The dexamethasone suppression test (DST) was administered to 95 patients referred to a psychogeriatric assessment service. Non-suppression of plasma cortisol was found in 28 out of 48 patients (58%) with senile dementia and all patients with arteriosclerotic dementia or acute confusional states. Non-suppression could not be explained by associated depressive symptoms. The DST was confirmed as a valid diagnostic test for endogenous depression in the elderly, but its value in distinguishing true dementing illnesses from depressive pseudodementia was not supported. The clinical implications of these findings for interpreting DST results in the elderly are discussed.

Professional raters who were blind to proband diagnosis used the schedule for affective disorders and schizophrenia (SADS-L) and the Research Diagnostic Criteria (RDC) to evaluate 1, 210 first-degree relatives of 327 probands with primary major depression, participating in the family sub-study of the NIMH Collaborative Study of the Affective Disorders – Clinical Branch. Bipolar II probands were significantly more likely to have bipolar II relatives than were non-bipolar or bipolar I probands. Bipolar II probands were slightly more likely than non-bipolar probands and slightly less likely than bipolar I probands to have relatives with bipolar I illness. Similar patterns have emerged in two other recently reported family studies of bipolar II illness. Taken together, these data suggest heterogeneity among patients with bipolar II depression. Some appear to be genotypes for bipolar I illness, while a small proportion may be genotypes for non-bipolar illness. A third group, of undetermined size, may breed true.

The depression and lability of mood which have been previously reported on the fifth day after childbirth are largely restricted to women with high neuroticism scores. The pattern of day-to-day mood changes is the same after Caesarian section as after vaginal delivery, but there is no ‘day five’ phenomenon after hysterectomy. Post-partum mood disturbance is less prominent in women who return home 48 hours after delivery.

Perceptual learning was examined with respect to variations in ECT electrode placement (bilateral versus right unilateral) and ECT stimulus waveform (sinusoidal versus brief-pulse). While patients receiving right unilateral ECT demonstrated more perceptual learning than did those receiving bilateral ECT, no difference in perceptual learning resulted from the variation in electrical stimulus waveform. Furthermore, the amount of perceptual learning was unaffected by EEG seizure duration and by the total amount of electrical stimulus energy delivered. The theoretical issue of whether an electrical or a seizure difference between bilateral and right unilateral ECT is responsible for inter-group learning or memory differences is discussed, as well as practical issues related to the choice of electrode placement.

The concept of ‘projective identification’, introduced by Melanie Klein and extensively used by her followers, is still held by many to be highly controversial and difficult to understand. Great importance is also attached by Kleinian workers to what they describe as the infant's early use of ‘idealisation’ as a defence against anxiety. A hypothesis is presented according to which both mechanisms could be seen as the continuation or persistence, in mental form and in early post-natal life, of some of the ways in which the unborn child could be said to relate to the mother physically during the last few months of intrauterine life.

Late paraphrenia is the form of expression of schizophrenia in old age. Twenty five patients diagnosed as suffering from the condition were studied, and their symptoms compared with the diagnostic criteria for schizophrenia of Spitzer et al (1975), the Catego system (Wing et al, 1974), Carpenter et al (1973a) and Langfeldt (1960). The study confirms late paraphrenia as one of the schizophrenias, and discusses differences with previous studies.

Admissions of mentally handicapped patients over a ten-year period to a hospital group with a catchment area population of 213, 000 are described and discussed. During this time, there was a progressive increase in temporary admissions for assessment, day care, and for both planned and emergency respite care. There were also 89 admissions for permanent care associated with conditions such as psychiatric disorder, multiple handicap, and changed family circumstances.

Three hundred and twenty-three patients were referred by psychiatrists for scanning with a 160 x 160 matrix CT 1010 Head Scanner at the Maudsley Hospital during the first year this machine was in use (1977/1978). Two hundred and one referrals were for clinical and 122 for research reasons, 50% of the former and 57% of the latter showed some abnormality on their scans. Review of the patients' notes identified data that were significantly predictive of abnormal scan results; and the referring psychiatrists were significantly more able to predict the scan results correctly during the second six months of the study. Diagnosis, management, and/or prognosis were influenced in 11.7% of those patients scanned for clinical reasons.

All chronic day-patients (n = 422), defined as patients aged 18–64 years attending a day facility of a psychiatric hospital or general hospital psychiatric unit continuously for more than a year, were identified in hospitals and units serving 56% of the Scottish population. The number of day patients was 14.8 per 100,000 of the general population, but the range between hospitals was very great—0 to 37.7 per 100,000—indicating the patchy development of such care. A typical day patient was a rather chronic middle-aged male schizophrenic, who lived on his own or with ageing parents. Most patients' accommodation was satisfactory, but the occupational activity of more than a third was inappropriate; 18% could have attended a local authority sheltered workshop if one had been available.

The relationship was examined between sinistral eye and hand preference and age at first hospitalisation, clinical course and social competence in chronic schizophrenics. Motor and sighting dominance were assessed in 52 newly admitted chronic schizophrenic males. Left-handedness in this study was associated with inferior social competence, but left-eyedness with later age of first hospitalisation and proportionally less time spent in hospitals. These findings were only true for paranoid schizophrenics.

Serum cholesterol levels were estimated in 313 mentally handicapped patients who subsequently died from various causes. Although cholesterol levels in the mentally handicapped are lower than those in the general population, it was found that there was still an association between relatively low serum cholesterol values and mortality due to cancer of the colon. Similarly, patients who died from myocardial infarction had relatively high serum cholesterol levels. The mechanism of the relationship between hypocholesterolaemia and cancer of the colon is unclear, but the increasing longevity of the mentally handicapped is an important factor which has contributed to a rising incidence of cancers, particularly gastrointestinal forms, in this group.

