A prospective study of antipsychotic drug treatment showed no difference in response between schizophrenic in-patients with or without a familial predisposition to the illness (N = 53). All patients received at least 600 mg chlorpromazine equivalents antipsychotic medication for 6 weeks. Ventricle brain ratios, ratings of cortical sulcal widening and a history of obstetric complications also failed to account for the variability, but early age of onset was associated with unsatisfactory response.

Relationships between clinical ratings and cortical evoked potentials were examined before and during antidepressant drug treatment in 32 patients with major depressive disorder (DSM-III). Clinical rating scales included Hamilton Rating Scale for Depression, Beck Depression Inventory, Present State Examination (PSE) and Newcastle Scale. Evoked potentials included contingent negative variation (CNV), post-imperative negative variation (PINV) and auditory evoked potential (AEP) There were close correlations between all rating scales, and factor analysis produced only one component, suggesting that the common variance between them related to severity of depression. CNV magnitude before treatment correlated negatively with severity of depression regardless of diagnostic category. Depressed patients had a prominent PINV which persisted during antidepressant treatment. The amplitude of late components (N1P2) of the AEP was reduced strikingly in patients with a history of suicide attempts.

Patients with Parkinson's disease, 132 in number, were followed up after approximately one year, and measures of depression and disability re-administered. Depression was common on both occasions, and was characterized by dysphoria, pessimism and somatic symptoms, but not guilt or self-blame. Depression and disability were associated on both occasions. The relationship between changes in disability and depression across time was complex. In trying to understand changes in depression, the absolute change in disability may be less important than the relative change and rate of change. The results were discussed in relation to findings from other disease groups, and the implications for the clinical management of depression in Parkinson's disease.

Tribulin (endogenous monoamine oxidase inhibitor/benzodiazepine receptor binding inhibitor) output was measured in the urine of 18 patients with post-traumatic stress disorder (PTSD) and 13 controls. The level of the two inhibitory activities was highly significantly correlated in the group as a whole. There was no difference between output of either inhibitor in patients and controls. However, when the PTSD group was subdivided according to various psychometric ratings, a pattern of output did emerge. Levels of both inhibitory activities were higher in agitated compared with non-agitated subjects, and lower in extroverts compared with introverts. This finding supports the view that tribulin output is raised in conditions of greater arousal.

Magnetic resonance imaging T1 values in Alzheimer's disease (ATD) were similar to age-matched controls although frontal T1 values tended to increase intraindividually with progression of the dementia. T1 values were raised, in both cortical grey and white matter, in Korsakoff's syndrome and multi-infarct dementia. T1 values appear of little value in studying the neuropathological changes in ATD in relationship to the neuropsychological deficits, but can assist in the differential diagnosis of pre-senile dementia.

This study examined the usefulness of self-report measures of emotional disorder in a relatively acute, severely head injured population (i.e. individuals who had sustained their injuries cwithin the previous two years). The General Health Questionnaire, the Leeds Scales of Depression and Anxiety, and Visual Analogue Scales of Depression and Anxiety were administered to 39 severely head injured subjects and 35 ‘close others’ who were required to give their opinions on how they thought the head injured subjects were feeling. Twenty head injured subjects were re-tested within a week. Results indicated that the head injured are able to reliably complete self-report scales as indicated by the ‘close’ others similar reports. The head injured seem to be relatively aware of their overt behaviours and emotions, at least when utilizing the General Health Questionnaire and the Leeds Scale of Depression. According to the measures of emotional disposition used in the present study, emotional disorder was found to be common. From the results it was further suggested that lack of a close confiding relationship predicts emotional disorder and may be used to identify those subjects at risk. Overall, the results provide confidence for the use of self-report scales as a preliminary approach to the identification of emotional disorder in the severely head injured.

Platelet α2-adrenoceptor binding was measured in 108 women in the 36th week of pregnancy, at ten and twenty days and at three and six months post-partum. An age matched non-pregnant control group of women (N = 25) was also studied. The number Bmax) of α2-adrenoceptors was elevated antepartum but fell to control values on the tenth post-partum day. At three and six months post-partum, however, α2-adrenoceptor Bmax was again increased. Women who developed maternity blues (N = 59) had significantly more platelet α2-adrenoceptors than those who did not (N = 49) at both ten and twenty days post-partum. In addition their α2-adrenoceptor Bmax was greater than controls at all time points measured except the tenth post-partum day. In contrast, the α2-adrenoceptor Bmax of women without the blues did not differ from controls at any stage. It is suggested that women who develop maternity blues may have a relatively enduring abnormality in α2-adrenoceptor sensitivity which is associated with psychological symptoms when concentrations of circulating sex-steroids suddenly change.

