Psychosomatic medicine begins with the Greeks. It finds a place in Galen's system as diseases of passion, a concept current until the middle of the nineteenth century. The great French and German clinicians of the nineteenth century were all familiar with psychosomatic diseases. During the twentieth century the field was for a while monopolized by psychoanalysts. The psychosomatic specialist is essentially the doctor who listens to the patient.

This research is part of the NIMH-CRB Collaborative Study on the psychobiology of depression. The main objective of the research programme is to test hypotheses concerning the interaction of neurobiological mechanisms and behaviour in the depressive disorders. Part I of the report describes the rationale and the overall approach to measuring behavioural state and outcome in the research programme. Part II reports on the results of applying the behavioural methods to a comparison of the clinical phenomenology of unipolar and bipolar depression. The behavioural patterns expressed during the episode by the two groups are different. Further, the two types are shown to react differently to treatment with tricyclic drugs, reinforcing the thesis that they are qualitatively distinct forms of the depressive disorders.

Preliminary data are presented from the NIMH Collaborative Study on the psychobiology of depression, biological studies, dealing with relationships between the pre-treatment levels of the neurotransmitter metabolites 3-methoxy-4-hydrophenethyleneglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) and the subsequent therapeutic response of depressed patients to imipramine or amitriptyline. Eighty-seven depressed patients were studied during pre-treatment and treatment periods. It has been found that (1) both low pre-treatment urinary MHPG and low CSF 5-HIAA values are associated with a response to imipramine; these relationships were not artefacts due to sex or age; (2) there were no significant relationships between pre-treatment urinary MHPG, CSF MHPG, 5-HIAA, or HVA values and the subsequent response, or failure of response, to amitriptyline; (3) there was not a bimodal distribution for CSF 5-HIAA. For both males and females, there were positive and statistically significant correlations between CSF MHPG and urinary MHPG; for the females, there were positive and significant correlations between both urinary and CSF MHPG and CSF 5-HIAA. The theoretical and practical implications of these findings are discussed.

Preliminary data from the National Institute of Mental Health – Clinical Research Branch Collaborative Program on the Psychobiology of Depression dealing with the human growth hormone (hGH) response to the Insulin Tolerance Test (ITT) during the pre-treatment (drug-free) period of the study are presented in this paper. Data are reported for 54 unipolar depressed, 21 bipolar depressed, and 40 normal control subjects, who represent approximately 50% of the final subject sample to be studied. In this population the unipolar depressed subjects showed a significantly greater resistance to insulin-induced hypoglycaemia than bipolar and control subjects. After applying the inclusion/exclusion criteria necessary to interpret hGH responses accurately, the data from only 54 subjects were acceptable. Mean peak hGH concentrations were not significantly different among the three groups. There was, however, a significant difference in the distributions of the hGH peak response, with the bipolar depressed population demonstrating greater variability in response than unipolar and control populations. These findings are discussed as they relate to previous reports and theoretical considerations.

Patients suffering from manic-depressive psychosis, manic type (ICD 296·0), were treated with lithium carbonate and randomly allocated to two groups, one received digoxin and the other matching placebo for 7 days. Severity of mania was rated by psychiatrists on the Manic Rating Scale and Analogue Line on days 0 and 7 and by nurses daily on the Hargreaves Rating Scale, Psychotic Rating. Fourteen patients received digoxin and lithium carbonate and 14 patients received placebo and lithium carbonate. Improvement in the placebo lithium group was significantly greater than that in the digoxin lithium group. This trial suggests, therefore, that the effect of inhibition of membrane cation carrier is to reduce the response to lithium. This result is in keeping with our hypothesis that an increase in Na–K ATPase is essential to the therapeutic effect of lithium carbonate. It does not, however, exclude the possibility that the observations resulted from the inhibition by digoxin of lithium entry into the brain.

Stereotyped movements are described in monkeys and humans and are classified as arising from constraint, sensory deprivation in infancy, amphetamine treatment or psychotic states. It is argued that, with the exception of cage stereotypies, stereotyped behaviour is evidence of abnormality in the nervous system consequent upon distorted maturational processes, organic defect or biochemical disturbance. Stereotypy is associated with a state of cognitive inflexibility and social and sensory isolation in humans and monkeys. It is suggested that, while no simple biochemical disturbance in the brain can describe these various occurrences of stereotypy, the cross-species occurrence of a syndrome of isolation, cognitive inflexibility and stereotypy implies a related mechanism mediating these divergent effects. If stereotypy is regarded as a consequence of failure to use sensory input to direct behaviour, therapeutic regimes designed to stimulate responsive behaviours and social interactions are more likely to be effective in the long run than direct attempts to suppress stereotypy.

Although motor features associated with schizophrenic disorders have been reported often, they have never been well understood and, since the introduction of neuroleptic drugs, they have been largely neglected. We report that disturbed voluntary motor activity occurs frequently among schizophrenics, is especially associated with features of formal thought disorder, but also with affective blunting, neurologic ‘soft’ signs. Certain motor and thinking abnormalities in schizophrenics may have a common pathogenetic basis.

