In 1903 Pierre Janet published perhaps the first detailed descriptions of patients with bulimia. Janet's observations, although anecdotal, are consistent with modern studies suggesting an association between bulimia and major affective disorder and between bulimia and anxiety disorders. Janet's writings also support the belief that bulimia is more prevalent today than a century ago.

The disorders of affect have not contributed much to the diagnostic definition of mental disease, and their phenomenological description has never achieved the richness of the psychopathology of perception or cognition. This paper shows how the subordinate role played by affectivity in the Western concept of man led to the early and enduring view of mental illness as an exclusive disturbance of intellect. Attempts by nineteenth-century alienists to challenge this notion were only partially successful, due to the conceptual unmanageability of most forms of affective behaviour and the terminological redundancy that this engendered. These efforts were frustrated by the rebirth of Associationism, the rise of brain localization experiments, the peripheralist definition of the emotions and, finally, by the unfolding of Darwinism. As a result, no autonomous psychopathology of affectivity was ever developed. The eventual recognition of the so-called ‘primary’ disorders of mood has not led, however, to a refinement in the semiology of the experiences themselves. This has been impeded by the use of descriptive behavioural surrogates or by metapsychological accounts of affect as a form of energy or as a driving force. None of these developments has contributed to the clinical description of the mood disorders.

The cognitive theories of depression put forward by Beck and his colleagues (1980), Brown & Harris (1978) and Abramson and her colleagues (1978) are described and compared. Although each theory has its strengths, it is argued that an adequate cognitive account of depression is awaited. Such a theory must link specific experiences with each of the cognitive themes of depression, and the links postulated should be specific to depression. Refinements of description and method are required before such a theory can be tested.

A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: (1) diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; (2) the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and (3) the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.

Ninety-eight men aged 25–50, who were unemployed because of involuntary redundancy and out of work for 2–18 months, completed the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ–30). Their scores were compared with those of a group of employed men matched for age and social class. The mean GHQ score for the redundant men was 13–0, compared with 4·0 for the employed group. The mean BDI score was 11·1 for the redundant group and 5·6 for the employed group. Eighteen per cent of the redundant men, compared with 6% of the employed group, scored 18 or more which are scores corresponding to those in depressive illness. We conclude that the prevalence of depressive illness may be increased among redundant men.

Six hundred and twenty-nine unemployed men were re-interviewed 9 months after initial measurement of their psychological health and commitment to the labour market. For those men remaining continuously unemployed between interviews, no further decrement was observed in mean General Health Questionnaire scores after 3 months without a job, but a significant deterioration was recorded for the sub-sample initially unemployed for less than 3 months. Small but significant declines were observed after 3 months on a single-item measure of reported health and on an 8-item index of commitment to the labour market. For those regaining paid work, all measures of health showed large improvements, and employment commitment was unchanged. Multiple regression analyses were used to examine factors associated with magnitude of changes during continuous unemployment, yielding a systematic pattern of significant relationships. For example, higher employment commitment at initial interview was significantly associated with a greater subsequent decline in psychological health, but not in physical health; reporting a chronic health impairment at initial interview was significantly associated with a greater subsequent decrement in physical health, but not in psychological health.

A psychiatric examination was conducted on 810 community dwelling subjects previously given a diagnosis derived from the Diagnostic Interview Schedule (DIS). The agreement in allocating subjects to a particular disorder was never high enough to encourage the confident replacement of a psychiatric diagnosis with a DIS diagnosis.

Forty-two patients attending a Huntington's Disease Research project at Johns Hopkins Hospital, Baltimore, were screened for alcohol abuse and alcohol-related problems. Prevalence of current or past alcohol abuse was 24% for males, 5.9% for females or 16.7% overall. When alcohol abuse occurred in HD probands it was often concurrent with depressive symptoms, and may have been associated with the threat of the disease. There was no evidence that HD patients had an increased rate of alcohol abuse above that of the local Baltimore community.

