A detailed analysis of the results of a multi-centre clinical trial shows that, while the relapse rate following recovery from an operationally defined depressive illness was smaller among patients subsequently treated with either amitryptiline or lithium than with a placebo, there was no clinically significant difference between the prophylactic efficacy of the 2 antidepressants. An account is given of the relative adverse effects of the treatments, and the implications of the findings are discussed.

Histocompatibility antigens were examined in 124 patients with Alzheimer's disease (AD), and the frequency of HLA-B15 was found to be significantly increased over controls. Pooling of data from the present and similar studies suggests that AD is not strongly associated with any particular HLA antigen, although there may be a weak association with HLA-A2, B15 and Cw3. In a family study of 34 patients with AD, secondary cases of AD were identified in 9·7% of the first-degree relatives, and cases of presenile dementia and senile dementia of the Alzheimer type were found to occur within individual families.

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 law about expert evidence is unsatisfactory: it gives scope for the expert to usurp the role of judge, jury and parliament; it brings the professions of the experts into disrepute; and it sets juries the impossible task of sorting pseudo sciences from genuine ones. The law should be reformed by changing statutes which force expert witnesses to testify beyond their science, by taking the provision of expert evidence out of the adversarial context, and by removing from the courts the decision whether a nascent discipline is or is not a science.

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.

This paper offers a conceptual and historical analysis of descriptive psychopathology. The first section defines it as a cognitive system constituted by terms, assumptions and rules for its application. It traces the conceptual implications of this definition and relates them to clinical practice. The second section contains an up-to-date assessment of current historical work on descriptive psychopathology and offers a new hypothesis to account for its development during the nineteenth century. It is suggested that the work involved in the testing of the hypothesis should be carried out by psychiatrists with historical training and as a separate speciality. It is concluded that the historical calibration of psychiatric symptoms must be considered as an essential stage in the construction of a viable descriptive psychopathology.

The gastric emptying rate of 8 heroin-dependent males was measured by means of a radioactive isotope method. A simultaneous oral glucose tolerance test was carried out. The glucose response showed a low, flat curve with a delayed peak, and increased secretion of insulin and growth hormone occurred. As the gastric emptying rate proved to be normal the observed metabolic abnormalities are not due to the effect of heroin on the gastro-intestinal tract, but must be attributed to some other effect of chronic heroin administration.

Ninety-nine patients with chest pain and a presumptive diagnosis of coronary heart disease were assessed blindly within 24 hours of angiography, using standardized psychiatric and social interviews and a personality inventory. Thirty-one patients had normal coronary arteries (NCA), 15 had slight disease and 53 had significant coronary obstruction. Twenty-eight (61%) of the 46 patients with insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity.

Associations between the overall severity of psychiatric morbidity and measures of social maladjustment were strongest in the patients with normal coronary arteries. The 26 men with insignificant coronary artery disease had higher scores of neuroticism and extraversion than the 41 with important coronary occlusions. No differences were observed when the same comparisons were made for the women.

The findings indicate that approximately two thirds of patients with normal and near-normal coronary arteries have predominantly psychiatric rather than cardiac disorders: the symptoms in these patients are more likely to represent the somatic manifestations of anxiety and overbreathing than the consequences of underlying cardiac disease. Physicians should be aware of the ways in which neurotic illness may present with symptoms mimicking cardiac disease, especially when cardiovascular symptoms are accompanied by phobic symptoms and unexplained shortness of breath.

The early literature on Alzheimer Dementia (AD) describes the clinical features aphasia, apraxia and agraphia as characteristic. We investigated the hypothesis that these features would specifically identify the familial form of AD (FAD). Since pedigree studies had suggested that FAD is an autosomal dominant genetic disorder, we hypothesized that the first-degree relatives of language-disordered or apractic AD probands would show at least 50% lifetime risks of dementia. Using standardized methods, we screened 3500 nursing home beds for stringently defined AD cases and controls, tested for agraphia, and obtained probands' clinical and family histories from multiple informants. Language disorder and apraxia were found in 78% of AD cases. They strongly predicted familial aggregation of dementia, with a 90-year lifetime incidence among relatives exceeding 50%, or 7 times the control values. The results suggest that language disorder and apraxia specifically identify a distinct clinical entity, Familial Alzheimer Dementia, that is among the commonest forms of senile dementia.

