This paper focuses on the later history of the York Retreat after the initial period for which it is best known. It discusses the marked changes which occurred in the social composition of its patients and the way in which these changes modified the asylum's management and therapy. It argues that the conventional image of the Retreat, based as it is on the institution's earliest years, needs considerable revision.

Hypothalamic–pituitary–adrenal axis function was investigated in 72 patients with primary depression. Forty-four per cent of the patients demonstrated abnormal suppression of their cortisol levels after a 1 mg overnight dexamethasone suppression test. Patients with abnormal suppression (‘non-suppressors’) were not clearly distinguished from ‘suppressors’ by the commonly used diagnostic classifications. They did not appear to be more severely depressed, but they were more likely than the ‘suppressors’ to be in-patients. Multivariate analysis of the data suggested that two clinical features were independently associated with non-suppression: the PSE syndromes of Slowness and General Anxiety. However, the association of these syndromes with non-suppression was relatively weak, indicating that the clinical significance of the dexamethasone suppression test is, as yet, unclear. The results raise doubts about the validity of using the dexamethasone suppression test as a diagnostic marker for a specific depressive syndrome.

Thirty-one (43%) of 68 patients with primary depression were found to have a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH). Increased thyroid activity, as measured by the free thyroxine index (FTI), was present in 16 (24%) of the patients. Patients with blunted responses had a higher mean FTI level than those with normal responses. Patients with blunted responses were significantly more likely to exhibit the symptoms of depersonalization, derealization and agitation. There was no clear association between blunting and any particular diagnostic category of depression.

Patients with blunted responses and high FTI values were more likely to report significant long-term environmental difficulties than patients with blunted responses and normal FTI values. It is suggested that there may be more than one mechanism responsible for blunting of the TSH response in depressed patients. In some patients blunting may be due to negative feedback from increased output of thyroid hormones, possibly released as part of a stress response. In other patients blunting may be due to a different mechanism, possibly involving pituitary gland dysfunction. These mechanisms would not necessarily be mutually exclusive in any one patient.

The vanadium content of hair, whole blood, serum and urine was estimated by neutron activation analysis in samples from manic patients, depressed patients, recovered manic patients, recovered depressed patients and normal controls. The results suggest that manic patients have significantly raised vanadium levels in hair which fall towards control levels with recovery, but there are no significant differences in the mean vanadium content of whole blood or serum. In contrast, depressed patients have raised levels of vanadium in whole blood and serum which appear to fall with recovery. Levels of vanadium in serum correlate strongly with those in whole blood, but neither shows significant correlation with vanadium in hair for either patients or controls. Hair and blood probably serve as indicator tissues for differing aspects of vanadium metabolism.

The growth hormone (GH) response to clonidine was measured in 10 patients meeting standardized criteria for ‘endogenous’ depression and in 10 patients individually matched for age and sex but meeting the corresponding criteria for ‘reactive’ depression. In a paired comparison of patients with reactive and endogenous depression (matched for age and sex), the GH response to clonidine was less in the endogenous member of the pair in 8 out of 10 cases. These findings are interpreted as evidence of a defect at alpha2 adrenoceptors in neuroendocrine systems in endogenous as compared with reactive depression.

Three problems with the dopamine hypothesis of major psychosis are pointed out: the long time-course of neuroleptic therapy; the absence of tolerance to the antipsychotic effects of neuroleptic drugs, or of a supersensitivity psychosis on drug withdrawal; and the absence of potent psychotogenic properties in the direct dopamine agonists. A resolution of these paradoxes is suggested relying on a role for dopamine in learning processes at a relatively high (cognitive) functional level. The hypothesis proposed is also used to explain the origin of some of the more distinctive psychotic symptoms.

A biometrical genetic analysis was carried out on the response of 419 pairs of twins to the 42-item version of the Leyton Obsessional Inventory. Just under half the variation in both the Obsessional Trait and Symptom Scales was due to heredity. Multivariate analysis revealed a genetic effect on the development of obsessional personality and also the transmission of a general tendency predisposing to neurotic breakdown. Although the influence of heredity was outweighed by that of the environment, the latter effect showed an absence of general factors and, in particular, of any noticeable effect from the common home environment.

Eight idiot savant calendrical calculators were tested on dates in the years 1963, 1973, 1983, 1986 and 1993. The study was carried out in 1983. Speeds of correct response were minimal in 1983 and increased markedly into the past and the future. The response time increase was matched by an increase in errors. Speeds of response were uncorrelated with measured IQ, but the numbers were insufficient to justify any inference in terms of IQ-independence. Results are interpreted as showing that memory alone is inadequate to explain the calendrical calculating performance of the idiot savant subjects.

This paper reviews recent research into cognitive functioning in depression, with particular reference to the theories of Lewinsohn, Beck, Seligman and Klein. The major cognitive changes in depression are a decrease in the ability to maintain concentration and effort, and an increase in the relative salience of aversive events and memories, with a corresponding decrease in the salience of pleasant events. There is as yet little evidence to support the view that depressions arise out of pre-existing depressive attitudes. Attention is drawn to the heterogeneity of depressive disorders, and the significance of the endogenous/non-endogenous distinction is discussed.

