The reliability of the total scores on three rating scales (Melancholia Scale and the two Newcastle Scales) and the algorithms leading to the Feighner, Research Diagnostic Criteria, and the DSM-III subtypes of depression have been compared. The degree of inter-observer agreements for the various item-combinations was significantly higher than would be expected by chance. The average agreement for each assessment system ranged from 80 to 93 per cent. This 7 to 20 per cent lack of total agreement probably reflects the limitation of clinical assessments including the influence of halo effects.

From a prospective study of tardive dyskinesia (TD), psychiatric patients with neuroleptically—induced “persistent” TD were contrasted with controls on a neuropsychological measure of abstracting ability. A significant association is demonstrated between impaired cognitive performance and TD, even when the neuropsychological measure was obtained in advance of TD onset.

Obsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.

Retrospective review of 89 patients with pre-senile dementia followed by necropsy indicated significant differences between sub types of dementia. Patients with multi-infarct dementia (MID, 27 subjects) more often had cardiovascular abnormalities than patients with Alzheimer's disease (46 subjects). No patients with MID alone had a systolic blood pressure below 140 mm Hg, whereas 23 of 46 Alzheimer subjects and three of 16 patients with mixed features had such a systolic pressure.

Different patterns of personality in old age were examined in an aged community sample of 82 subjects (mean age 79.6 years). Four personality patterns in old age were identified using multivariate techniques. They were the normal, the introverted, the perturbed and the matured integrated. The clinical implications of personality types in old age are discussed; the perturbed group are most likely to develop psychiatric disorder.

Births occurring in winter months, which are high viral infection months, have been repeatedly shown to produce a slight excess of later-diagnosed schizophrenics. As a result, some researchers have speculated on the possible aetiological effect of viral infections on some forms of schizophrenia. The implications of the viral hypothesis were indirectly tested in the context of an ongoing prospective study of Danish children at high-risk (HR) for schizophrenia. A third-order analysis of variance interaction was hypothesized. Genetically vulnerable individuals, born in winter, in an urban environment (which increases the likelihood of the presence and transmission of viruses) would be more likely, as foetuses or neonates, to have suffered some CNS damage due to the infection; thus they would show higher rates of schizophrenia diagnoses. This hypothesis was supported. The rate of schizophrenia in the HR-urban-winter birth condition reached 23.3 per cent, considerably above population base rates (1 per cent) or rates for the HR subjects (8.9 per cent). Alternative explanations for the results were explored.

The association between the risk for schizophrenia and season of birth was studied using a standard actuarial life table method. This method of analysis eliminates the possibility of the previously described statistical artifacts from the data. An increased risk for schizophrenia for winter born individuals was demonstrated. The analyses also supported the hypothesis that season of birth is associated with an increased risk for a subtype of schizophrenia.

Samuel Pepys's diary allows us an opportunity to see how a man of acknowledged ability and stability coped with the severe psychological trauma of being involved in the Great Fire of London in 1666. His self-monitoring provides an excellent record of the development of post-traumatic stress disorder and an account of his coping behaviour. Despite being one of the newest categories of mental disorder in the official nomenclature, posttraumatic stress disorder has obviously had a long existence.

The perceived parental rearing practices and attitudes of social phobics, agoraphobics, height phobics and non-patient normal controls were investigated, employing the EMBU, an inventory for assessing memories of upbringing. Findings revealed that, as compared with the controls, social phobics and height phobics scored both parents not only as lacking in emotional warmth, but also as having been rejective and overprotective. Agoraphobics reported both parents as having lacked emotional warmth, but only their mothers as being rejecting. Interestingly, the perception of negative rearing practices of parents appeared to be stronger in height phobics than in either social phobics or agoraphobics.

Two hundred inpatients suffering from primary depressive illness were studied. Seventy eight of the patients were treated by electroconvulsive therapy (ECT) and 122 patients received antidepressant medication. Response to ECT and antidepressant medication at 4 weeks showed a curvilinear relationship to Newcastle scores. Patients with Newcastle scores in the middle range (4–8) showed significantly higher percentage improvement than those with low (0–3) and high (9–12) scores. Ninety five patients with unipolar depression who received lithium therapy for one year were also studied. Response to lithium showed a linear relationship to Newcastle scores in these patients. It is suggested that these differences in response to antidepressant therapies reflect the heterogeneity of depressive illness.

In a survey of training in child psychiatry in Great Britain, all senior registrars were sent questionnaires; the response rate was 69 per cent. We describe background factors of the trainees, details of the clinical and academic experience available to them, and their attitudes towards their training.

Most trainees had had extensive previous experience in adult psychiatry and the predominant orientation was psychoanalytic. In general, they approved of the guidelines for training issued by the Joint Committee for Higher Psychiatric Training. Family therapy was the most popular treatment method. We comment on their training experience where the interest expressed was not matched by adequate availability of the training facilities.

