Oxypertine (Integrin, Winthrop Laboratories) is a phenylpiperazine derivative unrelated to the phenothiazines or benzodiazepines. It has powerful anti-psychotic properties demonstrated in early trials and reviewed by Skarbek and Jacobsen (1965).

Although accounts of neurological complications resulting from the use of neuroleptic drugs have consistently appeared in the psychiatric literature since the introduction of reserpine in the 1930's, serious concern about the permanence of these effects has been a rather recent development. As early as 1956, reports by Ey, Faure, and Rappard (10) and by Hall, Jackson, and Swain (13) called attention to the persistence of extrapyramidal symptoms several months after the cessation of extended chlorpromazine treatment. Emphasis on the persistence of dyskinetic symptoms after extended treatment subsequently appeared in reports by Broussolle and Rosier (2), Sigwald, Bouttier, and Courvoisier (20), and Ayd (1). In a survey of reversible and irreversible dyskinesia after treatment with reserpine, chlorpromazine, perphenazine and electroconvulsive therapy, Uhrbrand and Faurbye (22) noted the late appearance of the complication and termed it ‘tardive dyskinesia’.

Disorders in which anxiety or depression is the predominant feature constitute a large part of contemporary psychiatric practice. They are also being increasingly recognized as the underlying causes of many conditions in general medicine and family practice for which, even after prolonged investigation, no physical basis can be discovered.

The XYY constitution has achieved some measure of clinical definition, having been found in association with tallness, asocial personality, dilution of intelligence (Griffiths, 1971) and a tendency to psychopathic disorder (Griffiths, Richards, Zaremba, Abramowicz and Stewart, 1970). In addition, neurological, endocrinological, skeletal and other abnormalities have been reviewed (Griffiths, 1971), and the condition, like mongolism, has come to be regarded as affecting many systems of the body to a greater or lesser extent. Biochemical investigations, hitherto largely concerned with sex hormones, especially testosterone, have in general revealed no significant difference from matched controls. Some authors have, however, reported increased plasma testosterone levels both in 46 XY and 47 XYY patients of maximum security hospitals as compared to patients in other psychiatric hospitals and to the general population (Ismail, Harkness, Kirkham, Loraine, Whatmore and Brittain, 1968; Rudd, Galal and Casey, 1968; Price and Van de Molen, 1970). The pre-eminent desirability of rigorously selected controls has been remarked on in these investigations.

The County Borough of Brighton is a seaside town with a population at the 1971 census of 166,081. This population has fluctuated only slightly. In 1951, the total population was 156,486; in 1961 it was 163,159; in 1966 it was 159,510. Brighton's population contains a large percentage of elderly people; in 1966 there were 25 · 7 per cent of the population over the age of 60, and 18 · 8 per cent were over 65 years old, compared with 18 per cent over 60, and 12 per cent over 65 for England and Wales.

The literature on agreement between psychiatrists on the diagnostic assignment of cases has been extensively reviewed by Ley (1970). Percentage agreement figures ranged from 24 per cent and 28 per cent agreement for type of character disorder and type of neurosis respectively to 80 percent for type of organic illness. Taken at face value these findings suggested that psychiatric diagnosis may often be of little value.

Greiner and Nicolson (1965) put forward the hypothesis that schizophrenia was associated with a state of increased melanogenesis which they attributed to a biochemical defect in the pineal gland. Isolated literature reports had documented the occurrence of hyperpigmentation in schizophrenia. These observations might be relevant, as the neurone and melanocyte have common features: both are ultimately derived from the neural plate; both require tyrosine as precursor in the biosynthesis of their specific products (catecholamines and melanin respectively); and many neurocutaneous diseases show coexistent neuropsychiatric and pigmentary disorder.

The treatment of neurotic emotional responses and behaviour patterns has probably generated more controversies and fewer verifiable observations than any other aspect of psychiatric practice. Tentative hypotheses have been all too quick to take root, expanding into comprehensive theoretical systems, and often obscuring the growth of objective information. Lately, however, a more cautious and empirical attitude appears to be gaining ground. For example, Marks (1971) has pointed out that workers in this field increasingly recognize the presence of factors influencing outcome which are not explained or even contradicted by those concepts and strategies which underlie the techniques employed. Psychotherapists of both behaviourist and psychodynamic persuasions are beginning to express an awareness of the limitations and dangers of a too rigid theoretical approach. Such a movement towards uncommitted empiricism seems a healthy trend. This may be furthered by the more careful examination of specific treatment regimes applied to a variety of diagnostically homogeneous groups of patients, an approach which is clearly preferable to sterile arguments about their relative overall effectiveness in the usual heterogeneous collections of neurotic patients with which the literature abounds. In the recently published Handbook of Psychotherapy and Behavior Change (1971), the editors comment on the frequency with which their contributors criticize the lack of replicated studies and the common failure to describe in adequate detail the specific features of patient, method and therapist. From whatever aspect it is viewed, psychotherapy emerges as a complex personal interaction containing many components, all difficult to quantify and unlikely to combine their effects in an easily predictable way.

This is the second of two papers dealing with the classification of affective disorders in which the relationship between anxiety states and depressive illnesses is examined. The question at issue is whether a line of demarcation may be drawn between the two disorders or whether they are more appropriately regarded as merging insensibly along a continuum of affective disturbance.

