Ninety-one subjects diagnosed clinically as having a ‘neurotic depression’ were interviewed and then re-assessed at 6 weeks and 20 weeks. Four symptom profiles of clinical features were derived: ‘negative cognition’, ‘lack of drive’, ‘anxiety’, and ‘arousal’, the last being independent of the other three dimensions and of the severity of depression. Symptom profile scores were then examined against antecedent risk variables and outcome. Links between profile scores and personality variables suggest that personality may colour the clinical presentation of neurotic/reactive depressions, and challenge the assumption that a typology of these depressive disorders based on clinical features is achievable. The break-up of an intimate relationship in the preceding 12 months was a strong predictor of a good outcome. Further analyses suggested, firstly, that there was a distinct subgroup delineated by this life event, with features weighted to the ‘arousal’ symptom profile, including many symptoms often associated with diagnosis of ‘endogenous depression’; and, secondly, that this life event and a good outcome were directly linked, being uninfluenced by personality or other mediating variables.

It has been suggested that the quality of early parenting received by depressed adults is more negative than that received by non-depressed people. Since perceptions of parenting are usually examined only when subjects are depressed, depressed subjects' negative reports may be distortions due to their depression, rather than accurate recollections. In the present study, both depressed and remitted women reported experiencing greater parental overprotection than did non-depressed women, but only depressed subjects also reported less parental caring. The results are discussed with respect to the early experiences of depressed individuals, the distinction between parental caring and over protection, and the importance of interpersonal factors associated with depression.

Of 49 schizophrenic patients followed up 12 months after their first admission to hospital, only about 45% had experienced no relapse and had no schizophrenic symptoms; a poorer outcome was more often found in Feighner positive than Feighner negative schizophrenic patients. The patients' overall level of unemployment had more than doubled to 51%. In patients whose acute episodes responded to treatment, pimozide taken once weekly as maintenance therapy was as effective as intramuscular flupenthixol decanoate, but tardive dyskinesia appeared in two patients receiving weekly pimozide; the repeat psychometric assessment at 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relatives still showed significant psychological distress, which correlated with patients' schizophrenic symptoms, and the relatives' social functioning remained poorer than that of a normal community sample.

Voluminous data on the familial distribution of schizophrenia in Iceland were evaluated in terms of a partly dominant genetic mechanism. The risks were found in most instances to be proportional to the probability of harbouring the proposed gene, but penetrance rates, which generally are around 25%, appear to be elevated when additional risk factors are present. This occurs in individuals with multiple ill relatives, in offspring of two schizophrenic people, or in monozygotic co-twins. Excessive risks also occur in families with unusually severe disease.

The frequency of schizophrenic first-rank symptoms (FRS) were investigated in 1698 patients with an organic mental disorder (OMD) according to Schneider's and DSM-III criteria: 7% of the patients with OMD had FRS, compared with 47% of schizophrenic patients. However, the frequency of FRS depends on the state of consciousness and on the aetiology of the OMD: 20% of the patients with clear consciousness had FRS, but only 1.5% of those with clouded consciousness. In cases of some aetiologically defined groups of OMD, such as post-ictal epileptic psychoses or alcoholic hallucinosis, the frequency of FRS is similar to that in cases of schizophrenia. FRS appear to be psychotic reaction patterns whose substrate-related basis extends across the whole spectrum of endogenous and exogenous psychoses.

Three groups of neuropsychiatric out-patients, homogeneous according to parameters of violent behaviour, were identified in a previous study using a cluster analysis procedure and compared in this study on psychometric variables. These groups were (a) a group manifesting frequent, impulsive violence (n = 35), (b) a non-violent group (n = 57), and (c) a group whose violent behaviour was much less frequent and severe than in the first group, and more provoked (n = 31). Impulsively violent patients showed language and visual-perceptual deficits, but no other neuropsychological or intellectual deficits. The MMPI F, K and Ma and MacAndrews Alcoholism scales and a perceptual organisation factor derived from the Holtzman Inkblot Test significantly discriminated groups. Results of this and the initial study have implications regarding psychological aspects of aggression and underlying biological mechanisms.

