This paper describes the standard version of the MRC Social Performance Schedule, which covers 21 behaviour areas such as hygiene, initiating conversations, etc. and was designed to be used with long-stay populations, within a hospital or the community. Data on the schedule's consistency over raters, informants, time, and situation showed that the reliability was reasonable over all four areas. The schedule is recommended as a standard instrument to describe the behavioural difficulties of patients likely to be dependent on psychiatric services for some time. Recent data are provided on the levels of problem behaviours found within both long-stay hospitals and community settings, together with references for more detailed behaviour profiles of such groups.

Using an Arabic version of the PSE, supplemented by CATEGO, we selected 48 patients with acute schizophrenia from the population of the Najd region of Saudi Arabia. Their life-event histories for the six months before onset or relapse were compared with those of 62 control subjects. A postive association between events and onset was established only for married women, although there was a parallel trend for men and single women suffering their first schizophrenic episode. The observed impact of life events was limited to the three weeks before onset. These findings are discussed in the light of Saudi culture.

A validity study of the Self-Report Questionnaire (20 item version, Harding et al, 1980) against the criterion of a standardised psychiatric interview (Goldberg et al, 1970) was carried out at three primary care clinics in Sao Paulo; 875 patients filled in the SRQ-20 questionnaires and a subsample of 260 was interviewed by the psychiatrist. The SRQ-20 was shown to be a feasible screening instrument for psycho-emotional disturbance in these settings. Sensitivity was 83% and specificity 80%, and the questionnaire was a good indicator of morbidity. A correlation was found between questionnaire total scores and independent clinical judgment (r= +0.70). A sex difference in the validity coefficients is described.

Adults attending general health facilities in Guiné-Bissau were screened for the presence of mental disorder; minimum estimate of definite mentally ill cases was found to be 12%. The proportion correctly identified by general health workers was low: only one of every three patients with a mental disorder was recognised and of every 100 non-cases 12 patients were wrongly diagnosed by the health worker as suffering from psychiatric illness. On the basis of these results health workers are now being taught how to detect mental illness.

All patients formally detained in a Scottish psychiatric hospital between 1974 and 1979 were identified and their outcome determined 2½–8½ years later. A matched group, detained under Emergency Orders only, were also followed-up. Those formally detained had more previous psychiatric contact: functional psychoses were significantly more common in them. They remained in hospital longer, and required extensive community support when discharged. Those detained under Emergency Orders only, consisted of two sub-groups–one who left the area within two years of admission and could not be traced, and the remainder, who continued to require hospital treatment but for shorter times and with less continuous support. Amongst those detained, lack of insight was a predominant feature, which may create difficulty with regard to informed consent to treatment, given the present Amendments to the Mental Health Acts.

We reviewed data on adverse drug reactions (ADRs) to first- and second-generation antidepressants, recorded by two different drug surveillance systems. The rate of ADRs that led to discontinuation of the drug in the individual case, assessed within a multi-centred hospital-based drug monitoring system (AMüP), was significantly higher in case of exposure to tricyclics (7.4%) than with the second-generation drugs (3.1%). On the basis of voluntary reports to the Medicines Commission of the German Medical Profession (AMK), profiles of ADRs to the drugs under survey were constructed and compared with data compiled by the WHO. The types of ADRs varied more between second-generation drugs than between tricyclics. Special attention was paid to rare but serious ADRs (e.g. seizures during treatment with maprotiline, and blood dyscrasias attributed to mianserin).

Naloxone hydrochloride eyedrops 1 mg/ml dilated the pupils of 36 out of 47 opiate addicts on methadone maintenance treatment, without precipitation of acute withdrawal effects, but not those of healthy unmedicated subjects. The response in addicts was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. The size of the response suggests some potential clinical use for topical naloxone as a diagnostic test of current opioid influence and possibility of physical dependence. The local mydriatic response, which was restricted to the treated eye, indicates that the effect of opiates on the pupil in man is determined, at least in part, by a peripheral action.

The neuroleptic malignant syndrome (NMS) occurs as a hypersensitivity response in certain patients exposed to neuroleptics. It is a relatively rare, but potentially lethal complication, the incidence of which may have been underestimated. Recent interest in NMS has arisen due to the recognition that specific therapy may now be available. This review summarises the clinical features and discusses recent ideas regarding aetiology and treatment.

Plasma drug concentrations and clinical response were measured in two groups of hospitalised depressed patients, who received amitriptyline or Imipramine double-blind, in a dosage of 250 mg for four weeks. Virtually no significant linear or curvilinear relationships were found between any plasma measure and any measure of clinical response. Modest but significant direct relationships were found between age and concentration of parent drugs but not demethylated metabolites. Blood drug level measurement therefore appears to be of little value in monitoring drug treatment of depressed in-patients.

