Rhythmic variations with frequences from fractions of seconds to years characterise a wide variety of biological processes (Aschoff, 1979). Biological rhythms can be observed, not only in the individual of the species, but also in the cells which comprise the organism and the populations of which it is a member. These regular fluctuations can be endogenously generated by some form of internal oscillator, or alternatively may passively reflect exogenous environmental alterations. An important group of rhythms combines both endogenous and exogenous inputs with an internal oscillator or oscillators which are capable of being influenced by some external change. In this situation, the internal rhythm is kept in harmony with an environmental cycle by a change in the outside world acting as a synchroniser or zeitgeber. In this type if the animal is artificially isolated from its normal external synchroniser, the rhythm will continue, but free running, with a periodicity which is a close approximation to the duration of the environmental cycle to which it is normally tied. These rhythms normally synchronised to an environmental cycle but capable of being self-sustaining at approximately the same rate, are termed circa rhythms: thus circadian, circannual and circalunar rhythms, according to the geophysical cycle by which they are normally entrained.

The different brain functional states during sleep and wakefulness are associated with differences in processing strategies, memory stores, and EEG patterns. Shifts of functional state occur spontaneously or as orienting reactions to processed information, and cause the formal characteristics of dreams. Forgetting of dreams is a function of the magnitude of the difference between states during storage and recall. Based on EEG similarities between sleep stages and developmental stages, brain states during sleep in adults are proposed to correspond functionally with waking states during childhood. Repeated functional regressions occur during sleep, with access to earlier memory material and cognitive strategies unavailable during waking life, so that earlier experiences can be used for current problems. This dream work constitutes the biological significance of sleep.

A group of depressed patients and a group of normal subjects were assessed on two occasions. On each they were required to recall past real life experiences associated with a series of stimulus words. Subjects were subsequently required to rate each experience for happiness and pleasantness. The depressives showed an increased probability of recalling sad memories; within this group there was a significant relationship between severity of depressed mood and the percentage of sad memories recalled. The extent of reduction in depressed mood from occasion 1 to occasion 2 was significantly related to the increase in accessibility of happy memories and the decrease in recall of sad memories. For those patients who improved between the two occasions there was a significant reduction in the probability of recall of a very unhappy memory. The results extend the previous findings on the effect of mood state on the accessibility of memories of differing affective tone. The findings are discussed in terms of context specific encoding and retrieval.

The prevalence of psychiatric disorder was determined according to alternative diagnostic criteria in a random sample of 576 women from an Edinburgh community. Whichever diagnostic system was applied, significantly higher rates of disorder were found among the working class, the unemployed and women who were divorced, widowed, separated or cohabiting; in the subgroup of women who met all these conditions, up to half were found to satisfy the diagnostic criteria. The observed prevalence estimates can be explained as the effects of each demographic factor acting independently, no interaction effects being needed. Our results are discussed in relation to the findings of others, and in terms of the statistical issues involved.

Four research diagnostic schemes are compared in one community sample. The prevalence of psychiatric disorder ranged from 8.7 per cent (ID-Catego, threshold and definite) through 13.7 per cent (RDC, probable and definite) to 20.3 per cent (Bedford, borderline and definite). The main comparison made is between the PSE/ID/Catego and SADS/RDC systems. Sixty-one per cent of cases are identified as such by both these schemes. There is poor agreement about labelling; only 56 per cent of cases of depression and 16.7 per cent of cases of anxiety are so diagnosed by both systems. A post hoc check list was used to identify Bedford cases; all bar one were found to fulfil RDC and PSE case criteria. The results are compared with those from other centres which have used the same diagnostic criteria in community studies.

As part of a survey of 1517 women aged 20–60 years, a factor analysis and validation study of the General Health Questionnaire (GHQ) was carried out. Although three clinically relevant factors could be isolated, their sensitivity was less than that of the total GHQ score, which was found to be a good measure of current psychiatric disturbance in this community sample.

It has been hypothesized that the mechanism of action of antidepressant treatments is related to their ability to decrease the sensitivity of the alpha-2 adrenergic autoreceptor. In order to assess alpha-adrenergic autoreceptor sensitivity, the effects of clonidine, the alpha-2 adrenergic receptor agonist, on plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenethyleneglycol (MHPG), blood pressure (BP) and patient-rated sedation were measured in nine depressed patients before and during amitripytline treatment. Postsynaptic alpha-2 adrenergic receptor sensitivity was assessed by determining the growth hormone (GH) response to clonidine before and during treatment. Amitriptyline significantly attenuated the effects of clonidine on plasma MHPG, standing systolic BP, and sedation, indicating that alpha-2 adrenergic autoreceptors had become subsensitive. In addition, baseline plasma MHPG levels were significantly reduced. Amitriptyline had no effect on the GH response to clonidine.

A range of memory and perceptual tests not previously used in the assessment of the effects of ECT has shown no impairment in 38 depressed patients after six unilateral (one dominant and five non-dominant) ECT.