When Renaudin, aghast at the situation in 1856 wrote, “We now see anarchy in the field of classification threatening to split our ranks and robbing us of the victories of our predecessors”, he was not only providing an argument for adhering to a common system of communication in psychiatry, he was also stating why classifications are such an enchanting conundrum attracting attention, arousing emotion and giving rise to thought.

Out of a consecutive series of 130 potential probands with recent onsets of depression, 124 were deemed ‘in scope’ for a family interview study of social and genetic influences on depression. We were able to interview first-degree relatives of 83 probands (67% of those families ‘in scope’). Unexpectedly, interviewed first-degree relatives had, on average, a significantly lower occupational status than the depressed probands. However, the rates of depression among the first-degree relatives were high. Based on a PSE-Catego classification, 17.2% of 244 relatives were current ‘cases' of depression at the time of interview. This was significantly greater than the estimated population prevalence. Using a Past History Schedule in combination with the PSE, the lifetime prevalence of depressive illness, expressed as the proportion who had ever fulfilled PSE-Catego case criteria, was 38.9%. High rates of psychiatric treatment were also found in family members. The lifetime prevalence of any form of hospital treatment for depression in 315 first-degree relatives was 15.5%. This gives an age-corrected morbidity risk to age 65 years of 24.6%, as compared with a population estimate of 8.9%. In common with previous studies, significantly higher rates of depression were found among female than among male first-degree relatives for broader categories of disorder, but there was a small and non-significant excess of men among those relatives who had received in-patient treatment for depression. This apparent lessening of sex differences with more severe categories was not supported by an examination of ‘lifetime ever’ depressive symptoms, where severity was expressed as highest ever PSE-Catego-ID level. Here the proportion of women who had ever had depressive symptoms remained higher throughout the upper range of the Index of Definition. The findings raise the possibility that male relatives of depressed probands under-report their symptoms, but that their doctors compensate by adopting a lower threshold of psychiatric referral when faced with depressive symptoms in a man.

In a study of 28 attenders of a sexual and marital clinic, the relationship between marital distress and both general and specific sexual dysfunctions was investigated. It was found that for men there was a much closer relationship between sexual and marital problems than for women. In particular, it was noted that the specific male sexual dysfunctions of impotence and premature ejaculation played a much larger part in marital discord than did the female dysfunctions of anorgasmia and vaginismus.

The relationship between life events and depressive disorder was assessed in 83 families ascertained through depressed probands. Contrary to expectation and to previous suggestions, we found no inverse relationship between the presence of familial loading and reactivity to stress. Thus the relatives of probands whose onset of depression followed life events or chronic difficulties had slightly higher lifetime rates of depression than the relatives of probands whose onset was not associated with adversity. There was only a weak and non-significant relationship between recent life events and current disorder among relatives, and no apparent tendency for life-event-associated depression to ‘breed true’ within families. Comparison with a community sample showed that the first-degree relatives of depressives had significantly elevated rates both of current depression and of recent threatening life events. This finding still held when proband-associated life events were discounted, suggesting that both liability to depression and propensity to experience life events are familial.

A survey of all admissions of patients under the age of 65 during the first 6 years of a District General Psychiatric Department without mental-hospital support is reported. Three high-uptake groups of in-patients were defined; the long-stay (12 months or more), the medium-stay (6–12 months), and the revolving-door group (more than three admissions in any period of 12 months). Identifying characteristics which distinguish between these groups were examined. During a 7-year period there was no accumulation of long-stay patients, and a striking lack of schizophrenic patients who remained in hospital for more than 6 months or who had more than three admissions in any twelve-month period. This was not accounted for by drift of the high-uptake groups out of contact with the service, but may be related both to the style of service provision and to the socially cohesive nature of the area under study. Local variation should be given due importance when community services are being developed.

Chronic depression is defined as “symptomatic non-recovery for a period of 2 or more years”. Chronic primary major depressives (n = 24) were compared retrospectively with a control group of primary major depressives (n = 20) who had recovered from their illness episode within 2 years. The former had a significantly higher familial loading for affective disorder and showed an increased incidence of independent undesirable life events during the 6 months prior to and 2 years after the onset of their illness. Female chronic depressives also had a significantly greater number of previous illness episodes and a more frequent history of thyroid dysfunction. Personality as measured on the EPQ, psychiatric problems arising as secondary complications of the depressive illness, and developmental object loss did not differentiate chronic from non-chronic depressives.

