The development over the last 60 years of the concept of bradyphrenia, a syndrome including slowing of cognitive processing in parkinsonism, is described. Psychic akinesia and subcortical dementia are seen as more recent synonyms for this syndrome. Its relations to akinesia and the psychomotor retardation of depression are considered in a historical context, as are its implications for the relation of neurological and psychiatric disorder.

The history of the concept of presbyophrenia is traced from its inception in 1863 to the present day. Early in the twentieth century it was used to refer to a subtype of dementia characterized by confabulations, marked memory impairment, hyperactivity, disorientation, elevated mood and preserved social graces. At the time it was considered to be either a form of Korsakoff's psychosis or a subtype of senile dementia. The decline of the concept started in the 1920s and was precipitated by the redefinition of dementia in terms of impaired cognition, cortical symptomatology and specific neuropathological changes.

Three explanations for the curious combination of symptoms characterizing presbyophrenia were then suggested: toxic-delirious states, manic illness in late life, or a combination of cerebrovascular disease and senile dementia. It is suggested that the dismissal of presbyophrenia could have been premature as it may capture a behavioural phenocopy of relevance to clinical practice.

Hysterical symptoms are defined as complaints that are not fully explained by organic or functional neurological disease. Hysterical symptoms are common in neurological practice, accounting for about 1% of neurological diagnoses. Of those with neurological hysterical symptoms, about 80% will not have the hysterical personality, and about 80% will not have Briquet's hysteria. Some 60% will have a physical disease and perhaps as many as 50% will have recognizable psychiatric illness, particularly depression. Others may have unrecognized physical or psychiatric illness. Many hysterical symptoms may be understood in terms of abnormal illness behaviour.

DNA was extracted from the brains of patients with Alzheimer-type dementia, schizophrenia, Huntington's chorea and from patients without neurological disease, and examined for the presence of herpes simplex virus type 1 and human cytomegalovirus sequences. By selecting cloned virus DNA fragments which do not hybridize to normal human DNA we were able to achieve a detection level assessed on reconstruction experiments of 1 virus genome per 50 cells. Screening at such sensitivity did not detect virus sequences in the higher CNS, except in cases of encephalitis or immunosuppression. We conclude that, at this level of sensitivity, these viruses cannot be regarded as normal residents of the higher CNS, and at the time of death they do not appear to be associated with these neuropsychiatric conditions.

The nutritional status of 23 severely demented patients was compared with that of 23 similarly aged controls in the community. A 3-day weighed intake on all subjects showed lower mean intakes of energy, protein, ascorbic acid and nicotinic acid in the patient group. This group had lower levels of plasma ascorbic acid and red cell folate and of urinary N-methylnicotinamide excretion relative to creatinine. Over a third of both controls and patients had evidence of thiamin deficiency, as judged by a raised percentage erythrocyte transketolase activity. An earlier finding in patients with senile dementia of reduced fasting plasma concentrations of tryptophan was confirmed for total and protein bound fractions. With the possible exception of ascorbic acid, the data could not be explained satisfactorily in terms of intake. It is suggested that the association between the phenomena of ageing, senile dementia and nutritional status merits further investigation.

Neuropathological change found in nearly all individuals with Down's Syndrome over the age of 35 years closely resembles that of Alzheimer's disease. The extent to which dementia occurs as a result of this change is unclear, and the studies which have investigated presumed cognitive deficits are reviewed. The theories put forward to explain the association between these two disorders and their possible significance to the understanding of the aetiology of Alzheimer's disease are discussed.

Because of the practical difficulties which arise in studying manic patients, a reproducible model for mania using human subjects would be a valuable adjunct to research in this condition. Dextroamphetamine, given as a single oral 20 mg dose, fulfils the criteria for such a model in that there are very close similarities between the changes which occur after dextroamphetamine and those which have been observed in mania in terms of subjective experience, physiological and endocrine changes, and response to pharmacological agents.

The effects on serum electrolytes of carbamazepine, an acute and prophylactic treatment for manic-depressive illness, were assessed in subjects with primary affective disorder. Carbamazepine caused statistically significant, but clinically insubstantial, reductions in serum sodium and calcium, but not in the other electrolytes measured. Decreases in serum sodium and calcium were not related to carbamazepine dose, blood levels, or the degree of clinical improvement. The theoretical implications of these findings are discussed.

