The theory that many diseases were produced by focal infection or chronic sepsis enjoyed a brief vogue in general medicine in the first quarter of the twentieth century. This paper explores its practical applications in psychiatry, which extended well into the 1930s. The analysis focuses particularly closely on the activities of Henry A. Cotton at the Trenton State Hospital in New Jersey.

The pharmacological actions central to the therapeutic effects of lithium have not yet been established, despite almost 40 years of clinical use and scientific investigation. We review the biochemical and neuropharmacological data relating to this problem and attempt to identify profitable areas for further research.

The effect of diazepam on brain 5-HT-mediated neuroendocrine responses was studied in healthy male volunteers. An acute dose of diazepam (15 mg) significantly attenuated the prolactin and growth hormone responses to intravenous L-tryptophan. After 3 weeks administration of diazepam (25 mg/d) these responses had returned to normal despite much higher plasma diazepam concentrations, suggesting that tolerance had occurred. A reduction in brain 5-HT function may underlie some of the acute therapeutic actions of benzodiazepines. It is possible that excessive ‘rebound’ 5-HT activity may contribute to the abstinence syndrome seen on benzodiazepine withdrawal.

In order to ascertain the extent of hypothalamo-pituitary-adrenal cortical (HPA) hyperactivity in endogenous depression, we determined circadian serum cortisol patterns, cortisol responses to dexamethasone (DEX) administration, and urine free cortisol excretion before and after DEX administration in 40 definite endogenous depressives diagnosed with the Research Diagnostic Criteria. The cortisol measures ranged from normal to clearly elevated. To elucidate the clinical correlates of these hormone measures in the patients, we examined the relationships of the pre- and post-DEX cortisol measures to the diagnosis of endogenous/melancholic depression by different systems and to the overall severity and specific dimensions of depressive symptomatology.

In this group of endogenous depressives, none of the diagnostic schemes for endogenous/melancholic depression which we studied was significantly related to the pre- or post-DEX cortisol measures. Of the other subject and symptom variables, only age and the agitation/anxiety factor of the Hamilton depression scale showed consistent relationships with the cortisol measures. Both were positively correlated, to a moderate degree, with the hormone measures, and they were not correlated with each other. Together they explained approximately 20% of the variance in the cortisol measures. Thus, within a group of moderately to severely ill endogenous depressives, the older and the more agitated anxious patients have a significantly greater likelihood of showing increased HPA activity. These findings indicate that age should be controlled in studies of the HPA axis and that the subjective experience of anxiety may contribute to HPA hyperactivity in endogenous depression.

Neuropsychological studies have shown that the integrity of the posterior corpus callosum is necessary for accurate colour naming in the left visual field (LVF) and colour matching across hemifields. Using this model, 22 schizophrenics, 14 depressive and 16 healthy matched controls were given a battery of tachistoscopic tests of colour perception. The schizophrenics made significantly more errors, in naming colours in the LVF compared to depressives, and in matching colours across fields compared to depressives and normals. There were no differences between groups for right visual (RVF) colour naming or matching within right and left visual fields. These findings support the hypothesis that trans-callosal transmission may be impaired in schizophrenia and are unlikely to be due to a specific disorder of colour perception, neuroleptic drugs or generally impaired performance. Those schizophrenics whose LVF naming errors exceeded RVF errors were more likely to have first rank symptoms and showed less cerebral atrophy but did not differ on other variables. The techniques described may be useful for further research into interhemispheric function in schizophrenia.

The CNS maintains a fundamental distinction between actions elicited by external stimuli and actions elicited by internal goals (acts of will). As a result the intact organism can monitor centrally three aspects of its own actions: (1) the action appropriate to current external stimulation (stimulus intention or meaning); (2) the action appropriate to current goals (willed intention); and (3) the action which was actually selected (corollary discharge). In Type I (acute) schizophrenic patients, intentions of will lead to actions, but these willed intentions are not monitored correctly. This apparent discrepancy between will and action gives rise to experiential (1st rank) positive symptoms (e.g. delusions of control and passivity). In Type II (chronic) patients, intentions of will are no longer properly formed and so actions are rarely elicited via this route. This gives rise to behavioural negative signs (e.g. poverty of speech).