This study investigates the validity of the suggestion that food allergy is relevant to the manifestation of schizophrenic illness. Antibodies to oats, wheat, gluten, chicken, calf and milk protein were measured in 98 schizophrenics and in 90 unaffected close blood relatives. The majority of patients were male out-patients, and most were on neuroleptic medication. Antibodies were detected in only a minority of patients.

Acute schizophrenics were compared with depressed, normal and brain-damaged subjects on their ability to appreciate a meaningful picture. Their responses were measured for level of abstraction (how well the theme was conveyed), for strategy (whether details were reported before or after a global interpretation) and for appropriateness of content. Schizophrenics were less abstract than normals, more abstract than brain-damaged subjects, but no different from depressives on this measure. Their strategy was different from normals but comparable with that of depressives. The majority of schizophrenics gave inappropriate responses. It is suggested that meaningful picture interpretation might be a useful tool for evaluating the distortion of meaning which characterizes schizophrenia.

Thirty patients with cycloid psychosis were found among 244 general psychotic and schizo-affective patients studied in London. The main clues to the diagnosis were the presence of ‘confusion’, a pleomorphic clinical picture or an acute onset. Most of the patients were classified as schizophrenic by British psychiatrists and the Catego system, and as schizo-affective or mood-incongruent affective psychotics by the American Research Diagnostic Criteria and DSM-III. There was little overlap between the cycloids and any Anglo-American category, and cycloid psychosis is not synonymous with schizo-affective psychosis. The outcome of the cycloids was better than that of psychotic patients as a whole, and much better than schizophrenia as defined by Catego, Schneider's, Langfeldt's or Carpenter's rules, or by the guidelines set by the International Classification of Diseases. Compared with manic-depressive patients (defined by the presence of mania at some stage), cycloids had more schizophrenic and fewer depressive and manic symptoms. There was a negligible concordance between the diagnosis of cycloid psychosis and the final diagnosis of manic-depressive disease. It is concluded that these patients should not be diagnosed as schizophrenic, but that the relation of cycloid psychosis to manic-depressive disease is not yet resolved.

Seven cases of anorexia nervosa associated with a brief psychotic episode are described. The psychoses all resolved completely and were similar in their atypical form. In 5 cases an organic cause could not be established, but psychological stress may have been an aetiological factor.

In three collaborating institutions 105 hospitalized female anorexia nervosa patients were assessed for depressive symptomatology periodically during treatment. As a whole, patients were mildly to moderately depressed, being as depressed as anxious neurotics and less depressed than depressed neurotics. The more depressed patients showed a variety of characteristics, many of which have previously been shown to be indicators of poor prognosis. Over the course of treatment patients became less depressed. Weight gain was correlated with a decrease in depression.

The present study attempted to confirm the vulnerability model proposed by Brown and his colleagues, using data from a survey of 435 mothers from two semi-rural regions of Pennsylvania. The results were not consistent with the earlier findings. Methodological and conceptual issues were discussed to explain the differences in results.

The Leyton Obsessional Inventory was administered to 69 orthopaedic patients in Glasgow, and their responses were compared with those of 77 similar subjects in London and 73 in Cork. The responses of the Scots and the English did not differ, but both of these groups were significantly less obsessional than the Irish subjects, who were particularly likely to regard cleanliness and tidiness as virtues in themselves. Obsessionality was unrelated to age, sex, social class, family size and birth order, but higher Leyton scores were found among bachelors, and among women living in the country and without outside employment. It is suggested that the common factor among these 3 subgroups is emotional or geographic isolation, and that this may enhance any tendency to obsessional ruminations and routines. This could also account for the higher Leyton scores and greater incidence of obsessional neurosis in the Irish.

This study compared serial severity ratings from 2 methodologically similar tricyclic antidepressant studies. Though the groups resembled each other in terms of diagnosis and baseline severity, response patterns were surprisingly different. In particular, early change was highly predictive of outcome in one group but not in the other. The results of response predictor studies must, therefore, be generalized with caution. These data, nevertheless, do allow some guidelines for predicting response from early changes and severity.

This study examined the contribution that living arrangements made to the rehospitalization rates of mental patients discharged to the community during the first 7 months they spent there. Over 20000 mental patients discharged from psychiatric facilities in the state of New York were categorized on the basis of the living arrangements to which they were discharged. These included living alone, parental, marital, other relatives or friends, and domiciliary settings. The sample was divided in half and results of the analysis of the first sample were replicated on the second sample. Analysis of covariance and multiple regression techniques revealed that patients discharged to marital settings were rehospitalized less than those discharged to other settings, and that there were no differences in the return rates among the remaining settings. The major predictor of rehospitalization was the number of previous hospitalizations. The implications of these findings for further research on supportive as well as stressful parameters of community and family settings are discussed.

In a prospective study, 200 elderly psychiatric patients were followed for 5 years. A poor outcome–death or continuing major reliance on the hospital based services – was associated with poor intellectual functioning on admission. Continued use of the hospital services was also related to past psychiatric history.