The history of the description by Jean-Pierre Falret of circular insanity, the origin of our present day bipolar disorder, is presented as well as the claims of priority raised by his colleague Jules Baillarger. A detailed account is given of the long-lasting controversy which has often given rise to biased judgments about the respective roles of the two psychiatrists. It is shown that the clinical concept was an expression of Falret's views about the nature of mental disorders and that, through the influence these views had on future nosological systems, the apparently purely picturesque episode corresponds to a landmark in the history of psychiatry.

Primary health care is in the central position in the general sphere of mental health services. This article deals with, as a part of a joint Nordic project, the occurrence of mental disorders of patients in primary health care as based on the material (n = 1,000) collected in the health centre of Turku. The relation of the occurrence of mental disorders as diagnosed by means of a standardized psychiatric interview method (PSE) to the disorders, recognized by general practitioners (GPs) working in the health centre is also observed. It was found that one fourth of the patients had a clear mental disorder that required treatment, while studies in the general population, using the same method, reveal only 10% as having some kind of mental disorder. Three quarters of the evident mental disorders recognized by GPs were diagnosed as such also by the PSE, but the GPs were capable of recognizing only 43% of the cases identified by the PSE. On the basis of these results, the importance of the mental health issue in the basic and postgraduate training of the general practitioners must be emphasized.

This study considers the question of whether relapse rates among schizophrenic patients can be reduced by means of relatives' groups. In a randomized, controlled intervention study, two therapeutic strategies (therapeutic relatives' groups, initiated relatives' self-help groups) were compared with each other and with a control group. Interventions were confined to the relatives, with the patients continuing their standard treatment. The study involved 151 relatives of 99 chronic DSMIII schizophrenics. Data were collected before and after a 1-year intervention phase and in a 2-year follow-up. No difference existed between the groups with respect to rehospitalization data. However, numerous differences recorded in the psychopathological findings and in living and working circumstances suggest that therapeutic work with relatives is of clinically significant benefit.

Tests of both structure and function of the corpus callosum have revealed abnormalities in schizophrenic patients. One such functional test employed lateralised Stroop stimuli presented tachistoscopically, to measure the transfer of interference and facilitation between the cerebral hemispheres. An attempt was made to relate indices of callosal transfer to clinical and demographic variables, including family history, as well as to indices of brain morphology. The latter included ventricle: brain ratio (VBR) measured by computed tomography (CT) scanning on 31 DSMIII schizophrenics, and the cross-sectional area of the corpus callosum from magnetic resonance imaging (MRI), obtained from 20 of these patients. VBR did not relate to functional measures; however, anterior callosal area correlated with indices of callosal connectivity. Patients with auditory hallucinations had smaller anterior callosal areas and tended to show less connectivity. The results show links between functional and structural measures of the corpus callosum, but their precise nature remains unclear.

Lexical decision tasks were used in 17 schizophrenic subjects and 11 control subjects, to evaluate the so-called automatic priming of semantic links, and the controlled processes which involve longer lexical anticipation strategies. In this type of trial, inhibition in the recognition of the target word, when the preceding priming word is not semantically linked to it, indicates the activation of such controlled processes. Postulating that patients in the schizophrenic group were heterogeneous in terms of cognition, we compared the resultant scores in two subtypes of schizophrenic patients: paranoid and hebephrenic (CIM-9 criteria). The study demonstrated that there was a difference in performance between the schizophrenic subtypes. Although these findings need to be confirmed, they demonstrate the necessity of determining individual profiles of patients entering the trial, to take into account those of their phenomenological differences that may correspond to differences in cognitive functioning. The results indicate an absence of inhibition, but only in the paranoid group. In these subjects, results were consistent with the hypothesis of a failure to set up controlled processes rather than a stronger “automatic” activation of the semantic links. However, as the results were not significant, the hypothesis remains open to further investigation. The reasons for the nonsignificance of the results and alternative hypotheses are discussed.

Platelet monoamine oxidase (MAO) activities were assessed in 82 patients, 57 females and 25 males, who were admitted to the medical ward of a general hospital after a suicide attempt. The enzyme activities were compared to the activities of healthy subjects, 35 females and 26 males. In addition, MAO activities were analyzed in relation to sex, psychiatric diagnosis, mode of attempt, drugs ingested, and previous attempts. Compared to normal controls, only female patients showed lower MAO activities. In the male population, lower activities were found in the subgroup of patients who had made previous attempts. In relation to diagnosis, analysis performed in the female population revealed lower MAO activities in the dysthymic and personality disorder, and not in the adjustment or major affective disorder subgroups. MAO activities were not related to the violent mode of attempt, the type of medication used, or the score in the Beck Suicidal Intent scale. The finding of low platelet MAO activities in dysthymic disorder, indicates the need for further studies of biological variables in this underdiagnosed and undertreated diagnostic group.

The development, evaluation and use of biological markers with a diagnostic purpose in psychiatry is extremely important. However, with certain exceptions, truly sensitive and specific markers have not yet emerged. In order to investigate the relationship between the immune apparatus and the hypothalamic-pituitary activity on the one hand, and the psychopathological state of the patients on the other, we used a longitudinal design and assessed monocyte parameters (HLA-DR, CD 35, vimentin filaments, and phagocytosis index) and neuroendocrine tests (dexamethasone suppression test [DST] and thyrotropin-releasing hormone [TRH] stimulation test) at intake and at follow-up in 49 depressed patients. Immunological parameters were compared with neuroendocrine tests in both phases of the study. The combined use of both immunological and neuroendocrine tests did not add sensitivity to the immunological identification of depressed patients. The findings lead us to consider the role of the monocyte parameters as sensitive depressive state markers, while the combined use of both neuroendocrine and immunological tests in current clinical practice would be debatable.

Endogenous substances resulting from interactions between alcohol and possibly opioid metabolites and neurotransmitters (dopamine, indolamines) could be mediators of the pathochemical process towards dependence. Beta-carbolines (harman/norharman) are increased in alcoholics and — according to the presented results — in heroin addicts. Psychopathological disorders such as anxiety or depression do not seem to influence the level of beta-carbolines.