During 2 weeks on a waiting list 12 patients with morbid grief did not improve significantly. They were then randomly allocated either to guided mourning treatment, in which they were encouraged to face cues concerning their bereavement or to control treatment in which they were asked to avoid such cues. Each treatment comprised six 1½ hour sessions over 2 weeks. At week 4 guided mourning patients had improved significantly more than had controls on 3 measures, with a supportive trend on 4 measures. Improvement though modest was maintained to 10–28 weeks follow-up. Control patients did not improve significantly or show any trend to do so.

The Carroll rating scale (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scale (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.

Factor analyses were conducted for the Hamilton depression rating scale (HRS) and the self administered Carroll counterpart (CRS). The factor loadings for the respective first factors were similar; those for the respective second factors showed strict sign consistency but only moderate consistency of magnitude; the loadings for the respective third factors showed no particular consistency. The first three CRS and first three HRS factor scores were computed for each individual and correlations were computed from these factor scores. The first and second factors were highly correlated but the third factors were negatively correlated indicating that they were not measuring the same thing. The first factors of the CRS and HRS correlated highly with their respective raw total scores and were indices of the severity of illness. The self-administered CRS (with matching weights) is a credible alternative to the HRS for routine clinical assessment of the severity of depression.

Patients in an affective disorders out-patient clinic were studied with four depression rating scales: the Hamilton rating scale (HRS) the Carroll rating scale (CRS) a clinical global rating of depression (CGRD) and the visual analogue scale (VAS). The overall correlations between the self ratings (CRS, VAS) and the observer ratings (HRS, CGRD) were highly significant. Both the HRS and the CRS distinguished mild from moderate, and moderate from severe depression. CRS scores increased more rapidly than HRS scores with increasing severity of depression. The concordance of self ratings and observer ratings was highest for the two structured instruments (HRS and CRS), and was lowest for the two global scales (CGRD and VAS). The global scales have the advantages of speed and simplicity, but at the cost of some reliability. Patients with non-endogenous depression had significantly increased self rating scores in comparison to patients with unipolar or bipolar endogenous depression. The correlations between the self ratings and the observer ratings were notably lower in patients with non-endogenous depression than in patients with endogenous depression. Euthymic bipolar patients rated themselves on the VAS as significantly less well than euthymic unipolar patients. The clinical and research implications of these findings are discussed.

A longitudinal study of psychological disturbance in the affected population in Sri Lanka after the cyclone disaster of 1978 was carried out. The post-cyclonic stress identified among the rural communities after their return to the same destroyed environment was studied. Symptoms tended to be early or delayed in appearance. The degree of unpreparedness is postulated as the cause of the former. Group cohesiveness and feelings of community tended to delay the manifestation of symptoms. Realization of losses, family needs, and continued habitation in damaged homes acted as reminders and reinforcers. Morbidity continued to affect over half the population one year later. Early intervention within community settings after such disasters is recommended.

Over an 18 month period, 49 patients in a physical rehabilitation hospital were referred to an attached psychiatrist. Formal psychiatric disorder was uncommon, and the mood changes and behaviour disturbances observed often resulted from a poor adjustment to recent physical disability by patients or their families. The most important role of the psychiatrist in management was in helping rehabilitation staff use their own skills to deal effectively with the inevitable emotional disturbances which occur in this setting.

Two self-report scales of mood and morale were administered to 45 elderly in-patient depressives and 45 non-patient controls, matched for age and sex. The responses of the two groups differed significantly in the predicted direction. When 18 patients from the depressive group were re-tested 6 to 8 weeks later, at discharge, significant declines in self-reported depression, and increases in ‘life-satisfaction’ were reported. Within the depressive group, there was a significant relationship between ‘overt’ depressive behaviour on the ward and self-reporting of greater depressive symptoms, and lower ‘life-satisfaction’. The importance of independent validation of self-report measures of mood and morale in elderly populations is discussed.

