Do twins have a lower mean IQ score than singletons? Previous studies have not examined whole populations and are likely to be biased. Twin data from two whole-population surveys of IQ at age 11 years were examined: the Scottish Mental Surveys of 1932 and 1947. Additional variables from childhood were examined as possible mediating effects. There were 1080 twins from the 1932 survey, and 949 from the 1947 survey. In both surveys twins scored lower on the Moray House Test of verbal reasoning, equivalent to a deficit of about 5 IQ points. In the Scottish Mental Survey of 1947 the whole-population group of twins was compared in detail with a representative population sample. The same mental ability difference of about 5 IQ points was found, and was not accounted for by father's occupation, overcrowding in the childhood home, childhood height, school attendance or the number of people in the family.

The hypothesis that ECT produces selective effects on hypothalamic–pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine-and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probadly due to direct stimulation of the neuroendocrine neurones themselves.

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5–10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect.

Age-standardised rates were calculated for first admissions to hospital in Scotland with ICD-9 diagnoses of schizophrenia, affective psychoses, paranoid psychoses, reactive psychoses and depressive neuroses (ICD-9 295, 296, 297, 298 and 300.4) for the period 1969–88. First-admission rates for schizophrenia declined by an average of 3.3% per year in males and 4.4% per year in females over the period. The first-admission rate in males in 1988 was 8.4/100 000 (57% of 1969 rate) and in females was 4.8/100 000 (43% of 1969 rate). Rates for depressive neuroses, affective psychoses, reactive psychoses and combined psychoses also fell. Rates for mania rose, as did those for paranoid states in males. The decrease in first-admission rates is likely to reflect a true decrease in the incidence of schizophrenia over the period. The decline was unlikely to be accounted for by diagnostic change because there was no reciprocal increase in any other diagnosis sufficient to account for the change, and the rates for combined psychoses also decreased. There was evidence that rates for schizophrenia declined to a greater extent in younger age groups, especially in females. This could imply the presence of a birth cohort effect.

This annotation is concerned with how soon and at what rate antidepressant effects become apparent over a course of electroconvulsive therapy (ECT). The first question is of importance in the design and interpretation of biological studies of the mode of action of ECT. The second question is of practical interest to the treating psychiatrist when we ask how the speed of recovery is influenced by what the psychiatrist prescribes, that is, the number and frequency of treatments. These questions are little better answered now than 20 years ago. This may come as a surprise to many readers, who have been advised to use ECT when “seeking rapid improvement” in depressive disorders (ECT Sub-Committee of the Research Committee of the Royal College of Psychiatrists, 1989). This lack of progress is attributable to a dearth of appropriately designed ECT studies.

“A neuroendocrine hypothesis to explain the clinical activity of convulsive therapy is described. The hypothesis is based on the diabetes/insulin model and suggests that hypothalamic dysfunction with an insuffiency of a mood-maintaining peptide is the basis for affective disorders. Repeated seizures enhance the production and release of the hypothalamic peptide antidepressin – the active principle that relieves both neuroendocrine and behavioral abnormalities.”

To determine whether high plasma cortisol concentrations are a distinctive feature of depression or whether plasma cortisol is also elevated in other forms of psychosis, cortisol concentrations were measured in 59 patients with acute functional psychoses, six non-psychotic depressed patients and 37 control subjects, all free of antidepressant and neuroleptic drugs for at least three months. Patients with schizoaffective disorder, manic type, had the highest concentrations throughout the day and those with major depressive disorder, psychotic sub-type had higher concentrations than controls in the afternoon and evening. Manic and schizophrenic patients had cortisol concentrations above controls in the afternoon only. Elevated concentrations were not related to the presence of depressed mood or to duration of stay in hospital, and a return to normal occurred irrespective of the type of treatment used. Thus raised plasma cortisol concentrations are a feature of psychotic illness, but in drug-free patients are not specific for severe depression.

First admission rates from 1969–78 for Scottish psychiatric units were calculated for discharge diagnoses of affective psychosis for each five-year age-group from 15 years to over 74 years. There were clear-cut linear increases in rates of depressive psychoses, mania, and all affective psychoses, consistent with a relatively steady increase in the rate of first-onset affective psychoses with increasing age. These findings are discussed in terms of social, psychological, and biological hypotheses of the causes of affective disorder. It is argued that no single factor could produce the observed linear increases with age and that the data appear more consistent with an integrative aetiological model of affective disorder.

Annual age-standardised first admission rates from 1969–78 for Scottish mental hospitals were calculated for schizophrenia, paranoid states, reactive psychoses, all affective psychoses, mania, and depressive neuroses. Significant decreases were found in the diagnosis of schizophrenia (P <0.001) and, to a lesser extent, affective psychoses (P <0.01) and depressive neuroses (P <0.02). The incidence of paranoid states, reactive psychoses, and mania did not change significantly.

Several factors possibly contributing to the decline in diagnoses of schizophrenia are discussed, but it is concluded that the figures probably reflect a genuine fall in incidence. The decline in the categories of affective disorder is likely to reflect trends towards increasing provision of community-based care.

In South-East Scotland, 791 subjects treated with lithium for more than two months during 1967–76 were traced, using public and health service records; 751 were traced alive, 33 had died, and seven remained untraced. The standardised mortality rate was 2.83, and excess mortality was attributable to suicide (increased 36-times) and cardiovascular disease (increased 2.15-times); deaths from nephropathy, cancer or leukaemia were not increased. Comparison of the 33 deaths and 33 matched patients, selected from the 751 survivors, showed that patients dying on lithium were similar in most respects to survivors, but when first starting lithium, they had more signs of physical disease.