The results described are based on data from 47 male and 83 female patients randomly assigned to treatment with imipramine or phenelzine in an open trial. All were fresh (untreated) cases diagnosed as suffering from depressive illness (melancholia). They were rated before treatment and 2 and four months later. Imipramine did not give results which were significantly better than phenelzine. With both drugs it was found that patients had done either very well or very poorly at follow-up, i.e. the distribution of scores was U-shaped (or bimodal at the least).

The 55 men and 90 women who were unsuitable for treatment with drugs or who had failed to respond to such treatment were given a course of ECT and followed-up at corresponding intervals. The improvement after ECT was better than with drugs and the distribution of scores is quite different. An earlier series of male patients treated with ECT in the pre-drug days did not show as good a response to the treatment.

In a two-year period, 186 patients were admitted from Heathrow Airport to the nearest psychiatric hospital. Affective illness was related to time zone change. Depression was diagnosed significantly more often on flights from east to west (P < 0.012 east to west versus west to east; P < 0.015 north to south combined with south to north versus east to west, Fisher's exact probability test, two tailed). Hypomania was inversely related to depression in an east to west comparison (P < 0.025). No other associations with direction of travel were seen in other diagnoses. Ninety-three (50 per cent) were diagnosed as schizophrenic; 24 of these had been aimlessly wandering. Twenty patients had been admitted at least once before under similar circumstances. Schizophrenic patients from Heathrow constituted 20 per cent of the total number of schizophrenic patients admitted to the hospital during that period.

The psychiatric morbidity of chronic epileptic out-patients unknown to psychiatric agencies was assessed using two questionnaire measures of psychopathology (GHQ and CCEI). Nearly half of the epileptics were classified as probable psychiatric cases. Psychiatric morbidity was both more prevalent and more severe in this group than in a comparison group of chronic neurological out-patients. Depression, anxiety and hysterical symptomatology were the commonest characteristics of psychiatrically impaired epileptics. The type and severity of epilepsy were found to influence both the degree and pattern of psychiatric morbidity. Contrary to previous findings, age of onset had no relation to psychopathology.

Computerized axial tomography (CAT) scanning was carried out on 57 patients who had received a hospital diagnosis of psychoses associated with epilepsy, and 78 epileptic patients with psychiatric illness other than epilepsy. Abnormal scans were reported in approximately half of the cases in both groups. An excess of left hemisphere abnormality was noted in the psychotic group, but this was not significant. These findings failed to provide firm support for the hypothesis that lateralized structural damage to the cerebral hemispheres plays a major part in determining the specific pattern of associated psychotic illness.

Data on the families of 74 probands with autopsy-proven Alzheimer's disease did not support the hypothesis, advanced by Heston and co-workers, of a familial association between Alzheimer's disease, Down's syndrome and immunoproliferative disorders. However, there are difficulties of interpreting negative conclusions in this type of study, particularly those resulting from small sample size and the impossibility of tracing all relatives; only the data for immunoproliferative disorders are incompatible with the hypothesis, those for Down's syndrome being too few to be informative. The incidence of presenile dementia among the first-degree relatives of probands was raised, as in many previous studies, and was consistent with a simple polygenic model. The mean parental age at birth of the probands was significantly raised by about 2 years (P = 0.01), but so also was that of their unaffected sibs, suggesting that the mechanism differs from that occurring in trisomy 21 and certain other aneuploidies.

One hundred elderly patients with chronic organic brain syndromes were assessed by standard interviews, nursing ratings and from historical information. The data were subjected to cluster analysis and eight clusters were isolated. The significance of these clusters is discussed and other features of the patients reviewed.

Forty patients suffering from senile dementia who had been subjected to detailed clinical and psychological assessment and computed tomography (CT) were followed up for a mean period of 28.78 months. All but one were traced. The deceased (27) were compared with the survivors (12). All males had died at follow-up. The mean age was not statistically significant but the survivors differed significantly from the deceased in having performed better on a number of clinical and psychological tests, particularly those involving speech functions and constructoinal ability. Measures of ventricular size and cortical atrophy were not of predictive value, but a new technique of measuring radiological density showed that this was significantly lower in the right parietal region in the original CT scans of those who subsequently died. The study confirms that clinical involvement of the parietal lobes is an indication of poor prognosis and reports the first radiological support for this view. It also suggests that a more directly quantitative approach to computed tomography may yield results which are more useful than those obtained from visual reconstructions.