Psychiatric disorders in a sample of spouses of probands with recurrent Primary Affective Disorders (PAD) and in their first degree relatives were evaluated and compared with those in the spouses of control subjects without psychiatric illnesses. No differences were found in the risk for PAD, but spouses of PAD patients and their respective first degree relatives manifested a greater incidence of affective spectrum disorders.

The frequency of HLA-A2 was examined in 32 black and 22 white schizophrenic patients separated into two groups according to whether they had normal or reversed cerebral hemispheric asymmetries as determined by computed tomography. The black patients with reversed asymmetry had a significantly greater frequency of HLA-A2 as compared to black patients with normal asymmetry and a black normal control group. There were no significant differences for any other A, B or C antigens. These findings also held when only the 22 black patients without evidence of brain atrophy were studied. The results for the white patients were in the same direction but did not reach statistical significance. These findings suggest that, at least for black schizophrenic patients, reversed cerebral asymmetry is associated with an increased frequency of HLA-A2.

Urinary MHPG (3-methoxy-4-hydroxyphenyl-ethylene glycol) was measured in seven anorexia nervosa patients during a bed rest and refeeding programme. MHPG levels were positively related to increase in body weight.

To test the hypothesis that desipramine alters α adrenoceptor function in depressed patients, the effects of clonidine upon growth hormone sedation and blood pressure have been measured in depressed patients before and after treatment with desipramine. After three weeks of treatment the hypotensive and sedative effects of clonidine were inhibited in all patients even though plasma desipramine concentrations at this time varied from 42 to 560 μg/l. Growth hormone responses to clonidine were enhanced in five of the six patients but this effect was not statistically significant. These findings are consistent with the hypothesis that in these patients desipramine altered α adrenoceptor function: other explanations are discussed.

Eight patients suffering from a major unipolar depression and having failed to respond to treatment for three weeks or more with tricyclic antidepressants were given lithium. All eight patients experienced a remarkable relief of their depression within 48 hours. This rapid antidepressant effect of lithium in ‘treatment-resistant’ patients might be due to the enhancement of the efficacy of the central serotoninergic system, unveiling the tricyclic antidepressant-induced sensitization of the serotoninergic postsynaptic receptors.

In a recent review of the structure and function of aminergic systems Iversen (1980) paid particular attention to the dopaminergic (DA) and noradrenergic neurones (NA) and only mentioned in passing those with 5HT as a transmitter. Although the original work on the low concentration of 5HIAA, the metabolite of 5HT, in CSF of depressed patients (Ashcroft et al, 1966) which brought serotonin to the attention of biological psychiatrists may not have stood the test of time, nevertheless, recent information on the behavioural consequences in animals of drugs and lesions which influence the output of the 5HT system suggests it plays a role in the development of pathological mood and behaviour in affective illness. This is reflected in the resurgence of clinical interest in antidepressant drugs designed to affect specifically the 5HT system and emphasizes the need to continue animal and clinical exploratory experiments on serotonergic function.

A wide range of risk-taking behaviours may be associated with serious damage to the self although not consciously related to a wish for self-destruction: car driving and chronic alcoholism are two examples. Here, however, suicidal behaviour will be taken to refer only to that motivated by a conscious and deliberate aim to destroy the self. There is much evidence that prevention of suicide is a feasible proposition. The majority of suicides make contact with helping agencies in the few weeks prior to their death, they declare their intentions in a variety of ways and they tend to be recognizably unwell. It is just not true that most suicides decide to end their lives without declaring their intention to others. It is therefore important to acquire skills in recognizing and reaching out to those at risk in such a way that hope is rekindled and help accepted.

Few people (and the present writer is not one of them) will know enough about psychiatric books to be able to declare which are the greatest. My own list is a sample biased by chance, ignorance and prejudice. But within these limitations I have worked to a plan and chosen those books which seem to me to represent or reflect important stages in the historical development of psychiatry.