In the year 1899 there occurred an event which has had great consequence for psychiatry. This was the publication of the sixth edition of Emil Kraepelin's textbook, where he introduced for the first time his distinction between manic-depressive insanity and dementia praecox. It was a distinction which rapidly became accepted almost everywhere in the world, and it still forms the basis of our thinking about the nature of the functional psychoses. Kraepelin's concept of mania was quite different from the concept of mania held during most of the nineteenth century; and so, historically speaking, there are two manias, more or less sharply separated by the Kraepelinian revolution. The purpose of the present essay is to give some account of the term mania in its pre-Kraepelinian sense and of the events which led Kraepelin to his new concept; and also (in Part II) to put forward a new idea of why this revolution came about.

An account is given of the overall strategy and measures used in a three-phase study of styles and techniques employed in the initial diagnostic interviews with the parents of children referred to a child psychiatric clinic. The measures of interview style included interviewer activity and talkativeness, directiveness, types of questions and statements, interventions designed to elicit or to respond to feelings, and non-verbal qualities. The informant's response and the interview ‘outcome’ were assessed through measures of the quantity and quality of factual information obtained, and of the extent of expression of emotional feelings by the informant. Good inter-rater reliability was achieved with most measures. Some difficulties were experienced in achieving comparable thresholds for the recognition of expressed emotions.

Using a sample of 198 depressed patients (145 female, 53 male) retrospective histories of the illnesses were collected during a depression-free interval, based on a catalogue containing 38 symptom items and the course of the depression (including the interval personality). A cluster analysis on persons and items filtered out an endogenous depressive item profile, corresponding with the clinical syndrome of patients diagnosed as endogenous depressives in the clinics, although determined without reference to the clinical diagnoses. Our study supports many results from earlier multivariate statistical studies. We consider our data to be an essential contribution towards the establishment of a multiaxial clinical picture.

During 2 weeks on a waiting list 12 patients with morbid grief did not improve significantly. They were then randomly allocated either to guided mourning treatment, in which they were encouraged to face cues concerning their bereavement or to control treatment in which they were asked to avoid such cues. Each treatment comprised six 1½ hour sessions over 2 weeks. At week 4 guided mourning patients had improved significantly more than had controls on 3 measures, with a supportive trend on 4 measures. Improvement though modest was maintained to 10–28 weeks follow-up. Control patients did not improve significantly or show any trend to do so.

Psychotherapy and the changes it produces can be understood in terms of simple basic essentials. Intensive and longstanding clinical experience demonstrates its therapeutic potency. Those factors in the therapist which are most important in leading to change are described. The significance of the therapeutic relationship is discussed, as well as the necessity of its candid and intensive examination during the therapy, if marked change is to occur. What is not psychotherapy is also explored.

Serum samples from psychiatric patients were added to incubations of rat adrenal cortical cells synthesizing aldosterone. A high proportion of sera from patients with bipolar manic-depressive psychosis inhibited aldosterone production, but chronic in-patients without affective disorders gave few inhibitory sera. Inhibition was greatest in depression, lowest during normal affect. In one patient studied through 11 affective cycles the inhibitor score increased during transitions from mania to depression, showing a significant regression on time. The possible relationship of this in vitro phenomenon to the defect of aldosterone regulation in manic-depressive psychosis is discussed.

The Carroll rating scale (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scale (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.

Fifteen general physicians were given profiles of symptom combinations representing 80 depressed patients. They were asked to judge the severity of the disorder and to prescribe. There were two phases to the experiment the formal structure of both being the same. In the first phase, all physicians based their judgments only on the cues of the Hamilton Depression scale; in the second, each physician defined his own cues. Multivariate regression analysis was applied to the observations. Agreement between the judges was low. Most had a more complex policy, in regard to both judgment of the severity of the depression and prescribing, when selecting their own cues than when restricted to textbook variables, but used it more consistently. The observations have important implications for training and research in psychiatry and in psychopharmacology.

A naturalistic study was undertaken of 36 video and audio taped interviews made by 7 different psychiatric trainees. The interviews studied were those conducted in the ordinary course of clinic work for diagnostic and therapeutic planning purposes by trainees when first seeing the parent or parents of a child newly referred to a psychiatric clinic. It was found that a directive style with specific probes and requests for detailed descriptions was associated with the obtaining of better-quality factual information than that associated with a more free-style approach. Interviewers who talked less and who made more use of open questions and checks tended to have more talkative informants. Double questions were liable to result in ambiguous answers, but multiple-choice questions did not appear to cause distortion and in some circumstances might be helpful.