A historical analysis of the syndrome concept shows that this term has been used in many different ways, ranging from clinical experience to records of coinciding symptoms. However, there seems to be broad agreement on the use of the word ‘syndrome’ in daily practice. If empirical–mathematical methods are applied in syndrome detection, however, a precise operation-alization of the syndrome concept is needed. Traditional procedures have often used models more dictated by methodological considerations than derived from the field of application, i.e. psychiatric syndromatology. An alternative approach, Boolean factor analysis, is presented in this paper. This relatively new method is illustrated by means of the analysis of a small artificial sample with a known structure. As a point of reference, traditional methods (factor analysis, cluster analysis, and multidimensional scaling) are also briefly discussed. It is demonstrated that they all share a deficiency of information about inter-group structure. In contrast, Boolean factor analysis uses a syndromic definition which builds on the basic notion of concurrent symptoms. Moreover, this approach can easily be understood by clinicians.

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.

Assessment was made of the behavioural development of 3 monkeys whose levels of thyroxine were reduced by being given 131I and another 3 monkeys given a thyroxine depressant (TCAP) during the first weeks of life and maintained with low thyroxine levels for 3 months. When subsequently tested at normal thyroxine levels, these experimental subjects showed less positive social behaviour when compared with controls. When confronted with unfamiliar monkeys, the two experimental groups were less fearful than controls and also showed a lack of differential responsiveness in varying social situations, suggesting a low level of emotion. A foetal athyreotic group is also described.

This paper focuses on the morphology of affective disorder. We set out to confirm on the island of Lewis a cross-over result originally found on the island of North Uist, whereby in those sections of the population where the rates of depression were lowest the rates of anxiety were highest. These sections of the population varied in the degree to which their members were integrated into the traditional way of life. ‘Integration’ was characterized in terms of churchgoing and crofting (the word for farming in the Hebrides). It is predicted here that the churchgoing rather than the crofting component of the integration measure would account for any cross-over result found concerning the morphology of symptoms. This hypothesis, derived from a theoretical concern with links between repression and anxiety, is not confirmed. Instead, crofting is found to be the component of the integration index which predicts anxiety/phobia without depression. In seeking to explain this unexpected finding further significant associations between crofting, pure anxiety/phobia and the style of personal relationships are revealed. It is also confirmed that types of severe events among women are also found to vary with the degree of integration into traditional society. A perspective is then developed which might explain how the interaction between style of personal attachments and types of provoking event could produce variations in the morphology of affective disorder.

The effect of ascorbic acid and ethylene diamine tetra acetic acid (EDTA) in the treatment of manic-depressive psychosis was compared, using double-blind procedures, with recognized treatment regimes. There was no significant difference between the response of depressed patients to amitriptyline or ascorbic acid and EDTA. Manic patients responded significantly better to lithium than to ascorbic acid and EDTA. These results are in keeping with the suggestion that vanadium may be of aetiological importance in depressive psychosis, but do not support such a suggestion for mania.

The scope for the early detection of dementing disorders in the elderly by means of screening techniques is reviewed in the light of the basic principles of early disease detection. It is concluded that, while there is an increasingly urgent need for the development and application of psychogeriatric screening methods as a step towards preventive action, such methods are still at an early experimental stage. Prescriptive screening programmes are contra-indicated at present. The most immediate requirement is for evaluative research, which should be planned to take account both of the properties of the screening instruments and of the health-care and social settings in which these are to be applied. No major progress in this field can be expected unless it proves possible to integrate methods of early case-detection, and of systematic surveillance of the at-risk elderly, into the work of primary medical and social services.

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.

A community survey of psychiatric disorder carried out in South London enabled the authors to investigate the ‘vulnerability model’ proposed by Brown & Harris (1978). In the current study none of the ‘vulnerability factors’ proposed by Brown & Harris fulfilled the requirements of the model. It was, however, found that working class women with children seemed particularly prone to develop minor psychiatric disorder in response to adversity. A similar result is apparent in the analyses of the earlier authors. A number of studies now published give some support to the vulnerability model using what are broadly measures of social support, but there is little corroboration using the other variables proposed by Brown & Harris.

A series of drawing tasks was administered to 15 patients with senile dementia who were assessed for intellectual functioning and severity of dementia. Their performance was compared with that of 15 elderly control subjects. The demented patients' spontaneous drawings were found to be impoverished in comparison with those of the controls. Copies of the same objects included more details, but these tended to be wrongly positioned in space. The performance of the patients with dementia was unlike that reported for patients with focal brain lesions. Significant relations were found between drawing performance and intellectual functioning and severity of dementia. The theoretical and practical implications of these findings are discussed.

This review of the data on bilinguals in relation to hypnosis, psychotherapy and psychotic disorders presents evidence for the bilateral representation of language in the cerebral hemispheres of bilinguals, and outlines possible links between the neuropsychology of psychotic disorders and the lateralization of language in these patients. The relationship between affective states and the retrieval of memories and language is also explored.