We have observed a significantly higher growth hormone (GH) response to clonidine administration (150 μg i.v.) in 14 patients with a major depressive disorder who had never received antidepressant therapy than in 14 matched depressive patients who had not received tricyclic drugs for at least 15 days. Compared with a control group of eight subjects, untreated depressed patients, as a group, had a normal response, while matched patients had markedly blunted response. Results for the group of untreated depressed patients showed that some patients had a blunted response while others had a response in the normal range. The results suggest that studies on the GH response to clonidine in psychiatric patients need to take into account the confounding and long-lasting effects of tricyclics.

Few, if any, of children's behavioural or cognitive characteristics assessed in the first years of life demonstrate stability until later childhood; early characteristics have so far failed to show an association with future psychopathology. This longitudinal study, from 4–8 months to 4.7 years old, focused on stability and change of extreme temperamental traits in groups of infants subselected from a large birth cohort. Persistent extreme temperament at four and eight months old did not increase stability of temperament to four years of age, relative to other children in the whole population. Sizeable change occurred, and the environmental parameters associated with negative temperamental change did not seem to be the same as those related to positive change. Boys with extreme scores were more stable, while girls appeared more prone to positive change. It is hypothesised that the direction of temperamental change in the first years could be more meaningful for long-term prediction of disorders than any one assessment of temperament taken at any one year.

Expressed emotion (EE) in key relatives of 21 patients with bipolar affective or schizoaffective psychoses was assessed by the CFI. All patients had been on prophylactic lithium for at least three years and were without psychotic symptoms at interview. The relationship between relatives' EE status and patients' course of illness was studied both retrospectively and prospectively. Two critical remarks designated high EE. The relatives' EE status was not related to number of hospital admissions or to severity and length of recurrences if the entire period of lithium treatment is considered as a whole. However, patients living with high-EE relatives showed a significantly poorer response during the three years before interview, and an even poorer response in the nine-month follow-up.

It is argued that there are two kinds of benzodiazepine dependence: a therapeutic and a morbid kind. The therapeutic dependence is acceptable in that it mitigates the clinical manifestations in patients with long-standing and fluctuating anxious–depressive symptoms. The morbid dependence is an unfortunate complication which can arouse therapeutic concern because it ties patients to an excessive dosage, unless the penalty of a sometimes grim abstinence syndrome is paid on drug reduction. The present, often strident and threatening, damnation of benzodiazepines oversteps the mark and causes avoidable misery to patients whose well-being has become largely and therapeutically dependent on the drug.

An important topic in the neurobiology of the affective disorders relates to changes in the metabolism of neurotransmitters. Since the early 1960s, the ‘serotonergic’ hypothesis (Coppen et al, 1972) has been supported by findings such as a low concentration of 5-hydroxy-indoleacetic acid (5-HIAA) in the cerebro-spinal fluid (CSF) of patients with melancholic depression and/or suicidal behaviour (Banki & Arato, 1983; Åsberg et al, 1984; Banki et al, 1984; López-Ibor, Jr et al, 1985; Korpi et al, 1986) as well as the efficacy of serotonin precursors, when combined with MAOIs, in the treatment of depressed patients (Coppen et al, 1963; Glassman & Platman, 1969; Ayuso et al, 1971; López-Ibor, Jr et al, 1976).

Pathophysiological theories of tardive dyskinesia (TD) suggest the possibility of structural changes in the central nervous system of patients with TD. This report describes a case of choreoathetoid dyskinesia and spastic dysphonia associated with clinical and electromyographic signs of muscle denervation. The findings of this case suggest that the neurological syndrome originates within basal ganglia nuclei but may also extend to the peripheral neuromuscular system.

Binswanger's disease is a cerebrovascular disorder affecting deep white matter and is associated with dementia and affective disturbance. In the case reported, the mood disorder was successfully treated with a combination of lithium and amitriptyline, resulting in an improved quality of life despite continuing cognitive decline. This underlines the importance of treating the affective component of organic dementing conditions on its own merit.

Normal-pressure hydrocephalus (NPH) was described in 1964 (Adams, 1965; Hakim, 1965) and defined by the symptom triad: dementia, motor disturbance, and sphincter disturbance. The original publication by Adams already contained a reference to psychiatric symptoms: depression, slowness, hallucinations, and apathy. Rice & Gendelman (1973) reported five cases, and commented on the development of both early cognitive impairment and behavioural regression, suggesting that personality factors might play a role in the appearance of latter symptoms. Trevor et al (1977) described a case suffering from psychotic depression, paranoid symptoms, inadequate affect, and self-destructive behaviour.