The data for this cross-sectional survey were obtained from a stratified probability sample of 510 residents in South-Verona during the period May–June 1980. The two-week prevalence of psychotropic drug consumption was found to be 13%. The prevalence was higher in women (18%) than in men (9%). The most commonly consumed category of psychotropic drugs were the benzodiazepines, which accounted for 70% of all the psychotropic drugs consumed by women and 85% of those consumed by men. Using a logistic analysis, a strong association between drug consumption and minor psychiatric morbidity, as indicated by the GHQ scores, was found for both sexes, a finding not significantly different from that found in the West London study by Murray et al. (1981). Alcohol abuse in men was less prevalent in the youngest age-group. Thirty-three (19%) of the male GHQ low scorers were alcohol abusers, compared with 12 (40%) of the high scorers. No significant association was found between psychotropic drug consumption and alcohol abuse in men.

The individual's response to the occurrence of symptoms is conditioned by a variety of non-medical factors, of both an enduring (e.g. personality attributes) and a changing nature (e.g. social support). The health diary provides a particularly appropriate method of studying the daily variations in health and illness behaviour which make up so much of the clinical content of general practice.

Issues surrounding the collection of accurate information about the life events of girls aged 15–20 were tested on 67 mother/daughter pairs in a community sample. The Bedford system of classifying and rating the events was modified to accommodate the perspective of an adolescent. Mothers recalled fewer events than their daughters, but the difference was most marked for the ‘severe’ events of girls aged over 17. There was a marked fall-off in the reporting of severe and non-severe events after the 30th week, and a significant difference between the rate of events in the furthest 6 months, compared with the proximal 6 months.

The weekly distribution of deaths for myocardial infarction was studied, using mortality data for Lower Saxony for the years 1968–77. In accordance with hypotheses derived from Holmes & Rahe's stress model, an increase of deaths was found on Saturdays and Mondays only in men aged between 25 and 55 years.

Questionnaires were completed by 73 volunteers with a history of probable schizophrenia, and by 67 patients admitted to the accident wards of a general hospital. A high incidence of sensory distortions was recorded in the schizophrenic group compared with the controls, distortions of brightness contrast being the most common. Many schizophrenic patients reported that such distortions were reduced or removed early in treatment. Patients who reported visual distortions also tended to report visual hallucinations. The results are discussed with reference to the hypothesis that perceptual malfunction may underlie some other schizophrenic disorders such as delusions or catatonia.

A standardized pegboard task was used to investigate changes in manipulative skill as a function of age in 119 right-handed subjects. The typical pattern of cognitive impairment in old age indicates a relative preservation of functions which depend on the integrity of the left hemisphere. In accord with these observations, we predicted that, with increasing age, right hand motor skills would be better preserved than left hand skills. We found this on initial exposure to the task (P < 0·01); however, the phenomenon was masked by practice, because older subjects (over 60 years of age) derived more improvement to their left hand motor skill, as a result of practice, than they did to their right hand skill (P > 0·05).

A computed tomographic study of 101 depressed patients and 52 normal control subjects is described. Increasing age and male sex were both associated with larger ventricular size in both patient and control groups. Controlling for these effects, the depressed patients had larger ventricles than the control subjects. In the patient group there was no association between ventricular size, course of illness or exposure to drug treatment or electroconvulsive therapy.

Computed tomography (CT) research in psychiatry often relies on the assessment of minor structural changes. Recently, it has come to encompass changes in regional brain X-ray absorption density. The artefacts prone to be encountered in density measurements are reviewed, and illustrated by a series of studies carried out using a CT 1010 scanner. They are shown to be more important than hitherto assumed in the interpretation of CT scan research.

A small proportion of smokers who stop smoking with the aid of nicotine chewing gum continue to use the gum for more than a year. This study shows that when these people abstain from nicotine gum use they experience withdrawal symptoms similar to those found during cigarette withdrawal, including increased irritability, difficulty in concentrating and a drop in heart rate.