In a study of the evolution of behavioural symptoms in severely and profoundly mentally retarded adults in hospital over a period of six years, items of abnormal behaviour were found to be remarkably persistent. There is a high prevalence rate of psychiatric disorder in this population, when this disorder is defined in a widely descriptive sense. A substantially improved living environment, and increased staff-patient ratios, are prerequisites for improving disturbed behaviour in these patients.

Power spectral analysis was performed on the visual evoked potentials (VEPs) recorded in response to flashes of different intensity in both unmedicated schizophrenic and normal subjects. At occipital locations (01, 02), schizophrenics showed less power than normals in the 10–14 Hz frequency range. In the 18–22 Hz range, schizophrenics showed under-activation in the left hemisphere and over-activation in the right. At temporal locations (T3, T4), schizophrenics showed abnormal (left greater than right) hemisphere patterns of activation in 10–14 Hz and 18–22 Hz ranges. There were no group differences in relationships between power and intensity changes at vertex (Cz). The results suggest abnormal cortical-subcortical interactions during analysis of visual information in schizophrenia.

Daily levels of anxious and depressed mood, as well as motor and speech activity were monitored for five depressed and four hypomanic patients during the courses of their in-patient treatment. The data were compared with results from nine matched control subjects. Motor activity was assessed using the actometer—a wrist watch which translates activity into movement of the watch hands—and the speech activity by recording the pause, phonation, and total times taken to recite the digits from one to ten. Validity data for the actometer and for total and pause time were found to be encouraging as outcome monitors for the treatment of depressive affect; the significant results from the total time measure suggest that this simple method is worthy of more widespread use in clinical settings.

Evidence concerning the impact of the violence in Northern Ireland on psychiatric morbidity is limited to studies examining admission rates and psychotropic drug prescribing rates; their results varied from suggesting no effect to indicating that greater levels of violence are actually equated with higher levels of mental health. The present study is the first to use a community sample, in which respondents (797) from two towns, which have experienced contrasting levels of violence over the last ten years, completed the 30-item version of the General Health Questionnaire (GHQ), and also indicated their perception of the level of violence in their area and how safe they felt this was to live in. Those who lived in the more violent town scored higher on the GHQ, as did women compared to men and those who perceived that their area had experienced more violence. There was also a two-way interaction, such that the small number of people, who perceived much violence in their area and who also lived in the more violent town, scored more highly on the GHQ. It is possible that the majority of people in Northern Ireland deal effectively with stress generated by the political violence, but do so by denying the existence of this violence around them.

Fifty consecutively referred female patients with anorexia nervosa were followed-up to identify those completely healthy at a minimum of four years (mean eight years) since onset. As well as using Morgan's Outcome Measures, an independent psychiatrist elicited details of food/weight pre-occupation and psychiatric state. The outcome results, based on weight and menstruation, (36% ‘good’, 36% ‘intermediate’, and 26% ‘poor’ including 2% dead, and 2% not assessed) did not differ significantly from those of the three similar published studies on similar patients; 62% of patients continued to have some food/weight pre-occupation. DSM III criteria for a psychiatric disorder other than eating disorder were fulfilled by 50%; dysthymic disorder was common (34%), occurring exclusively in patients with continuing eating disorder symptoms, while only 20% of the sample were free of any physical or mental abnormality. Of 52 prognostic factors studied, only four were significantly related to the outcome measures. Length of illness at presentation was the only prognostic factor common to all four similarly conducted studies.

Zetidoline (ZTD), a compound chemically unrelated to any available antipsychotic, with selective dopamine receptor-blocking properties, was compared with haloperidol (HLP) in a double-blind study on 56 in-patients who had either first episodes or acute relapses of schizophrenia. ZTD was found to be safe, as effective as HLP, and to produce significantly fewer extrapyramidal side-effects (EPS).

Although memory tests are commonly used to help differentiate organic conditions from depression, the extent to which depression might influence test performance is unclear. Comparison of the performances of normal, brain-damaged, and depressed subjects on a battery of verbal and visual memory tests revealed that the incidence of impairment amongst the depressed subjects was not significantly greater than amongst normal subjects on the majority of measures, and that within the depressed group, the degree of depression was not related to poor test performance. The brain-damaged group displayed a significant incidence of impairment on all measures, and a significantly greater incidence than the depressed group on the majority of measures. It is concluded that memory tests have a useful role to play in differential diagnosis.

Of 603 patients receiving in-patient or day-patient psychiatric care, one-sixth were taking no psychotropic drugs, but nearly 50% of those receiving medication had a combination of two or more such drugs. Hypnotics and minor tranquillisers were frequently prescribed together with neuroleptics and antidepressants. One-third of all patients receiving neuroleptics received a combination of oral and depot preparations, while half of all patients on neuroleptics were prescribed anti-parkinsonian drugs. One-fifth of patients treated with neuroleptics had a diagnosis other than schizophrenia, and one-third of patients treated with antidepressants had a diagnosis other than affective disorder. A comparison of our findings with those from Oxford show some significant differences, particularly in the use of depot, oral, of combined neuroleptic drugs. An analysis of prescribing could be a useful part of self-audit for hospitals.

Measurements of skin conductance response frequencies (SCRf) were obtained from 30 acutely ill schizophrenic patients during a standardised videotaped interview, conducted with the patient's key relative present. Significant differences in SCRf's were demonstrated between patients whose relatives had high and low Expressed Emotion (EE) respectively. Patients at high risk of relapse were allocated either to a control or an experimental group, the latter being offered a number of social interventions in order to reduce the relative's EE and/or contact with the patient. Follow-up measurements were obtained on 19 patients nine months after discharge. Although social intervention was highly successful in reducing relapse rates, its effects did not appear to be directly mediated via SCRf, which was found to be independently related to relapse.