The contemporary practice of involuntary commitment to psychiatric institutions of individuals diagnosed as mentally ill is based upon practices established by psychiatrists in the nineteenth century. The justifications given by nineteenth-century German-speaking psychiatrists for involuntary commitment are considered. An examination of sixty-seven texts by German-speaking psychiatrists reveals that involuntary commitment was justified more often as benefiting the mentally ill individual than as benefiting society. Justification for involuntary commitment was made somewhat more frequently during the second part of the nineteenth century than during the first part

This research was aimed at studying the rate of action of tricyclic drugs in depressive disorders, specifying the behavioural effects associated with recovery, and predicting clinical response. The research design involved comparison of a recovered group with a group treated for the equivalent four weeks, who showed minimal to no response. The findings indicated significant differences in baseline characteristics between responders and non-responders. Further, the drugs were found to act early in the responders, within the first week of treatment. Specific changes at one week which distinguished responder and non-responder groups occurred in the disturbed affects, and in cognitive functioning. Improvements also occurred in somatic symptoms, but these latter changes were general and not associated with later recovery. At 2½ weeks, all facets of the depressed condition showed positive change in the responders. Implications of the results for assessing rate of tricyclic drug actions, their effects on the interaction of affect and neurochemistry, and the practical application of the results for the clinical situation, are discussed.

Erythrocyte transketolase activation by thiamin diphosphate has been studied in elderly patients with moderate or severe chronic dementia, acute alcoholic admissions and chronic alcoholics with evidence of brain damage, mostly of the Wernicke–Korsakoff type. Significantly more patients in each group than controls showed abnormal activation of transketolase, not only by 0·3 mM thiamin diphosphate (TDP) but also in further activation by increase to 3 mM. This indicated the presence in a proportion of the alcoholic and the demented patients of an abnormal enzyme variant, similar to that previously found in vitro. The modified transketolase activation test may warn not only of marginal thiamin deficiency but also independently, of susceptibility to brain damage in patients at risk.

The hypothesis that ECT produces selective effects on hypothalamic–pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine-and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probadly due to direct stimulation of the neuroendocrine neurones themselves.

The effects of physostigmine on test performance of a patient with multiple cognitive deficits were observed in a double-blind, placebo-controlled study. Scores on tests of learning and memory and tests of visuo-spatial and constructional ability were both improved by physostigmine, while lecithin improved scores only on the former tests.

The vasopressin analogue 1-desamino-8-D-arginine vasopressin (DDAVP) has been shown in healthy male volunteers to cause significant improvement in short-term memory and to reduce alcohol-induced amnesia. There was no significant effect upon semantic retrieval or simple reaction time. It was concluded that vasopressin benefited the initial processes of consolidation and learning, while the reduction of the amnesic effects of alcohol may support the contentions of other authors that the peptide improves memory in states of mild amnesia.

The relationship between memory performance and CT scan measures of ventricular size was investigated in a sample of 39 chronic alcoholics and 39 controls. Measures of verbal, non-verbal, recognition and recall memory were derived from the tests administered and were viewed in relation to the lateral ventricle and third ventricular size measurements. The results showed that the memory performance of male alcoholics was significantly related to measures of third ventricular size, but probably not to measures of the lateral ventricles. An association between verbal memory performance and CT scan measures was found in the male controls.

Auditory-event-related potentials, including the P300 response, were recorded from 20 patients with Aizeheimer-type dementia (ATD), 17 patients with Korsakoff's syndrome (KS) and 23 age-matched control subjects. Each of the subjects was assessed using a version of the Luria Neuropsychological Investigation. Prolonged P300 latency and reduced P300 amplitude, which are features of normal ageing and which also occur, to a greater degree, in ATD, correlated significantly with degree of impairment of language ability in both Alzheimer patients and controls. On the other hand, the association between P300 latency changes and various tests of memory was not consistent across the three subject groups; there was a significant negative correlation between P300 latency and visual memory in ATD and a significant positive correlation in KS, whereas in controls no significant correlation was found. By contrast, P300 latency and memory for words were significantly negatively correlated in controls, but in neither of the patient groups.

Detailed studies of language function may further elucidate the complex relationships between neuropsychological measures and P300 changes in normal ageing and dementia.

