The contribution of biological psychiatry to research on schizophrenia should not be seen only in terms of discovery of biological markers or identification of definite etiological factors. Although biological research has failed up to now to identify such markers or factors, its influence on the clinical conceptualization of the illness has been considerable. On the other hand, biological research on schizophrenia has not been insensitive to the continuous re-shaping of the clinical concept of the illness which occurred during the last decades. There are at least three issues for which this reciprocal influence can be identified: 1), the question of the symptoms to be included in the definition of schizophrenia; 2), the problem of the relationship between “core” schizophrenia and mild non-psychotic conditions such as schizoid and schizotypal disorders; 3), the issue whether schizophrenia represents a mixture of different entities or a basically unitary condition.

Junior doctors who trained in psychiatry at the Maudsley Hospital between 1965 to 1975 were followed up at a mean of 17 years to ascertain whether pre-psychiatric experience or performance during training could predict future career paths. The most consistent predictor of a career in academic psychiatry was involvement in research during training.

In patients with chronic idiopathic pain disorders we have analysed the construct validity of the Melancholia Scale as compared to the results with the scale in primary depression. The patients (n= 253) were treated in a placebo controlled trial with either clomipramine or mianserin independently of the Melancholia score. The construct validity of the Melancholia Scale was further analysed by the testing of the intensity model of depression versus anxiety using the Beck Depression Inventory, the Hamilton Anxiety Scale, the Spielberger State-Trait Anxiety Scale, and the Melancholia Scale. The construct validity in terms of scale homogeneity was analysed by Loevinger coefficients which can be considered as a latent structure evaluation. The Melancholia Scale showed acceptable homogeneity, while the Hamilton Anxiety Scale lacked sufficient homogeneity. In total, 33% of the patients had a score of 10 or more on the Melancholia Scale (corresponding to 13 or more on the Hamilton Depression Scale). The predictive validity of the Melancholia Scale was evaluated using active treatment versus placebo response after 6 weeks of therapy. It was shown that in patients with a Melancholia Scale score of 10 or more (corresponding to “less than major depression”) 72% had full recovery when treated with clomipramine, while 36% of the placebo treated patients obtained a full recovery (P≤0.05). The patients treated with mianserin obtained a full recovery in 52%. The group of patients with a Melancholia Scale score of 10 or more scored higher also on the anxiety scales indicating that the relation between depression and anxiety is a matter of severity. The depressed patients had significantly lower imipramine binding sites than the non-depressed patients.

The interest in social adjustment of psychiatric patients has increased since potent therapeutic strategies have become available, allowing patient treatment within their natural social habitat. DSM III has formally recognized the need to evaluate social variables for each patient, introducing Axis V into its multiaxial system. This is of particular relevance for personality disorders where the main pathology is manifested within the social context. In this study, 94 patients with a DSM III-R diagnosis of Panic Disorder, Major Depression, and Generalized Anxiety Disorder have been evaluated with PDE (Personality Disorders Examination) to detect the presence of DSM III personality disorders, and with SAS (Social Adjustment Scale) to assess social adjustment. Results have shown that both Axis I and Axis II diagnoses affect social adjustment, though in a slightly different manner.

Computer based quantitative evolution of the electroencephalogram (QEEG) holds promise as an adjunct in the evaluation of psychiatric patients. One such method is neurometrics (N-QEEG) in which quantitative electrophysiological features are evaluated by statistical comparison with age appropriate normative data and compared with the profile of dysfunction seen in different psychiatric populations. This paper is based upon the experiences of the senior author in using this method in a series of 88 patients seen in a clinical setting. Neurometric testing provided a unique and significant contribution to the clinical diagnosis or management of 12% of these cases and gave some clinically useful information in another 44% of this population. In the remaining 44%, the method did not provide any additional contribution to the clinical diagnosis and/or to the management of the patient. Six case histories are provided to illustrate these 3 categories. It must be emphasized that N-QEEG is not a technique that can be substituted for any part of a systematic clinical evaluation, least of all for the process itself, which remains crucial. Once embedded in a solid clinical framework, N-QEEG has the capacity to enhance one’s diagnostic efforts and therapeutic strategies by providing objective quantitative data reflecting brain dysfunction. In such a context, the nominative and cost-effective nature of this technique can further adds to its practicality.

The Autoradiographical Memory Test elaborated by Williams and Scott (1988) consists of presenting positive and negative cue words to subjects, and asking them to retrieve specific personal memories in response to each cue in under 60 s. This method was applied to 20 subjects who met the DSM III criteria for Major Depressive Episode, and 20 volunteers paired for age (± 3 years), sex and instructional level. In general, our data confirm the results obtained by Williams and Scott (1988): the number of specific memories is significantly lower in depressive patients than in control subjects, especially in response to positive cues.

This study examines changes in language markers in patient and therapist speech over the course of a 12-session cognitive depression therapy. Sessions 4, 8 and 12 were analyzed for the following clinical and language indices:

– scores on the Hamilton Depression Rating Scale and the Beck Depression Inventory.

– relative frequency of predicative verb categories, deictics, modalization and situation markers in patient and therapist speech (propositional analysis). The findings show that language indices change significantly and correlatively with therapeutic change, and can thus serve as one measure of the changes in the patient’s psychological organization brought about by cognitive depression therapy.