The treatment of depressive disorders was significantly altered by the introduction of the tricyclic antidepressants and the monoamine oxidase inhibitors. One salient factor in determining efficacy is the dose prescribed. The few good dose response studies which are available indicate that patients should receive 300 mg of imipramine or equivalent, and a separate trial of 90 mg of phenelzine or equivalent, before concluding they are treatment refractory. Data are reviewed which suggest many patients receive inadequate doses.

Almost since the beginnings of psychiatric practice, there has been a recognition that negative life experiences and stressful happenings may serve to precipitate mental disorders (Garmezy & Rutter, 1985). Nearly 200 years ago, Pinel wrote about the psychiatric risks associated with unexpected reverses or adverse circumstances, and it is reported that his initial question to newly admitted psychiatric patients was: “Have you suffered vexation, grief or reverse of fortune?” Nevertheless, although an appreciation that a variety of stressors may play a role in the genesis of psychiatric disorder has a long history, the systematic study of such effects is much more recent.

Surveys using clinical-type interviews have documented a high rate of depression among working-class women, and this is discussed in the light of a recent survey in an inner-city area. While women with caseness of depression contacting a psychiatrist did not differ in number of core depressive symptoms from those who did, they did in certain characteristics that would make them worrying for a general practitioner to deal with. It is concluded that there is a considerable overlap in the severity of depressive conditions between those seen by psychiatrists and those defined as cases in population surveys; any differences that do exist may relate more to the way symptoms are expressed than to the severity of the depressive disorder as such.

Patients with chronic schizophrenia were treated with either propranolol (640 mg daily) or thioridazine (400 mg daily). In a double-blind study lasting five weeks, propranolol was superior to thioridazine on both psychiatrists' and nurses' ratings. Significant improvements were noted with propranolol in both positive (Type I) and negative (Type II) symptoms.

To gain more insight into the social (as opposed to clinical) outcome of schizophrenia, a unidimensional, hierarchical scale was constructed. Items were selected from the Disability Assessment Schedule (DAS)–a new instrument, used in the WHO Collaborative Study on the Assessment and Reduction of Psychiatric Disability. Data were derived from the Dutch cohort participating in this study, which consisted of patients with a first life-time episode of a non-affective, functional psychosis. Patients were followed-up during the first three years of their illness, and analyses of the stability and reliability of the scale proved to be satisfactory. It was subsequently used to characterise the course of social disability.

‘New chronic inpatients' (patients aged 18–64 years in hospital more than one but less than six years) were followed-up two years after identification in the catchment areas of 14 psychiatric hospitals, serving 56% of the Scottish population. Nine per cent had died, 71% remained in-patients, and 20% had been discharged; 40% of those discharged had no contact with after-care services, and 37% of those remaining in hospital did not need in-patient care. Discharged patients were younger, had been in hospital a shorter time, and less often had organic brain disease. Only 13% of patients who, when first identified, had been rated at a low functioning level had been discharged; 64% of those remaining in-patients at follow up had such a rating.

In a case control study, 32 onset cases of depression, separated into PSE-CATEGO Categories N and R, were compared with individually matched symptom free general practice attenders. Combining both categories of depressives together a significantly greater number reported an Undesirable Life Event and a Threatening Life Event in the six months prior to onset, compared with their matched controls. Significantly more CATEGO R (retarded or endogenous) depressives reported an Independent Threatening event than their matched controls. These findings do not support the view that depression secondary to a major life event is more likely to be mild in character.

The case notes were studied of 142 mothers admitted to psychiatric hospitals in the south-east Thames region within 12 months of childbirth during the years 1979 and 1980. Only 6% of the sample were categorised as schizophrenics by RDC criteria, whereas affective disorders were found to predominate in 80%. Manic and schizo-affective illnesses almost always began within two weeks of parturition, as did psychotic depressions. A third of the patient sample had suffered relatively minor disorders, and given adequate resources, some might have been better managed in the community. A parallel investigation of diagnostic returns to the Department of Health revealed considerable uncertainty about how to classify puerperal mental illnesses in accordance with ICD-9. There is an urgent need to improve the system for categorising and registering mental illnesses related to childbirth. Until this is achieved, research into aetiology, outcome, and the provision of services will continue to be impeded.