The dexamethasone suppression test (DST) was performed on 21 patients with dementia of the Alzheimer type (DAT), 11 patients with multiinfarct dementia (Ml) and 14 healthy controls. Twelve of the DAT patients and eight of the Ml patients showed abnormal lack of suppression, compared with just one member of the control group. Abnormal DST was related to dementia as such and not to age or depression, or to levels of CSF monoamine metabolites. Basal serum prolactin concentrations were not increased.

In a study of plasma amino acids in psychiatric patients, serine to cysteine (S/C) ratio was higher (S/C = 1.57±0.28) in 57 psychotics compared to 27 nonpsychotics (S/C = 1.06±0.23). This difference was highly significant at P <0.001. Psychotic patients were given a psychosis score (p score) of 1–4, The S/C ratios of individual patients were significantly correlated to their p scores (r = 0.65, P <0.001). S/C ratios were not related to diagnosis, age, sex, food intake and medications. When the initial S/C ratio and p scores of 22 patients were compared to their S/C ratio and p score at the time when they were improved and ready to be discharged, there was a concomitant fall both in S/C ratios and p scores suggesting the high S/C ratios may be indicative of a state rather than a trait characteristic. Our findings lead us to the conclusion that S/C ratios may provide a marker for the presence of psychosis and an index of its severity.

Two groups of normal volunteers had regional cerebral blood flow (rCBF) measured, by the 133Xenon inhalation technique, before and 30 minutes after 250 mg or 500 mg caffeine given orally. rCBF was measured in a third group of subjects, twice, at a similar interval under identical laboratory conditions. Subjects who received caffeine showed significant decreases in rCBF while the others showed no rCBF change from the first to the second measurement. However, the two caffeine groups did not differ in degrees of rCBF reduction. There were no regional variations in the post-caffeine decrease in cerebral blood flow. The three groups did not show significant changes in end-tidal carbon dioxide, pulse rate, blood pressure, forehead skin temperature and respiratory rate.

In a sample of young mothers an association was found between a depressed mood and the recall of poor parental relationships during childhood. Women who had been depressed but had recovered by the time of questioning did not recall a poor relationship. A second retrospective measure of a childhood experience, based on more factual details, was unrelated to current mental state.

Despite a large research effort, there is still some doubt whether life events can increase the rate of psychiatric morbidity. It is argued that this doubt arises from a confusion between measures of goodness of fit and measures of causal importance. The distinction between these types of measures is discussed.

Epidemiological studies of life events and psychiatric cases are reviewed. It is argued that, in general, 32 per cent of psychiatric cases can be attributed to stressful life events. Within female samples, approximately 41 per cent of psychiatric cases can be attributed to life events. It is suggested that the effect of specific types of events on specific psychiatric disorders may be of even greater importance.

The outcome of 78 patients with anorexia nervosa treated in a special clinic is described, using a standardized follow-up technique. The findings are compared with two previous studies which utilized an identical evaluation procedure. Certain predictors of poor outcome already identified by previous studies (long duration of illness before referral, previous personality problems, difficulties in relationship between family and patient) are confirmed. The findings suggest that early intervention may be an important component of effective treatment. The possible advantages of long term continuity of outpatient care are also discussed and the need for careful scrutiny of criteria for hospital admission emphasized.

It is concluded that chronic morbidity due to anorexia nervosa represents an important topic for further research. There is need for further identification of factors associated with chronicity, some of which may be secondary repercussions of the illness itself, and prospective evaluation of treatment programmes which focus on predictors of poor outcome.

Over a 25 year period, 2.4 per cent of Birmingham medical students developed psychiatric disorder which was severe enough to cause loss of time from the course; 1 per cent of the total required hospital admission. One-third of the psychiatrically ill students did not graduate, but those who did were as likely as graduates who had not been ill to remain on the Medical Register.

Eight patients with bulimia nervosa were given methylamphetamine or placebo intravenously under double blind controlled conditions. In every patient, methylamphetamine reduced self-ratings of hunger and amount of food eaten as measured under laboratory conditions. This shows that the food intake of patients with bulimia nervosa can be modified by experimental drugs. The symptom of bulimia (rapid, excessive and distressing eating) which may be followed by self-induced vomiting or purgation was seen in four patients after receiving placebo but in none after receiving methylamphetamine. These findings suggest that the severe symptom of bulimia may be amenable to drug treatment. Further studies are needed to explore the mechanism by which methylamphetamine appears to prevent bulimia.

Past history of suicidal behaviour was investigated in 51 depressed women (27 unipolar and 24 bipolar) in whom the TSH response to TRH was studied. Patients with a history of violent suicidal attempts were shown to have a reduced TSH response to TRH, compared to depressed patients with a history of non-violent suicidal attempts and depressed patients with no history of suicidal behaviour. A five-year follow-up study on these patients revealed that four patients who died from suicide had an absence of TSH response to TRH.