Animal studies have suggested that the mechanism of the antidepressant action of ECT may be to increase monoaminergic post-synaptic receptor sensitivity. We have tested this hypothesis in 12 drug-free patients suffering from severe depression, 11 of whom had depressive delusions. The responses of growth hormone, prolactin and Cortisol to 0.75 mg subcutaneous apomorphine were examined before and after a successful course of ECT. There were no significant differences between hormonal measurements on the two occasions, with the exception that basal plasma Cortisol concentrations were significantly lower following ECT and recovery from depressive illness. These results do not support the hypothesis that ECT increases dopaminergic post-synaptic receptor sensitivity.

During two weeks' treatment of 11 manic patients with pimozide there was close correspondence between the timecourse of improvement in clinical ratings and the rise in plasma prolactin between the second and fourteenth day. There were no significant differences in growth hormone levels during the manic episodes compared to recovery. These findings are discussed in relation to the role of dopamine in the release of prolactin and growth hormone, and in the pathogenesis of mania.

In a double blind trial, 28 male chronic schizophrenic in-patients received either pimozide, given once weekly, or fluphenazine decanoate, given mostly once fortnightly. There was no difference in relapse rates over nine months. However, three-quarters of the patients on pimozide who completed the trial developed at least mild tardive dyskinesia. All patients on pimozide lost weight, the average loss being 5.4 kg (12 lbs). Plasma pimozide levels suggested satisfactory drug compliance. Plasma prolactin levels confirmed that in the pimozide group there was fluctuating dopamine receptor antagonism, while in the fluphenazine group average plasma prolactin levels throughout most of the interval between injections were at the upper limit of normal.

Sixty-eight depressed out-patients were allocated to treatment with either oral amitriptyline (75–225 mg/day) or intramuscular flupenthixol decanoate (10–30 mg every 14 days) in flexible dosage for 12 weeks under double-blind procedures. Various observer- and self-rating scales were applied before and after 2, 4, 8 and 12 weeks of treatment. Twenty-four patients completed the course of amitriptyline and 20 the course of flupenthixol. All variables improved over time, but there were no significant differences between the two drugs. The Newcastle scores pre-treatment were not related to drug response suggesting that both drugs were similarly effective across a wide spectrum of depressive disorders. Patients on amitriptyline tended to complain of dry mouth; those on flupenthixol had a higher incidence of extrapyramidal signs, the majority receiving anti-parkinsonian drugs at some time during the treatment. Flupenthixol decanoate in low dose is a useful anti-depressant, but should be restricted to short courses of treatment, to patients refractory to other treatments, and to patients suspected of poor compliance.

Melancholia is thought by many investigators to have a biological basis, and biological research, particularly on abnormalities of the neuroendocrine system and of the sleep electroencephalogram, is now beginning to yield results which can help in the differential diagnosis of depressive illness. This review will focus on the most widely studied neuroendocrine disturbance: disinhibition of the hypothalamus-pituitary-adrenal cortex (HPA) system as revealed by the dexamethasone suppression test (DST).

A comparison of hyperactive boys with and without associated conduct disorder was made to determine the validity of a narrowly defined concept of pure hyperactivity. Although clinical differences between the two sub-groups supported the diagnostic distinction, few differences appeared with respect to various possibly causal background factors. A small group of boys with pure hyperactivity was separated, however, on the basis of subnormal IQ scores. In contrast to the hyperactive boys with normal IQ, these boys showed a more serious history of developmental disturbances which appeared to be linked to organicity. It was concluded that pure hyperactivity is an elusive concept and probably defines a heterogeneous group of children whose primary problems are cognitive in nature.

Thirty-six patients with infantile autism and various neurological disorders underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a diagnostic radiologist. Two techniques modified from two previous studies were used for measuring parieto-occipital asymmetry. The frequency of reversed asymmetry in autistic patients was the same as that in patients with various neurological disorders, and there was no significant association between reversed asymmetry and delayed language development. The study does not support the concept that unfavourable morphological asymmetries of the brain near the posterior language zone may contribute to the difficulties autistic children experience in acquiring language. Methodological difficulties and the design of new studies are discussed.