The life and the ideas of a mentally aberrant figure in mid-seventeenth century England are presented in relation to the sociocultural background of the time and the available clinical information. The material illustrates the need to draw on both sources when applying psychiatric concepts to particular historical epochs.

Schizophrenia may be associated with increased prostaglandin synthesis in certain parts of the brain. This hypothesis is based on the following findings: (1) Catalepsy, which is the nearest equivalent in animals to human catatonia, develops in cats when prostaglandin E1 is injected into the cerebral ventricles and when during endotoxin or lipid A fever the prostaglandin E2 level in cisternal c.s.f. rises to high levels; however, when fever and prostaglandin level are brought down by non-steroid anti-pyretics which inhibit prostaglandin synthesis, catalepsy disappears as well. (2) Febrile episodes are a genuine syndrome of schizophrenia.

Serum luteinizing hormone(LH) responses to a course of clomiphene citrate were studied in eleven patients with anorexia nervosa at different stages of the illness. In malnourished patients basal levels of LH were invariably low. With the resumption of a normal weight a small but definite rise in LH levels was observed but this spontaneous response to weight gain was variable in that many patients continued to exhibit abnormally low LH levels.

The response to clomiphene in terms of a rise in basal LH levels after administration of the drug, followed by a second peak of LH and subsequent menstrual bleeding, was clearly dependent in part on the patient's nutritional state. In the malnourished state the response to clomiphene was usually either absent or incomplete. After the resumption of a more normal weight, the patients invariably showed an initial rise in LH after the clomiphene, but the second LH peak and subsequent menstruation were frequently not demonstrated. Six patients maintained a normal body weight for at least six months after a course of clomiphene, but only three of them resumed cyclical menstrual bleeding. It was concluded that factors additional to the nutritional state contribute to the prolonged amenorrhoea in anorexia nervosa and that clomiphene appears to have only a limited role in the treatment and management of patients with the disorder. Some aspects of current knowledge of the endocrine mechanisms that regulate normal menstruation and of the mode of action of clomiphene are outlined.

The results of the present study are discussed against this background in an attempt to elucidate further the hypothalamic disorder underlying the amenorrhoea in anorexia nervosa.

Eleven patients in remission from manic-depressive illness were studied by means of metabolic balances before and after the administration of lithium carbonate. Lithium caused a sharp diuresis of isotonic saline and a smaller excretion of potassium over the course of two days. During the subsequent two days there occurred a compensatory retention of Na, K and water. These short-term changes were not associated with any significant alteration in the patients' mood. There was no significant and systematic retention of Na, K or water over the 14 days of Li administration. The recovery of Li was measured simultaneously. During the first week only a proportion of the administered Li was recovered in the urine and faeces, suggesting that a gradual distribution of Li throughout its body space was occurring. After the first week, nearly all the administered Li was recovered, indicating an equilibrium with an even distribution of the ion throughout its body space. This equilibrium was more complete at this early stage in those patients who had been given a smaller dose of lithium carbonate.

A slow, continuous infusion of 1000 μg TRH (thyrotropin releasing hormone) over a period of 4 h had a very faint and diffuse short-lasting beneficial effect on a group of 10 depressive patients. This was assessed in a double blind cross-over trial with placebo. The effect was of no therapeutic value. No difference was found between the depressive patients and a control group of normal subjects in TSH response, T3 resin uptake, T4 or free thyroxine index values as a consequence of the TRH infusion.

Tryptophan and 5-hydroxyindoleacetic acid (precursor and metabolite respectively of 5-hydroxytryptaminę) were determined in ventricular CSF of psychiatric patients undergoing stereotactic subcaudate tractotomy. Tyrosine and homovanillic acid (precursor and metabolite respectively of dopamine) were also determined. Results suggest an association between affective state and the above precursor amino acids with lower concentrations in primary depression and higher ones when anxiety or agitation predominate. This leads to lower 5-hydroxyindoleacetic acid concentrations in depression and higher concentrations in anxiety and agitation.

Seventeen acute psychotic patients were studied in the course of chlorpromazine (CPZ) treatment. Blood samples were taken weekly both before and two hours after the morning CPZ dose. Plasma levels of CPZ, CPZ sulphoxide (CPZSO) monodesmethylated CPZ (NOR1CPZ) and 7-hydroxy CPZ (7OH CPZ) were estimated by gas chromatography. Plasma prolactin, luteinizing hormone, testosterone and oestrogens were measured by radioimmunoassay. Six of the seven patients who showed no clinical improvement had plasma CPZ levels equal to or higher than those of patients who improved. ‘Non-responders’ had a greater proportion of CPZ SO in pre-dosage samples. The occurrence of parkinsonian side effects was associated with a mean plasma CPZ of > 50 ng/ml and a mean plasma prolactin of > 30 ng/ml two hours after dosage. The elevation of prolactin preceded the onset of parkinsonian symptoms by 1–2 weeks. There was a significant positive correlation between mean plasma prolactin and mean plasma CPZ levels. The prolactin response may prove a useful index of the central antidopaminergic effect of neuroleptic drugs.

