrease in conjugated and free tyramine output after an oral tyramine load remained unchanged and abnormal. Whilst a direct deficit in intestinal tyramine-conjugating ability still needs to be finally ruled out, this appears most compatible with a deficit due to bodily metabolic failure, perhaps a deficit in membrane transport which could be an essential aspect of the depressive illness syndrome. Attention is drawn to a similar defect in migraine. The two illnesses may represent a common predisposition which an appropriate triggering mechanism may transform to the florid disease. Biochemical detection of such vulnerability may have important diagnostic and predictive significance.

Erythrocyte catechol-O-methyl transferase (COMT) activity was studied in 65 patients with depressive illness and anxiety states. A hypothesis that measurement of this enzyme might have some value as an aid to diagnosis and as an index of clinical recovery has not been confirmed. In patients with endogenous depression, agitated subjects had COMT levels significantly higher than normal (P < ·01) and retarded subjects had levels significantly lower than normal (P < ·02). These observations are congruent with some reports of high and low urinary MHPG excretion in patients with depression. Further data correlating COMT assays with catecholamine metabolites in depressed patients may reveal homogeneous biochemical subgroups which could serve as a guide to rational therapy.

The incidence and quantities of dimethyltryptamine and O-methyl-bufotenine were studied in the cerebrospinal fluid of patients suffering acute schizophrenic illnesses and in surgical and neurological control groups. Some schizophrenic patients have higher levels of both amines than do controls, though the differences in distribution did not reach statistical significance in the sample studied. The gas-chromatographic technique used is sensitive at the low picogram level.

Gamma-aminobutyric acid (GABA) levels in the CSF were measured in 9 normal individuals, 17 drug-free schizophrenic patients and 10 of these same schizophrenic patients after neuroleptic treatment. There was no significant difference between CSF level of GABA in the control group compared to those in schizophrenic patients; however, 6 of the 7 lowest GABA levels were from schizophrenic patients. There was a significant decline of 12 per cent in mean GABA levels in the CSF after a mean of two months of neuroleptic treatment.

The HLA (Human Leucocyte Antigen) types A and B were studied in 80 patients diagnosed as schizophrenic. There was an increased incidence of HLA-BW5 and a decrease in HLA-AW29 and HLA-BW17 as compared with healthy controls. In the sub-group of patients exhibiting Schneider's first-rank symptoms there was an increased incidence of HLA-A1 with a decrease in HLA-A2 and HLA-BW17.

The correlation between serum and saliva lithium levels in patients undergoing lithium prophylaxis therapy is discussed. Although a high correlation can be obtained, there is an unacceptably high individual variation of paired results. Two strategies were used in an attempt to improve the reliability of saliva as a predictor of serum levels. A naturally occurring marker in saliva and serum was used. This showed high correlation but still did not prevent large sporadic differences. Serially paired results in individual patients also showed occasional excessive variation. Although saliva lithium has been used for monitoring when serum assessment is impracticable, it is considered that it is, as yet, an unreliable technique.

The quarterly distribution of births of patients born in England and Wales 1921–60 and first admitted in 1970–75 was examined by decade of birth and by age at year of admission. For patients with schizophrenia and affective psychosis, the distribution varied: in the early decade (1921–30), and for older patients (45–54 years) the proportion of births in the fourth quarter of the year was high, compared with expectation from live births in the general population; but it became lower in succeeding decades and for younger age groups. No comparable change occurred for births of patients with neurosis or personality disorder.

Three different patterns of morbid grief are noted. The effect of forced mourning procedures on morbidly grieving patients is discussed with some indication of beneficial and harmful effects of psychotherapeutic intervention.

To date there has been no suitable scale for the self-assessment of irritability in the clinical situation. Existing scales have either included aspects of personality trait together with present state or they have been constructed on non-clinical populations. A self-assessment scale has been constructed which seeks to overcome such faults. Measures of depression and of anxiety are included, together with measures of outwardly directed irritability and inwardly directed irritability. This scale should be known as the Irritability, Depression, Anxiety—or IDA—Scale.

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

It is known that official suicide statistics underestimate the incidence of suicide, but it is not clear whether the extent of under-reporting remains constant. An examination of coroners' records in Dublin from 1900 to 1904 and comparison with a similar series in 1964–68 suggests that the underestimation was of similar proportions in both series. It is suggested, therefore, that official suicide statistics are likely to reflect valid temporal changes in suicide and are therefore of value for the study of socio-economic influences on trends in suicide frequency.

This paper brings up to date a 1970 study of suicide attempters coming to a major emergency room in an United States urban community and reviews international trends in suicide attempts. Results of the study and the review of the international literature indicate that the high rates of suicide attempts that were observed in 1970 are continuing into 1975. The incidence of suicide attempts continues to be a public health problem primarily among young women. Pill ingestion, usually barbiturates and psychotropic drugs, continues to be the most common method used.

The results of a follow-up study of schizophrenics attending a centre in North West India are reported. The relevant literature is reviewed, The results were compared with two well-known studies, one from the United Kingdom and the other from Mauritius. The evidence presented suggests that the course taken by schizophrenia in a newly-developed city and its neighbourhood in this part of India is similar to the one seen in the Western world. This study does not support the view that chronicity of schizophrenia in non-European, non-white populations is different, at least in an urban setting.

Analysis of medical students' formulations and replies to clinical problems indicates difficulty in deciding on the nature and organization of treatment. A programme describing a problem-solving approach was devised, and students taught in this way were shown to be significantly more able to formulate organized treatment plans with more precise aims. It is suggested that problem-solving methods are likely to be much more effective than conventional teaching of psychiatry.

Two child observation and assessment centres run by a Social Services Department have quickly filled up with older children who stay indefinitely. Many of these children have physical as well as emotional problems and have been admitted as family emergencies in an unplanned way. The paper discusses how, if at all, the psychiatrist called in for advice by social workers can help. This is thought to be a widespread problem.