It is suggested that chlorosis, or the ‘green-sickness’, was not a single disease entity, but a name applied to at least two distinct conditions affecting young females in the past. The first (‘chloro-anaemia’) was a form of hypochromic anaemia possibly associated with gastric ulceration and poor diet. This form predominated in the late nineteenth and early twentieth centuries. The second (‘chloro-anorexia’) was a disorder of psychogenic origin resembling, but not identical to, anorexia nervosa. The latter form predominated in earlier periods but also occurred throughout the nineteenth century; it was also known as ‘the virgin's disease’ or ‘febris amatoria’. The ‘green’ of‘;green-sickness’ may originally have indicated innocence rather than a green colour of the skin.

A detailed analysis of the results of a multi-centre clinical trial shows that, while the relapse rate following recovery from an operationally defined depressive illness was smaller among patients subsequently treated with either amitryptiline or lithium than with a placebo, there was no clinically significant difference between the prophylactic efficacy of the 2 antidepressants. An account is given of the relative adverse effects of the treatments, and the implications of the findings are discussed.

Ninety-nine patients with chest pain and a presumptive diagnosis of coronary heart disease were assessed blindly within 24 hours of angiography, using standardized psychiatric and social interviews and a personality inventory. Thirty-one patients had normal coronary arteries (NCA), 15 had slight disease and 53 had significant coronary obstruction. Twenty-eight (61%) of the 46 patients with insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity.

Associations between the overall severity of psychiatric morbidity and measures of social maladjustment were strongest in the patients with normal coronary arteries. The 26 men with insignificant coronary artery disease had higher scores of neuroticism and extraversion than the 41 with important coronary occlusions. No differences were observed when the same comparisons were made for the women.

The findings indicate that approximately two thirds of patients with normal and near-normal coronary arteries have predominantly psychiatric rather than cardiac disorders: the symptoms in these patients are more likely to represent the somatic manifestations of anxiety and overbreathing than the consequences of underlying cardiac disease. Physicians should be aware of the ways in which neurotic illness may present with symptoms mimicking cardiac disease, especially when cardiovascular symptoms are accompanied by phobic symptoms and unexplained shortness of breath.

The early literature on Alzheimer Dementia (AD) describes the clinical features aphasia, apraxia and agraphia as characteristic. We investigated the hypothesis that these features would specifically identify the familial form of AD (FAD). Since pedigree studies had suggested that FAD is an autosomal dominant genetic disorder, we hypothesized that the first-degree relatives of language-disordered or apractic AD probands would show at least 50% lifetime risks of dementia. Using standardized methods, we screened 3500 nursing home beds for stringently defined AD cases and controls, tested for agraphia, and obtained probands' clinical and family histories from multiple informants. Language disorder and apraxia were found in 78% of AD cases. They strongly predicted familial aggregation of dementia, with a 90-year lifetime incidence among relatives exceeding 50%, or 7 times the control values. The results suggest that language disorder and apraxia specifically identify a distinct clinical entity, Familial Alzheimer Dementia, that is among the commonest forms of senile dementia.

The scope for the early detection of dementing disorders in the elderly by means of screening techniques is reviewed in the light of the basic principles of early disease detection. It is concluded that, while there is an increasingly urgent need for the development and application of psychogeriatric screening methods as a step towards preventive action, such methods are still at an early experimental stage. Prescriptive screening programmes are contra-indicated at present. The most immediate requirement is for evaluative research, which should be planned to take account both of the properties of the screening instruments and of the health-care and social settings in which these are to be applied. No major progress in this field can be expected unless it proves possible to integrate methods of early case-detection, and of systematic surveillance of the at-risk elderly, into the work of primary medical and social services.

A series of drawing tasks was administered to 15 patients with senile dementia who were assessed for intellectual functioning and severity of dementia. Their performance was compared with that of 15 elderly control subjects. The demented patients' spontaneous drawings were found to be impoverished in comparison with those of the controls. Copies of the same objects included more details, but these tended to be wrongly positioned in space. The performance of the patients with dementia was unlike that reported for patients with focal brain lesions. Significant relations were found between drawing performance and intellectual functioning and severity of dementia. The theoretical and practical implications of these findings are discussed.

A prospective follow-up study was undertaken of two groups of women first studied in the mid 1960s when they were children: 94 girls reared in institutions to which they had been admitted because of a breakdown in parenting, and 51 girls in a general population comparison group. Both groups were interviewed in detail when aged 21–27 years and home observations were undertaken for those with young children. The institution-reared women showed a markedly increased rate of poor psychosocial functioning and of severe parenting difficulties in adult life. However, the support of a non-deviant spouse and of good living conditions in adult life provided a powerful protective effect.

