Systematic variation in aspects of the sleep-wakefulness cycle of a depressed woman showed that recovery occurred reliably after 19 to 20 hours sustained wakefulness, unrelated to diurnal rhythm. Depression returned during as little as 15 minutes sleep. The effect of sleep deprivation was a specific response, probably unrelated to REM sleep.

Psychiatric disorder was studied in 62 patients with temporal lobe epilepsy (study group) and 70 patients with grand mal epilepsy (control group), both diagnosed electroencephalographically. The two groups were similar as regards age, sex, socio-economic status, duration and frequency of fits, family history and premorbid personality.

A significantly greater number of temporal lobe epileptics had emotional disturbances in childhood and psychiatric abnormalities at the time of study. Neuroses, schizophrenia and behaviour disorder occurred more commonly in the study group, while epileptic personality and confusional psychosis were seen more frequently in the controls.

The findings of the study are discussed in the light of relevant literature.

Ten of 114 psychiatric patients undergoing combined lithium-neuroleptic treatment exhibited somnambulistic-like episodes. These episodes are differentiated from nocturnal wanderings and epileptic attacks during sleep; they occurred within two to three hours after sleep onset and were characterized by the patients appearing confused and walking about in a quiet, detached and clumsy manner. Generally, there was amnesia for the event. Since sleepwalking occurs out of slow wave sleep, the increase in slow wave sleep induced by lithium and certain neuroleptics may represent a neurophysiological mechanism responsible for these patients’ somnambulistic behaviour. The occurrence of grand mal seizures in two patients was probably unrelated to the somnambulistic-like episodes. However, persistence of the latter appears to be associated with drug-induced EEG irregularity.

Twenty former male patients who in childhood had been diagnosed as having schizoid personality were followed up in adulthood. In comparison with controls, they used psychological ways of construing infrequently. Interpretations of this finding are discussed, in particular its relationship to impaired empathy.

The ‘Coping With Drinking’ questionnaire, administered to 124 A1-anon members, was factor analyzed and revealed nine identifiable styles of coping. Multiple regression analyses between three measures of sobriety and each of the nine styles of coping factors provide support for the general hypothesis that the coping styles used by wives of alcoholics are related to drinking outcome. Further, those modes of coping in which the wife communicates her feelings of distress and frustration to the drinking husband in a way which is minimally threatening for him seem to be most positively related to his attainment of sobriety.

Psychiatric diagnoses are arranged in a rough hierarchy, generally regarded as a convention to enable patients with a wide range of symptoms to be allocated to single diagnostic categories. Foulds, on the basis of self-report questionnaire responses, claimed that patients with symptoms at the higher levels of this hierarchy not only may but characteristically do exhibit symptoms at all lower levels as well. Foulds’ hierarchy model was tested here, using PSE ratings from two large series of in-patients; at least 75 per cent fulfilled the requirements of the model, but up to 50 per cent of schizophrenic and manic patients failed to do so. Almost two-thirds of all patients with psychotic symptoms establishing them in one of the upper two classes of the hierarchy did not exhibit the neurotic symptoms they required lower in the hierarchy.

Apomorphine, a direct-acting dopamine agonist, stimulates release of growth hormone (hGH) and suppresses release of prolactin (PRL) from the anterior pituitary. Previous studies comparing the magnitude of these responses in schizophrenics and controls suggest that many acute (and some chronic) schizophrenics have exaggerated hGH responses; many chronic schizophrenics (and patients with tardive dyskinesia) have blunted hGH responses to apomorphine, and possibly blunted PRL responses. The present studies extend and confirm these findings in chronic schizophrenics; in addition, several studies were undertaken to further characterize these apomorphine-induced endocrine responses. Studies in which apomorphine was given on 2 or 3 separate occasions to each of five subjects indicate that the hGH response is a highly reproducible individual index, but PRL suppression is a less satisfactory measure. hGH responses to apomorphine were consistently antagonized by pretreatment with haloperidol, supporting the concept that the hGH-releasing effect of apomorphine is mediated by its action on dopamine receptors. Cyproheptadine pretreatment was associated with erratic increases or decreases in the hGH response to apomorphine, but did not alter PRL levels or apomorphine-induced PRL suppression. The relationship of these findings to biological hypotheses of schizophrenia and to neuroleptic-induced receptor changes is discussed.

The revelation that opium-like substances are constitutional body elements is surely one of the major biological advances of the decade. The notion that the brain contains an inbuilt supply of opioid chemicals has been particularly seductive to the psychiatrist. It seems to offer a key to understanding, and therefore manipulating, the cerebral substrates for somatic pain, drug addiction and psychic discomfort. At a time when research effort in this area is increasing logarithmically, I present here a selective and personal view of certain aspects of endorphin research which have been claimed to be psychiatrically relevant. For detailed accounts of the background and breadth of endorphin research the reader is directed to other more extensive recent reviews (Kosterlitz and Hughes, 1977; Guillemin, 1978; Snyder, 1978; Watson et al, 1979; Hughes, 1979). The term endorphin will be used in the generic sense to include the specific Endorphins (such as β-Endorphin) and the enkephalins (Leu- and Met-)—see figure.