First rank symptoms (FRS) in association with affective features predict improvement on ECT. When affectivity was disregarded in 142 schizophrenic probands given ECT and the relationship between FRS alone and ECT response examined, those without FRS had a significantly better ECT outcome score than those with FRS. In various schizophrenic sub-samples, defined in terms of hypothesized predictive abilities of different sets of FRS, no differences came to light.

In an effort at replication of the original report (Rosenthal and Bigelow, 1972) of increased callosal thickness in schizophrenic brains, the corpus callosum was measured in a blind study of 64 brains autopsied between the years 1972 and 1976. Diagnosis was established by independent chart review. The mean corpus callosum mid sections of 21 early onset chronic schizophrenic brains were found to have a significantly greater thickness when compared with 8 subjects with late onset schizophrenia, 13 patients with neurological diagnoses, or 14 patients with other psychiatric diagnoses. These studies, if independently confirmed, should provide an impetus for testing the hypothesis that some chronic schizophrenic patients have an illness associated with a pathological process in the corpus callosum.

Increasing evidence suggests that the concentrations of cyclic guanosine 3′5′-monophosphate (cGMP) in the cerebrospinal fluid (CSF) may reflect central cholinergic activity. When the concentrations of this nucleotide in the CSF from 28 schizophrenic patients (13 without and 15 with neuroleptic treatment) and 16 psychiatrically healthy controls was determined the schizophrenics showed significantly lower CSF levels of cGMP as compared to controls.

As dopamine and homovanillic acid concentrations were not altered in these CSF samples, this finding of reduced cGMP suggests a cholinergic-dopaminergic imbalance in schizophrenia, with a reduction of the former and consequently a relative dominance of the latter.

This study surveys the discharge register of a large London teaching hospital over 20 years and presents data on its 48 cases of clinical sexual fetishism. An attempt was made to answer two questions: (1) What are the clinical problems these patients present? They have more to do with the perception of fetishes as personally or socially unacceptable than with ‘objective’ restrictions placed on sexual activity. (2) What is the classification used to describe? The data have not enabled any conclusions to be drawn about the existence of particular fetishist syndromes. Certainly, a fifth or more of the sample had fetishes for clothes or rubber or rubber items, or wore or stole a fetish or fetishes; but this information is insufficient to allow one to assume that these patients had something significant in common, and leaves open the question of what more precisely each individual was attracted to.

Changes in sexual behaviour in patients with Parkinson's disease treated with levodopa are well recognized. Barbeau (1969) was the first to draw attention to “a clear-cut visually evident increase in libido” occurring in at least four out of 62 male parkinsonian patients treated with levodopa. Hyyppa et al (1970) reported that among 41 treated patients 10 experienced an increase of libido. De Ajuriaguerra et al (1972) reported that 29 out of 202 treated patients spontaneously told the authors of their satisfaction in respect of sexual behaviour. They commented “despite a few complaints from their spouses we do not believe there are any grounds to support the hypothesis of hypersexuality, but rather a more or less complete return to normal”. Similarly, Duvoisin and Yahr (1972) found that 8 per cent of a total of 283 patients reported an increase in sexual activity that “generally appeared to represent a partial return towards normalcy”. However, hypersexuality during levodopa therapy in parkinsonian patients was seen in senile dements, or as a feature of a more generalized disturbance, e.g. hypomanic behaviour. The subsequent experience of other authors (Bowers et al, 1971; Shapiro, 1973; Ballivet et al, 1973) has left no doubt that frankly hypersexual behaviour, albeit uncommon, may be provoked by levodopa treatment. Goodwin (1971) reviewed the literature on 908 patients and found an incidence of 0.9 per cent and Shapiro (1973) concurred, with an incidence in the region of 1 per cent of treated patients. Bowers et al (1971) reported 7 out of 19 patients on levodopa who indicated an activation of sexual behaviour on a combined scale of feeling and performance at some time during levodopa therapy. They divided the subjects into three groups: firstly patients who showed increased sexual drive apparently independent of motor improvement, secondly others whose sexual drive increased proportionately with their mobility, and thirdly those who developed hypersexual behaviour as part of an acute brain syndrome with an agitated and confused state.

A postal survey of male and female university students is reported, using the Eating Attitude Test (EAT) and the Crown Crisp Experiential Index (CCEI). Eleven per cent of the 156 female respondents but none of 120 males scored above 30 on the EAT, thereby declaring eating attitudes comparable to anorexic subjects. Of those interviewed, none fulfilled diagnostic criteria for anorexia nervosa, but half showed eating disorder of clinical severity. There was a clear association between high EAT scores and higher scores on all the subscales of the CCEI except the phobic scale. The results are discussed in relation to ideas about the possible origins of clinical eating disorders.

Two patients are described with both anorexia nervosa and diabetes mellitus. In addition, both patients suffered from bulimic episodes. A third patient with bulimia is also described. All patients admitted to using their diabetes in a purposeful and direct way to pursue their morbid goal of weight loss. Management proved extremely difficult.