Against the background of impressive advances in the neurosciences, which are opening new perspectives on the mechanisms of mind, and the development of increasingly powerful instruments and methods with a potential to revolutionise clinical research in psychiatry, clinicians continue to disagree on the definition and taxonomy of the elementary units of observation in their universe of discourse: the individual mental disorders.

A review of all known schizophrenic people living in Nithsdale in South-West Scotland identified long-stay in-patients, patients living on their own and those living with relatives showing low or high expressed emotion (EE). A prospective 12-month follow-up identified relapsing patients, defined as those readmitted to hospital with exacerbation of schizophrenic symptoms or a fresh episode of illness, or, if not readmitted, with a significant increase in antipsychotic medication. There was no difference in relapse rates in patients living on their own, with low-EE, or with high-EE relatives. Amount of contact with high-EE relatives did not affect relapse rates. The different results obtained from the Nithsdale group compared with one from Camberwell are discussed.

Twelve women, reporting rape to the police, were interviewed on three occasions over a 4-month period. Their psychological and behavioural experiences, during that time, were compared with those of 12 controls: women who were attending a Family Planning Clinic and without a history of such trauma, and small numbers of victims of non-sexual assault. All victims showed, initially, high levels of distress or some psychopathology but only the rape victims were reliable in attending follow-up appointments. In all but one case the acute, intense symptoms of distress resolved, but other substantial changes in lifestyle had taken place. The particular difficulties in counselling and research in this area were highlighted by this pilot work. Would-be counsellors should be cautious about taking on this kind of work unless considerable practical and emotional support is available to them.

A case-control study was undertaken to evaluate the effects, if any, of sibship size, birth order and parents' age at birth on the risk of a person's developing schizophrenia. Information was obtained, during an 18-month period, from 221 schizophrenic patients in the only mental-health hospital of the region of Peloponese, Greece, and from an equal number of matched patients. The data were analysed by modelling through logistic regression. No relationship was found between the occurrence of schizophrenia in a patient and either father's or mother's age at patient's birth, or sibship size, or birth order, when demographic and socio-economic variables were accounted for in the analysis. Although patients with schizophrenia were of similar socio-economic status to the comparison patients, they came from families with higher original socio-economic status, a fact which appears to reflect the decline of both schizophrenic and pre-schizophrenic people in the social ladder.

Among custodially remanded male prisoners from Greater London and its surrounds, in 1979–1980, nearly 3% (63 men) were aged 55 or over, about one-third of these being over 65. More than 40% were detained on theft charges and few for more serious offences, although serious violence was not unknown and nearly one-fifth of those 65 or over were subsequently convicted of non-violent sexual assaults. Like their younger counterparts, less than one-fifth of those aged 55 or over appeared to be first-time offenders. About half of the men of 55 or over had active symptoms of psychiatric disorder on entering the prison and about half had some form of physical disorder, twice the rates for those under 55. Psychosis and alcoholism were the major psychiatric problems; 27% were alcoholics, to the extent of showing withdrawal symptoms on or soon after entering prison. Schizophrenia was less common than the younger age groups, but affective psychosis more so; 37% of the older men had a major functional psychosis. Two-thirds of the 55–64 age group and over three-quarters of the over 65s were without an address; most of both groups were personally isolated.

The growth hormone response to clonidine was measured in ten drug-free recovered patients, seven of whom had previously been tested when endogenously depressed, and compared with the response in ten individually matched controls. In eight of the patients there was an impairment of the growth hormone response, despite clinical recovery, although the hypotensive effect of clonidine in these patients was normal. This is suggestive of a persisting abnormal alpha2-adrenoceptor function in forebrain regions after recovery from an episode of endogenous depression, and may represent a trait marker for this condition.

The discussion here is largely concerned with the purposes and structure of classifications of clinical concepts, variously called diseases, illnesses, disorders and syndromes, which are the main reasons why patients go to see doctors. Multiaspect (or multiaxial) classification has deservedly come to the fore in recent years, and seems likely to increase in importance for purposes of education, communication and research in the near future, but it is mentioned only briefly in the following discussion. The main focus of attention for the moment is the clinical descriptions of disorders; this is, of course, usually the first aspect in a multiaspect system, and the one around which the other aspects tend to be organised.

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.