The paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.

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.

Self-reports of memory problems have been evaluated prospectively in depressed patients receiving bilateral ECT or unilateral ECT, and in depressed patients receiving treatments other than ECT. Depressed patients did not complain of poor memory at seven months after hospitalization. Compared to bilateral ECT, right unilateral ECT was associated with only mild memory complaints. At three years after treatment approximately one-half of the persons who had received bilateral ECT reported poor memory. These reports seemed to be influenced by three factors: (1) recurrence or persistence of conditions that were present before ECT; (2) the experience of amnesia initially associated with ECT and a subsequent tendency to question if memory had ever recovered; and (3) impaired memory for events that had occurred up to six months before treatment and up to about two months afterwards.

The concept of schizophrenia has changed since it was first introduced by Kraepelin. To overlook or misunderstand this evolution will lead to confusion with adverse effects on the clinic and on research. Kraepelin's exclusively somatic approach to the study of the illness gave rise to a variety of attempts to provide a wider theoretical framework which will accommodate a subjective psychological approach. The first of these attempts was that by Bleuler and Jung, but it brought with it new difficulties. Jaspers' methodology was applied to the study of schizophrenia by Schneider, and it creates the theoretical space which will accommodate both the objective and subjective study of the illness and its victim as a person. An attempt is made here to outline a brief history of these ideas.

At the autumn meeting of the Medico-psychological Association in 1871, Maudsley—that time President of the Association—reada paper entitled 'In Issanity on the Increase?. The question was then one of profound concern both to the British public and to psychiatrists. Not only had there been for years a constant need to build new asylums—a cause ‘of terrible discouragement and complaint with the ratepayers’ (Arlidge, 1859)—but also, as was clearly apparent in the publications of the Poor Law Office and the Annual Reports of the Commissioners in Lunacy, the number of the registered insane was increasing every year, far out of proportion to the increase in the population (see Fig 1). This circum stance, it was said, ‘miwghetll give rise to alarming apprehension of a mental degeneracy’ in the country (Arlidge, 1862).

The treatment of 15 adolescents with obsessive-compulsive disorder is described. Treatment was in most cases primarily behavioural (response-prevention), with the family involved in the therapy. Other components of treatment which were used in some cases are also described: medication, psychotherapy, and ‘milieu’ therapy. Outcome after treatment was generally good, with symptoms in most cases being relieved entirely or reduced to a mildly incapacitating level. Treatment gains in most cases were maintained at follow-up. Obstacles to treatment are noted, and recommendations are made as to the management of the disorder in adolescence.

An evaluation of the prevalence of Schneiderian first-rank symptoms, and their diagnostic and prognostic value is described. 35.2 per cent of schizophrenic patients had first-rank symptoms. The presence of first-rank symptoms did not indicate either chronicity of illness or a poor outcome.

A system of ward support for chronic psychiatric patients in an urban community is described, which makes available ward and staff facilities throughout the 24 hours and at weekends. Details are given of a group of 41 patients using this facility over a period of six months. Two types of use of the ward were identified, based on the amount of social interaction with other staff and patients. The ‘unengaged’, with a high rate of visits, were mainly schizophrenic patients with an early first onset of illness and currently a scanty social network (small primary group and often no confidant). The ‘engaged’, with a lower rate of visits, were people with a later onset and a larger social network.

The medical school at Queen's University offers a 4-year M.D. degree course. Because the majority of graduating students consistently choose family medicine as a career, it was decided that the overall objective of the undergraduate course should be to provide the students with the skills and knowledge required to deal with the psychiatric disorders commonly found in general medical practice. The teaching of psychiatry is limited to the second, third and fourth medical years, and teachers are clinicians rather than nonpractising experts in particular fields related to medicine.