To determine whether high plasma cortisol concentrations are a distinctive feature of depression or whether plasma cortisol is also elevated in other forms of psychosis, cortisol concentrations were measured in 59 patients with acute functional psychoses, six non-psychotic depressed patients and 37 control subjects, all free of antidepressant and neuroleptic drugs for at least three months. Patients with schizoaffective disorder, manic type, had the highest concentrations throughout the day and those with major depressive disorder, psychotic sub-type had higher concentrations than controls in the afternoon and evening. Manic and schizophrenic patients had cortisol concentrations above controls in the afternoon only. Elevated concentrations were not related to the presence of depressed mood or to duration of stay in hospital, and a return to normal occurred irrespective of the type of treatment used. Thus raised plasma cortisol concentrations are a feature of psychotic illness, but in drug-free patients are not specific for severe depression.

The dexamethasone suppression test (DST) has been widely used in psychiatry as a laboratory aid for the diagnosis of endogenous depression; failure to suppress serum cortisol levels is interpreted as confirming a clinical diagnosis of endogenous depression. We found that serum dexamethasone concentrations in this test vary widely and are determinants of the DST response: non-suppression of serum cortisol levels is associated with low serum dexamethasone concentrations, and suppression is associated with high concentrations.

An impairment in lymphocyte response to mitogen stimulation, a correlate of cell-mediated immunity, has been reported in patients with depressive illness. To investigate whether such impairment in lymphocyte function is related to excessive secretion of cortisol, an immunosuppressive hormone, we compared mitogen-induced lymphocyte proliferation in three groups of subjects: (1) depressed patients with elevated 24-hour urinary free Cortisol (UFC) excretion; (2) depressed patients with normal UFC excretion; and (3) normal controls. Depressed patients in both groups showed significant reductions in lymphocyte mitogenic activity, in comparison with the normal controls, but the two depressive groups did not significantly differ from each other in their lymphocytic responses to any of the mitogens used. Furthermore, no significant correlations were found, within depressed patients, between UFC excretion and lymphocyte mitogenic responses. Depression is therefore associated with an impairment in lymphocyte function that cannot be explained solely on the basis of increased cortisol secretion.

Of 25 primiparous women, investigated prospectively for six months post-partum, 19 persisted with breast feeding and six changed to artificial during the first six weeks. Sexual activity, mood, and feeding patterns were recorded in weekly diaries. Hormones were measured from weekly urine samples (oestrogen and pregnanediol) and fortnightly blood samples (prolactin, testosterone, androstenedione, and sex hormone binding globulin). In breast-feeding women, testosterone and androstenedione levels were significantly lower in those who reported severe reduction in sexual interest. Changes in sexuality or mood were not related to levels of prolactin or oestrogen, or to the return of follicular activity, which was delayed in persistent breast feeders. The relationships of mood, sexuality, and hormones are discussed.

The clinical, psychometric, and computed tomographic (CT) status of previously fit elderly volunteers is described at follow-up for up to four years. A number of relationships were found between psychometric and CT scores, but a dementing group could not be determined on the basis of a single scan. However, a subtle reduction in cognition over time was significantly related to CT changes, and occurred in 10%. Larger ventricles were also found in a small sub-group, who developed late-onset depressive disorders; recent bereavement was related to ventricular size. Thus a single CT scan may not be a useful discriminatory test in early dementia, but a repeat demonstrating ventricular enlargement, is likely to be significant. In the elderly, cognitive and CT scan deterioration should not be expected unless a disease process is occurring; this may be indicated by subtle cognitive impairment or by late-onset depressive disorder.

The historical and conceptual aspects of the pseudodementia state are briefly touched upon. A “collective sample”, composed of 61 cases culled from the literature, is analysed and compared with the “Fulbourn sample” consisting of 22 cases reported for the first time. Two sub-types of pseudodementia emerge, one associated with depressive illness and the other with delirium. A follow-up of the Fulbourn sample (1–4 years after discharge) showed 14 patients to be alive and 8 to show no signs of dementia. No variable except the diagnosis “non-specific psychosis” correlated with death during the follow-up period.

Many experimental findings suggest that disturbances of noradrenergic neurons in the CNS are involved in the pathogenesis of depressive disorders. Moreover, evidence indicates that adaptive changes of central noradrenergic neurons contribute to the biochemical mechanism of action of most anti-depressive treatments (Goodwin, 1984; Johnstone, 1982). Accordingly, assessing the activity of central noradrenergic neurons in depressive patients has become important in psychiatric research.