The last 20 years have seen a rapidly growing interest in disorder of brain function in psychiatric illness but this is only the latest phase in a steady development of ideas over the last three centuries. Throughout this time, biological and psychological formulations of psychiatric disorder have co-existed and, at different periods, one or other has been the focus of attention. Thomas Willis, who coined the word ‘neurology’ 300 years ago, felt that psychiatric disorder represented brain disorder, but it was only during the nineteenth century, as understanding of brain function made its first real progress, that this opinion became more explicit and accepted. By the second half of the century, it was axiomatic that psychiatric disorder was synonymous with brain disorder (Griesinger, 1845; Maudsley, 1873; Ferrier, 1878); all that was lacking was the actual neurophysiological basis of mental disorder.

This paper describes the clinical features of selected examples of organic and psychogenic amnesia, and it discusses the nature of the dysfunction that these amnesias entail. The anterograde component of organic amnesia involves a severe impairment in acquiring (or learning) new information, rather than accelerated forgetting, and this may reflect an underlying limbic or neurochemical dysfunction. Retrograde amnesia has a basis which is (at least partially) independent of anterograde amnesia - in some patients, it appears to involve a failure to reconstruct past experience from contextual cues, and this may reflect a superimposed frontal dysfunction. Two types of confabulation are discussed, one of which (‘provoked’) is a normal response to poor memory, and the other ('spontaneous’) appears to reflect incoherent, context-free retrieval, associated with more severe frontal pathology. It is argued that many cases of psychogenic amnesia may resemble organic amnesia, in that they result from an impaired acquisition of information at the time of initial input, perhaps thereby predisposing the subject to subsequent retrieval difficulties.

The response to the dexamethasone suppression test (DST) was examined in 543 patients suffering from major depressive illness and 246 healthy controls, from 13 research centres, representing 12 different countries, in a World Health Organization Collaborative Study. In almost all the centres, the post-dexamethasone plasma Cortisol concentration was significantly higher in the patients than in the controls. Although there is variation between centres, this abnormal response to the DST was shown to be frequent in patients from widely different geographical areas.

In a structured sample of 100 male and 100 female minimally impaired patients, aged 60 years and over, females were more depressed. Varimax factor analysis demonstrated four factor groupings which have clinical relevance - Depression, Anxiety, Cognitive impairment, and Psychosomatic disorder; their relative importance is different in males and females. Analysis of variance of the scores of clusters generated by cluster analysis demonstrated four groups of subjects - normal, mildly depressed, moderately depressed with borderline dementia and disability, and severely depressed with moderate dementia and frank disability. In the mildly and moderately depressed, symptoms of anxiety predominated.

DSM-III personality disorder clusters had not previously been tested for their ability to distinguish between different population groups. A major obstacle - different demographic characteristics of different populations - was overcome by using logistic regression. Three out-patient psychiatric referral groups (chronic pain, disability applicants and competency to stand trial) provided subjects; adjustments were made for age, race, sex and education. The groups were significantly different in the adjusted prevalence of DSM-III personality disorder clusters. Clinical association between personality disorder and drug or alcohol abuse was again confirmed.

This study attempted to use feedback from the Model Standards Questionnaires (a series designed to measure the quality of care) to improve care on a psychiatric hospital's rehabilitation wards. Both a controlled and quasi-experimental design were used. The controlled design provided evidence that feedback from the Questionnaire concerned with the Individual Programmes of Treatment and Care led to improvements in these practices but not for the remaining three questionnaires. The quasi-experimental design indicated that the significant generalised improvement in care, over all questionnaires, was most likely due to the feedback.

A structured sample of mobile elderly patients in a rural community practice was assessed on validated rating scales for depression, dementia and disability. A total of 62% of the sample was abnormal on at least one variable. The overall prevalence of depression was 13%; the overall prevalence of dementia was either 10 or 18% depending on the criterion of Mental Test Score (MTS). Depression and dementia were related, depression being more common in females. In depressed and demented patients, MTS was age-related in those over 60 years; in depression alone, MTS was not age-related. Dementia was age-related, particularly over the age of 75. Disability increased with age and was more common in females. Disability was associated with both depression and dementia.

To evaluate qualitative differences in the nature of thought disorder, the ‘cloze’ procedure and the Scale for the Assessment of Thought, Language and Communication were used to compare speech samples from schizophrenic, depressive, manic, schizo-affective and normal subjects at two different times. At the acute phase, thought-disordered subjects (schizophrenics, manics and schizo-affectives) were less communicable than non-thought-disordered subjects (depressives and normals). Communicability increased with remission of the more flagrant features of disturbance. Comparison of the thought-disordered diagnostic groups in the rate and pattern of remission of specific features of thought disorder indicated that factors reflecting goal-disrupted cognition distinguished the groups.

In a survey of psychotropic drug prescribing for in-patients in three different types of psychiatric hospitals, the prevalence of combinations of more than one psychotropic drug varied from 45% in one hospital to 94% in another, with significant consistent differences between the use of drug combinations in the various hospitals. Combinations of two antipsychotic drugs were particularly frequent; the hospital with the lowest prevalence of polypharmacy was the only one with an associated psychopharmacology unit. Access to clinical pharmacology teaching may be an important factor in determining appropriate drug-prescribing habits.