Three groups of patients were identified during a study of men who had recently suffered an acute myocardial infarction: those with psychiatric morbidity antedating the infarction, those with psychiatric morbidity immediately following the infarction and those with no significant psychopathology. Compared to the other two groups, patients with psychiatric morbidity before the infarction were more likely to be unmarried, unemployed and to have received previous psychiatric treatment. They also obtained higher scores for neuroticism and psychoticism on personality assessment. Patients whose symptoms have been precipitated by the infarction resembled the psychologically healthy group with regard to their demographic characteristics and personality. Their symptoms tended to be transient, improving without special psychiatric treatment.

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.

In a study of 229 neurotic same-sex adult twins admitted to all psychiatric in- and out-patient clinics and mental hospitals in Norway, a statistically significant, moderately higher concordance was found for MZ than for DZ twins. When the sample was subdivided, this higher concordance for MZ pairs was true only for male twins and for twins admitted to mental hospitals. The results are compared to those from earlier studies; different findings on the importance of genetic factors in the development of neuroses may be due to differences in sample selection.

Problems in psychiatric and psychosocial education arise from the absence of agreement on curricular content, failure to emphasize observable skill development, and the ambivalent views on psychosocial material found in modern medicine. The curriculum for medical students presented here emphasizes an integrated approach to teaching psychiatry and psychosocial material. Great emphasis is placed on interviewing and history-taking as well as on problem-solving. Specific courses in development, psychiatry and ageing are prescribed. Preclinical education in psychiatry emphasizes a bio-psycho-social view of mental disorder.

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.

Eighteen depressed chronic schizophrenic out-patients were matched with non-depressed schizophrenic out-patients. The depressed schizophrenics had had significantly more psychiatric admissions, past depression, past treatment for depression, significantly more had attempted suicide, lived alone, had low self-esteem, had early parental loss and had had more life events in the six months before the onset of depression. Depressive disorder in schizophrenic out-patients well controlled by neuroleptics may occur in those who are at risk for depression and experience an excess of life events.

Platelet monoamine oxidase (MAO) activity was compared in four age and sex-matched groups: monozygotic (MZ) twins discordant for schizophrenia, normal MZ twins, normal dizygotic (DZ) twins and unrelated individuals. Among the twin groups, schizophrenic and normal, there was a remarkably consistent degree of genetic control amounting to 70–80 per cent of the variation in activity. The mean platelet MAO activity of the schizophrenic twins was significantly lower than that of controls, but not than that of their psychiatrically well, neuroleptic-free cotwins; indeed the correlation for the MZ twins discordant for schizophrenia was almost exactly the same as that for the normal MZs. Thus, lower platelet MAO activity in schizophrenia, where it is found, is genetically modulated and not the result of the illness or its treatment.

Of 26 patients with active Cushing's syndrome assessed before and at three and 12 months after treatment, 21 had pituitary-dependent disease. Median urinary free Cortisol values (per 24 hours) were 680, 180 and 200 nmol at zero, three and 12 months (normal <270 nmol), with significant improvement (P <0.001) at three and 12 months. Depression on the Hamilton rating scale was significantly less at three months (P <0.01) and at 12 months (P <0.001). We have already demonstrated that some patients with Cushing's syndrome have PSE diagnoses of depression and are more depressed than patients with other pituitary tumours. This is the firmest evidence to date that when Cushing's syndrome occurs it commonly causes depressive illness.

The majority of men convicted of manslaughter by reason of diminished responsibility used to receive hospital orders, but are now receiving prison sentences. A sample of offenders convicted between 1966 and 1977 was studied to see the reasons for the change. It was found that the make-up of the offender population did not change materially over the period, nor did the willingness of judges to make hospital orders. What changed was the pattern of treatment recommendations made by the examining doctors in their court reports.

The 420 first-degree relatives of 14 patients with anorexia nervosa, 55 patients with bulimia, and 20 patients with both disorders were evaluated for the presence of psychiatric illness, using DSM-III criteria, by the family history method. The morbid risk for affective disorder in the families of the eating disorder probands was similar to that found in the families of patients with bipolar disorder; but was significantly greater than that found in the families of patients with schizophrenia or borderline personality disorder. These results add to the growing evidence that anorexia nervosa and bulimia are closely related to affective disorder.