A study has been made of cases coming before the Brighton coroner in the period 1970–2. Fifty cases in which a suicide verdict was recorded were specially studied, and relatives and acquaintances of the deceased were interviewed. The information thus obtained was compared with information available to the coroner in considering his verdict in 83 further cases in which he made a verdict of ‘suicide’. The reliability of thewhich the coroner's decision is based was largely validated. A study was made of variables which differentiated ‘suicide’ from 25 ‘open’ and 33 ‘accident’ cases considered by the same coroner. The prevalence of depression did not differentiate ‘suicide’ and ‘open’ cases, and this finding contradicts suggestions that the association of depression and suicide might be an artefact of the method of arriving at a suicide verdict. A number of other demographic and clinical factors did however significantly vary between ‘suicide’, ‘open’ and ‘accident’ cases.

The hypothesis has been tested that three types of suicide (‘old and handicapped’, ‘sociopathic’ and ‘depressed’) will vary in prevalence across ecologically defined urban areas. The hypothesis is supported with respect to ‘old and handicapped’ suicide, which predominates in middleclass areas with established residents of middle-class status; and with respect to ‘sociopathic’ suicide, which predominates in central areas with high rates of social pathology of all kinds, and poor housing conditions.

A post mortem enquiry has been made into the social family and clinical circumstances of 50 individuals who, according to a coroner's verdict, killed themselves in Brighton. A dimensional analysis of the 123 variables thus collected suggested the possibility of three distinct types of suicide: ‘depressive suicide’, ‘sociopathic suicide’ and ‘physical illness suicide’. The reliability of this typology has been checked by the analysis of 55 selected variables for a total of 193 cases considered by the same coroner. A cluster analysis has confirmed that the data contain at least three independent types of suicide. Some implications for the prevention of suicide are discussed.

A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.

One hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of ageing may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.

The Leyton Obsessional Inventory (LOI), together with 46 questions taken from Sections M–R of the Cornell Medical Index, were administered to 30 inpatients suffering from duodenal ulcer and to 30 patients admitted for ulcerative colitis to test the hypothesis that the latter have more obsessional traits than the former. The results indicated that although the two groups did not differ much in their obsessive personality traits, the ulcerative colitis patients were significantly more worried and concerned about them. None of the socio-cultural factors measured, which are known from other studies to influence these obsessive scores, was associated with the differences found. An analysis of the individual LOI items between the two groups showed that the ulcerative colitis patients were more indecisive, and also more morose, more rigid and more punctual than the duodenal ulcer patients, i.e. traits traditionally associated with obsessional personality types. The two groups did not differ on the Cornell score.

Clinical and psychometric characteristics of a sample of elderly psychiatric patients were established soon after admission and they were then followed for 1 year. Anoutcome was most successful for an unfavourable type which was predictable by measures related to intellectual impairment.

Occurrence of life events was recorded in 30 recovered depressed women undergoing clinical relapse in a controlled trial of maintenance treatment with amitriptyline and psychotherapy, and in 30 matched patients who did not relapse. Overall, patients who relapsed experienced significantly more life events in the three months before relapse, and especially in the month immediately preceding it. Undesirable events were particularly implicated. Event rates prior to relapse were closely comparable in treatment subgroups, giving no evidence that differential stress was required to produce relapse. The findings reinforce previous studies indicating an overall relationship between life events of certain types and depression, but do not suggest that the beneficial effects of maintenance treatment are specifically protective against life stress.

Suicidal intent was assessed in a sample of 151 admissions to a general hospital for selfpoisoning or self-inflicted injury. Severity of intent was associated with the act's medical seriousness and with the risk of suicide derived from a validated risk scale. Although high and low intent cases were comparable in respect of precipitating factors, patients rated high on suicidal intent were more likely to have experienced depressive symptoms in the previous month.

Fewer than one half (238) of a cohort of 489 psychiatric patients who had stayed in hospital more than one year (longstay) were still in hospital three years later. One third of these ‘old’ longstay patients (170) were discharged and resettled – and 81 elderly patients died. During the same three years 1971–3 a further 108 patients became (new) longstay; 57 remained at the end of the study. The discharged patients were neither readmitted unduly often, nor did they become destitute.

There has been a child psychiatry research group within the Institute of Psychiatry since 1952. At first it constituted a section of the Department of Psychiatry and for a while it formed part of the MRC Social Psychiatry Research Unit. However, in 1973 London University established a Chair of Child Psychiatry and since that time there has been a separate Department of Child and Adolescent Psychiatry. The research in this field undertaken up to 1967 has been described previously (Rutter, 1968a) and the present report brings the account up to date with a summary of work carried out during the last eight years.