Radioligand binding to intact platelets was carried out in antidepressant-free patients and the 1 mg dexamethasone suppression test (DST) was performed. There were no differences in binding characteristics between patients and controls for either [H]yohimbine or [H]imipramine. There were no differences in binding between patients classified as endogenous using the Newcastle Scale, compared with non-endogenous patients, and no difference between DST suppressors and non-suppressors. The severity of depression did not affect binding values. After 4–6 weeks antidepressant treatment [H]yohimbine binding was significantly reduced but [H]imipramine binding was unaffected.

Mental-hospital admission rates in Edinburgh for mania, schizophrenia and psychotic depression were studied from 1970 to 1981, a 12-year period during which long-term lithium therapy was increasingly employed in affective illnesses. If this treatment had been effective admission and readmission rates for mania, and perhaps also for depression, should have fallen progressively. In fact, they rose steadily, while the admission rate for schizophrenia fell. These changes could not easily be attributed to changing diagnostic criteria, to the admission of milder affective illnesses, or to poor and deteriorating lithium surveillance. Their explanation is uncertain, but they cast some doubt on the efficacy of lithium prophylaxis in ordinary clinical practice.

The results of an examination of the 238 cases of anorexia nervosa on the Aberdeen Psychiatric Case Register for the period 1965–82 are reported. A highly significant increase in the number of cases over time was found. The average annual incidence rate for the period 1978–82 was 4·06 per 100000 population. The case notes of every second patient on the register were inspected to assess diagnostic reliability, to define patient characteristics further and to look for changes in these over time. The diagnosis was highly suspect in 5% of cases. A social class bias was found, with an over-representation of classes I and II but an under-representation of social class III. Few significant changes were noted in the patients over time. The utilization of services was also examined, and it was found that 24% of the patients remained in contact for 4 years or more.

Hysterical symptoms are defined as complaints that are not fully explained by organic or functional neurological disease. Hysterical symptoms are common in neurological practice, accounting for about 1% of neurological diagnoses. Of those with neurological hysterical symptoms, about 80% will not have the hysterical personality, and about 80% will not have Briquet's hysteria. Some 60% will have a physical disease and perhaps as many as 50% will have recognizable psychiatric illness, particularly depression. Others may have unrecognized physical or psychiatric illness. Many hysterical symptoms may be understood in terms of abnormal illness behaviour.

This paper describes a comparison of the cerebral cortical appearance of 101 patients with a history of clinical depression and 52 control subjects. An age-related increase in sulcal widening was evident in both groups. However, after controlling for age, the patients were found to differ from control subjects in two respects: they had a greater amount of sulcal widening, most noticeably in the frontal and temporal areas; and there was a positive correlation between increasing sulcal widening and increasing lateral ventricular size not found in the control subjects. Patients with a past history of treatment by electroconvulsive therapy showed more sulcal widening in the parietal and occipital areas than those not so treated.

DNA was extracted from the brains of patients with Alzheimer-type dementia, schizophrenia, Huntington's chorea and from patients without neurological disease, and examined for the presence of herpes simplex virus type 1 and human cytomegalovirus sequences. By selecting cloned virus DNA fragments which do not hybridize to normal human DNA we were able to achieve a detection level assessed on reconstruction experiments of 1 virus genome per 50 cells. Screening at such sensitivity did not detect virus sequences in the higher CNS, except in cases of encephalitis or immunosuppression. We conclude that, at this level of sensitivity, these viruses cannot be regarded as normal residents of the higher CNS, and at the time of death they do not appear to be associated with these neuropsychiatric conditions.

Twenty patients with a major depressive disorder and 20 control subjects were subjected to a 1 mg dexamethasone suppression test (DST) and a challenge with intravenous (IV) methylphenidate (MP)(0·3 mg/kg). None of the controls, but 9 depressives, were DST non-suppressors. Among the depressives there were correlations between DST-cortisol and baseline (4 p.m.) levels of cortisol, growth hormone, prolactin and adrenaline. Compared with the controls the depressives had a decreased cortisol response and an enhanced adrenaline response to the MP challenge. The decreased cortisol response was not related to either DST-cortisol or baseline cortisol, but was correlated with the mood response to MP.

The plasma beta-endorphin response to glucose ingestion was compared in 8 bulimics and 8 controls. The bulimics demonstrated a sustained elevation of plasma beta-endorphin unrelated to glucose ingestion throughout the 5-hour study period. It is hypothesized that such an elevation of beta-endorphin is the result of stress and that it may play an important role in the perpetuation of the binge-vomiting cycle.

The nutritional status of 23 severely demented patients was compared with that of 23 similarly aged controls in the community. A 3-day weighed intake on all subjects showed lower mean intakes of energy, protein, ascorbic acid and nicotinic acid in the patient group. This group had lower levels of plasma ascorbic acid and red cell folate and of urinary N-methylnicotinamide excretion relative to creatinine. Over a third of both controls and patients had evidence of thiamin deficiency, as judged by a raised percentage erythrocyte transketolase activity. An earlier finding in patients with senile dementia of reduced fasting plasma concentrations of tryptophan was confirmed for total and protein bound fractions. With the possible exception of ascorbic acid, the data could not be explained satisfactorily in terms of intake. It is suggested that the association between the phenomena of ageing, senile dementia and nutritional status merits further investigation.

