The diagnoses given to samples of 1,000 first admissions to English mental hospitals in 1977 and 1980 were compared in order to find out how much influence the 9th revision of the International Classification and its glossary had had on the diagnostic habits of English psychiatrists since its introduction in January 1979. Although the differences between 1977 and 1980 diagnoses were modest they were greater than those found in an earlier comparison of 1968 and 1971 diagnoses, before and after the introduction of the 8th revision. Comparison of all four sets of diagnoses, from 1968 to 1980, revealed some serial changes in the categorization of depressive illnesses and a slowly increasing familiarity with the ICD. Although a higher proportion of diagnoses used the nomenclature of the ICD in 1980 than in previous years, this was mainly because the ICD had adapted itself to the habits of English psychiatrists rather than the other way about.

We report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.

We used the Wechsler Adult Itelligence Scale (WAIS) to study a sample of patients with affective disorder (N = 52), schizophrenia (N = 17) and organic brain disease (N = 8). Schizophrenic patients had lower verbal, performance and full-scale IQs than patients with affective disorder, but were no different from those with organic brain disease. An individual WAIS subscale analysis showed that, compared with affectives, schizophrenics had relatively poorer performance on language than non-language tasks.

These differences were independent of age, sex, handedness, educational level or drug administration and are consistent with a variety of studies demonstrating significant cerebral dysfunction in carefully diagnosed schizophrenic patients.

Patients conforming to the Feighner criteria for schizophrenia who had been discharged from hospital were traced after 5–9 years. They were assessed in terms of mental state and cognitive, behavioural and neurological functioning; the results of these assessments were related to information obtained from casenotes. The findings of this study of 120 discharged patients were compared with those of an earlier study of 510 in-patients with schizophrenia. When factors of age and duration of illness were taken into account there was no difference between the two groups in terms of positive or negative schizophrenic features or behavioural performance, although the in-patients performed less well on cognitive tests. This study indicates that the deficits of chronic schizophrenia are an integral feature of the disease: process, and that any effects of institutionalisation are relatively small.

Although auditory hallucinations in schizophrenic patients are usually thought to be private events, several early writers observed vocalizations concurrent with hallucinations. The content of such vocalizations corresponded to what the voices were reported to have said. A schizophrenic patient is described whose whispers were increased to an intelligible level by the use of auditory feedback. This has implications for the self-control of hallucinations, and for neurological theories of verbal hallucinations.

The patterns of self-reported symptoms in 103 chronic psychiatric patients were examined using the Delusions-Symptoms-Sign Inventory (DSSI). The subjects were all those able to co-operate drawn from the total population of psychiatric patients in Leicestershire who had been in continuous in-patient or day-patient care for over one year. A majority reported dysthymic symptoms and some sort of delusions. Three-quarters produced patterns of response predicted by the hierarchy hypothesis of Foulds.

A longitudinal study of neurotic disorder in the community showed that half the cases identified at first interview had remitted one month later. Remission was significantly related to four variables: recency of onset and of peak of the disorder, the occurrence of recent threatening life events and the occurrence of subsequent ‘neutralizing’ life events. A neutralizing event was defined a priori as one which neutralized the impact of an earlier threatening life event or difficulty. One third of all remissions were caused by such an event. Remission of disorder was not significantly related to demographic variables, symptom severity, syndrome type, medical consultation or psychotropic drug prescription. The implications for neurotic disorder in the community are discussed, in particular its relation to life events and the favourable outcome in the absence of treatment.

This study compared life events in three groups: hospitalized psychiatric, hospitalized paediatric, and non-patient non-hospitalized children, all aged 7–12 years. The most common life event in each group respectively was moving to a new school district, hospitalization for physical illnesses, and outstanding personal achievement. The hospitalized children had a significantly greater number of life events and mean score of life events than that of the general population. The authors conclude that the study of life events alone is insufficient to infer a causal relationship between life events, onset of illness and hospitalization in children.

A medical, psychiatric and social assessment was conducted on 272 residents admitted consecutively to local authority residential care for the elderly in Nottingham in the year ending 31st January 1978. A high level of medical and psychiatric pathology was discovered, in spite of frequent general practitioner contact in the community and recent hospital admissions. Few of the staff in the old people's homes were sufficiently qualified to deal with the medical and psychiatric conditions of the residents only a third of whom had been examined by a general practitioner during the month after admission. The social service provision in the community showed an uneven pattern and did not appear to have a direct relationship with the residents' requirements, 12 per cent of whom could have remained in the community had there been adequate social assessment and support. Only just over half were appropriately placed, and a further third should have been in the care of the hospital services.

Recommendations for change are directed towards the provision of routine medical, psychiatric and social assessment of all potential residents by geriatricians and psychogeriatricians in close collaboration with social services in special local authority assessment homes.

This paper examines the capital costs and accommodation provided in three different types of residential facility for mentally handicapped people—a large campus hospital, a small campus hospital and a network of individually-sited hospital units. The findings do not indicate any economy arising from increased size, or from centralization of facilities on a single site. These findings, together with the other research cited, have implications for the design of future residential services.

Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between ‘dieters' and ‘vomiters' were less pronounced than those reported elsewhere. However, the ‘vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown–Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.

Previous speculation based on a mail survey of psychiatrists suggested that exhibitionism is rare in Latin American countries. This survey of potential victims conducted in Guatemala and using a comparable United States facility as a control, shows the incidence in the two countries to be essentially the same. This suggests that the psychopathology of the exhibitionist has more to do with the act than does the culture in which it occurs.

I live in a basement flat in Central London. Three years ago I opened my front door and found a woman asleep outside. She seemed about 55-years-old. I had never seen her before. Since then she has used this area for sleeping purposes and has slowly acquired prescriptive rights over my doorstep and over the disused coke cellar adjacent to it (where she stores her possessions). Before she turned up on my doorstep she had tried sleeping in several other doorways in the vicinity, but my neighbours are all, to varying degrees, afraid of her. She is only a small woman, weighing perhaps 8 stone and rather frail, so clearly she represents no physical danger, but her strangeness may put people in mind of a witch.

The status of enuresis as a symptom of psychiatric disturbance is still uncertain despite a considerable amount of research, which has been well reviewed by Shaffer (1973, 1977, 1980). The problem is that although general population surveys, such as the Isle of Wight investigation (Rutter et al, 1973) and the National Child Development Study (Essen and Peckham, 1976) have indicated a definite association between enuresis and psychiatric disorders, particularly the common neurotic and conduct disturbances, they have also made it abundantly clear that the majority of children who wet are actually well-adjusted and free from other problems affecting their behaviour. Enuretic children referred to clinics for treatment are more likely to be psychiatrically disturbed (Hallgren, 1957), but even then the majority of them are free from other behaviour difficulties.

Presumably one function of an hypothesis is to provoke further thought and observation. Therefore, I welcome the critical comments of Ashcroft and colleagues (Journal, March 1981, 138, 268–9) on my suggestion concerning the relationship between dopaminergic disturbances and the positive and negative symptoms of schizophrenia (Crow, 1980a, b). However, I think they have misunderstood the proposal and have underestimated some of the relevant evidence. I believe the evidence for two processes is more compelling than they have conceded and I note that in their own hypothesis they have introduced two factors to account for phenomena that both Mackay (1980) and I regard as a problem for the simple dopamine theory.