A double-blind clinical trial has been carried out to ascertain whether patients making a good recovery from depressive illness with tricyclic antidepressant medication derive any benefit from continuation of therapy with the same drug at a lower dose level. Of the 92 patients who entered the trial significantly fewer on active treatment relapsed during the six-month trial period: 22% as compared with 50% of patients receiving placebo. Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had made a complete recovery. The findings relate to a six-month trial period only, and any possible advantage of continuation therapy over a longer period remains uncertain.

In a partly retrospective, partly follow-up study, 27 patients aged 1 year 10 months to 16 years 2 months with reversible somatotropin deficiency, showed a relationship between the rate of statural growth and sleep, graded as good, poor, or mixed. During periods of good sleep the overall growth rate averaged 1·04 cm per month, and during periods of poor sleep it averaged 0·34 cm per month (t=8·46, df=32, P<0·001). Presumably, good growth, good sleep, and optimal nocturnal somatotropin release intercorrelate in this syndrome of dwarfism, but the data with regard to nocturnal somatotropin release remain to be demonstrated empirically.

Results are presented of pituitary gonadotrophic and testicular steroid hormone assays carried out on 11 phenotypic males with a 47, XYY karyotype. These results are compared with those from a control group of normal ambulant males and a group of patients with a 46, XY karyotype who were detained in a maximum security hospital.

Increases in barbiturate tolerance and in scores on certain cognitive tests were found to have occurred after the treatment of elderly depressives. These changes were related to original severity of illness and to the extent of improvement, as well as to a number of other clinical features including age at first attack. The reported findings lent support to theories linking depressive illness with reduction in cortical arousability.

Plasma cortisol-binding capacity (CBC) was determined in 18 psychiatric patients, including 14 who had affective disorders, and 18 controls. Men with unipolar depressive illnesses had significantly lower CBC values than men with bipolar illnesses and male controls. No other significant differences in CBC values were found and it was concluded that elevated total plasma cortisol levels in affective disorder were probably associated with increased levels of unbound cortisol. The possibility that low CBC values may be a genetic marker for certain types of affective disorder requires further investigation. The effect of certain drugs on CBC was also investigated.

A theory is proposed which relates the learning theory concepts of reinforcement and incentive motivation to visceral afferent pathways in the central nervous System. Herrick's hypothesis of the functional significance of the difference between olfactory and gustatory connexions is used to demonstrate a parallel between olfactory and ‘drive inducing’ stimuli in their role in energizing and directing behaviour; and a somewhat similar parallel between the roles of gustatory and ‘reinforcing’ stimuli. This theory is used to explain recent evidence that there is a relationship between catecholamine-containing neurones and electrical self-stimulation behaviour. It is proposed that self-stimulation can be understood as resulting in most instances from activation of one or both of two ascending Systems: (1) a ‘reinforcement System’ (which may be phylogenetically related to gustation), arising from cell-bodies in the locus coeruleus and releasing noradrenaline as a neurohumour from terminals distributed to the neocortex; and (2) an ‘incentive motivational’ System (which may be a phylogenetic derivative of olfactory pathways), arising from cell bodies in the ventral mesencephalon and releasing dopamine from terminals distributed to the corpus striatum and related nuclei. Some implications of this theory for the action of certain psychotropic drugs and the ‘catecholamine hypothesis’ of affective disorders are discussed.

The paper focuses on recent criticisms of the study of the role of life-events in the onset of psychiatric conditions and suggests that measurement error and bias can be reasonably well controlled by various methodological procedures. Failure to comply with these may be expected, however, to increase rather than decrease the chances of establishing a ‘positive’ resuit. Three further factors to do with the design of studies and the analysis of data are discussed which are likely to mask real differences between patient and comparison group, and which therefore might explain the ‘negative’ results reported in the literature. They concern: (1) the choice of an appropriate comparison group; (2) specification of the length of the period between event and onset; and (3) specification of the event in terms of some measure of severity. Results from two London studies of schizophrenic and depressive patients are presented to illustrate the argument. The studies suggest that life-events do play an important causal role in bringing about both disorders.

Results of studies with various versions of the Symptom Rating Test are described. The test was designed to measure changes in the symptoms of neurotic patients participating in experiments in therapeutics such as drug trials. In all studies the test scores discriminated significantly between psychiatric patients and normals. In drug trials the test was found to be effective in discriminating between the responses to psychotropic drugs and to placebo. The findings suggest that the test is a valid and reliable measure of distress.

Three videotapes of diagnostic interviews were rated by psychiatrists at several different centres in the British Isles. Audiences were asked to use a number of rating schedules including a list of 116 technical psychiatric terms. They were also asked to make a provisional diagnosis. The influence of the psychiatrists' concepts of normality and the type of training and other factors such as age on the perception and quantitative assessment of psychiatric symptoms and the use of technical terms is discussed. Maudsley-trained raters tended to see fewer symptoms of all kinds in all three patients, while Glasgow psychiatrists made more ratings of affective symptoms–both manic and depressive—on two of the three tapes. Dublin raters use more ‘dynamic’ terms in their daily routine than do raters from the United Kingdom. Raters over 40 years of age tended to use ‘dynamic’ terms more often than raters under 40 years. Raters trained in university departments differed only slightly in the terms they used from those trained in area mental hospitals. This study points to the problems of psychiatric communication within one culture.

Previous writers have suggested a relationship between psychiatric disability and epilepsy, and this is confirmed in the present survey of epileptic prisoners.s The older epileptics, who included four cases of severe cerebral damage, were particularly prone to anxiety and depression. Those with temporal lobe epilepsy had been the most suicidal. The one schizophrenic was a ‘doubtful’ epileptic.

This survey investigates drug defaulting by schizophrenic patients on a regime of long-term medication with injections of long-acting phenothiazines (LAP). Although the frequency of discontinuing LAP was appreciably less than reported in most surveys on oral medication, it remained a problem. An analysis of the reasons for patients discontinuing LAP identified several causes: patient-refusal, side-effects, failure of administration of the regime, and patients losing contact with the medical services by moving to other districts.

A double-blind trial of phenelzine versus placebo in psychiatric outpatients with long-standing phobic anxiety is described. Forty patients with agoraphobia or social phobias entered the trial and 32 of these completed treatment with either phenelzine or placebo (with appropriate dietary restrictions) in flexible dosage for two months. Fourteen pairs of patients were prospectively matched, and analysis of the score differences between these pairs showed a significant improvement for patients on phenelzine compared with placebo on overall assessment (P<0·01) and secondary phobias (P<0·05). These differences were not shown at assessment after one month's treatment, but became marked after two months. The improvement on phenelzine, which was maintained at follow-up, was not related to initial depressive symptoms in the patients. It is suggested that phenelzine is an effective agent in the treatment of phobic anxiety but that treatment needs to be continued for at least two months before full benefit is achieved.