The relative speed of recall of pleasant and unpleasant experiences was investigated in patients with unilateral temporal lobe epilepsy and after unilateral temporal lobectomy. Indications have been obtained that right, but not left, temporal lobe dysfunction may impair hedonic aspects of memory selectivity.

Fifty-six bulimia nervosa patients were treated by means of a behavioural approach and followed for at least one year after completion or dropping out of treatment. Outcome was encouraging in about half of the patients and several psychiatric indicators, such as duration of illness and response to treatment, were identified. The significance of the findings and unresolved methodological issues are discussed.

An examination was made of urinary catecholamine and metabolite outputs in 28 unipolar depressed patients and 25 normal controls. The total group of depressed patients had significantly higher urinary outputs of norepinephrine (NE) and its metabolite normetanephrine (NM), and significantly lower urinary outputs of the dopamine metabolite dihydroxyphenylacetic acid (DOPAC), than controls. Patients who met DSM-III criteria for a major depressive episode with melancholia (N = 8) had significantly higher urinary outputs of normetanephrine than controls, whereas patients with a major depressive episode without melancholia (N = 7) and dysthymic disorder patients (N = 8) had levels comparable with controls. We postulate that the higher urinary outputs of norepinephrine and its metabolite, normetanephrine, reflect dysregulation of the sympathetic nervous system in depression.

Neuropathological change found in nearly all individuals with Down's Syndrome over the age of 35 years closely resembles that of Alzheimer's disease. The extent to which dementia occurs as a result of this change is unclear, and the studies which have investigated presumed cognitive deficits are reviewed. The theories put forward to explain the association between these two disorders and their possible significance to the understanding of the aetiology of Alzheimer's disease are discussed.

Consecutive series of male and female alcoholics, Alcoholic Anonymous (AA) members and controls were examined by interview and with a CT brain scan. Male controls were shown to have larger CT brain parameters than healthy females of the same age. Female alcoholics revealed equivalent CT scan abnormalities, apart from less sulcal widening, after a markedly shorter drinking history and at a lower estimated peak alcohol consumption than male alcoholics. The CT scan findings persisted after accounting for body weight and after matching for age and length of drinking history. The CT scan parameters of female AA members approached control values more completely and after briefer abstinence than did those of male AA members. Methodological problems and sex differences in selection and other processes are discussed. The findings are consistent with sex differences in the vulnerability of the brain to alcohol toxicity, and in its recovery with abstinence.

‘Weight pathology’ – defined by Kalucy et al. (1977) as ‘deviations in weight, shape, eating behaviour and activity’ – has been hypothesized to be unduly common in families with anorexia nervosa. It was investigated in this study by means of questionnaires evaluating both weight history and attitudes towards weight-related matters in 58 mothers of anorexia nervosa patients and 204 mothers of schoolgirls of similar age and socioeconomic status (SES). No support was found for the hypothesis. A family history of aberrant weight and mother's current weight and past weight histories showed no significant differences between the groups. 142 other mothers of schoolchildren and 446 attenders at Weight Watchers also completed the questionnaire on attitudes towards weight-related matters. Mothers of patients showed a lower concern on all scales than did all other groups. The findings are discussed in relation to earlier controlled studies of family factors in anorexia nervosa.

This study uses matched-tasks methodology in order to test memory function in depressed and euthymic patients with major affective disorder. Neither drug-free depressed patients nor lithium-treated euthymic patients show a differential deficit in verbal versus non-verbal recall. However, while euthymic patients show no memory impairment, drug-free depressives do show poor memory functioning. The results support the view that memory deficits observed in affective patients in the depressed state are transient, secondary manifestations of depression and are neither indicative of underlying organic pathology, nor of abnormal hemispheric laterality. This suggests that memory impairment in depression can be treated by treating depressive symptoms, both chemically and behaviourally. The results also support the view that prophylactic lithium treatment has no adverse effects on these memory tasks.

Nine male patients with bulimia nervosa, accounting for one in 24 bulimic patients attending a clinic for eating disorders, are described. Symptomatology and demographic characteristics were similar in males and females. A history of either anorexia nervosa or obesity was always present, and a chronic course was seen in 6 patients. Five of the men showed atypical sexuality.

Because of the practical difficulties which arise in studying manic patients, a reproducible model for mania using human subjects would be a valuable adjunct to research in this condition. Dextroamphetamine, given as a single oral 20 mg dose, fulfils the criteria for such a model in that there are very close similarities between the changes which occur after dextroamphetamine and those which have been observed in mania in terms of subjective experience, physiological and endocrine changes, and response to pharmacological agents.

Seven volunteers received diazepam for a 3-week period, maximum dose rate 25 mg per day, and were tested on a variety of functions before, at two points during, and at two points after the period. Their performance was compared with that of 8 controls and was inferior on a number of measures. There was no indication either of habituation or of potentiation of the effects as the period continued. Equally, the low performance persisted for some time after administration ceased, although performance was on the whole better than during the experimental period. The particular measures showing deterioration suggested that the effects are similar to those of barbiturates as opposed to those of, for example, chlorpromazine.

The evidence on cognitive decline in senile dementia is reviewed with respect to the distinction between controlled and automatic processing. It is argued that controlled processing, which requires the attentional resources of the individual, declines in early senile dementia. However, automatic processing, which does not require attentional resources, is well maintained until late in the disorder. Implications of this view are drawn for the development of effective screening instruments which can be used for the early detection of dementia in the general population.