Sixty-seven patients with melancholia and 42 normal controls were tested with a battery of neuropsychological tasks selected to assess regional cortical functioning in both hemispheres. Compared with controls, melancholics exhibited a pattern of bifrontal and right parietal impairment, which was independent of age, sex, handedness and drug administration. These findings confirm and extend prior studies and contrast with those we and others have reported in patients with schizophrenia.

Families with more than one member affected by schizophrenia were identified and their members were interviewed. Four standardized diagnostic definitions (PSE, DSM-III, ICD-9, Feighner) were applied to all subjects who were classified as schizophrenic or not schizophrenic according to each definition. Non-schizophrenic psychiatric disorders which have been shown to be familially associated with schizophrenia were also identified. Twenty blood markers were ascertained for all subjects and evidence of co-segregation with schizophrenia was sought. No selective segregation was found and therefore there was no evidence suggesting linkage or supporting a monogenic theory of transmission of susceptibility to schizophrenia.

In a sample of 268 cases of first-episode schizophrenia, 15 patients were found to have organic disease which appeared relevant to the mental state. There were three cases of syphilis, two cases of sarcoidosis, three of alcohol excess and two of drug abuse. There was one case each of carcinoma of the lung, autoimmune multisystem disease, cerebral cysticercosis, thyroid disease and previous head injury. In this series, identified organic disease was associated with less than 6% of cases of schizophrenia.

The blood counts of 80 patients with depression were examined (50 unipolar, 30 bipolar). Many had reduced numbers of circulating lymphocytes. This abnormality was more common in the unipolar group (52%) than in the bipolar group (27%). When those patients with an abnormal dexamethasone suppression test response in both groups were compared, the relative and absolute lymphocyte counts were significantly lower in unipolars. Although cortisol hypersecretion may reduce lymphocyte numbers it is not yet clear whether the findings can be satisfactorily explained in this way.

This study of 111 institutionalised Down's syndrome subjects and 74 controls found a relatively low risk of hypothyroidism in both groups compared with certain other studies of Down's subjects, which found very high rates of thyroid hypofunction. However, the Down's syndrome group had a significantly raised risk of hypothyroidism (9%), hyperthyroidism (1·8%) and the presence of thyroid microsomal antibodies (29%) compared with the controls and with laboratory reference data. It is recommended that thyroid function testing should be routine in older Down's syndrome subjects, with special attention being given to the clinical status of those with microsomal antibodies present.

Psychological factors have long been thought to play a contributing role in either the predisposition, onset or course of various physical illnesses. Recently, rapid advances in immunology have created interest in the interaction between psychosocial factors, behaviour and the immune system. This paper reviews some of the models proposed to explain the relationship between psychological variables and physical illness and presents evidence for a contribution of psychological factors to certain illnesses in which abnormalities in immunologic state are thought to be important. From a somewhat different perspective, animal studies have demonstrated complex effects of stress, on disease susceptibility. Recent human studies have demonstrated consistent immunologic changes in people undergoing acute naturally occurring psychological stress such as bereavement or an important examination. In humans, the effects of chronic stress may be different from acute stress, corresponding to the findings in animals. Abnormalities in immunologic functioning and physical illness are reviewed for different psychiatric disorders — depression, anorexia nervosa and schizophrenia; depression is the only disorder which consistently demonstrated immunologic changes. Possible mechanisms for the stress/immune-change relationship are suggested.

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

Affiliation preferences of 150 cancer out-patients were assessed in the waiting-room and day-to-day life. Results indicated the vast majority avoided fellow patients, preferring to be alone or with healthy people. Similarly, patients tended to avoid the topic of illness in their social contacts. Moreover, those desiring to be with the healthy displayed the highest levels of negative emotion. Finally, avoidance of fellow patients was higher among males, the elderly, and the more highly educated. Overall, the findings were inconsistent with the thesis that those under stress seek out others in similar straits, as suggested by Schachter's emotional comparison theory or Will's downward comparison theory. Rather, they support Rofé's utility theory of stress and affiliation.

This study of 519 coronary angiography patients failed to replicate our earlier findings in 90 angiography patients (Tennant & Langeluddecke, 1985) which showed that trait tension, trait anxiety and suppression of anger were correlates of atherosclerosis. In the present studya variety of psychological measures, including state and trait anxiety, tension, anger, locus of control and suppression of anger, depression and anxiety, showed no significant association with coronary atherosclerosis as assessed by coronary angiography.