In a study of 11 patients with anorexia nervosa, plasma levels of luteinizing hormone (LH) and of oestrogens (oestradiol) were found to be low while the subjects were emaciated. After weight gain, hormone values rose and two patients spontaneously resumed menstruation. Clomiphene citrate was administered on one or more occasions to five patients, and bleeding was induced in the majority of those whose weight exceeded 80% of standard. In two of these patients an irregular cycle resumed for a brief period thereafter. Clomiphene appeared to be of limited practical value in the mangement of patients with anorexia nervosa, but the study provided some elucidation of the relationship between body weight and the menstrual disturbance in this condition.

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.

An epidemic of falling, confined to one single class of a large comprehensive school in a London suburb, is described. There were 24 adolescent girls in the class, all in the 16 to 17 age group, and the class was involved in examinations. The school authorities decided to close down the class one week before the end of term, when eight girls and a young locum teacher lay unconscious on the floor. Most of the girls affected belonged to the ‘in group’: the very bright, the Greek, the Jewish, and the one coloured girl were unaffected. Although the school refused permission for a sociometric investigation, information was obtained from the school medical officer, from two teachers, and from the two girls who were clearly the most powerful members of the class and the protagonists of the epidemic. They were both referred for medical treatment and, after all physical investigations had proved negative, they were both admitted to a psychiatric hospital for observation and treatment. Their case histories are given in some detail, together with a ‘confession’ written by the girl who started the epidemic. This same girl, during the course of her hospital admission, started a ‘pseudo-pregnancy epidemic’ in her ward. It was discovered that one member of the class had left the school during the course of the previous trimester because she had become pregnant. The epidemic, which appears to follow her childbirth and subsequent death from cerebral haemorrhage, lasted from December to the following July. Possible dynamic factors are discussed.

Evidence is presented to show that patients with Alzheimer's disease owe their memory disturbance to both an impairment in short-term memory and an additional difficulty in establishing new material in long-term storage. These findings are particularly discussed in relation to the notion that, since the pathological changes in Alzheimer's disease are particularly manifest in the hippocampal region, then this involvement of the hippocampus might explain the memory disorder. The present experiment, which is similar to one previously reported using subjects with bilateral hippocampal lesions, shows the two types of memory disorder resulting from bilateral hippocampal damage and Alzheimer's disease to be qualitatively different. Some outstanding problems with regard to obtaining a complete understanding of the nature of the amnesic phenomena in Alzheimer's disease are discussed.

Erythrocyte sodium concentration, potassium concentration, Na-K ATPase activity, and ouabain sensitive potassium influx were determined in female inpatients suffering from a depressive illness. In most patients the biochemical values were also determined shortly before the patient's discharge from hospital. The Na-K ATPase and the ouabain sensitive potassium influx increased significantly with improvement in the depressive mood rating.

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.

Forty-nine patients with radiological evidence of cortical atrophy were followed up five to 10 years after their radiographic examination. The survivors were examined personally. The original radiographs were then reassessed to establish features indicating a good and poor prognosis. Dimensions of the body of the lateral ventricle distinguished good and poor prognosis, whereas the appearance of the cortical surface did not.

An animal model of morphine dependence is described, in which rats learned to overcome their aversion to solutions of morphine and eventually drank such solutions in preference to water on choice trials. Selected aspects of the acquisition, maintenance, and elimination of this type of morphine dependent behaviour were studied and the findings are discussed in terms of their relevance to man.

The case is described of a patient with hyperparathyroidism who developed catatonic stupor, a rare complication. Electroencephalography proved to be of value in deciding the correct diagnosis and treatment. The relationship between hypercalcaemia, psychiatric symptoms, and EEG abnormalities is discussed in the light of the available literature.

The Medical Research Council Unit for Metabolic Studies in Psychiatry was set up at Middle-wood Hospital, Sheffield, in 1967. It was to a considerable extent a continuation of the Medical Research Council Unit for the Chemical Pathology of Mental Disorders which had been associated with the Department of Physiology in the University of Birmingham under the direction of Professor I. E. Bush. The latter unit had in its turn largely corne from a group headed by Sir George Pickering at Oxford.

In close agreement with Essen-Möller, a classification of mental disorders is described. The two basic principles are the application of four independent classifying bases—namely, symptomatology, severity, aetiology, and course, and the breakdown of doubtful disease entities and syndromes to elementary cardinal symptoms and of comprehensive personality terms to simple traits.

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.

As part of its programme on the standardization of psychiatric diagnosis, classification, and statistics, the World Health Organization has sponsored studies in different parts of the world to evaluate systematically a multi-axial approach to classification with particular reference to the field of child psychiatry. Preliminary findings from the United Kingdom study with 22 child psychiatrists are reported. The study included two parts: (1) a reliability study using the case histories of 17 patients; and (2) the testing of the classification in routine clinical practice. The ways in which these methods may be used to evaluate a new system of classification are described. It is concluded that a multi-axial system has such important advantages that it should be tried out further both in the field of child psychiatry and in other branches of psychiatry.

An earlier investigation which showed that admission rates to a psychiatric hospital were higher from the higher noise zones close to Heathrow Airport than from relatively quieter areas was repeated. The present paper could not confirm those results, although a trend in agreement with the original findings was found. The scope of the relationship between levels of aircraft noise and types of psychiatric morbidity is discussed.

Eugen Bleuler's Dementia Praecox oder die Gruppe der Schizophrenien was published in 1912. Thirty years later an erudite historian of psychiatry referred to it as an epoch-making monograph, a product of many years of careful research—‘the most important contribution to psychiatry made in the 20th century’. It was a bold prediction, and he could hardly have foreseen that in another 30 years there would be another product of many years of careful research into schizophrenia, again providing a classic of psychiatry, the work of yet another Bleuler. There have been many instances of son following father in the psychiatric career but in none of them have father and son tilled the same wide field with the same assiduity and unremitting mastery as these.

The occurrence of anorexia nervosa in monozygotic twins discordant and concordant for this illness is reviewed. Two additional pairs of identical twins, one discordant and the other concordant for anorexia nervosa, are described.

The unit was originally established in 1961 under the directorship of Professor G. M. Carstairs. Within a year of its formation it moved from London to Edinburgh where it has continued since, functioning in close collaboration with the Edinburgh University Department of Psychiatry. In April 1971 it was reconstituted under the same name and under the direction of the former assistant director, Dr. N. Kreitman. Its activities have been directed throughout primarily to the neuroses, personality disorders, and forms of abnormal behaviour such as ‘attempted suicide’ rather than to the psychoses or mental defect. The scientific staff currently number nine whole-time and two part-time workers.