Synopsis An outline is provided of Henrik Sjöbring's contributions to psychology and psychiatry. Emphasis is placed on the significance of his work on mental functioning, personality dimensions and lesional disorders.

A brief account is given of the evolution of the concept of social psychiatry and its relationship to that of social medicine. The central role played in its scientific development by Sir Aubrey Lewis is traced in some detail.

Social psychiatry, like social medicine of which it is a part, has two basic sciences – biology and sociology. People with psychiatric disorders suffer from acute breakdowns or chronic impairments which can be severely disabling in themselves, but these are often precipitated, amplified or maintained by social pressures and social disadvantages and by personal reactions, such as a loss of self-esteem and self-confidence. It is impossible, therefore, to draw a line between the medical and the social aspects of treatment, care and prevention.

The chief innovations during the past 40 years have been made in the context of a change-over from a system of care based on large institutions towards a more open but much looser and less-coordinated system of smaller units managed by staff from different professions who have developed their own, sometimes conflicting, views as to the best ways of helping the mentally disabled. Nevertheless, knowledge has accumulated which, if properly applied, could lead to a better quality of life for the ill and disabled and a decrease in the burden placed upon relatives. Further innovations are now required which will lead to the development of a responsible, comprehensive and integrated mental health service.

It is not yet known whether social measures taken to relieve or prevent lesser psychiatric disorders will lead to a decrease in the incidence or prevalence of more severe conditions and this question deserves further investigation. There is evidence, however, that relatively inexpensive help can be useful in the short term.

Progress will depend upon the accumulation of new knowledge. One of the most encouraging trends has been the improvement of evaluative designs and methods aimed at testing ideas for improving services, thus allowing planners to make better informed decisions.

1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13·9 %. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.

Blood pressure levels as recorded in a community-wide screening programme were compared with findings in an earlier mental health study for persons who participated in both programmes. Blood pressure was not related to previously ascertained psychosocial characteristics among persons who were not under treatment for hypertension, suggesting that depression, hostility, psychosomatic reactions to stress, or the felt need for help with emotional problems were not important in the pathogenesis of hypertension. Treatment for hypertension, however, was associated with an excess of psychosomatic symptoms, a factor which needs to be taken into account in assessing the benefits of treatment.

Forty-four young adults, admitted to a rehabilitation centre after very severe head injury, were followed-up 2 years after their accident. Comparison with a control group showed that the head injured had experienced marked changes in work, leisure activities, contact with friends and family life. Though these changes still created problems, the majority of patients and relatives appeared to have made a number of successful adaptations to their altered situation. Neurophysical status, personality change and memory loss all affected work capacity, while presence of personality changes was especially important in the loss of pre-accident friendships.

A multiple criterion screen was developed as part of a study which was designed to assess different types of intervention for school children with psychiatric disorder. The foremost requirement was that false positives be kept to a minimum, with selected children being unequivocally disturbed. Children were identified for treatment by the following measures: (a) teacher rating on the Rutter B2 Scale, giving a total score and subscores for neurotic and antisocial behaviour; (b) peer ratings on a sociometric measure, yielding isolation and rejection scores; and (c) self ratings on the Junior Eysenck Personality Inventory, specifically the neuroticism dimension. A weighting system was developed so that children could be selected on the basis of extreme scores on either teacher or self-rating measures alone, or by a combination of less extreme scores on more than one measure. The results are presented and discussed.

Twenty-nine published ward rating scales for long-stay psychiatric patients are reviewed according to a standard set of criteria. Attention is paid to details of the rating setting, the rating procedure, and scale construction and evaluation, and some detailed recommendations are made. Only 4 scales meet a subset of 5 minimal criteria.

The authors review the evidence that parental death in childhood predisposes to depressive disorders in later life. The findings in general are quite inconsistent; this is due in part to the methodological limitations of most studies, principally that of inadequate control of potentially confounding variables. Where experimental and control samples were most rigorously matched, no association was found between childhood parental bereavement and depression in later life. Parental death in childhood appears to have little effect on adult depressive morbidity.

The reliability of reporting of life-events was examined in 52 subjects attending clinics. An inventory of events and longer-standing difficulties was administered on 2 occasions, 7–14 days apart. High levels of reliability were found for the number of events, the mean score for distress or change over all events, and for the single event with the highest score. The reporting of individual events was less reliable: only 70 % of those events reported at either interview were reported under the same heading at both interviews. Subjective reactions to events differ in reliability according to the type of response, and they are less reliable for single events than overall. Lastly, the reliability of highly distressing events is in fact lower than for the less distressing. These findings point to some of the shortcomings of inventory methods in life-event research.

The dipeptidyl peptidase, angiotensin-converting enzyme (EC 3.4.15.1), was measured in various regions of post-mortem brains. Results from 51 patients with the hospital diagnosis of schizophrenia who were divided into the clinical categories of ‘schizophrenia’ and ‘schizophrenialike’ illness on the basis of case-note analysis were compared with those from 40 control subjects. A significant reduction in angiotensin-converting enzyme activity was observed only in the substantia nigra pars reticulata and in the lateral and medial segments of globus pallidus in the ‘schizophrenia’ group, with no significant differences in enzyme activity in substantia nigra pars compacta, caudate nucleus, nucleus accumbens, subthalamic nucleus or cerebellar cortex. Reduced enzyme activity was not seen in the ‘schizophrenia-like’ group, and occurred most significantly in ‘schizophrenia’ patients in whom the onset of the illness had occurred between the ages of 15 and 24 years. In the control population the activity of angiotensin-converting enzyme in substantia nigra pars reticulata decreased significantly with age. It is possible that patients with early onset ‘schizophrenia’ may represent a separate disease entity, rather than belonging to a spectrum of a single disease.

Loss of neurons from the ageing human brain is accompanied by reduction in biochemical markers. Compared with age-matched controls about one third of nerve cell components are lost from the temporal lobe of patients with senile dementia of Alzheimer's type. There is marked loss of choline acetyltransferase activity, especially in the hippocampus. This alteration parallels the intensity of neuropathological damage and relates to prior mental impairment. Smaller changes in other neurotransmitter synthesizing enzymes are generally found.

Two hundred and forty neurotic out-patients were allocated to no diagnostic category but were rated in terms of observer and self ratings of both depression and anxiety at weekly intervals during a 4-week trial of amitriptyline, diazepam, amitriptyline and diazepam, and placebo. The sample could not be divided into anxious and depressed groups on the basis of the clinical picture. The outcome tended to be good irrespective of medication but the significant drug effects found were due to amitriptyline and concerned measures of anxiety as well as depression. It is concluded that a distinction between anxiety and depression in neurotic out-patients is of no practical value with regard to drug treatment.

A group of bipolar manic depressive patients attending a routine lithium clinic were investigated. The results suggest that, when on treatment with lithium, manic depressive patients with a good prognosis tend to have a higher erythrocyte Na-K ATPase and higher plasma and erythrocyte lithium concentrations than those with a poor prognosis. There was no evidence to suggest that the erythrocyte: plasma lithium ratio was useful in predicting clinical response to lithium therapy. There was also a positive correlation between plasma lithium concentration and Na–K ATPase activity, confirming that in manic depressive subjects lithium produces a rise in erythrocyte Na–K ATPase activity.

Patients who presented with acute psychoses and were treated with chlorpromazine were first divided into 2 groups with good (23) and poor (13) outcome. These outcome groups differed little in their initial clinical features and showed no difference in 2 indices of dopamine receptor blockade (extrapyramidal symptoms and plasma prolactin concentrations). The group which improved was then subdivided on the basis of evidence of dopaminergic blockade into 15 who had improved and also showed anti-dopamine effects (‘responders’) and 8 who had improved but showed no anti-dopamine effects (‘remitters’) The remainder were eventually classified as ‘resistant’ to the effects of the drug. The group of ‘remitters’ contained no patients with nuclear schizophrenia; the ‘responders’ were mainly nuclear schizophrenics; and the ‘resistant’ patients were schizophrenic or schizo-affective. The 3 groups who were defined in this way also differed in their subsequent clinical course. It is suggested that this scheme for dividing patients may be useful in clinical work and could also assist research workers to identify the patients who can most appropriately be studied to determine mechanisms of drug action.

A 10-year follow-up study is reported of 50 hypogonadal males, 34 of whom had the karyotype 47,XXY and 16 karyotype 46,XY. The social class of the former group was significantly lower and the frequency of criminal behaviour higher when compared with the latter group and the Danish male population. The frequency of mental illness was higher in the Klinefelter males with karyotype 47,XXY than in the remainder. The aetiology and pathogenesis of deviant mental development in the patient population and various aspects of their treatment are discussed.

Of 50 women charged with crimes of violence, 44% committed their offence during the paramenstruum (P < 0·02) and there was a significant lack of offences during the ovulatory and post-ovulatory phases of the menstrual cycle (P < 0·01). This association could not be accounted for by psychosocial factors. Offences were unrelated to symptoms of premenstrual tension. When considering treatment, recurrent behavioural changes rather than subjective symptoms should be looked for.

Janis (1958) has proposed a curvilinear relationship between pre-operative anxiety and post-operative emotional state. While other hypotheses share the prediction of a poor outcome for patients with pre-operative high anxiety, Janis' theory is unique in predicting a poor outcome for those with low anxiety. Subsequent research has failed to confirm Janis' hypotheses, perhaps because the designs have been insensitive to the predictions for low anxiety patients.

The current study tests the hypothesis more directly and finds some support for a linear relationship between pre-operative anxiety and post-operative negative affect, with no support for Janis' curvilinear hypothesis. On the whole, pre-operative anxiety was a poor predictor of other measures of recovery but, on one measure, patients with low anxiety showed a slower recovery than those with moderate anxiety, i.e. supporting the prediction of a poor outcome for low anxiety patients.

The implications of these results for pre-operative preparation of surgical patients and the development of theories of anxiety are discussed.

Previous research on meditation and the EEG is described, and findings relating to EEG patterns during meditation are discussed. Comparisons of meditation with other altered states are reviewed and it is concluded that, on the basis of existing EEG evidence, there is some reason for differentiating between meditation and drowsing. Research on alpha-blocking and habituation of the blocking response during meditation is reviewed, and the effects of meditation on EEG patterns outside of meditation are described. In conclusion, the need for more precisely formulated research is pointed out.