Cholecystokinin (CCK) is a peptide originally isolated from the gut. It has been investigated as a candidate treatment for schizophrenia on the assumption that the illness is associated with an imbalance between CCK and dopamine in the mesolimbic dopamine system. Many of the studies to assess the efficacy of CCK used open designs and are prone to observer bias and over-optimistic reporting. Most of the studies used CCK as an adjunct to standard neuroleptic treatment and are too small to be able to demonstrate extra efficacy above that of the active compound. Only three out of ten studies using CCK or placebo as an adjunct to neuroleptics reported limited efficacy. Of the 14 placebo-controlled reports only three were in drug-free patients. These were unfortunately too small, or too brief, to draw valid conclusions of efficacy. A summary of these data suggests that although 500 patients have received CCK, its efficacy in the treatment of schizophrenia has not been properly tested.

Studies of experimentally induced respiratory infections and illnesses showed that influenza impaired performance on a visual search task but had no effect on a simple motor task, whereas colds impaired the motor task but not the search task. The effect of influenza on the search task was observed in both volunteers with significant clinical symptoms and volunteers who were shown, by virological techniques, to be infected but who had no significant clinical illness. Performance was also impaired during the incubation period of this illness, which confirms that subclinical influenza virus infections can have behavioural effects. In contrast to influenza, the effects of colds were restricted to volunteers who had significant clinical symptoms, and the impairments in performance were observed only when the symptoms were apparent.

To evaluate the relation between annoyance to environmental noise, general neurophysiological sensitivity, subjective noise sensitivity and other individual characteristics, experiments were undertaken in which 93 subjects assessed their subjective annoyance after exposure to noise under laboratory conditions. Evaluations were made of the discomfort threshold for pulsating sound, the light discomfort, and heat and cold discomfort. The heart rate and discomfort after exposure to a series of impulse noises was also determined. Subjective noise sensitivity, attitudes to noise, mood and personality characteristics of the subjects were evaluated using questionnaires.

The results show that the annoyance after exposure to noise was not closely related to the general neurophysiological sensitivity, measured as discomfort threshold for noise, heat, cold and light; or to the heart rate reaction or discomfort after exposure to impulse noise. The annoyance was highly correlated with subjectively reported noise sensitivity and with the attitude to noise. There was also a relationship with neuroticism, measured with the EPI scale.

It is suggested that the subjective noise sensitivity, attitude and neuroticism for the definition of noise sensitivity be defined in future studies of long term effects of noise exposure.

All patients aged 16–50 years who had been discharged from the Maudsley Hospital over a 4-year period with a diagnosis of schizophrenia were ascertained retrospectively. Case records were rated blindly for a history of obstetric complications (OCs). Sixty-one patients who satisfied the RDC for schizophrenia had undergone CT scanning. Those with a definite history of OCs presented at an earlier age. In this group widening of cortical sulci and fissures was more strongly correlated with VBR than in subjects without OCs. Moreover, large VBRs when accompanied by widened cortical sulci and fissures occurred more commonly in subjects with OCs than in those without. These results support the hypothesis that OCs, or a factor associated with them, lead to brain damage of aetiological significance in some cases of schizophrenia.

Some schizophrenics show anomalies in the frontal and temporal lobes. It is uncertain whether the cognitive deficits shown by Type I schizophrenics are caused directly by such anomalies, or by a deficit in the exertion of attentional effort. In this study, 16 acute schizophrenics, who broadly fitted the Type I characterization and their controls were given a battery of cognitive tests. The patients were impaired on effort-demanding tasks such as the Wisconsin Card Sorting Test, a verbal fluency test and the WAIS, which are susceptible in varying degrees to frontal, temporal and parietal lobe lesions. Patients were not disproportionately impaired, however, on a test of temporal memory and another of spatial memory, an impairment pattern that selectively reflects frontal and medial temporal lobe lesions respectively, nor were they impaired on a rate of forgetting task sensitive to medial temporal lobe lesions. These tasks were chosen not only because performance on them is selectively sensitive to frontotemporal lobe lesions, but also because it seems to depend on exerting minimum amounts of attentional effort. It is tentatively concluded that the cognitive deficits shown by Type I schizophrenics are caused by a problem in exerting attentional effort of unknown origin.

