It has long been my wish to review the early history of the Maudsley Laboratories, which were my working home for many years. While I was on their active staff, however, I was forced to postpone this plan in favour of more pressing problems.

Ever since Kraepelin introduced his schizophrenic-manic-depressive dichotomy in 1896, this classification of the functional psychoses has enjoyed virtually unanimous acceptance. However, the frequency with which the differentiation of schizophrenia from manic-depressive psychosis seems to present problems in clinical practice inclines one to question whether Kraepelin's classification was entirely adequate. The object of this paper will be to try and highlight some of the reasons for the existing confusion and tentatively to suggest possible means of clarifying the situation.

There has been a reawakening of interest in the classification of psychiatric patients. Clinicians and researchers alike have realized that it is impossible to evaluate methods of treatment, determine aetiology, or measure the course of illness of psychiatric disorders without adequate methods for diagnosis. On the other hand, it has been shown that conventional clinical methods for making psychiatric diagnoses are of distressingly low reliability, except for the broadest categories, and have only marginal relationships to such criteria of validity as common aetiology, common response to treatment, and common prognosis (Baldessarini, 1970; Beck et al., 1962; Jenkins, 1966). Klein (1967) has shown that the usual clinical diagnoses, because of low validity, can actually obscure important relationships between types of psychopathology and such crucial variables as response to treatment.

Hypochondriasis, though recognized as common and important, has not been accorded the study that its ubiquity and prominence might be thought to require. It is not long since anecdotes and uncontrolled observations masqueraded as knowledge.

Among the various methods of assessing morbid anxiety the psychiatric interview remains pre-eminent. By this means, we attempt to elicit what patients actually feel—the criterion against which all other measurements are validated. Dissatisfaction with the subjective nature of psychiatric interviews and with their low reliability (Cattell and Scheier, 1958; Kreitman, Sainsbury, Morrissey, Towers, and Scrivener, 1961) has led, on the one hand, to the use of rating scales which quantify subjective clinical judgements (Kellner, Kelly and Sheffield, 1968), and, on the other, to the development of techniques which purport to measure anxiety objectively. The latter fall into two broad categories: (i) questionnaires such as the Manifest Anxiety Scale (Taylor, 1953) and the IPAT Anxiety Scale (Cattell and Scheier, 1963), and (ii) measurements of somatic correlates of anxiety, in particular the various endocrine and physiological responses reviewed by Mason (1968) and Lader (1969), respectively.

D-L-propranolol has been reported as having a beneficial effect in anxiety (Granville-Grossman and Turner, 1966; Wheatley, 1969; Suzman, 1971). The effect is believed to be due to the drug's (β-adrenergic blocking action which suppresses many of the somatic manifestations of anxiety, such as tachycardia (Turner, Granville-Grossman and Smart, 1965) and tremor (Marsden, Gimlette, McAllister, Owen and Miller, 1968). Although the peripheral manifestations of anxiety may be ameliorated by propranolol it is not clear whether the drug has any effect on the subjective, central feelings of anxiety experienced by the patient (Marsden, 1971).

Bereavement is a crisis from which few people are spared. In spite of its universality, there have been few carefully designed, well documented, systematic studies describing its natural history and its relationship to other affective disturbances.

Phobic imagery is used extensively in the treatment of phobic disorders by psychological means. The physiological and subjective accompaniments of such imagery are thus of some importance for both treatment and assessment. An earlier report (Marks et al., 1971a) described a standardized method of assessment of phobic imagery and results in one trial of 16 phobic patients. To date the method has been used in the assessment of 77 phobic patients before and after treatment in 6 different studies. This report summarizes our experience with it and its sensitivity to clinical changes. The main finding was that subjective report was a more consistent discriminator between phobic and neutral images than were measures of heart rate or skin conductance. Nevertheless physiological measures were often useful indicators of clinical changes.

