At the autumn meeting of the Medico-psychological Association in 1871, Maudsley—that time President of the Association—reada paper entitled 'In Issanity on the Increase?. The question was then one of profound concern both to the British public and to psychiatrists. Not only had there been for years a constant need to build new asylums—a cause ‘of terrible discouragement and complaint with the ratepayers’ (Arlidge, 1859)—but also, as was clearly apparent in the publications of the Poor Law Office and the Annual Reports of the Commissioners in Lunacy, the number of the registered insane was increasing every year, far out of proportion to the increase in the population (see Fig 1). This circum stance, it was said, ‘miwghetll give rise to alarming apprehension of a mental degeneracy’ in the country (Arlidge, 1862).

The treatment of 15 adolescents with obsessive-compulsive disorder is described. Treatment was in most cases primarily behavioural (response-prevention), with the family involved in the therapy. Other components of treatment which were used in some cases are also described: medication, psychotherapy, and ‘milieu’ therapy. Outcome after treatment was generally good, with symptoms in most cases being relieved entirely or reduced to a mildly incapacitating level. Treatment gains in most cases were maintained at follow-up. Obstacles to treatment are noted, and recommendations are made as to the management of the disorder in adolescence.

Eighteen depressed chronic schizophrenic out-patients were matched with non-depressed schizophrenic out-patients. The depressed schizophrenics had had significantly more psychiatric admissions, past depression, past treatment for depression, significantly more had attempted suicide, lived alone, had low self-esteem, had early parental loss and had had more life events in the six months before the onset of depression. Depressive disorder in schizophrenic out-patients well controlled by neuroleptics may occur in those who are at risk for depression and experience an excess of life events.

Somatosensory potentials (SEPs) evoked by vibrotactile finger stimulation have been reported to be the same in both hemispheres in schizophrenics, whereas they are asymmetrical in normals, with the contralateral hemisphere leading the ipsilateral (Jones and Miller, 1981). These findings were taken to indicate that the corpus callosum is nonfunctional in schizophrenics. To attempt replication of these results, vibrotactile SEPs of 6 schizophrenics and 6 normal controls were recorded with both bipolar and monopolar derivations. Assymetrical bipolar SEPs were obtained in both schizophrenics and controls; previous observations of schizophrenic-control differences were not replicated. Acceptable evidence of ipsilateral early SEPs was not obtained; the test procedure seems inappropriate for measuring callosal conduction time.

Each hemisphere's ability to sustain attention over extended time periods was investigated in 14 schizophrenics and 17 controls using dichotic detection tasks. Schizophrenics produced significantly higher rates of omission errors, as compared to that of commission errors. The rates of omission errors for schizophrenics fluctuated markedly, while the rates of commission errors remained fairly constant. Primarily due to the fluctuation of omission errors, the detection index decreased progressively when schizophrenics were engaged in right-ear tasks. These results suggest that schizophrenics demonstrate a deficit concerning ‘response set’, especially in the left hemisphere. It is feasible that there may be a correlation with disturbances in integration mechanisms of both hemispheres in schizophrenics.

In nine schizophrenic patients on drug holiday, growth hormone (GH) response to apomorphine HCl 0.75 mg (APO) was compared with normal control data. Patients were tested at two month intervals for up to 14 months. Seven patients relapsed, and of these, five had exaggerated GH responses to APO at that time. Of these five, three had exaggerated GH responses to APO prior to clinical deterioration. Further work is required to determine whether this test can be a useful predictor of relapse.

Eighty women taking part in a population study were subjected to a dexamethasone suppression test (DST) intended as a diagnostic aid for melancholia. The women were selected systematically from two age strata, 38 and 50 years. Fifteen subjects (19 per cent) were found to be non-suppressors. High post-dexamethasone serum Cortisol concentrations were not the result of elevated concentrations of the main Cortisol binder, transcortin. There were no differences between suppressors and non-suppressors as regards depressive symptoms, strain experience, body mass, gynaecological history, drug use, smoking, erythrocyte sedimentation rate, number of leucocytes, activity of serum aminotransferases and γ-glutamyltransferase, serum iron, bilirubin, ferritin content, serum growth hormone or serum prolactin. However, the non-suppressors reported a significantly lower (P <0.01) orgasmic capacity in a questionnaire inquiry about two weeks before the DST. The outcome of the study indicates that DST as the presently recommended procedure for out-patients has a lower specificity for melancholia than has been reported previously.

The prevalence of an abnormal response to the dexamethasone suppression test (DST) was examined in 119 in-patients suffering from a major depressive disorder and in 79 normal controls. Only 11 per cent of controls showed an abnormal DST as against 70 per cent of depressed patients. The specificity of the DST was examined by testing patients with other psychiatric disorders. Abnormal responses were found in one-fifth of a sample of schizophrenics, over one-quarter of abstinent alcoholics, two-fifths of neurotics (including neurotic depressives) and almost half of senile dements. Abnormal DST was also found in 33 per cent of patients receiving prophylactic lithium for recurrent affective disorders.