Choline influx and choline content were measured in healthy volunteers (N = 36), patients with unipolar affective disorder (N = 28), and bipolar patients before and during treatment with lithium (N = 14, N = 13 respectively). Erythrocyte choline content was not found to be significantly elevated in any of the groups studied, except in patients taking lithium. Choline influx into the erythrocytes of healthy controls was found to decrease with increasing age, while choline influx into lithiated erythrocytes increased with increasing age in patients. An inverse relationship between erythrocyte choline influx and content was found to exist only in the erythrocytes of elderly healthy volunteers (≥ 60 years old).

The hunger perceptions and satiety responses to a high-calorie, carbohydrate-rich food among 10 normal-weight females who met the DSM-III criteria for bulimia were compared with 10 normal-weight females who denied a current or past history of eating or weight disorders. As indicated by self-report responses on the Hunger–Satiety Questionnaire, bulimics did not differ from the normals in their perceptions of hunger sensations. Differences, however, were detected the responses following eating. Most notably, the bulimics reported feelings of irritability, nervousness, tenseness and depression which persisted 30 minutes later. These findings and directions for future research are discussed.

A postal survey with selected follow-up interviews was conducted on a complete population of females aged 18–22 registered with two group general practices in Leicestershire. The mailing included the Eating Attitudes Test (EAT) and the Crown—Crisp Experiential Index (CCEI). There was a 70% response rate and 411 usable questionnaires were returned. Twenty-eight respondents (6·8%) produced EAT scores of 30 or more. One case of anorexia nervosa and one of bulimia were identified. Interviews of high EAT scoring subjects revealed several subjects with partial syndromes which failed to fulfil diagnostic criteria for either clinical eating disorder.

There is an increasing need for early detection strategies to take a part in the daily routine of general practice. A cost—benefit analysis is performed for the use of the CAGE questionnaire in case finding for at risk drinkers among general practice attenders. The questionnaire is shown to be of advantage to the general practitioner over and above his usual diagnostic methods.

Psychological correlates of gastric and duodenal ulcer disease were assessed in a group of somewhat older patients with ulcer disease identified by endoscopy. Associations between both ulcer types and symptom measures (anxiety and depression) seemed only to reflect severity or chronicity of gastrointestinal symptoms or the impending endoscopy procedure. Associations with ‘trait’ psychological indices may be of causal significance. Duodenal ulcer patients had higher ‘introversion’ and ‘psychoticism’ scores (on the EPQ) than controls, while gastric ulcer patients had higher psychoticism scores and ‘trait anxiety’ scores. These findings could not be attributed to confounding variables.

When the two ulcer groups were compared, the gastric ulcer group had significantly higher neuroticism, psychoticism and hostility scores which were not attributable to confounding variables. The higher depression scores in gastric ulcer patients, however, simply reflected the greater chronicity of their physical symptoms. The groups did not differ significantly on measures of trait anxiety, tension, introversion or Type A behaviour.

Couples in whom the main complaint was of a lack of female sexual response were treated using a practical counselling approach. A number of pre-treatment measures were studied to determine which factors were predictive of treatment outcome. While age and chronicity were not predictive, the quality of the general relationship and measures of sexual attitude did give useful indications of likely outcome.

In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.

Latent trait modelling is a recent psychometric technique with great potential for the construction and refinement of psychiatric instruments. It provides a greater insight into the nature of measurement in psychiatry and the statistical machinery for improving it. This expository paper starts with a non-technical outline of the latent trait model, gives a detailed analysis of the 12-item General Health Questionnaire (GHQ) and examines points raised by the empirical analysis through computer simulation. It is shown that the latent trait model can give a good representation of empirical data and uncover new aspects of a familiar instrument. It provides a precise methodology for evaluating the functioning of a questionnaire and for developing better short instruments. It highlights the need, and provides the means, to tailor instruments for different tasks, such as (a) screening, and (b) measuring over the whole range of the population. We examine scoring in the light of the model, and show that simple scoring is often adequate. While points for further methodological development are noted, it is argued that the method is already sufficiently developed for general application.

Case register data are used to describe the age and diagnostic distribution of people using the community psychiatric nursing (CPN) service in Salford. Data are related to those in hospital-based psychiatric services. Annual prevalence rates grew dramatically, and increasing numbers of people were found to have received continuous CPN care for 2 years and over. Following the establishment of the CPN service in a primary care setting, the proportion of patients suffering from depression in receipt of CPN care increased, and the resulting overall diagnostic distribution of CPN patients became similar to that of the specialist psychiatric services as a whole. Patients under the sole care of community psychiatric nurses (about 19 % of the total CPN prevalence each calendar year) contributed to an overall increase in treated prevalence. The data indicate that CPN services in Salford are treating the morbidity found at primary care level, rather than reducing the demands made on the traditional services.