One thousand and ten unselected London state schoolgirls were screened by questionnaire to identify an ‘at risk’ cohort displaying abnormal eating attitudes and two control cohorts, one with probable general psychiatric morbidity, one without. Members of all cohorts were assessed at interview for the presence of eating disorder and for putative risk factors implicated in the development of anorexia nervosa. A prevalence rate of 0·99 % was detected for clinical eating disorder and 1·78 % for the partial syndrome of eating disorder. Factors specifically associated with abnormal eating attitudes were identified, in particular, current or past overweight, history of amenorrhoea and perceived stress in school and social life. Some commonly accepted risk factors for eating disorders were discovered to be associations with general psychiatric morbidity. These were perceived parental pressure to eat more, taking exercise to lose weight, perceived stress at home and reporting a family history of anxiety or depression. Other well reported putative risk factors for eating disorder, including social class, birth order, age at menarche, obsessional personality and weight related career choice were not associated specifically with abnormal eating attitudes in schoolgirls. These findings represent cross-sectional data at entry into a prospective epidemiological study.

Seventy-six women, with a mean age of 35–7 years, who reported premenstrual craving for sweet foods in a retrospective questionnaire, were assessed prospectively with a pre- and postmenstrual eating questionnaire and daily ratings of craving, mood, irritability and breast tenderness over two menstrual cycles.

In 72 % of these women a perimenstrual pattern of food craving was confirmed. In 13 % this craving was confined to the menstrual phase. There was no consistent association between food craving and mood change, either in timing or severity. Women with more severe mood change did not report more severe craving. There was also no association between food craving and cyclical breast tenderness. Perimenstrual food craving, therefore, appears to be a cyclical phenomenon in its own right, of uncertain aetiology and worthy of further study.

Computerized tomographic (CT) brain scans were obtained in severely ill, chronic schizophrenic patients hospitalized in a long-term in-patient facility of a Veterans Administration hospital, and compared to CT brain scans from an age, sex and education-matched normal control population. In contrast to results obtained in our previous studies with younger, less severely ill, chronic schizophrenic patients, the current study population exhibited significantly increased rankings of third ventricular size and of fronto-tempero-sylvian atrophy, compared to normal control subjects.

Clinical, radiological and neuropsychological findings in the first reported case of schizophrenia with complete agenesis of the corpus callosum are described. Although causal inferences were made difficult by the co-existence of a left frontotemporal cyst and a family history of affective disorder, some theories of the role of callosal dysfunction in schizophrenia require revision in the light of this case.

Twenty-five patients with anorexia nervosa were compared with 17 normal healthy control subjects in terms of their cerebral computed tomographic (CT) scan appearances. The patients displayed significantly greater ventricular and sulcal enlargement when compared to control subjects. There were no relationships between the CT scan appearance and clinical indices of illness severity or weight loss in the patient group. In 14 patients who had repeat scans after attaining normal body weight, no significant change was observed in the ventricular appearance, but there was a significant lessening in the degree of sulcal widening.

This study examined the relationship between patient's gender and family environment, and the consequences of this for the course of treatment of schizophrenia. Data for 160 DSM-III schizophrenics and a family member were obtained regarding attitudes towards treatment, tolerance of symptomatic deviance, and one-year rehospitalization and lengths of hospital stay. Findings suggest that ill sons may be sent to hospital more often and remain in hospital longer than ill daughters, in part due to social norms and expectations of parents associated with gender.

Measures of body-fat or adiposity, body-image, and other psychological variables were obtained from a sample of 100 female volunteer subjects. The measures of adiposity included surface anthropometry, underwater weighing and a new electrical impedance method. Body-image measures were derived from two experimental techniques, namely the visual-size estimation (or calliper) method and a distorting-mirror, and also from a self-report body-satisfaction scale (BSS).

The main findings were that measures of adiposity were positively and significantly related to each other. But, that by contrast, measures of body-image separated out into three distinct sets, namely: (i) ‘mirror’ accuracy, (2) ‘callipers’ accuracy, and (3) ‘dissatisfaction/desire for change’. The ‘accuracy’ measures were found to be unrelated to measures of adiposity or other psychological variables: while the ‘dissatisfaction’ measures were found to relate to both of these. The implications of these findings for future studies of weight and eating disorder groups are discussed.

As part of the Collaborative Study of the Psychobiology of Depression, we have examined the pretreatment growth hormone response (ΔGH) to insulin (0·1 U/kg) and the magnitude of the hypoglycaemic response in a large number of well-defined depressed patients (N = 132) and healthy controls (N = 80). After applying rigorous exclusion criteria, data were analysed from 93 patients and 66 controls for blood glucose response and from 56 patients and 52 controls for ΔGH. Depressed patients, either unipolar or bipolar, showed less of a fall in glucose than controls. A weak association was found between the magnitude of the fall in glucose and the severity of depression. No significant differences were found in values for ΔGH between the unipolar or bipolar depressed patients and controls either for males, pre-menopausal or postmenopausal females, or the total female group. These data do not support previous claims of a lowered ΔGH response to insulin in depressed patients. However, the resistance to hypoglycaemia seen in the depressed patients is consistent with previous reports.