Fifty-one school phobic children, aged nine to fourteen years, were assessed for psychiatric diagnosis; this revealed the presence of two clinically meaningful sub-groups—depressed and residual school phobic. A wide range of symptoms were studied to identify those which might prove useful in diagnosing adult-type depression in childhood and early adolescence, both in terms of frequency of symptoms in the depressed group and the extent of the distinction between the two groups. Eleven such key symptoms were identified and based on these, a formula for diagnosing adult-type depression was evolved. The validity of several different ways of classifying the above cases were explored; these covered: kind of disorder; type of onset; adolescence versus pre-adolescence; and sex of the child. However, on only one dichotomy—depression versus absence of depression—were there many significant discriminants. Affective symptomatology of more recent onset was contrasted with pre-morbid personality traits, usually associated with school phobia. There was no evidence to support the concept of ‘masked depression’ in childhood.

The effect of depressed mood on the tachistoscopic recognition of neutral/unpleasant words was investigated in a group of 18 depressed inpatients and in 17 normal controls. A 50% recognition threshold for 30 neutral words was calculated for each subject, in order to exclude the effects of depressive slowness on the experimental task. Each subject was tachistoscopically presented with a series of experimental words (30 neutral/30 unpleasant) at his 50% level, and the ratio of neutral to unpleasant words recognised calculated. Depressed subjects tended to recognise a higher ratio of unpleasant to neutral words.

Fifty-one patients with a primary major depressive disorder preceded by a stressful environmental event were compared for their response to pharmacological treatment with 75 depressives who experienced no stressful life event before illness episodes. There was no difference between the groups in treatment response rates after four and six weeks of treatment respectively.

Twenty depressed multiple sclerotic patients were randomly allocated either to cognitive-behaviour therapy or to a waiting list control condition. Assessment of depressive symptoms was conducted at pre-treatment, post-treatment, and a four-week follow-up. In comparison to the waiting list control condition, cognitive-behaviour therapy was found to result in clinically and statistically significant improvement on most measures. Although the mechanism by which such treatment achieves its effects is unclear, these results clearly support the use of cognitive-behavioural treatments for depression in this population.

In 231 psychiatric in-patients, the 1 mg or 1.5 mg DST with blood samples at 0900 h, 1600 h and 2300 h and a post-dexamethasone plasma cortisol threshold of ⩾ 5 μg/dl were tested for their differential diagnostic utility in clinical psychiatry. Neither test significantly separated endogenous depressed. patients from patients with other depressive or non-depressive psychiatric disorders. Studies of the 1 mg or 1.5 mg DST in 75 healthy subjects revealed about 12% of cortisol non-suppressors, when a post–dexamethasone cortisol threshold of ⩾ 5 μg/dl was used. This seemed to be an unacceptably low specificity of the test in normal subjects. A threshold criterion of ⩾ 8 μg/dl, however, yielded only 2.7% of non-suppressed normal subjects. Analyses of the DST data of the psychiatric patients, using a cortisol threshold of ⩾ 8 μg/dl, also failed to reveal a significantly higher specificity of the DST for endogenous depression. However, it was demonstrated that intervening variables such as stress due to hospital admission, drug withdrawal, suicidal turmoil, weight loss, as well as a low dexamethasone plasma level, enhance the rate of abnormal DST results in psychiatric in-patients, regardless of their diagnostic classification.

Dexamethasone suppression Test (DST) and sleep electroencephalogram (EEG) recordings were carried out during three consecutive nights in 39 depressed patients who met Research Diagnostic Criteria (RDC) for major depressive disorder and in nine normal controls. Cortisol response to DST was abnormal in 26 patients and normal in all controls. REM latency and REM density were compared in patients with abnormal DST (n = 26) to values obtained in patients with normal DST (n = 13) and in normal controls (n = 9). Rapid Eye Movement (REM) latencies were significantly lower in depressed patients showing cortisol non-suppression after dexamethasone than in patients with a normal DST or in controls. REM densities were significantly higher in depressed patients than in normal controls (P <0.025), but there was no significant difference between DST suppressors and non–suppressors. The DST provided high specificity (100%) and a sensitivity of 67%, while REM latency showed a lower specificity (78%), but a higher sensitivity (85%).

The dexamethasone suppression test (DST) was administered to 95 patients referred to a psychogeriatric assessment service. Non-suppression of plasma cortisol was found in 28 out of 48 patients (58%) with senile dementia and all patients with arteriosclerotic dementia or acute confusional states. Non-suppression could not be explained by associated depressive symptoms. The DST was confirmed as a valid diagnostic test for endogenous depression in the elderly, but its value in distinguishing true dementing illnesses from depressive pseudodementia was not supported. The clinical implications of these findings for interpreting DST results in the elderly are discussed.

