Preliminary data are presented from the NIMH Collaborative Study on the psychobiology of depression, biological studies, dealing with relationships between the pre-treatment levels of the neurotransmitter metabolites 3-methoxy-4-hydrophenethyleneglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) and the subsequent therapeutic response of depressed patients to imipramine or amitriptyline. Eighty-seven depressed patients were studied during pre-treatment and treatment periods. It has been found that (1) both low pre-treatment urinary MHPG and low CSF 5-HIAA values are associated with a response to imipramine; these relationships were not artefacts due to sex or age; (2) there were no significant relationships between pre-treatment urinary MHPG, CSF MHPG, 5-HIAA, or HVA values and the subsequent response, or failure of response, to amitriptyline; (3) there was not a bimodal distribution for CSF 5-HIAA. For both males and females, there were positive and statistically significant correlations between CSF MHPG and urinary MHPG; for the females, there were positive and significant correlations between both urinary and CSF MHPG and CSF 5-HIAA. The theoretical and practical implications of these findings are discussed.

The clinical condition occurring in the elderly with preserved intellectual functions, characterized by vivid, elaborate and dynamic recurrent visual pseudo-hallucinatory phenomena of a pleasant or neutral nature and often associated with ocular pathology – the Charles Bonnet Syndrome – is described. Its main clinical features are illustrated and the aetiology discussed. Two new cases are presented and areas for future research are outlined.

During recent years there have been important changes in the prevailing concepts of psychiatric disorder, in views concerning the goals of treatment, and in therapeutic strategies and tactics. These changes are reviewed, together with evidence on the efficacy of psychological therapies in the treatment of child psychiatric disorders, in order to consider some of the key clinical and research issues, as well as prospects for the future.

A brief review of post-war developments indicates the course of research into psychiatric morbidity at the level of primary care in the United Kingdom. The theoretical and practical importance of such work has now been demonstrated and some major lines of future enquiry are outlined.

LH, FSH, PRL and testosterone were estimated by radioimmunoassay in serial venous samples from 20 male chronic schizophrenic patients, 17 age-matched controls, 3 patients in remission from acute schizophrenia, and in single samples from age–sex matched populations. LH and FSH, but not testosterone or PRL, were significantly reduced in patients with chronic schizophrenia. There was an associated reduction in the frequency, but not amplitude, of LH secretory episodes in patients with chronic schizophrenia. No abnormalities of LH secretion were detected in those patients in remission from acute schizophrenia. Fourteen of the chronic schizophrenic patients were retested at a later date with similar results, except in the case of the few patients who had been started on neuroleptic medication. Some relationships were established between hormonal secretion and the clinical features of these patients. The possible significance of these findings is discussed in the context of the complex control of gonadotrophin secretion from the anterior pituitary and the natural history and nature of chronic schizophrenia.

One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan–amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active tratment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the difference was not significant. Plasma amitriptyline and nortriptyline and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.

The relationship between psychological and biological processes is examined. Criteria for the distinction between reasons and causes are described. These provide a basis for a separation of those mental states and behaviour that can be explained in a reductionist fashion, and those that are not reducible. The proposed conceptual framework has clinical and research implications.

Preliminary data from the National Institute of Mental Health – Clinical Research Branch Collaborative Program on the Psychobiology of Depression dealing with the human growth hormone (hGH) response to the Insulin Tolerance Test (ITT) during the pre-treatment (drug-free) period of the study are presented in this paper. Data are reported for 54 unipolar depressed, 21 bipolar depressed, and 40 normal control subjects, who represent approximately 50% of the final subject sample to be studied. In this population the unipolar depressed subjects showed a significantly greater resistance to insulin-induced hypoglycaemia than bipolar and control subjects. After applying the inclusion/exclusion criteria necessary to interpret hGH responses accurately, the data from only 54 subjects were acceptable. Mean peak hGH concentrations were not significantly different among the three groups. There was, however, a significant difference in the distributions of the hGH peak response, with the bipolar depressed population demonstrating greater variability in response than unipolar and control populations. These findings are discussed as they relate to previous reports and theoretical considerations.

HLA types studied in 113 patients with manic-depressive psychosis did not confirm the previously suggested association with HLA Bw16. No difference was found between unipolar and bipolar manifestations. A possible excess of A10 in patients is of interest, since this antigen binds with psychotropic drugs.

Assortative mating among 56 married in-patients with primary affective disorders and their spouses was studied by determining the prevalence of psychiatric illness among the spouses by means of direct interviews and standardized diagnostic criteria. A high degree of assortative mating among both male and female patients was observed for total psychiatric illness, broad spectrum affective illness and major depression. A significantly higher prevalence of psychiatric and affective illness was found among the first-degree relatives of the ill spouses when compared with the first-degree relatives of the well spouses. There was a high degree of diagnostic concordance between the patients and spouses for both affective illness and alcoholism, with a higher degree of assortative mating among bipolar patients than among unipolar patients. The finding in this study of an increased prevalence of psychiatric disorder in the first-degree relatives of the ill spouses would support the hypothesis that there is a tendency for individuals with a predisposition to psychiatric illness to marry, rather than the existence of a marital interaction which causes an increased concordance for psychiatric illness.

