Goodwin Wharton (1653–1704) was a nobleman's son and a Whig MP who played no small part in English public life. His manuscript journal shows, however, that he also lived a bizarre secret life of the mind of a kind which, in later generations, would have led to his confinement as suffering from mental illness. Above all, through the offices of his medium and lover, Mary Parish, he entered into elaborate relations both with the fairy world and with God and His Angels. This paper examines our records of Wharton's consciousness

Data on the history of cannabis use and a spot urine test for cannabinoids were obtained for 137 schizophrenics in treatment. Subjects who were using cannabis during the 6-month observation period presented with a significantly higher degree of delusional and hallucinatory activity than those who did not. Moreover, the group using cannabis made a higher average number of visits to the hospital during the same period. The status of cannabis use appeared to contribute to such variance more than did other relevant factors (age, stage of the illness, amount of medication prescribed, occasional use of other psychoactive substances).

Mental-hospital admission rates in Edinburgh for mania, schizophrenia and psychotic depression were studied from 1970 to 1981, a 12-year period during which long-term lithium therapy was increasingly employed in affective illnesses. If this treatment had been effective admission and readmission rates for mania, and perhaps also for depression, should have fallen progressively. In fact, they rose steadily, while the admission rate for schizophrenia fell. These changes could not easily be attributed to changing diagnostic criteria, to the admission of milder affective illnesses, or to poor and deteriorating lithium surveillance. Their explanation is uncertain, but they cast some doubt on the efficacy of lithium prophylaxis in ordinary clinical practice.

Twenty patients with a major depressive disorder and 20 control subjects were subjected to a 1 mg dexamethasone suppression test (DST) and a challenge with intravenous (IV) methylphenidate (MP)(0·3 mg/kg). None of the controls, but 9 depressives, were DST non-suppressors. Among the depressives there were correlations between DST-cortisol and baseline (4 p.m.) levels of cortisol, growth hormone, prolactin and adrenaline. Compared with the controls the depressives had a decreased cortisol response and an enhanced adrenaline response to the MP challenge. The decreased cortisol response was not related to either DST-cortisol or baseline cortisol, but was correlated with the mood response to MP.

An examination was made of urinary catecholamine and metabolite outputs in 28 unipolar depressed patients and 25 normal controls. The total group of depressed patients had significantly higher urinary outputs of norepinephrine (NE) and its metabolite normetanephrine (NM), and significantly lower urinary outputs of the dopamine metabolite dihydroxyphenylacetic acid (DOPAC), than controls. Patients who met DSM-III criteria for a major depressive episode with melancholia (N = 8) had significantly higher urinary outputs of normetanephrine than controls, whereas patients with a major depressive episode without melancholia (N = 7) and dysthymic disorder patients (N = 8) had levels comparable with controls. We postulate that the higher urinary outputs of norepinephrine and its metabolite, normetanephrine, reflect dysregulation of the sympathetic nervous system in depression.

Consecutive series of male and female alcoholics, Alcoholic Anonymous (AA) members and controls were examined by interview and with a CT brain scan. Male controls were shown to have larger CT brain parameters than healthy females of the same age. Female alcoholics revealed equivalent CT scan abnormalities, apart from less sulcal widening, after a markedly shorter drinking history and at a lower estimated peak alcohol consumption than male alcoholics. The CT scan findings persisted after accounting for body weight and after matching for age and length of drinking history. The CT scan parameters of female AA members approached control values more completely and after briefer abstinence than did those of male AA members. Methodological problems and sex differences in selection and other processes are discussed. The findings are consistent with sex differences in the vulnerability of the brain to alcohol toxicity, and in its recovery with abstinence.

Seven volunteers received diazepam for a 3-week period, maximum dose rate 25 mg per day, and were tested on a variety of functions before, at two points during, and at two points after the period. Their performance was compared with that of 8 controls and was inferior on a number of measures. There was no indication either of habituation or of potentiation of the effects as the period continued. Equally, the low performance persisted for some time after administration ceased, although performance was on the whole better than during the experimental period. The particular measures showing deterioration suggested that the effects are similar to those of barbiturates as opposed to those of, for example, chlorpromazine.

Multidimensional scaling, in the form of principal coordinates analysis and two-way correspondence analysis, is used to illustrate inter-practice variation in patterns of psychiatric diagnoses provided by data from the longitudinal file of the Second National Morbidity Survey. The results strongly support the view that general practitioners' diagnostic habits should be validated before their records are used to provide data on ‘official’ estimates of psychiatric morbidity. It is recommended that, whatever the quality of the data, large tables of official socio-economic or medical statistics should be supplemented by graphical summaries, as they quite often are in France.

