Arguments concerning the nature of depressive disorders have involved as a central issue the question of the bimodality or otherwise of the distribution of some variable expressing variation in symptomatology. The implications of a particular type of frequency distribution along this dimension, whether uni- or bi-modal, have been misunderstood by a number of workers, and an attempt is made to clarify the situation.

Physostigmine (0.25 mg-1 mg), arecoline (2 and 4 mg) and saline were administered intravenously over 30 minutes in a randomized double blind design to 11 patients with a clinical diagnosis of Alzheimer presenile dementia. Significant improvement was seen on a picture recognition test with physostigmine 0.375 mg and arecholine 4 mg. A trend towards improvement was also seen with physostigmine 0.25 mg and 0.75 mg, and arecholine 2 mg. For the majority of the patients improvement was only slight but in two patients it was clear cut and consistent.

Eleven schizophrenic and three manic patients were randomly administered 0.3 mg/Kg b.wt. of naloxone or placebo in a drug-free state using a double blind procedure. BPRS and CGI were employed for making periodic assessment of mental status; the MRS was additionally used for manic patients. The authors discuss their findings, which are essentially negative.

Urinary MHPG (3-methoxy-4-hydroxyphenyl-ethylene glycol) was measured in seven anorexia nervosa patients during a bed rest and refeeding programme. MHPG levels were positively related to increase in body weight.

During a two-year biochemical screening for thyroid disease amongst 191 psychiatric admissions, 38 (20 per cent) had an abnormal result, 5 were hyperthyroid and 7 hypothyroid. Thyroid dysfunction was associated with female sex and affective psychosis, but not with age. During the three weeks before admission the patients with an abnormal result had been prescribed significantly more phenothiazines, antiparkinsonian drugs and lithium than the patients with normal thyroid function. Almost half of those with abnormal function were physically ill on admission. Despite these findings we concluded that in most patients thyroid dysfunction was not a major determinant of the psychiatric disturbance.

A prospective follow-up study of 60 randomly selected cases of closed adult civilian head injuries was conducted for three months from the time of head injury to assess the frequency, patterns, and factors related to posttraumatic psychiatric disturbances.

Eighty per cent of the cases had a neuropsychiatric disturbance as assessed at 1½ months. The commonest was post-concussional syndrome (43 per cent). The extent of social dysfunction was directly related to the severity of head injury. However, the total number of symptoms (largely subjective) correlated highly with pre-traumatic neuroticism. The inter-relatedness of organic and personality factors in the post-traumatic syndrome, and their predictive value, are discussed.

The growth hormone response to clonidine was significantly less in 10 drug-free patients with endogenous depression than in 10 normal subjects who were individually matched with the patients for age and sex. The hypotensive and sedative effects of clonidine in the two groups were similar. The findings may indicate a defect at central a adrenoceptors at least in neuroendocrine systems.

NHS consultants who are asked to accept Special Hospital patients can judge the prognosis, since the extent of both psychiatric and criminal histories provides the most accurate prediction of future behaviour. Patients discharged to the community have different outcomes from those transferred to NHS hospitals, but overall about one in five of those released are returned to a Special Hospital; up to one in two will subsequently be convicted, but the offences are mainly trivial and directed at property. Perhaps one in ten will be involved in serious or homicidal acts of violence.

To test the hypothesis that desipramine alters α adrenoceptor function in depressed patients, the effects of clonidine upon growth hormone sedation and blood pressure have been measured in depressed patients before and after treatment with desipramine. After three weeks of treatment the hypotensive and sedative effects of clonidine were inhibited in all patients even though plasma desipramine concentrations at this time varied from 42 to 560 μg/l. Growth hormone responses to clonidine were enhanced in five of the six patients but this effect was not statistically significant. These findings are consistent with the hypothesis that in these patients desipramine altered α adrenoceptor function: other explanations are discussed.

The prevalence of emotional disorder in a total of 72 patients suffering from myasthenia gravis or from peripheral neuromuscular disorders was assessed, using the General Health Questionnaire and Present State Examination.

Approximately half the patients were being treated with an alternate day regime of prednisone, receiving high dosage one day and low the next. Emotional disorder was found to be less prevalent among these patients than among patients not on steroids. The significance of the finding is discussed.

Two patients are described who developed behavioural changes following brainstem injuries. Both patients had neuro-ophthalmological signs indicative of lesions of the rostral brainstem, which were confirmed by CT scanning. It is suggested that the behavioural changes were related to interruption of nearby limbic, hypothalamic and reticular structures.

Eight patients suffering from a major unipolar depression and having failed to respond to treatment for three weeks or more with tricyclic antidepressants were given lithium. All eight patients experienced a remarkable relief of their depression within 48 hours. This rapid antidepressant effect of lithium in ‘treatment-resistant’ patients might be due to the enhancement of the efficacy of the central serotoninergic system, unveiling the tricyclic antidepressant-induced sensitization of the serotoninergic postsynaptic receptors.

The initial period of enthusiasm for the surgical treatment of certain psychiatric illnesses, has later given way to increasing rejection of this mode of therapy. But more recently there has been a reappraisal of the therapeutic possibilities of the modern refined operations, which are now receiving more objective assessment.