It is now widely accepted, especially in the United States, that confining lawbreakers in mental hospitals as insane, without the benefit of a real trial, rather in prisons as criminals, after a proper trial, is a recent, enlightened Western practice. Nothing could be further from the truth. The practice is not recent, enlightened, or typically Western – resembling the Oriental despotic arbitrariness towards troublesome persons much more closely than the Occidental legal respect towards persons accused of crimes. Many 19th-century cases illustrate the procedure and support my foregoing interpretation of it. The following is a typical example.

A mother and her son shared delusional beliefs that doubles of themselves existed and that they were being harassed by the police and social and educational services. The nature of these ‘double double’ symptoms is discussed.

Data were obtained for some 89 psychiatrists who were responsible for 372 first-author research publications over the period 1978–1984, to define predictors of productivity (rate of publishing in scientific journals). A principal components analysis suggested three key researcher dimensions, comprising ‘track record’, ‘experience’ and ‘resource base’ variables. The ‘track record’ dimension was the only significant predictor and was contributed to principally by the number of publications in the early part of the review period, number of citations to published work, rating by peers, and possessions of a research degree.

In a retrospective analysis of 100 cases of mania (1981–1985), the incidence of subsequent depression was found to be 30%. Its occurrence was significantly associated with three factors: cyclothymic premorbid personality, family history of affective disorder, and past history of depression. By discriminant analysis, outcome could be predicted successfully in 81% of cases.

Gastric emptying of a mixed meal was measured in 22 patients with anorexia nervosa, ten with bulimia nervosa and ten controls. Ratings on a visual analogue scale (VAS) were made during the test. Patients with anorexia nervosa felt fuller and less hungry than controls, although satiety was not related to gastric emptying rate. Controls showed a correlation of about 0.6 between gastric contents and reported hunger and satiety. Patients with anorexia nervosa had significantly lower correlations between gastric contents and hunger, but normal correlations with fullness. Significant correlations were often observed between gastric contents and symptoms of eating disorder in both anorexic and bulimic groups, but not in controls.

A man temporarily developed an organic personality change, psychosis and epilepsy after a frontal lobe operation for a subarachnoid haemorrhage. While affected, he set fire to his house. The arson is thought to have been a direct result of a seizure. The case and its legal management are discussed.

A case showing various involuntary movements during mianserin treatment and after a withdrawal of mianserin is described. This is the first case report of mianserin-induced involuntary movements. The report suggests that these symptoms can occur with a therapeutic dose of mianserin in certain susceptible patients.

Freud's Three Essays on the Theory of Sexuality (1905) made possible the understanding of the concept of perversion as a form of psychic conflict resulting from both constitutional and acquired factors. He stated (as against earlier views) that sexual deviations could not be separated from ‘normal’ sexual behaviour, on the grounds that both sprang from a common source (infantile sexuality). In the first essay, Freud classified sexual deviations into two groups, depending on whether the aim (e.g. sadism and masochism) or the object of the instinct (e.g. homosexuality and paedophilia) were displaced. In the second essay he characterised infantile sexuality as a collection of partial instincts and erotogenic zones, on which both the source and the object of the instinct converged. He also stated that infantile sexuality was auto-erotic, implying that the sexual object was contingent.

“Functional psychosis is conventionally subdivided into schizophrenia and manic depressive psychosis. Response to treatment is assumed to be a validating criterion for these diagnoses. The efficacy of pimozide (a dopamine antagonist neuroleptic), lithium, and a combination of the two was compared with that of placebo in a 4-week trial in 120 functionally psychotic patients, each of whom was assessed for psychotic symptoms, manic symptoms, and depressive symptoms. The sample was subdivided into patients with predominantly elevated mood, predominantly depressed mood, and no consistent mood change. Pimozide reduced psychotic symptoms in all groups of patients. The only significant effect of lithium was to reduce elevated mood. Thus dopamine blockade seems relevant to the resolution of psychotic symptoms in all types of ‘functional’ psychosis, but the mode of action of lithium in psychotic patients concerns only mood. Application of standardised classifications of functional psychosis to these data did not change this conclusion.”

A woman who suffered multiple losses in childhood and adolescence became depressed 40 years later, after a series of new losses. Concomitant alexithymic features caused a masking of her depression by somatic symptoms. The relationships between alexithymia, masked depression and loss are discussed.

An unusually young woman (18 years old) who misused alcohol and developed Wernicke's encephalopathy is described.

It would be absurd to suggest that mental health legislation is never abused, that individuals are never detained unnecessarily on inappropriate psychiatric grounds, or that political expediency does not sometimes exert an influence on decision making in this regard. Dr Szasz, however, takes an extreme view in rejecting the moral or legal right of psychiatrists to participate in the compulsory hospital admission of offenders. He rightly points out that if psychiatric involvement is wrong in principle, then “periodic outbursts of indignation against ‘abuses'” are “both naive and foolish”. Nevertheless, he sees fit to support his arguments with examples of what he deems abuses.