Hearing impairment and mental disorders are common among residents of nursing homes and homes for the aged; however, the relationship between sensory deficit and psychiatic illness has been little investigated in this population. The prevalence of hearing impairment, psychiatric illness, and co-morbidity was investigated in a sample of 102 elderly residents from consecutive admissions to a home for the aged. Examining the coincidence of these disorders showed evidence of an association between hearing loss and paraphrenia, and hearing loss and dysphoric states, but not between hearing and cognitive impairment. The results of this survey provide only suggestive evidence regarding aetiology, but strongly support conjoint assessment of the elderly.

It is not sufficiently realised that sleep-walking is not an hysterical condition, nor in any way related to epilepsy, nor that it can be accompanied by violent injury to the self or others. Three case reports here include that of a 14-year-old boy who rose from his bed at 2 a.m. and severely stabbed his five-year-old girl cousin. The sleeping mind is not in touch with reality and amnesia for events during sleep is usual.

A cross-over comparison study of exposure, in the evenings only, to bright versus dim light was carried out on nine female patients with seasonal affective disorder. A significant antidepressant effect of the bright lights was shown. No consistent observable effects were produced by the dim lights. These results support earlier studies demonstrating the efficacy of bright light given morning and evening. The antidepressant effect of light is not mediated by sleep deprivation, and the early morning hours are not crucial for a response.

Temporal orientation in 235 normal elderly subjects was examined and compared with previous results from a young adult population. Orientation for time in the elderly remains reasonably intact; the major exception to this was inaccurate recall of the date, which was most pronounced among women in the older group studied (71 +).

Indalpine 150 mg per day and mianserin 60 mg per day were compared in a double-blind study of 65 depressed out-patients: 52 patients completed the 4-week trial. At the end of four weeks there was no significant difference in antidepressant effect between the two drugs; but in the first two weeks, improvement in the mianserin-treated group was significantly greater than that in the indalpine group. The mianserin-treated group reported more side-effects of sedation (eg. drowsiness, clumsiness, heaviness of limbs etc.) and one patient on indalpine developed a mild leucopenia.

Fifteen cases meeting the diagnostic criteria for presbyophrenia are reported and compared with a control sample of patients suffering from dementia. The presbyophrenic patients exhibited more elevated mood, more hyperactivity, more disorientation, and had lower information scores than the controls. Traditional explanations of ‘presbyophrenic behaviour’ such as delirium, pathoplastic effect of personality, or superimposed cerebrovascular disease are not adequate. Instead, presbyophrenia may constitute a sub-type of dementia characterised by severe atrophy of the locus coeruleus, marked impairment of noradrenergic transmission, and uninhibited behaviour.

The relationship between antecedent life events, clinical profile, and hypothalamic–pituitary–adrenal function was examined in 72 depressed patients. Antecedent life events were associated with first episodes of depression and with greater severity of illness, but their presence did not distinguish between patients diagnosed as endogenous or neurotic, and status on the dexamethasone suppression test was not associated with a greater or lesser likelihood of antecedent events. However, urinary free Cortisol levels were higher in those patients with life events and difficulties.

One hundred and four Yoruba Nigerian patients are described who presented with manic disorder over a five-year period; 55 could be classified as suffering from recurrent unipolar manic disorder, while 36 had suffered only one attack of mania. Only 13 patients suffered from bipolar disorder, in contrast to studies from Western societies, in which bipolar disorder is much more common than unipolar. The unipolar manic and bipolar patients could not be differentiated on the basis of clinical and social data, apart from a possible preponderance of the female sex in the bipolar group. The clinical presentation of mania was similar to that described from Western Countries. Long-term prophylaxis with depot neuroleptics may be advisable in such cases.

Accidents may often have been far more traumatic psychologically and emotionally than appears to be the case at first sight. Attention is drawn to such “Cryptotrauma” and illustrated with three clinical vignettes. Emphasis is placed on the need for painstaking analysis of the accident in all its details. Without such careful investigation “Post traumatic stress disorders” can easily be overlooked, since patients tend not to offer the information spontaneously.

Cerebrospinal flud (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.

The P300 (P3) and other long latency auditory evoked potentials were measured in 15 patients with presenile dementia Alzheimer type (ATD), 16 patients with alcoholic Korsakoff syndrome (KS) and 23 age-matched control subjects. All were drug free for at least four weeks before testing. The latency of the P3 was significantly longer and the amplitude significantly smaller in the ATD group than in both the KS and control groups. The KS group did not differ significantly from the control group in either latency or amplitude of P3 but both the KS and ATD groups had reduced N1 and P2 compared to controls. Using a combination of P3 latency and amplitude, 70% of the ATD patients could be separated from the other groups with no false positives. These findings suggest that evoked potential recording may be of value in the diagnosis of early ATD.