The age at onset of dementia of the Alzheimer, Pick or senile type in relatives of probands with early onset dementia was examined using survival analytical techniques applied to data collected by Sjögren et al. (1952). Female relatives were found to have a higher risk of dementia than males, and there was a deficit of affected brothers compared with fathers of probands. In these comparisons due allowance was made for age at the last observation of each relative. Relatives of probable and definite Pick probands had a higher risk than relatives of probable and definite Alzheimer probands, but the difference was not significant and dementia did not occur at an earlier age to the former group.

For the relatives as a whole, and for subgroups of relatives, the risk of dementia increased with age, at least up to age 80. It is hypothesized that the pattern of the age-related hazard of dementia is due to the nature of the dementing process; that this slow degenerative process is widespread; and that individual differences in the rate of the process are under the influence of genes. The statistical methods are explained in detail as they have rarely been applied to dementia before, though Chase et al. (1983) have used life tables and survival analysis in testing genetic hypotheses, with an application to Alzheimer's disease.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membershp analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three of more somatic symptoms from the somatization disorder section of the Dagnostic Interview Schedule. The analysis indicates that seven ‘pure’ types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One ‘pure’ type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

In a Danish community psychiatric service the patients referred from general practitioners (GPs) to the community psychiatric service (CPS) are compared with matched individuals with conspicuous psychiatric morbidity treated in general practice only. The psychopathology of the referred patients is more severe, as estimated by two different methods. They make fewer social contacts and their work situations are unfavourable. It was found that to a great extent the GPs refer their patients with mental disorders to the CPS so that the ‘filter’ between the GP and the CPS is very permeable. Of the patients treated by the GPs only (the matched group), no more than 54% were assessed by a psychiatrist as psychiatric ‘cases’. Psychopathology thus only partly determines the GPs' assessment of psychiatric ‘caseness’, in which social impairment plays an important part. The GPs diagnose more mental disorder than the psychiatrists, possibly because of an intimate acquaintance with the anamnesis.

Two matched samples of Arab female undergraduate students attending London and Cairo Universities were recruited to determine the relative prevalence of abnormal eating attitudes and the effect of exposure to Western culture upon this prevalence. A positive response was reported on the Eating Attitudes Test (EAT-40) in 22% of the students in the London group and 12% in the Cairo group, indicating that abnormal attitudes occur in this non-Western population. Six cases among the London sample fulfilled diagnostic criteria for bulimia nervosa, but no cases of either anorexia or bulimia were identified in the Cairo sample.

Four measures of mental health – Panic, Depression, Somatization and Well-Being – have been developed for use in a population of Southeast Asian refugees. The scales, a product of work with 1348 refugees, demonstrate conceptual significance, good reliability, concurrent validity and stability of structure across samples. They are culturally sensitive, enabling intra-cultural study as well as screening for clinical purposes. The measures also permit comparisons, for research purposes, with non-Asians.

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18–65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is ‘lack of care’, defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such ‘lack of care’ is more frequent after loss of mother than after loss of father.

A comparison was made of the crime rate among 181 suicides and 181 controls, representing an unselected sample of the population matched with the suicides for sex, age, marital status, place of residence and occupational level. Sixteen per cent of the suicides and 11% of the controls had a criminal record, a statistically insignificant difference. In addition, no significant differences were found in the proportion of recidivists and of violent offenders, or in the number of their offences and convictions. A significant difference was found regarding the distribution of the offences by particular laws: more than a half of the offences committed by criminal suicides concerned violations of the road traffic laws, this being in agreement with the hypothesis that risky, accident-prone behaviour is a suicidal behaviour equivalent.

A Fijian community affected by a cyclone was compared with an unaffected but similar community. Two months after the cyclone both psychological and physical morbidity was 2–3 times greater in the affected community than in controls. By the third month morbidity had resolved to levels similar to those in the unaffected population. Brief, catastrophic stress without loss of life appears to provoke psychological and physical morbidity of relatively brief duration.

A retrospective case note analysis for 30 boys diagnosed as having a ‘schizoid’ personality disorder (Asperger's syndrome) in childhood, and for 30 matched clinic attenders (with systematic follow-up data for 19 matched pairs), showed the incidence of antisocial conduct to be the same in the two groups. However, the ‘schizoid’ boys stole less often and had fewer alcohol problems. In this group antisocial conduct was less related to family disruption and social disadvantage, and more to an unusual fantasy life. Clinical descriptions of a series of ‘schizoid’ boys and girls with conspicuous antisocial conduct follow. They suggest that characteristic patterns of antisocial conduct in such children are persistent expressions of hostility and, especially in girls, pathological lying, for which environmental circumstances provide no explanation.