Evidence relating smoking and neuroticism is inconsistent; some studies report no significant relationship, while others report a positive association. The present study examined smoking in relation to neuroticism (N), extraversion (E) and psychoticism (P), in the light of predictions that interactions between N and E, and between N and P, could underly these inconsistent findings. The subjects were female student nurses (N = 270), of whom 34·1% were smokers. Discriminant analyses revealed that E differentiated most strongly between smokers and non-smokers. N and P did not add to the predictive power of the discriminant function, but the N × P and N × E interactions did make significant contributions. Among extraverts, and among subjects low in psychoticism, N was not related to smoking; but among introverts, and among subjects high in psychoticism, the relationship was significant and positive.

Using an apparatus which provides a continuous horizontal slit of light of variable length, self-estimations of 4 body widths were carried out before and after a mirror confrontation procedure on 4 groups of young female subjects – anorexic, bulimic, emotionally disturbed and normal. The results confirm that anorexic subjects overestimate body size, although in this study the hip diameter was frequently underestimated. Bulimic and emotionally disturbed subjects overestimate to much the same degree as anorexics, whereas normal subjects are remarkably accurate with the exception of the head width. Mirror confrontation resulted in reduced estimations in the majority of subjects, but significant differences were found in the degree to which this occurred in the 4 groups; anorexic subjects showed the greatest change and normal subjects the least. This relative instability of the anorexic subject's body image cannot be explained simply on the basis of a self-correcting experience, as many estimations which were initially below actual width were even lower on re-testing. In the anorexic and bulimic groups a significant correlation was found between the degree of overestimation after mirror confrontation and progress in treatment, as measured on a specially devised rating scale. Possible explanations for these findings and their diagnostic and prognostic implications are discussed.

Normal and anorexic subjects' estimates of their own body width were obtained. The estimates were reliable measures, but they did not correlate with the subjects' actual body widths. The implications of this finding especially when relating anorexic patients' self-perceptions to their clinical outcome, are discussed. It seems preferable to use such estimates untransformed by division with the subjects' actual body widths.

The relationships between illness severity, allergy as indicated by serum total immunoglobulin E, and various psychological and social factors were studied in 66 adult asthmatics. No substantial relationships were found between these factors. An earlier onset of illness before 3 years was associated with a higher serum IgE. These results do not support the commonly held concept that asthma is a ‘psychosomatic’ disorder.

A 4-year prospective study was undertaken of the families of 137 newly referred English speaking psychiatric patients with children at home aged under 15 years. The group comprised a representative sample of such patients living in one inner London borough. Teacher questionnaires were obtained yearly for all children of school age in the families, and for age-, sex- and classroom-matched controls. Detailed standardized interviews were undertaken yearly with parent-patients and with their spouses. A comparison was also made with a control group of families in the general population with 10-year-old children. Patients' families differed in terms of a higher rate of psychiatric disorder in spouses and a much higher level of family discord. Both parental mental disorder and marital discord tended to persist over the 4-year period, but persistence of both was much more marked when the parent had a personality disorder. The children of psychiatric patients had an increased rate of persistent emotional/behavioural disturbance, which tended to involve disorders of conduct. The psychiatric risk to the children was greatest in the case of personality disorders associated with high levels of exposure to hostile behaviour. Boys showing temperamental risk features were most vulnerable to the ill-effects associated with parental mental disorder.

A non-recursive structural equation model designed to examine the reciprocal relationship between life event reports and depressive symptoms in women is presented. The model was fitted to data from a 2-year longitudinal study of life events and depression in a sample of women with 5-year-old children. The findings suggest that life event reports may be influenced by mental state; however, even when this tendency is taken into account, there is still a substantial relationship between life events and depressive symptoms in women. This indicates that it is unlikely that the life events/depression correlation can be explained simply by a tendency for depressed women to over-report life events.

A comparison of medication prescribed for elderly residents in long-term care institutions in London and New York shows that New York residents are prescribed more drugs. The contrast is sharpest for those suffering from dementia who are much more likely to receive neuroleptic medication than their counterparts in London. Analysis indicates that the differences may reflect the greater emphasis in New York on the nursing-medical model of care, rather than any differences between the residents themselves.

Between 1968 and 1981 there were roughly equal numbers of male and female schizophrenic parasuicides in Edinburgh: males were significantly younger than females at parasuicide (33 v. 37 years), and had received a diagnosis of schizophrenia for a shorter time (3·4 v. 7·2 years). The clinical, epidemiological and social characteristics of such parasuicides are, by and large, those that might be expected from a knowledge of the epidemiology of schizophrenia.

Eight per cent of a sample of Edinburgh schizophrenic first-ever parasuicides subsequently committed suicide, when followed up for up to 14 years. This percentage is close to what would be expected for later suicide in non-schizophrenic parasuicides. When all the suicides were considered, similar numbers of male and female schizophrenics killed themselves; their mean ages at death were 42 and 43 years respectively; and the mean duration of the schizophrenic illness was 10 years in both cases, according to hospital records.

We found slight evidence that parasuicide is commoner in schizophrenic suicides than in schizophrenic controls but little evidence to support the contention that there may be a specific relationship between suicide (or parasuicide) and the presence of auditory hallucinations, recent discharge from in-patient care, the use of depot neuroleptic medication, or recent parasuicide.

From the point of view of the prevention of suicide and parasuicide in schizophrenics, it is noteworthy that we found few differences between the clinical characteristics and management of schizophrenic parasuicides and suicides, and schizophrenic controls.