Eysenck (1952a) has postulated the existence of three main dimensions of personality: Extraversion, Neuroticism and Psychoticism. These are conceived of as independent of each other, and as continuous, with neurotics and psychotics respectively marking the extreme ends of the N and P dimensions. Within each dimension, the particular type of neurotic or psychotic illness is considered to be determined by the degree of extraversion of the patient; thus dysthymic and hysterical disorders mark the introverted and extraverted types of neurotic illness (Eysenck, 1947), while within the psychotic field degree of social withdrawal might be considered to be the variable most closely related to introversion/ extraversion (Venables and Wing, 1962). Hypotheses have also been formulated to account for the causal factors underlying E and N (Eysenck, 1967), although no such hypotheses have been elaborated with respect to P. A special statistical technique (criterion analysis—Eysenck, 1950) has been worked out to test the crucial question of continuity between normal and abnormal (neurotic and psychotic) populations with respect to N and P; application of this method has given support to the theory of continuity (Eysenck, 1950, 1952b).

Unilateral ECT (U/ECT) produces therapeutic generalized convulsions with less amnesia and confusion than classical bilateral ECT (B/ECT). The clinical effects of these two methods have recendy been compared (Abrams et al., 1972) and reviewed (Abrams, 1972), with the conclusion that U/ECT is less effective than B/ECT in the treatment of depressed patients. Generalized seizures are induced with both methods, and we considered the possibility that the therapeutic advantage for B/ECT lay in its bilateral stimulation of the brain. An opportunity to evaluate the effects of bilateral stimulation exclusive of the temporal lobes arose at the suggestion of Inglis (1970) that seizures induced with treatment electrodes placed over the front of the head should improve mood but have less effect on memory than the other techniques.

Much of the recent work on electroconvulsive shock has been concerned with retrograde amnesia. These studies have generally produced results consistent with Ribot's Law (1885), which states that the susceptibility of a memory to impairment in retrograde amnesia bears an inverse relationship to the age of the trace (Chorover and Schiller, 1965; Kesner and D'Andrae, 1971).

In most mental hospitals some attempt is made to effect change among long-stay patients. This problem in rehabilitation has been approached in several ways, but irrespective of individual approach it is desirable to have some assessment of the degree of change accomplished. Social aspects of behaviour, rather than symptoms, are the target of such rehabilitative efforts, and nurses play an important part both in pursuing the goals of treatment and in assessing change in individual patients. The NOSIE (Honigfeld and Klett, 1965; Honigfeld, Gillis and Klett, 1966) is a particularly well-developed rating scale whose content has been tailored to the task of assessing change in long-stay patients and has been successfully used for this purpose in the United States. In its present form it comprises 30 items which form 6 scales: namely, Social Competence, Social Interest, Personal Neatness, Irritability, Manifest Psychosis and Retardation. This note is concerned with three questions which the British user should ask before using the scale; does it do what it claims to do, does it do it accurately, and what range of scores could be expected in a British hospital population.

In the course of a study on endogenous depressive illness, whole blood 5-hydroxytryptamine (5HT) has been recorded in sixteen in-patients at Roffey Park Hospital. Thirteen patients received L-tryptophan 1 G t.d.s. and 3 G nocte, of whom two received in addition phenelzine 15 mg. b.d. for 48 hours followed by 30 mg. b.d. thereafter. Three patients received amitriptyline 25 mg. b.d. and 50 mg. nocte for 48 hours followed by 50 mg. b.d. and 75 mg. nocte thereafter. One patient receiving Ltryptophan had essential hypertension and received α-methylDOPA throughout. Observation continued for six weeks.

This single case history is reported because scant information is available in textbooks of psychiatry and medicine on depression in acromegaly and gigantism. Attention is drawn to relevant recent articles.

Manic-depressive illness is believed to comprise two different clinical entities: Bipolar and Monopolar. This paper aims to study any differences there may be between monopolar and bipolar depressions in respect of three factors: occurrence of affective disorder (including suicide) in first degree relatives; parental death before the patients' twelfth birthday and the extent of ‘jointness' (Khatri, 1970) of the patients' family.