Perceptual learning was examined with respect to variations in ECT electrode placement (bilateral versus right unilateral) and ECT stimulus waveform (sinusoidal versus brief-pulse). While patients receiving right unilateral ECT demonstrated more perceptual learning than did those receiving bilateral ECT, no difference in perceptual learning resulted from the variation in electrical stimulus waveform. Furthermore, the amount of perceptual learning was unaffected by EEG seizure duration and by the total amount of electrical stimulus energy delivered. The theoretical issue of whether an electrical or a seizure difference between bilateral and right unilateral ECT is responsible for inter-group learning or memory differences is discussed, as well as practical issues related to the choice of electrode placement.

The relationship was examined between sinistral eye and hand preference and age at first hospitalisation, clinical course and social competence in chronic schizophrenics. Motor and sighting dominance were assessed in 52 newly admitted chronic schizophrenic males. Left-handedness in this study was associated with inferior social competence, but left-eyedness with later age of first hospitalisation and proportionally less time spent in hospitals. These findings were only true for paranoid schizophrenics.

Fifty consecutively referred female patients with anorexia nervosa were followed-up to identify those completely healthy at a minimum of four years (mean eight years) since onset. As well as using Morgan's Outcome Measures, an independent psychiatrist elicited details of food/weight pre-occupation and psychiatric state. The outcome results, based on weight and menstruation, (36% ‘good’, 36% ‘intermediate’, and 26% ‘poor’ including 2% dead, and 2% not assessed) did not differ significantly from those of the three similar published studies on similar patients; 62% of patients continued to have some food/weight pre-occupation. DSM III criteria for a psychiatric disorder other than eating disorder were fulfilled by 50%; dysthymic disorder was common (34%), occurring exclusively in patients with continuing eating disorder symptoms, while only 20% of the sample were free of any physical or mental abnormality. Of 52 prognostic factors studied, only four were significantly related to the outcome measures. Length of illness at presentation was the only prognostic factor common to all four similarly conducted studies.

In a collaborative study between St George's and the Maudsley Hospitals, 34 pairs of twins and one set of triplets were identified in which the proband had anorexia nervosa. The diagnosis was based on standard criteria and zygosity was established by blood group analysis or by use of the physical resemblance questionnaire. In the 30 female twin pairs, 9/16 of the monozygotic (MZ) and 1/14 of the dizygotic (DZ) pairs were concordant for anorexia nervosa. Three of the non-anorexia co-twins had other psychiatric illnesses, and two had minor eating disorders. None of the male co-twins had anorexia nervosa.

In a sample of 130 consecutive patients with a lifetime diagnosis of anorexia nervosa and/or bulimia, 17 displayed psychotic symptoms. In 16 patients, these symptoms appeared attributable to major affective disorder or schizo–affective disorder, while in one, they appeared to represent factitious psychosis. No cases of schizophrenia or organic psychosis were identified.

With the aid of the Texas Inventory of Grief, 130 first-degree relatives were studied eight years after bereavement. It was found that relatives of persons who had died suddenly and unexpectedly had more pronounced grief reactions than those of persons whose deaths were more expected. The same was observed concerning parents as a group, compared with widows and widowers. The inventory was found to be of value for assessing whether the outcome was good or poor, but it was not possible to identify risk groups with this method.

It has been suggested that schizophrenic patients have a lower risk of cancer than the general population. We therefore investigated the smoking patterns of 100 current chronic schizophrenic in-patients, and the causes of death in 122 recently deceased schizophrenics. We found that schizophrenics are heavy smokers, and that schizophrenics do die from carcinoma of the bronchus. Proportional mortality rates for all malignancies were not significantly lower in schizophrenics than in the general population but there was a significant absence of cancer of the gastro-intestinal tract. Proportional mortality rates for female mammary carcinoma, pneumonia, and suicide were raised, and that for cerebrovascular disease was low. These differences between schizophrenics and the general population warrant further investigation.

A survey of police and medical records in a province of Fiji indicated high rates of suicide for Indian women under 30 and for Indian men over that age, especially amongst families engaged in sugar-cane farming. Indian suicide rates were high during the Indenture period (1879–1920), and are still higher amongst Indians than amongst native Fijians: almost 90% of all suicides are Indian, though this group comprises only 50% of Fiji's total population. Age/sex/ethnic distribution, methods, and precipitating factors of recorded suicides were examined for one province of Vanua Levu during the period 1979–82. The increasing use of toxic herbicides, especially paraquat, as a vehicle for suicide is discussed.

A case is described in which a diagnosis of paranoid schizophrenia was made using the criteria of Schneiderian first-rank symptoms. The patient showed the Capgras syndrome, with delusional misidentification of her son and other people in her environment, and also Ekbom's syndrome, with the delusion that she was infested with parasitic worms which migrated between various parts of her body. In this case, the two syndromes are descriptions of a specific delusional content, and occur as part of the psychopathology within a schizophrenic disorder, rather than as distinct disease entities.

A questionnaire was sent to 274 doctors and nurses. The first section was to see if certain symptoms and signs elicited the description of patients as ‘confused’, and the second to discover the respondents' definitions. The results showed a marked discordance in health workers' understanding of this word ‘confused’ in reference to patients, and it is suggested that it should only be used if it is clearly defined.