Compulsory detention rates of white, West Indian and Asian males under Part IV and Part V (offenders) of the 1959 Mental Health Act were compared: British-born West Indians and Asians were differentiated from migrants. Rates for Asians were similar to those for whites, but West Indians were significantly over-represented amongst compulsory detentions, especially as offender patients. A high total number of admissions and diagnostic differences accounted for the excess of West Indians admitted under Part IV, but not Part V.

The prescription sheets for all patients in a mental handicap hospital on one day in 1972 and on the same date in 1982 were examined to identify trends in anticonvulsant medication over a 10-year period. There was a reduction in size of the hospital population associated with fewer very young and milder handicapped persons. Prescription of anticonvulsants fell slightly during the decade under study with a dramatic fall in the use of phenobarbitone, and a parallel increase in the prescription of carbamazepine. Other changes included the use of sodium valproate in a significant minority of patients and the occasional use of clonazepam in 1982, while phenytoin remained a first-rank anticonvulsant throughout the period under review. The proportions of patients on polytherapy did not change over the 10-year period, though the contribution of phenobarbitone to the combined drug regimes was significantly reduced.

Asphyxia as a means of heightening sexual pleasure unfortunately comes to notice more often in the coroner's court than in the psychiatrist's consulting room. The victims are usually adolescent men who strangle or hang themselves while masturbating; transvestism is frequently associated with this behaviour (Simpson, 1979; Friedmann & Faguet, 1982; Mason, 1983). Few such people ask for help, and behavioural treatment in such a case has not been previously described.

A Classification of suicidal behaviour was derived by cluster analysis from descriptive data on parasuicide patients. The grouping was meaningful in terms of clinical interpretation and had both therapeutic and prognostic implications. The sample was broken down into three groups, identified as repeated, serious and non-serious attempts. The repeated attempters had the worst prognosis at 1 -year follow-up. When the sample was classified into five groups according to seriousness of the attempts, the repeater and non-serious groups were retained, while the serious attempts were split into three subtypes, which differed on nosological characteristics, treatment disposal and outcome. An excessively high successful suicide rate was found in a small group of elderly attempters.

We completed the Newcastle Diagnostic Scale on 152 unipolar depressed in-patients: its validity was supported by the findings that endogenous depressives were, in contrast to neurotic depressives, older, more severely depressed, with better social support, fewer life events, less personality disorder, and a lower morbid risk of alcoholism and antisocial personality in their first-degree relatives. The relationship between Newcastle scores and the morbid risk for alcoholism was non-linear, such that a cut-off score of 4, rather than 5, maximised the difference between the endogenous and neurotic groups with respect to familial alcoholism rates as well as other validating variables.

The physical examination on admission, as recorded in the psychiatric case notes, was assessed for 100 consecutive admissions under the age of 65. Assessment was made on the presence or absence of reference to 43 items of examination and the recording of the examinations was found to be uniformly poor. One of the authors re-examined 50 patients within 48 h of admission and the findings were then compared with the initial recorded examination. Significant unrecorded positive findings were most frequent in the neurological and locomotor systems.

Significantly more of 300 patients with non-endogenous depression compared with 300 matched controls were unemployed and had a poor marriage before the onset of depression, had a first-degree relative who had been treated for depression, had experienced separation for one year or more from a parent before 17 years of age and had three or more children under 14 years of age at home. However, significantly more of 44 patients with endogenous depression, than their 46 controls, also had a poor marriage before the onset of depression and 43% of them had a first-degree relative who had been treated for depression. Thus a family history of depression and a poor marriage before the onset of depression are associated with both non-endogenous and endogenous depression but unemployment, separation for one year or more from a parent before 17 years of age, and having three or more young children at home may be risk factors for non-endogenous depression.

As a treatment for tardive dyskinesia, sodium valproate was tested in a double-blind placebo-controlled parallel group trial, with 6-week base-line observation period followed by 6 weeks of treatment. Sodium valproate was not found to be an effective treatment for either tardive dyskinesia or drug-induced Parkinsonism, and did not affect mental state or behaviour.

The rate and degree of consanguinity in the parents of 143 schizophrenics who satisfied the DSM-III diagnostic criteria, was compared in the same number of controls matched for age, sex and socioeconomic class. A family history of disorders suggestive of schizophrenia in the offspring of consanguineous parents who were schizophrenic, was compared with the incidence of a similar history in the schizophrenic offspring of non-consanguineous parents. There was no statistically significant difference in the former, but there was in the latter. This finding supports the theory of a familial tendency towards schizophrenia and the possibility of recessive or a multigene pattern of inheritance.

A study comparing the use of electrodermal response with the cuff technique and clinical judgment as monitors in electroconvulsive therapy is reported. A sensitivity of 90.5% and a specificity of 41.7% were found and it is, therefore, suggested that this method is not used routinely.