The development and definition of four contrasting interview styles is described. The four styles were designed using different permutations of techniques which, on the basis of an earlier naturalistic study, appeared to be most effective in eliciting either factual information or feelings. A ‘sounding board’ style utilized a minimal activity approach; an ‘active psychotherapy’ style actively sought to explore feelings and to bring out emotional links and meanings; a ‘structured’ style adopted an active cross-questioning approach; and a ‘systematic exploratory’ style aimed to combine a high use of both fact-oriented and feeling-oriented techniques. Quantitative measures based on video-tape and audio-tape analysis showed that two experienced interviewers could be trained to adopt these four very different styles and yet remain feeling and appearing natural. An experimental design to compare the four styles is described.

Classroom Reality Orientation was investigated with a sample of dements drawn from a psychogeriatric hospital and an old people's home. Treatment effects were examined on a range of cognitive and behavioural measures, and compared with the effects of a specific behaviourally directed orientation training in the ward. Class RO improved cognitive functioning but not behaviour, irrespective of degree of dementia. Highly significant behavioural change was demonstrated for ward behaviour orientation training and this technique is not only cheaper but has potential in managing dements.

Patients attending a clinic for sexually transmitted diseases (STD) were interviewed to estimate the presence of sexual dysfunction, and the GHQ-60 was used to measure psychiatric morbidity. Over one-fifth of the males and more than one-quarter of the females were experiencing sexual dysfunction problems, and the majority of them would have liked further help for their problems. The implications of the findings are discussed, and suggestions are made for dealing with these patients.

A double-blind trial failed to demonstrate any significant short-term effects of clomipramine in doses recommended for use in general practice (in addition to the usual range of psychotherapeutic help) in the treatment of children with school refusal and neurotic disorder. Patterns of improvement were also studied for the sample as a whole irrespective of treatment. Neither age nor sex were significantly related to improvement, except on one behavioural measure where girls initially did better than boys. In addition, it was found that there was a rapid relief of depression but neurotic symptomatology tended to persist.

The Munchausen syndrome was first described by a physician (Asher, 1951), the classical criteria being exaggerated symptoms, factitious physical signs, and the tendency to wander between hospitals (Bursten, 1965).

Factor analyses were conducted for the Hamilton depression rating scale (HRS) and the self administered Carroll counterpart (CRS). The factor loadings for the respective first factors were similar; those for the respective second factors showed strict sign consistency but only moderate consistency of magnitude; the loadings for the respective third factors showed no particular consistency. The first three CRS and first three HRS factor scores were computed for each individual and correlations were computed from these factor scores. The first and second factors were highly correlated but the third factors were negatively correlated indicating that they were not measuring the same thing. The first factors of the CRS and HRS correlated highly with their respective raw total scores and were indices of the severity of illness. The self-administered CRS (with matching weights) is a credible alternative to the HRS for routine clinical assessment of the severity of depression.

The study compares 72 female psychiatric patients who had a history of suicide attempt with 122 who had neither attempted nor contemplated suicide. Of these 194 women, 128 had experienced the death of their mothers before the age of 11, but the proportions of early bereaved and not early bereaved who were suicidal were similar. Not even the events which followed bereavement affected suicidal behaviour, but the suicidal patients tended to come from larger sibships. Poor quality of the marriage and, for the early bereaved only, having three or more children related significantly to suicidal behaviour. The suicidal women were significantly more often described as dependent. Suicidal behaviour was not differentiated on the endogenous/neurotic depressive dichotomy but it was significantly related to severity of depression.

The Clifton Assessment Schedule and the Shortened Stockton Rating Scale were administered to 38 elderly, mentally handicapped patients. Inter-rater reliability was high and the CAS was found to be a useful measure of cognitive ability. The tests measure different features of patients, but both correlated significantly with estimated levels of independence.

The effect of deficiencies in social relationships has been studied prospectively in a community sample. In the half who were exposed to the higher level of adversity, these deficiencies explained 30 per cent of the variance in neurotic symptoms four months later. They explained only 4 per cent in those with lower adversity. Contrary to expectation, it was not the lack of relationships, but perception of these as being inadequate under adversity, which had by far the stronger predictive power. This may mean that actual conditions in the immediate social environment are not important for neurosis. Instead, intrapsychic and personality factors may have a much stronger effect.

Dextroamphetamine (0.15 mg/kg) intravenously administered to a group of normal postmenopausal women induced a dysphoric reaction with drowsiness, annoyance, sadness and anger. Young normal men, receiving the same dosage, responded with elation of mood and alertness. It is suggested that age and hypoestrogenism may alter the behavioural response to amphetamine.