It has been found that young people suffering from school phobia, particularly those of secondary school age in Britain, tend to be the youngest in their family (Hersov, 1960; Smith, 1970). This paper reports an investigation carried out in an attempt to confirm and extend this observation. A hundred school-phobic youngsters admitted to Highlands, a psychiatric in-patient unit for adolescents, were looked at from the point of view of order in the sibship; in this respect they were compared with 91 non-school-phobic children suffering from neurotic or conduct disorders admitted to the same hospital unit and with 127 randomly selected normal secondary school children stratified for age, sex and social class. The state of excessive dependency which appears to exist between mothers and their children in school phobia, even in early adolescence (Berg and McGuire, 1971) may be partly due to the circumstance of the affected individual being a younger child in the family.

While detailed and systematic studies have been carried out on the course and outcome of manic-depressive psychoses (Kraepelin, 1921; Rennie, 1942; Poort, 1945; Lundquist, 1945; Astrup et al., 1959; Olsen, 1961; Bratfos and Haug, 1968), depressive illnesses (Lewis, 1936; Kay et al, 1969) and anxiety states (Miles et al., 1951; Eitinger, 1955; Greer and Cawley, 1966), there is little information concerning the prognosis of affective disorders as a whole.

In the search for environmental causes of mental disorder, the epidemiologist looks for an association between the disorder and some environmental factor. The significance of such an association can only be determined by a comparison of the patient population with a control population. Ideally, die control population will be the general population from which the patients have been drawn, but because this often presents great technical difficulties an alternative is to compare one diagnostic group with another. Sound conclusions cannot, however, be drawn from such a comparison unless it is known how far the diagnostic groups differ for factors which influence, or are thought likely to influence, the association being studied. Such factors, of which age- and sex-distribution are the most obvious, will often include social and cultural status. Cultural status—at least in so far as this may be equated with religion and country of birth—can be allowed for by confining the comparison to patients of a particular religion and place of birth. As regards social status, it is the patient's background rather than his present condition which seems important; for on the one hand present social status will be varyingly influenced by the type and severity of disorder, and on the other hand a person's general social behaviour and attitude (in as far, at least, as these are associated with the sort of social factors which psychiatrists have commonly studied) are more likely to stem from the type of upbringing he had than from his recent experiences.

In recent years a number of new hypnotics have been introduced which are claimed to give a more natural sleep than barbiturates, and to be free from the dangers of addiction and of respiratory depression when taken in overdosage. Among these drugs is methaqualone, which is used either on its own (Melsed), or in combination with the antihistamine diphenhydramine hydrochloride (Mandrax).

A Consistency of Relationship score for comparing two grids was proposed by Bannister in 1960, revised slightly in 1962 and again, more substantially, in 1966. The theory behind it is that schizophrenic thought disorder results from repeated experiences of invalidation in construing. If a subject is repeatedly compelled to change his evaluation of an element in terms of a construct, that construct's relationship to the others composing his system may gradually become weakened—e.g. if his evaluations of an intimate acquaintance fluctuate repeatedly between loving and hating, the relationship between ‘loving’ and 'sincere’ or ‘reliable’ in his construct-system may tend to become looser. Progressive weakening and loss of stability in the system as a whole through repeated invalidation of parts of it is the mechanism which supposedly results in schizophrenic thought disorder.

The incidence of deliberate self-injury without fatal outcome (‘attempted suicide’), and with consequent referral to casualty departments and wards of general hospitals, is a constant and growing concern for the medical and social professions. The situation may be described as a steady, never-ending epidemic, with no ready remedy capable of halting it. Indeed, for many hospitals all over the country the epidemic seems likely to overwhelm existing facilities for the treatment of psychiatric, and even non-psychiatric conditions.

Seizures induced by movement were first described by Gowers (1901), who considered them a variant of epilepsy. Several reports have appeared since then of attacks of choreo-athetoid movements precipitated by sudden movement (Lishman et al., 1962; Whitty et al., 1964; Stevens, 1966; Kertesz, 1967). The case described here is one of Lishman's et al's original group (Case No. 5); along with the movement-induced seizures he had developed over the years an increasing agoraphobia which had grossly restricted his activities. This paper reports on the successful treatment of this agoraphobia by ‘flooding’ and the associated amelioration of his movement-induced seizures.

That a distinction may be made on clinical grounds between anxiety states and depressive illnesses has been affirmed by some authors (Garmany, 1956, 1958; Stenbäck, 1963), and rejected by others (Mapother, 1926; Conrad, 1958; Ey, 1963; Lewis, 1950–1966). This problem is also of interest from a biological point of view in that anxiety neuroses represent in an exaggerated form an emotion that is ‘directly serviceable’ (Cannon, 1928) and one which has potential survival value for the organism. Moreover, analogous conditions can be reproduced experimentally in animals, while no convincing models have so far been described of states akin to depressive illnesses (McKinney and Bunney, 1969).

Though divorce is frequent among psychiatric patients, its relative frequency among persons with various psychiatric disorders remains unclear. In addition, it is unclear to what extent family history variables, variables of the sexual history or marital history, or environmental deprivation are associated with divorce.

A review of some of the literature concerned with the aetiology of homosexuality shows that certain variables, in particular those involving the relationship between the homosexual and his parents, differ between studies involving populations of neurotic homosexuals and those concerned with non-psychiatric populations. Investigators concerned with the former group (Bieber et al., 1962; O'Connor, 1964; West, 1955), have placed emphasis on the importance of the mother-child relationship, having found this to be abnormally intense in the case of many homosexuals. On the other hand, a well controlled study by Bene (1965), involving a non-psychiatric population of homosexuals, revealed no difference between her homosexual and heterosexual groups as regards maternal overprotection. Her findings caused her to place more emphasis on the father-child relationship.

UK 3557 is a new indoline derivative with antidepressant properties (Canas-Rodriguez, 1969), and the following formula: