A community study on stroke registered 976 patients. Over 60% of survivors at three weeks, six months and 12 months after the stroke were assessed for depressed mood, using the Wakefield self-assessment depression inventory, and on other functional and social activities. At each point, 25–30% of those assessed were depressed; over 50% of patients depressed at three weeks remained so at one year. Factors associated with depression included loss of functional independence, a low level of other activities, a low reasoning ability, and being female and living with someone; path analysis showed that most depression was not explained by these factors. Few depressed patients at six months were on antidepressant medication.

Prior research suggests that psychotherapeutic techniques which differ in their contents are quite similar in their outcomes. Outcome data are reported from a study designed to maximise sensitivity to technique effects on outcome in a clinically realistic setting, and to permit detailed analysis of the relations between content, immediate impact, and outcome of therapy. Forty professional and managerial workers with depression or anxiety received eight sessions of Prescriptive (cognitive/behavioural) and eight sessions of Exploratory (relationship-oriented) therapy in a crossover design, with each client seeing the same therapist throughout. Outcome was assessed by standard interview and questionnaire methods. The results favoured Prescriptive therapy, although this difference was of moderate extent. The outcome was largely unaffected by the order in which the two methods were offered.

In a clinical trial investigating the effectiveness of social work intervention with depressed women patients in general practice, 80 women were randomly allocated to an experimental group for referral to attached social workers or to a control group for routine treatment by their GPs. They were reassessed at 6 and 12 months. The results indicated that women who had major marital problems were more likely to be depressed at follow-up than those with good relationships. However, patients with marital difficulties in the experimental group made more improvement than the controls. Women initially assessed as suffering from ‘acute on chronic’ depression and having major marital difficulties were found to benefit most from social work intervention.

New psychiatric out-patients with depressive, phobic, and anxiety neurosis were randomly allocated to out-patient care or to one of two types of day hospital treatment one specialising in psychotherapy and the other offering all forms of day care. Of 106 patients who entered the study, 78 had assessments of psychiatric symptomatology and social adjustment both before treatment and after 4, 8 and 24 months. There was no significant difference in outcome between depressive, phobic, and anxiety neurosis, and no overall difference in response to treatment between the three types of care. Suicidal symptoms were significantly less common in out-patients. In many respects, neurotic disorder can be regarded as a single syndrome.

Thirty-eight people with a moderate to severe degree of aerophobia self-referred themselves to a course designed to help them travel by air. The course involved three long sessions based on giving information, graded exposure without avoidance, and group support with natural coping models. Measures of self-reported anxiety levels were taken at regular intervals. The results showed that being given information or undergoing a simulated flight had little effect on perceived anxiety. Prolonged exposure to flying had a marked effect on reducing anxiety and anticipated apprehension about future flying. At one-year and three-year follow-up, 40% and 60% of participants had flown commercially, although there was some minor restoration of anticipated anxiety associated with flying; 84% showed less anxiety about flying. Psychological intervention, in collaboration with airlines, may have marked benefits in reducing fear of flying.

We observed 15 ‘new’ long-stay patients in wards in a District General Hospital Unit and a mental hospital, and again when they had lived for a year in a new hospital-hostel. There were significant changes in time spent in the community, social interaction, activity and abnormal behaviour. Residents believed they had more freedom and none wanted to return to wards. Six patients remained on wards. They showed no comparable changes and all wanted to live elsewhere.

Bimodality in a distribution of symptoms is often claimed to be convincing evidence that a disorder is categorical, a discrete disease entity, rather than the extreme on a continuous dimension. However, using concepts from contemporary psychometric theory it is shown that bimodality can arise from the dimensional viewpoint. In fact, contrary to the usual belief, bimodality would be expected to occur in many research contexts if the dimensional alternative were correct.

Spouses of 24 patients suffering from persistent depression were interviewed to find out how they were affected by the patient's illness. These effects were marked, although mainly endured without complaint, and included restrictions in social and leisure activities, a fall in family income, and a considerable strain on marital relationships. Some of the behaviour shown by patients was hard to bear, and ‘negative’ symptoms such as misery, withdrawal, and worrying commonly caused problems. Few relatives, however, know how to deal with difficult behaviour. Despite this, the majority remained committed to staying with the patient. Spouses had a variety of complaints about the way they were handled by hospital staff, particularly about being deprived of information and advice. These results have considerable implications for the way in which relatives should be dealt with as part of the overall management of persistent depression.

Data from two sources-the Edinburgh Psychiatric Case Register and the psychiatric inpatient records of the Scottish Health Service-were used to compare large populations of first-admission schizophrenics born in winter (January to March) and in summer (June to October). Parallel comparisons were carried out for affective psychoses. Comparison of the months of birth of the Scottish patients with those of the general population indicated that there was a 9% excess of schizophrenic births and a 3% excess of affective births in the first 3 months of the year. In the Edinburgh material, winter-born schizophrenics were more likely than the summer-born to receive a diagnosis of paranoid or schizoaffective schizophrenia and less likely to receive diagnoses other than schizophrenia on readmission, but neither of these differences emerged in the much larger Scottish material. There were no differences between winter-and summer-born schizophrenics in age of onset, sex ratio, or prognosis in either data set, nor were any significant differences found between winter- and summer-born affectives. We have therefore failed to demonstrate any convincing differences between winter-and summer-born schizophrenics.