The behaviour of Type II schizophrenics has surface similarities to that shown by patients with Parkinson's disease and patients with frontal lobe lesions in that all three types of patient show a relative deficit of actions elicited by willed intentions. Dopamine blocking drugs reduce positive symptoms in Type I patients precisely because they induce Parkinsonism, i.e. reduce the likelihood of actions being initiated by willed intentions. This in turn reduces the likelihood that actions will occur for which the patient had no awareness of his intention to act.

The principle of distinguishing between selective memory deterioration and global intellectual decline has been applied to 38 patients with alcoholic Korsakoff's syndrome. Indices were developed for each type of deficit and their distributions explored. Considerable variation was seen in both parameters, the transition from pure memory loss to global intellectual deficits appearing to be gradual. Differences were found in the sex and CT scan associations of the indices. The implications of the distinction for future research are discussed.

It has been suggested that amnesic patients suffer a selective loss of episodic memory while semantic memory remains well preserved. To assess the validity of this idea we studied remote memory in an amnesic patient, (M.R.L.), using several different measures that differ in the extent which they engage episodic or semantic memory. On two different versions of the Albert et al. (1979) remote memory battery M.R.L. displayed severe retrograde amnesia (RA) extending backwards in time for about 15 years with excellent preservation of older memories. With standard recall instructions his overall performance on the Crovitz test of autobiographical memory was impaired and all of M.R.L.'s specific, temporally dated memories were given from the first half of life. When asked to reconstruct his past residential history in detail, M.R.L. provided specific and generally accurate information for residences occupied from his boyhood until 1970, but thereafter his memory became quite unreliable. On a test of knowledge of terms commonly employed the surveying profession, in which he worked for the past 20 years, M.R.L.'s performance was also impaired. The consistent pattern of RA displayed by this patient on all of the tests of remote memory indicates that both episodic and semantic memory are impaired in amnesia.

Four diagnostic systems for dementia and depression are compared on a community sample of 274 subjects. They are: DSM-III, Gurland's system, AGECAT and a clinician's ratings. These are compared, not in the usual terms of prevalence rates and cross-tabulations of diagnostic categories, but by examining the performance of each system in terms of hypothetical, continuously distributed traits underlying the symptoms of dementia and depression, as in the latent trait model described by Duncan-Jones et al. (1986). Each diagnosis is characterized by the level of severity (threshold) at which it operates, and its accuracy. Evidence is given to support a dimensional view of dementia.

The purpose of the present study was to determine whether individuals with unusually high scores on the Scale for Physical Anhedonia (Chapman et al. 1976) would differ from average scorers in their emotional responses to affect-evoking stimuli. Ten male and ten female anhedonics, well as ten male and ten female control subjects, were each shown brief filmclips that were expected to elicit emotional responses. The subjects' facial expressions were videotaped while they watched the filmclips, and they also completed adjective checklists describing how they felt while watching them. The anhedonics and nonanhedonics did not differ in their self-reports of emotional experience, nor did they differ in their facial expressions of emotion while viewing the filmclips. Compared to men, women reported experiencing more emotion, and their facial expressions also indicated greater responsiveness.

Accounts of musical ability in idiots-savants have up till now been confined to stressing the astounding musical memory which such persons may possess. The present study investigates compositional and improvisational skills in five idiots-savants. The findings are interpreted as indicating that a representational system of musical rules and structures is accessible to persons of low general intelligence, and that such a system may underlie reproductive as well as generative musical capacity.

Seventy eight men were assessed one month before coronary artery bypass graft surgery using standardized measures of psychiatric morbidity and personality as well as a measure of emotional expression (the CECS). All patients had at least one coronary vessel occluded by 75% or more of its diameter, and functional capacity was assessed by calculating the exercise treadmill time (in seconds) for each patient.