A sample of 79 young women whose mothers had died in the subjects' childhood, and whose fathers had remarried, was studied to determine any effects on state and trait depression associated with modification of high and low risk parental style. Lack of care from fathers and lack of care from step-mothers were the parental variables most strongly associated with high trait depression, and almost all subjects scoring both these parents as uncaring affirmed a distinct life-time episode of depression. In a married sub-group of 63 subjects, low marital affection and low step-mother care accounted for 33% of the variance in trait depression scores, while low paternal care was no longer a significant predictor. Data for the married sub-group suggested that an affectionate husband largely corrected any diathesis to greater depression exerted by uncaring parenting, while the protective effects of caring parenting on adult depressive experience were largely undone by marriage to an unaffectionate husband.

Although numerous reports have strongly argued that there is a need for a closer collaboration between the health and social services, studies investigating the health of clients in contact with the personal social services have been few and limited. This study collected information regarding the physical and mental health of clients referred to social workers in a local authority intake team and to a general practice attachment scheme by means of questionnaires completed by the client and at interview. The results indicated that the proportions of patients with physical or mental illness were very high. However, while social workers in the attachment scheme had many contacts with members of the primary care team regarding these clients, contacts between intake social workers and medical personnel were very limited.

The age of onset in bipolar affective disorder was determined in 200 hospitalized patients. The mean age of their first affective syndrome was 28·3 years, and the mean age of first hospitalization was 30·8 years. However, the median age for first affective syndrome was 23 years (26 years for first hospitalization), and the most common age of onset was 15–19 years. Those patients with an early onset, especially if they were first hospitalized for mania, were most likely to have received a diagnosis of schizophrenia.

Prior research has indicated that the type-token ratio (TTR), a measure of repetition in language, correlates with clinical judgements of thought disorder when spoken language was examined, and differentiates statistically thought-disordered from non-thought-disordered schizophrenics and psychiatric and normal controls. We replicated this finding and examined the clinical sensitivity and specificity of the TTR measure in the diagnosis and in the assessment of thought disorder. The current clinical value of the TTR is limited, but further investigations of the nature of repetition in schizophrenic language are warranted.

The reliability and validity of Psychological Stress Evaluator (PSE) output and frequency modulation suppression as an inaudible vocal measure of stress-arousal was further explored, using a new interval scoring method. ‘Yes’ answers to 6 neutral questions were obtained from 106 volunteers 2 weeks before, the day before and one week after a stress-provoking event (oral comprehensive examinations for an MS degree). The data show excellent construct validity and good but not high internal consistency (0·77–0·81) and test-retest (0·72–0·74) reliability. Interrater reliability ranged from 0·94 to 0·98. Correlations of PSE output with other psychological and physiological measures (criterion-related validity) was very poor.

Sample survey techniques are often used to assess the prevalence of illness in a community and to determine any variation with environmental, social and demographic factors. Analysis of survey data is often carried out using several elementary statistical procedures. The formulation of a statistical model is an effective way of conducting a unified analysis. The model provides a concise description of the study population and is a most effective way of summarizing community prevalence data. The testing of statistical hypotheses is equivalent to model simplification and is conveniently performed using general procedures. Two alternative statistical models are given for an investigation into the extent of minor psychiatric morbidity in Perth, Western Australia.

This study assessed the inter-relations of socio-demographic, resource and policy factors with standardized measures of short-term psychiatric bed-use in 42 counties of Atlantic Canada. The policy factor made up two-thirds of the total variability (61%) accounted for among males, and nearly one-half of the 47% accounted for among females. An accurate assessment of in-patient resource needs is seen as resulting from intertwining morbidity surveys with utilization studies.

The present study describes and evaluates aspects of care in a new residential unit for chronic patients. The findings suggest that the unit is relatively resident-orientated in its management practices and that the staff are similarly orientated in their attitudes. Staff also hold generally optimistic attitudes to residents' potential accomplishments and consider themselves highly involved in decision-making. They also show high levels of positive interactions with the residents. Various aspects of staff attitudes and behaviour are positively correlated with seniority or length of time on the unit. The results are discussed in terms of the unit's organizational structure and its possible impact on residents' functioning.

A 26-year-old man developed a syndrome following a head injury, characterized by disturbances of memory, language, and beliefs, and lasting for several years. The clinical picture was suggestive of a number of conditions, but diagnostic of none. The aetiology involved a complex interaction of biological and psychological factors, and these are discussed in relation to similar syndromes described in the literature.