Eighty parasuicide patients were studied. The importance of life stress, age, and General Health Questionnaire score as predictors of the suicidal intent and medical lethality which they exhibited was examined. Medical lethality and suicidal intent were closely related: those whose parasuicide resulted in high lethality differed from those showing low lethality in their degree of suicidal intent, but did not differ in life stress, age, or GHQ score. Although both life stress and GHQ score were significantly correlated with suicidal intent, the GHQ score accounted for a greater proportion of the variance. These results suggest a more complex relationship between life stress, GHQ score, and suicidal intent than is often assumed.

In a study of 357 long-stay hospital residents aged 40 years and over, 30% had significant psychiatric disorder, while a retrospective survey of 215 new admissions over a seven-year period to a psychiatric unit for the mentally handicapped revealed that 20% of patients were aged 40 years and over. Both similarities and differences were found in the overall pattern of disorders between the two groups and a non-handicapped population in a comparable age-range.

Psychoanalytical and family therapies are contrasted: psychotherapeutic change involves a change of frame. The new frame in family therapy is the system; for analytical therapy it is the unconscious, but there are striking formal similarities between them. To achieve this change, there are two basic modes of therapy, reflective and directive, each containing elements of both. An essential ingredient in therapy is an uncoupling of action from effect, which occurs in play; psychotherapy can be seen as a special type of play. In family therapy, the therapist may useful playful paradox: ‘therapeutic double binds'. Transference, the vehicle of psychoanalytical therapy, is a metaphorical relationship that is also essentially playful—serious but not real. Some guidelines for considering the relative indications and contraindications of family and individual psychotherapy are offered.

A variety of psychiatric symptoms have been described in relation to Wilson's disease, an inherited disorder of copper metabolism. At least four symptom clusters can be identitifed: affective, behavioural/personality, schizophrenia-like, and cognitive; the first two groups appear to be the commonest. Four cases (three newly reported) are described, and current approaches to the psychiatric management of Wilson's disease discussed.

We compared the psychiatric manifestations of 56 CATEGO S schizophrenic in-patients from three ethnic groups (white, coloured and black). A marked similarity among the groups on both schizophrenic and non-schizophrenic symptoms was found, as well as a high prevalence of depressive and anxiety symptoms. Differences occurred on the syndromes of (1) olfactory hallucinations and (2) subcultural delusions and hallucinations. Black patients had both syndromes more frequently than either white or coloured patients.

It is not sufficiently realised that sleep-walking is not an hysterical condition, nor in any way related to epilepsy, nor that it can be accompanied by violent injury to the self or others. Three case reports here include that of a 14-year-old boy who rose from his bed at 2 a.m. and severely stabbed his five-year-old girl cousin. The sleeping mind is not in touch with reality and amnesia for events during sleep is usual.

Temporal orientation in 235 normal elderly subjects was examined and compared with previous results from a young adult population. Orientation for time in the elderly remains reasonably intact; the major exception to this was inaccurate recall of the date, which was most pronounced among women in the older group studied (71 +).

Cerebrospinal flud (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.

The P300 (P3) and other long latency auditory evoked potentials were measured in 15 patients with presenile dementia Alzheimer type (ATD), 16 patients with alcoholic Korsakoff syndrome (KS) and 23 age-matched control subjects. All were drug free for at least four weeks before testing. The latency of the P3 was significantly longer and the amplitude significantly smaller in the ATD group than in both the KS and control groups. The KS group did not differ significantly from the control group in either latency or amplitude of P3 but both the KS and ATD groups had reduced N1 and P2 compared to controls. Using a combination of P3 latency and amplitude, 70% of the ATD patients could be separated from the other groups with no false positives. These findings suggest that evoked potential recording may be of value in the diagnosis of early ATD.

Patients were treated with three different types of electroconvulsive therapy in random order in the first three sessions of their courses. Anaesthetic and muscle relaxants were administered in standard doses, and treatment applied a set time after bolus injection. Electroencephalographic recordings were undertaken before, during, and after treatment, and hormonal measures before and after. The responses to treatment differed between the three types of current in both EEG and prolactin measures. It is suggested that the quality of the convulsive response varies with different currents.