Patients suffering from manic-depressive psychosis, manic type (ICD 296·0), were treated with lithium carbonate and randomly allocated to two groups, one received digoxin and the other matching placebo for 7 days. Severity of mania was rated by psychiatrists on the Manic Rating Scale and Analogue Line on days 0 and 7 and by nurses daily on the Hargreaves Rating Scale, Psychotic Rating. Fourteen patients received digoxin and lithium carbonate and 14 patients received placebo and lithium carbonate. Improvement in the placebo lithium group was significantly greater than that in the digoxin lithium group. This trial suggests, therefore, that the effect of inhibition of membrane cation carrier is to reduce the response to lithium. This result is in keeping with our hypothesis that an increase in Na–K ATPase is essential to the therapeutic effect of lithium carbonate. It does not, however, exclude the possibility that the observations resulted from the inhibition by digoxin of lithium entry into the brain.

A case is reported in which mercury intoxication produced visual symptoms with an unusual compensation. The similarity of this patient to Schn., a much reported neuropsychiatric case, was striking and prompted correlation of the two cases. Experimental psychological studies performed on the present case provide a basis for an understanding of both cases.

133 samples of plasma taken from 9 normal control and 8 manic-depressive subjects were analysed for vanadium by atomic absorption spectrometry. Mean plasma vanadium concentrations were 0·15 μM in normal control, 0·34 μM in manic and 0·28 μM in depressed subjects, and 0·23 μM in manic-depressive subjects after recovery. The differences between normal subjects and manic and recovered subjects were statistically significant. Significant negative correlations were found between plasma vanadium concentration and the ratio of Na–K–Mg ATPase to Mg–ATPase in 2 manic-depressive subjects, but not in normal subjects. The results suggest that vanadium may be a cause of the variations in Na–K–Mg ATPase and sodium pump activity which are associated with manic-depressive illness.

The Lundby cohort consists of all inhabitants in a delimited area in Sweden studied in 1947 by Essen-Möller, then by Hagnell in 1957, and by Hagnell & Öjesjöin 1975. It has been claimed that depressive disorders have increased during the sixties and seventies. In order to examine this hypothesis on a normal population (the Lundby Study), comparisons were made of the incidence figures for depression during the periods 1947–57 and 1957–72, and during the five 5-year intervals within the period.

Stereotyped movements are described in monkeys and humans and are classified as arising from constraint, sensory deprivation in infancy, amphetamine treatment or psychotic states. It is argued that, with the exception of cage stereotypies, stereotyped behaviour is evidence of abnormality in the nervous system consequent upon distorted maturational processes, organic defect or biochemical disturbance. Stereotypy is associated with a state of cognitive inflexibility and social and sensory isolation in humans and monkeys. It is suggested that, while no simple biochemical disturbance in the brain can describe these various occurrences of stereotypy, the cross-species occurrence of a syndrome of isolation, cognitive inflexibility and stereotypy implies a related mechanism mediating these divergent effects. If stereotypy is regarded as a consequence of failure to use sensory input to direct behaviour, therapeutic regimes designed to stimulate responsive behaviours and social interactions are more likely to be effective in the long run than direct attempts to suppress stereotypy.

Cluster analyses with 60 depressive patients resulted in a division of the patients into 4 groups: (1) one main group of endogenous depressives; (2), (3) two mixed groups, indicating that it is not always possible to distinguish between endogenous and neurotic depression by means of symptoms; (4) one group of neurotic depressives. Our interpretation of the results is that the latter 3 clusters differ from the main group of endogenous depressives by their greater inner involvement with the world around them, though this involvement assumes different forms in the 3 groups.

Higher than normal auditory thresholds were demonstrated in chronic schizophrenic patients. A greater right ear sensitivity than left was exhibited, although right ear superiority diminished with repeated testing over weeks while left ear thresholds remained relatively stable. The results of acoustic impedance measures suggest that these findings are not associated with peripheral outer and middle ear disorders.

Little is known about the effects of non-MAOI antidepressants on cognitive functions, despite their wide application to ambulant patients. Evidence from studies involving healthy volunteers suggests that differences exist between drugs, with imipramine, amitriptyline and mianserin being associated with the most marked detrimental effects. However, these findings have generally not been supported by the few studies using clinical populations, for which improvements in cognitive functions are often recorded following treatment. The reasons for this discrepancy are discussed, and the need for further research suggested.

Although motor features associated with schizophrenic disorders have been reported often, they have never been well understood and, since the introduction of neuroleptic drugs, they have been largely neglected. We report that disturbed voluntary motor activity occurs frequently among schizophrenics, is especially associated with features of formal thought disorder, but also with affective blunting, neurologic ‘soft’ signs. Certain motor and thinking abnormalities in schizophrenics may have a common pathogenetic basis.

This investigation aimed to ascertain the levels of anxiety, depression and religious attitude, by means of rating scales, in a group of physically sick men and women planning to go on a pilgrimage to Lourdes. These levels were reassessed one month and ten months after the pilgrims had returned. There was a statistically significant decrease in anxiety and depression which was sustained. The possible reasons for these findings are discussed.