In the practice of our department at the Middlesex Hospital, the need has been felt for a means of rapid quantification of common symptoms and traits relevant to the conventional diagnostic categories of psychoneurotic illness. Until now, none of the available British scales have fulfilled this requirement. The most widely used is the Maudsley Personality Inventory (Eysenck, 1959) with its subsequent modifications. This, however, although scientifically based, is limited to the assessment of broad categories such as “neuroticism” and “extraversion” which appear to go only a small way towards describing the wide variability of psychoneurotic disturbances. Foulds and his co-workers (Foulds, 1965) have for a number of years developed personality scales in which clinical sophistication and a rigorous methodology are combined. Their Symptom-Sign Inventory, however, consists of eighty questions which have to be presented orally. Furthermore, although the inventory covers psychotic disturbances, it is necessary to use an additional questionnaire, the Hysteroid-Obsessoid Questionnaire (Caine & Hawkins, 1963) to complete the spectrum of psychoneurotic illness. Moreover, the concept of psychiatric illness developed by these workers is individual rather than conventional in a number of respects. The Tavistock Self-Assessment Inventory (Sandler, 1954) is too long for the present purposes (876 items in six booklets). The Taylor Manifest Anxiety Scale (Taylor, 1953) is short and convenient, but it measures one dimension only. As many doctors, including psychiatrists, find it useful to think in terms of orthodox clinical categories for diagnostic, therapeutic, prognostic and research purposes, it was decided to design and attempt to validate a self-rating scale adapted to these categories, taking the patient 5–10 minutes to complete and capable of being rapidly scored by the doctor or an assistant.

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Psychotherapy, like any other effective treatment in medicine, may lead to negative effects either in the patient or those around him. The source of these unwanted effects may be in the patient's or the therapist's personality, in the patient-therapist interaction, in faulty therapy technique or in the patient's unresolvable social situation. The possibility of negative effects should be anticipated during the descriptive and psychodynamic assessment of the patient and before establishing the therapeutic contract. The technique of a trial of psychotherapy should be more frequently used than it is in cases where the therapist is in doubt. If negative effects do develop, these should be minimized by decreasing the frequency of psychotherapy sessions and depth of exploration. This may be done by allowing greater therapist "transparency", by making fewer psychodynamic interpretations and by altering the focus of therapy from problems of early development to problems of current living.

SynopsisIn a prospective study of rheumatoid disease (RD) clinical, serological, radiological, and biochemical factors were assessed on 102 patients and scores obtained on the Middlesex Hospital Questionnaire (MHQ). Patients with early RD had MHQ scores closely resembling those in the normal population. Using a new clinical prognostic index, patients who develop severe RD tended to have low scores at initial testing on the MHQ. Patients whose serum was positive for rheumatoid factor also tended to have low scores on the MHQ. Together these findings suggest a possible subclassification of RD into a less severe form in which psychosocial factors may be important, and a more severe form in which heredity or some other constitutional factor (or factors) may be important, rheumatoid factor acting as a ‘marker’.