Groups of organically and functionally mentally ill psychogeriatric day patients were assessed by the 37-item Roth-Hopkins test and the abbreviated ten-item Roth-Hopkins test. The scores correlated highly, correlation being equally good for both diagnostic groups. Among the functionally ill and the mild organically ill, scores improved between first and second test. The quicker, better tolerated ten-item test is a useful test of mental impairment for psychogeriatric patients in the community, as well as in institutional care.

The relationship between cognitive function and violence in 76 remanded prisoners, without formal psychiatric illness, was investigated. The violent group tended to be of slightly lower general ability than the non-violent group, but not abnormally so in relation to the general population; no relationship was found between specific patterns of cognitive functioning and violence. The violent group reported significantly higher levels of neurotic symptoms than the non-violent group, and were more socially deviant. To a small extent general intelligence (reasoning ability), in interaction with many other factors, may be related to a propensity for violent behaviour, but no particular aspect of cortical functioning seems to be related to violence.

Psychoanalytical methodology has been described as causal explanation or hermeneutic understanding. This methodological dichotomy has been introduced into psychopathology by Karl Jaspers. Contemporary authors' contributions in the area are discussed. Although these authors accept a role for both methods, they agree with Jaspers that psychoanalysis should be subjected to the logical limitations of hermeneutic analysis. A logical framework for the interaction of explaining with understanding is presented and discussed in relation to psychiatric research.

There has been a recent renewal of interest in the use of monoamine oxidase inhibitors, but the concurrent administration of narcotic analgesics is often a cause for concern. This review clarifies the different types of MAOi/narcotic interactions and offers guidelines for the use of narcotic analgesics in the presence of MAOIs. The MAOI/pethidine interaction has two distinct forms: an excitatory and a depressive form. Pethidine must never be used in the presence of MAOIs because of the risk of a fatal excitatory interaction. Morphine does not cause this excitatory interaction, and is the drug of choice provided an allowance is made for possible potentiation of the depressive narcotic effect. It is inevitable that strong analgesia will occasionally be required as an emergency measure in patients on MAOIs, and insufficient attention is paid in psychiatric textbooks to the two different types of interactions and their therapeutic implications.

Twenty chronic male schizophrenic subjects aged 30–50 years were examined by an auditory event-related potential procedure for the evaluation of the P300 component, a CT scan and a neuropsychological test battery. The P300 latency was increased and its amplitude was reduced. CT scan measures showed lateral and third ventricle enlargement, and there was a global neuropsychological impairment. Poor neuropsychological performances were consistently associated with delayed P300 latencies, but not with CT scan measures. Ventricular enlargement was more pronounced among subjects with a negative family history for major psychiatric disorders.

Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1, relaxation time rose immediately after the fit reaching a maximum 4–6 h later. The T1, values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

A controlled modified cost-benefit evaluation of a hostel ward caring for new long-stay patients is described and results are presented for the first two years. In some respects the residents of the hostel ward had fewer psychotic impairments than those remaining on the wards of the district general hospital, mainly because the latter seem to continue to acquire such defects, while the former have remained relatively unchanged. The hostel ward residents also develop superior domestic skills, use more facilities in the community, and are more likely to be engaged in constructive activities than controls. These advantages were not purchased at a price, since the cost of providing this form of care for these patients has cost less than care provided by the district general hospital.

Brain function was evaluated in four psychiatric patients with a history of repetitive purposeless violent behaviour, using EEG, CT scan, and positron emission tomography (PET). Three patients showed spiking activity in left temporal regions, and two showed CT scan abnormalities characterised by generalised cortical atrophy. The PET scans for the four cases showed evidence of blood flow and metabolic abnormalities in the left temporal lobe. Two patients also had derangement in the frontal cortex. The patients showing the largest defects with the PET scans were those whose CT scans were reported as normal. This paper shows the utility of PET in investigating possible brain derangements that could lead to violent behaviour.

Examining the impact of natural disasters on psychological health provides an opportunity to study the role played by extreme adversity in the onset of psychiatric disorder. Four hundred and sixty-nine fire-fighters who had been intensely exposed to an Australian bushfire disaster completed a detailed inventory of their experiences four months later. They also completed a brief life events schedule and the 12-item General Health Questionnaire. Only 9% of the GHQ score variance could be accounted for by the disaster and other life events; the effects of the disaster appeared to be separate and additive. This is similar to the relationship between life events and psychiatric illness found in other settings. It is suggested that vulnerability is a more important factor in breakdown than the degree of stress experienced.

The impact of a 16% increase between censuses in the population aged 65 and over, on a psychogeriatric department whose bed complement remained static between 1974 and 1984, has been studied. Demand for service, as measured by new referrals, rose by 150%, while admissions fell by 14%. The increase in new referrals was uniform across the diagnostic spectrum, but the fall in admissions was not. Functional admissions fell in all age-groups except that of women of 85 and over, while organic-case admissions other than for cases of dementia virtually collapsed. Overall admissions for dementia rose to the predicted level, but the distribution of the increase was irregular and unexpected. Admissions of males and females aged 65–74 and females of 85 and over fell relatively and absolutely, while those of women aged 75–84 and men of 85 and over were little changed. Only admissions of men aged 75–84 alone increased in real terms.

Seven patients suffering from severe endogenous depression who had proven resistant to lengthy trials of treatment with tricyclic and other antidepressants are described. Their successful treatment with a combination of clomipramine, L-tryptophan and lithium is discussed in the context of other strategies for the treatment of resistant depression.