The results of 41 standardised dexamethasone suppression tests (DST) with the Newcastle Scale diagnostic weighting for endogenous depression correlated significantly (P <.001). Specificity of the DST was found to be 89 per cent, sensitivity 82 per cent and the diagnostic confidence for endogenous depression 94 per cent. This strongly supports the validity of the Newcastle Scale diagnostic weighting for endogenous depression.

In a double blind controlled study, 14 affectively ill patients (2 bipolars, 12 unipolars) were randomly allocated to L-Deprenil treatment (an irreversible selective MAO-B inhibitor without “cheese effect”) and 13 patients (3 bipolars, 10 unipolars) to placebo only. Patients on L-Deprenil showed a significantly greater clinical improvement than placebo patients. A positive relationship was found between clinical improvement and degree of platelet MAO inhibition in patients treated with L-Deprenil.

Propranolol 40 mg was compared with a matched placebo tablet in its effect on the performance of anxious and non-anxious human volunteers. Subjects were required to give a brief speech, which was video-taped and later rated by trained observers for signs of anxiety; propranolol clearly reduced rated anxiety in the non-verbal behaviour of anxious subjects, as well as the anxiety observed in the speech of the anxious compared to the non-anxious. It also affected self-reported anxiety in the anxious, and reduced the pulse rate of anxious and non-anxious alike. Subjects were also prompted, by being given the first letter, to recall both difficult and easy words, drawn from selected verbal categories; propranolol impaired recall of difficult items in the memory of anxious subjects. Results were interpreted as showing a central as well as peripheral role for propranolol in blocking adrenergic receptors' activity in anxiety.

In order to investigate the validity of Foulds' hierarchical model of psychiatric illness a cross-cultural study was carried out. The DSSI, a self-report symptom inventory, was administered to 100 English psychiatric patients and a translated version was administered to 100 Turkish psychiatric patients. The report of symptoms in both nationality groups conformed to Foulds' hierarchy principles in 93 per cent and 87 per cent of cases respectively.

When the reporting of symptoms within classes was investigated, nationality effects were observed to influence the self-reporting of ‘hysterical’ neurotic symptoms, irrespective of diagnostic class. Nationality was also observed to influence the reporting of ‘delusional’ symptoms, but in non-psychotic patients.

These results suggest that Foulds' model is a useful one in cross-cultural psychiatry, because it indicates both the universal features of hierarchical ordering of symptoms and the cultural influence on those symptoms which do not define the diagnostic class of the patient.

The relationships between patients speaking out and measured outcome were investigated over 18 months in an out-patient group. The parameters of therapeutic progress were derived from the Symptom Check List and individualized repertory grid rating scales. Each patient's verbal participation was compared to that of other group members and to his own participation over other measurement phases. Speaking out phases were associated with more chance of change and improvement, while silent phases were associated with less chance of change and an increased likelihood of negative change. This study demonstrates the use of a relatively non-disruptive measurement model in testing clinical hypotheses in single psychotherapy groups.

Are heterosexual pairings in which the male is dominant more satisfactory? Coital rates of couples in which husbands were younger than their wives were contrasted with those in which husbands were older, but there was no significant difference. However, the data were not controlled for duration of marriage, and for a constant spouse-age-sum, couples with the husband the younger marry later on average than do the others. So whether younger-husband couples have lower coital rates is undecided.

D. H. Myers et al (Journal, 1981, 139, 118–21) reported negative results of a double-blind investigation of propranolol (up to 1,920 mg per day for up to several months) as an adjunct to conventional neuroleptic treatment in 10 therapy-resistant chronic schizophrenics (compared with 10 control patients under placebo in addition to neuroleptic medication). They concluded with Gardos et al (1973) that the “failure to find propranolol effective in chronic schizophrenia does not cast doubt on its possible effectiveness in acute psychoses.” Our own experience of the short-term treatment of acute psychoses with propranolol and/or oxprenolol in high doses was unsuccessful in three schizophrenics and affected only the manic symptomatology in four out of six patients with schizoaffective psychoses (cf. von Zerssen, 1976; Table I). In two of these patients paranoid delusions even intensified during medication. In two separate drug trials there was a definite improvement in four out of six manic patients treated with propranolol (up to 2,300 mg/day). Therapeutic failures were restricted to incomplete trials (medication of less than 1 g/day or of less than one week's duration).

One may read something about the psychiatry of old age by adhering to the College's reading list, supplementing it with more up to date papers from current journals or selections from the bibliographies and reference lists of reviews and textbooks. It would be profligate of a limited allowance for this article to repeat such lists or even to highlight choices from them. It is arguably as enlightening, perhaps more so, to read around the subject.