Patients diagnosed as reactively or endogenously depressed were given electroconvulsive therapy (ECT). The endogenously depressed patients tended to respond to the treatment more quickly and favourably. Measures of age and severity of depression were as predictive as the classification into endogenous or reactive depression using the Newcastle rating scale. The degree of psychological stress ascertained and presumed to be operating did not contribute to the prediction of outcome.

A prospective study of 45 cases, 25 of whom had had previous episodes of affective disorder, predominantly manic, showed further episodes in 14 cases. A positive history of psychotic disorder in 1st-degree relatives, not always affective, was obtained in only eight cases. There was a history of drug abuse in seven patients. The clinical presentation in the Nigerian patients was similar to that described in the classical literature, but, flight of ideas was uncommon.

Language, conceptual, and cultural factors are discussed in relation to a Xhosa translation of the Present State Examination which was administered to a series of 120 consecutive new admissions to a psychiatric hospital.

The experiential events of psychiatric disturbance as defined by the PSE exist in Xhosa-speaking patients and it is a valid instrument.

The charts of 52 hebephrenic/catatonic schizophrenics requiring long-term institutionalization were selected from the Iowa 500 study and reviewed. The presence or absence of 28 different symptoms was noted on a year by year basis over a span of 35 years. Symptoms usually classified as positive symptoms of schizophrenia, such as hallucinations and delusions, were found to have earlier onset and greater tendency to resolve over time than symptoms usually classified as negative such as flat affect, decreased social interaction and sensorium defects.

Acetylator phenotype, determined by blood levels after sulphadimidine, was related to outcome in a controlled trial of phenelzine in patients with depression and mixed anxiety depression. Slow acetylators showed more improvement and greater phenelzine-placebo differences than did fast acetylators, at two, four and six weeks. A tendency towards faster acetylation was observed in subjects with previous increased alcohol intake. Acetylator phenotype was not related to other symptom, diagnostic or history data.

In a behavioural clinic, over a period of nine years, trainee nurse-therapists treated 65 unusual referrals (8 per cent) out of a total of 800 patients. The remainder had phobic, obsessive-compulsive, sexual and social disorders, which responded encouragingly to behavioural treatment. Of the unusual referrals, useful results were obtained by behavioural treatment for stuttering, hairpulling, tics, and writer's cramp; bulimia is worth further study. Unresponsive conditions included compulsive gambling and obesity.

The view that schizophrenics have been exposed to a parental style of low care and overprotection was assessed in a case-control study of 72 schizophrenics using the Parental Bonding Instrument (PBI) which measures perceived parental characteristics. Those who assigned one or both parents to the low care/overprotection group had an earlier age of initial hospitalization, and in nine months following hospital discharge were more likely to be readmitted. The PBI is a simple measure capable of predicting schizophrenic relapse.

Fifty-one schizophrenic patients diagnosed using the New Haven Schizophrenic Index and 29 other patients who did not score enough on this index for a diagnosis of schizophrenia were studied for depressive symptoms using the Present State Examination. There was no significant difference in the frequency of depressive symptoms in the two groups.

Plasma Cortisol suppression after dexamethasone administration in 113 consecutively hospitalized patients (54 patients with primary depression, 41 with secondary depression and 18 non-depressed controls) showed early morning hypersecretion of Cortisol and Cortisol non-suppression after dexamethasone mainly in patients with primary depression. The sensitivity of the dexamethasone suppression test was 79 per cent in unipolar and bipolar primary depressed patients, specificity 79 per cent and diagnostic confidence of a positive test 82 per cent. Non-suppression to dexamethasone was observed in 81 per cent of patients with psychotic depression but only 37 per cent of those with non-psychotic depression. Age, sex and severity of depression, menopausal status, or benzodiazepines did not influence results. There was no association between Cortisol non-suppresssion and any genetic subgroup of affective disorder.

Constipation is a frequent effect of treatment with antidepressant and neuroleptic drugs as a result of interference with neuronal control of colonic muscular activity. Motilin, a circulating peptide, is involved in induction of myoelectric complexes in the colon. Significantly elevated circulating basal motilin levels were found in patients receiving tricyclic antidepressant drugs, mean 128±33 pmol/l (control 48±6 pmol/l) or neuroleptic therapy, mean 213±29 pmol/l (control 87±8 pmol/l).