Most of the variance in exercise treadmill time was accounted for by the following variables: young age, short duration of symptoms, and less severe angina. Only one in five men was designated a psychiatric ‘case’. The only psychological measure significantly associated with atherosclerosis was expression of fear (on the CECS). A measure of Type A behaviour (Bortner score) was related to exercise treadmill time, but not to any of the angiographic or clinical indices of coronary heart disease (CHD).

Like other measures of Type A behaviour, the Bortner scale is psychometrically impure and has doubtful validity. More valid behavioural variables (such as those measured by the CECS) require further investigation. Future studies on the relation between psychological factors and the extent of CHD should take account of not only sex differences but also patients without significant CHD: high rates of psychiatric morbidity in such patients confound the relation between psychological trait measures and atherosclerosis.

Fifteen persons who admitted to chronic worry were asked to complete morning and evening diaries in which they reported the occurrence of headaches, assessed their mood, and observed a visually stressful pattern, noting the illusions it induced. Results showed an association between both trait and state measures of mood and headache occurrence, and between trait and state measures of headache occurrence and illusion susceptibility. However, mood and illusion susceptibility did not appear themselves to be associated either as trait or state variables. The implications of these results for remediation of headaches are discussed.

Research suggests that Type A behaviour and ‘social insecurity’ (SI) may represent independent additive task factors for coronary disease. Research examining SI and Type A behaviour, however, has not rigorously evaluated the structure of the SI scale. The present study examined the structure of a previously used eight-item SI scale, and its relation to a questionnaire measure of Type A (the student Jenkins Activity Survey), for a sample of 504 undergraduates. Exploratory and confirmatory factor analyses of responses to the SI items revealed a three-factor solution was most appropriate for Type As, and a two-factor solution for Type Bs. For both As and Bs, the first factor reflected insecurity regarding one's own capabilities and worth (self-specific insecurity), and the second factor reflected insecurity specific to a group or social context (group-specific insecurity). A third factor emerging only for Type As reflected insecurity regarding others' capabilities (other-directed insecurity). Semipartial correlations revealed Type A total score was marginally negatively related to group-specific insecurity and marginally positively related to other-directed insecurity, corroborating previous angiographic and prospective medical research. The hard-driving/competitive subscale was significantly negatively related to self-specific insecurity, supporting evidence regarding Type A and interpersonal dominance, competitiveness, and aggression.

This longitudinal study examined the psychological impact of a bushfire disaster on a group of 808 children aged from 5 to 12. Contrary to prediction, the prevalence of behaviour and emotional problems 2 months after the fire was less than the prevalence in a carefully selected comparison group. Rather than decrease with time, the prevalence of psychological morbidity increased significantly, being as great 26 months after the disaster as at 8 months.

A theoretical model designed to assess the contribution of systematic factors contributing to vulnerability to life-events exposure is described. This model is applied to six-year longitudinal data on life events exposure for a sample of New Zealand women with school-aged children. The fitted model suggests that in the region of 30% of the variance in life-event reports over the six-year period was attributable to a common vulnerability factor. Modelling of this vulnerability factor suggested that two major determinants of vulnerability to life events were the level of social disadvantage of the woman and her level of neuroticism: women of socially disadvantaged backgrounds and women with high neuroticism scores showed a consistent tendency to report high life-event exposure during the six-year period. The implications of these findings are discussed.

In a randomized prospective treatment study, 80 overdose patients (not requiring intensive psychiatric intervention) received either brief out-patient counselling or were returned to the care of their general practitioners with advice on management. There was little difference in outcome between the two groups. However, two sub-groups of patients benefited more from out-patient counselling than from general practitioner care, these were: (a) women, and (b) patients with dyadic problems. Counselling following overdoses should be focused on groups of patients such as these who are most likely to benefit from it. Further work is needed to identify treatment approaches that will help other groups who take overdoses, especially men.