A brief historical introduction traces the evolution of the concept of hypochondriasis. It is suggested that the term should now be used only as a descriptive adjective when there is a morbid preoccupation with health or body. Social and cultural factors are outlined, as well as problems of measurement. The psychopathology, as formulated by Freud and others, is also described. Clinical aspects are discussed under the headings of general symptoms, pain, smell, bodily appearance, sexual, gastro-intestinal, cardio-respiratory, eyes, and ears, nose and throat. Psychiatric syndromes mentioned are: hypochondria as a possible primary state, personality disorders, phobic-anxiety state, neurasthenia, obsessional neurosis, hysteria, depression, paranoid psychosis and organic. In general, hypochondriacal symptoms seem to make the prognosis rather worse. Treatment is to be aimed at the primary condition, which is most commonly depression, anxiety state or conversion reaction.

During the last fifty years, and particularly the last twenty, innumerable different classifications of depressive illness have been proposed, and several disputes are smouldering away between the protagonists of rival schools. Much of this is too well known to need, or bear, repetition. But the conflicting claims and proposals are now so numerous, and methodological problems loom so large, that those who are not intimately involved have increasing difficulty in understanding what is going on; while those who are involved are mostly too intent on developing and promoting their own particular schema to review the overall situation in any broader context. This article is an attempt to describe the main elements in a confusing situation, to outline the important problems, and to indicate the areas of agreement that are beginning to emerge, without advocating any particular solution.

A woman aged 20, first presenting with what appeared to be hysterical blindness as part of the syndrome of hysterical pseudo-dementia, soon showed the picture of speech-prompt catatonia, one of the subtypes of chronic schizophrenia described by Karl Leonhard. However, within a short time the neurological, EEG and laboratory findings indicated that the condition was one of subacute sclerosing panencephalitis.

This study compared matched groups of patients with acute schizophrenia and with depression on three tests used in the assessment of schizophrenic thinking disorder. Most measures derived from these tests significantly differentiated the groups; however, within the schizophrenic group there were no significant correlations between scores on the three tests. Further data were available from a choice reaction-time card-sorting task, from which estimates of distractability, stimulus decision time, response decision time, and movement time, were obtained. Only one significant relation was found between these measures and scores on the clinical tests. The possible confounding effects of intelligence and responsiveness are discussed. It is argued that more direct measures of the latter are preferable to interpreting tests of thinking disorder in terms of information processing deficits.

The relationships between obsessional personality, obsessions in depression, and symptoms of depression were investigated by means of a retrospective study of case notes and item sheets. One hundred and sixty-eight cases of depression, aged 20 to 29 years, were rated for obsessional personality as defined by Ingram (1961). The presence of previous obsessions, of obsessions in depression and of eight symptoms of depression was assessed from the item sheets.

Obsessional personality was found to be significantly associated only with a decreased frequency of objective apathy, although it seemed to act to reduce the anxiety experienced by those with obsessions in depression. Obsessions in depression were associated with rapid changes of mood, anxiety, agitation and overactivity and with a relative absence of retardation.

Data from non-rapid-cycling bipolar (manic-depressive) patients who were receiving long-term treatment with lithium carbonate were analysed by the life table method to determine when lithium carbonate prophylaxis failures occurred. Forty-four of 96 patients failed to keep well in spite of maintenance lithium therapy. The analysis revealed an early, rapid failure rate during the first six months of treatment, which was followed by a slower rate of failure. Several clinical factors were assessed to determine if any of them predicted which patients would experience their initial failure in the early or late interval, but none of these factors, which included age, sex, age of onset, rate of affective attacks, family history, and the nature of the preceding episode, were found to have any predictive value regarding lithium prophylaxis failure. We found, however, that patients who had early failures tended to have a subsequent early failure in spite of continued maintenance with lithium carbonate.

The seasonal variation of admissions to hospital with a diagnosis of mania (296.1) in England and Wales was examined. The results indicated that for females there was a significant seasonal trend, the peak being in August–September, while for males there was no significant seasonal pattern. The possible reasons for these findings are discussed.

The season of birth of the siblings of psychiatric patients was studied to test the hypothesis that an unusual seasonal pattern of maternal conception is the cause of the excess of births in the early months of the year which has been found in national studies of psychotic patients. Information on the month of birth of the siblings was obtained from interviews with psychiatric in-patients born in Britain. The quarterly distribution of births of 670 mentally well siblings of psychotic patients (schizophrenia and manic-depression) was significantly different from that of 1,513 siblings of other psychiatric patients and also from that of all births in England and Wales. The results lend qualified support to the hypothesis, but they were not clear-cut and there was some evidence that the information on birth dates was biased.

Psychiatric descriptions of bodily symptoms have usually been derived from narrowly restricted clinical experience. It is argued that it is more useful to review evidence from all medical settings and occurrence, nature, disability and presentation are here discussed. Syndromes of hypochondriacal reactions appear to be extreme and uncommon manifestations of a universal potential.

A comparison is made between the General Health Questionnaire (GHQ) and the Symptom Checklist (SCL) as psychiatric screening tests in community-based research projects. Both are shown to correlate equally well with independent clinical assessment, and the differences between them mainly reside in the form of their response scales. The GHQ works best as a screening test, since it has fewer false positives associated with its use, but it may miss those with long-standing disorders. The SCL tends not to miss long-standing disorders and furnishes diagnostic sub-scales if these are required. Both tests function better with men than with women and with whites than with blacks, but neither is affected by social class or age of the respondent. The study revealed high correlations between the symptoms of anxiety and depression, and indicated some possible differences between the symptom clusters seen in whites and in blacks.

This paper is concerned with the further evaluation of the Clifton Assessment Schedule (CAS), a brief psychogeriatric assessment procedure, providing a cross-validation study on a second sample of acute elderly psychiatric admissions. Additionally, further work is reported on its use with a psychogeriatric population resident within the hospital. The results suggest the usefulness of the CAS across a broad range of psychogeriatric patients, providing significant differentiation between groups receiving varying degrees of care and with differing outcome expectations.

In a day hospital all staff members must be able to make rapid decisions, even when they cannot refer to their seniors. It is difficult to develop this capability in a teaching day hospital where the staff and student groups are constantly changing. It has, however, been facilitated by regular staff discussions with a visiting psychotherapist. In these staff groups, the study of role attributions and dynamics characteristic of families has diminished the interference caused by ‘family’ type dynamics in daily professional interaction. The paper describes the effect of such discussion in stimulating the adoption of a treatment approach which takes the family situation into account. This family approach is distinguished from family therapy, and its advantages are discussed.

Tradition retains the practice of attaching mental nurses to wards rather than to groups of patients, even though the wards are increasingly empty as patients come to lead more active lives in hospital. A system is described which enables nurses to relate more fully to the people in their care instead of having to confine their activities to the place in which only a part of the care is provided. This system involves all ward nurses in leaving their wards empty in ‘working hours', being relieved of the care of their intercurrently ill patients and undertaking in exchange the complete day care of their fitter patients in both wards and workplaces. The consequences of these changes are attractive to many nurses and helpful to many patients.