Plasma Cortisol levels examined at 16.00 hours after dexamethasone in 31 controls and in 34 psychotic patients with various diagnoses, suggests that the ranges of such levels may help to discriminate among subtypes of psychotic patients. They were significantly higher in the unipolar depressed psychotic group than in control subjects or in psychotic patients with bipolar depression or schizophrenia. Moreover, the distribution of values differed between groups. Whereas 8 of 14 psychotic patients with unipolar depressive illness had post-dexamethasone Cortisol values ≥ 14 μg/dl, none of the remaining psychotic patients had similarly high values. Implications of these data are discussed.

There was a significant rise in the human growth hormone response to intravenous thyrotropin releasing hormone in 5 of 10 chronic schizophrenic adolescents maintained on antipsychotic agents, but in none of 10 age and sex matched control subjects. In 4 of the 5 patients with growth hormone rise there was a positive family history of schizophrenia, but such a family history was obtained in only one of the non-responding schizophrenics.

Patients were randomly allocated to treatment with either low energy pulses, high energy pulses, or high energy sinusoidal wave ECT and, despite the induction of convulsions of similar duration, were found to respond at different rates and to a different degree, depending on whether low or high energy currents were used. It is suggested that the quantity of current, as well as the induction of a convulsion, is relevant to therapeutic outcome with ECT. A reexamination of previous work shows that this is not necessarily inconsistent with these findings, which also explain the contradictory results in recent controlled trials of ECT.

Significant deficiencies in personal social networks and social support in non-psychotic psychiatric out-patients have been reported by Henderson and his colleagues. In a replication study, 50 non-psychotic psychiatric out-patients were compared with 50 matched controls. Patients reported spending less time in social interaction, but more time in unpleasant interaction during the previous week; they also had fewer attachment figures, close relatives and good friends and fewer social contacts than controls. However, the separate analysis of Neurotic and Retarded depressives (using the Present State Examination) failed to replicate all these findings in the Retarded depressives. It is concluded that these associations are confirmed in neurotic patients, but that the more severe depressive disorders require further investigation.

The responsiveness of eccrine sweat glands to local intradermal injections of carbachol and phenylephrine was studied in six male and six female healthy volunteers and six female patients suffering from anxiety neurosis, using a plastic paint impression method. Carbachol evoked consistently greater responses than phenylephrine. The response to carbachol attained a peak approximately two minutes after injection, whereas the response to phenylephrine attained a peak within fifteen seconds of the injection. Males showed greater responsiveness to both drugs than females, this being reflected in significantly higher maxima of the dose-response curves for the males. The anxious females showed a higher level of spontaneous sweat gland activity and greater responsiveness to both drugs (reflected in higher maxima of the dose-response curves) than the normal females.

This paper explores the relationship between depression and chronic intractable pain in which somatic pathology is playing a minor role. In this study, 114 patients with chronic pain were compared with 53 patients with depression. Patients with chronic pain were older, more likely to be married, more frequently attributed difficulties in activity and sleep to pain, and reported greater impairment of motor functions. They had less dysphoria and an illness behaviour profile (on the Illness Behaviour Questionnaire) suggestive of a conversion reaction. Depressed patients recalled more life events in the year prior to presentation, whilst pain patients recalled more events of nine and ten years earlier. It is concluded that the two patient groups cannot be considered identical. It is argued that the concept of abnormal illness behaviour helps to distinguish the two groups.

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

Electroconvulsive therapy was compared with imipramine in the treatment of endogenous depression in a double blind randomized controlled trial. Both treatments produced equally significant improvement which was equally maintained till the end of six months. However ECT produced its effects quicker with lesser subjective side effects to the patient. ECT did not cause any organic brain dysfunction as assessed at the end of three and six months.

The incidence of vegetative symptoms was found to be higher in 61 medication-free patients with anxiety compared to an equal number of age and sex-matched normal controls. Multiple regression analysis identified depression, as rated by Beck Depression Inventory (BDI), as the most highly predictive factor associated with these symptoms. Twenty-two anxious patients who obtained scores less than 5 on BDI (absent or minimal depression) were compared with an equal number of age and sex-matched patients with depression. The depressed patients reported a higher incidence of sleep disturbances, weight loss and appetite loss.

Sixty-nine patients, each with a combined diagnosis of epilepsy and psychosis, were compared with 53 patients with a diagnosis of functional psychosis. The epileptic affective patients often lacked convincing psychotic features; ECT and lithium were rarely prescribed; only three showed evidence of bipolarity. The epileptic schizophrenic patients were judged to have the better premorbid personality, experienced more paranoid delusions and delusions of reference, and showed less catatonic features than the functional schizophrenic patients. The course of the epileptics' illness was more variable.

The concept that the schizophrenia-like psychosis associated with epilepsy is a distinct nosological entity is supported, but not the suggestion of a relationship between affective psychosis and epilepsy.