In the year 1899 there occurred an event which has had great consequence for psychiatry. This was the publication of the sixth edition of Emil Kraepelin's textbook, where he introduced for the first time his distinction between manic-depressive insanity and dementia praecox. It was a distinction which rapidly became accepted almost everywhere in the world, and it still forms the basis of our thinking about the nature of the functional psychoses. Kraepelin's concept of mania was quite different from the concept of mania held during most of the nineteenth century; and so, historically speaking, there are two manias, more or less sharply separated by the Kraepelinian revolution. The purpose of the present essay is to give some account of the term mania in its pre-Kraepelinian sense and of the events which led Kraepelin to his new concept; and also (in Part II) to put forward a new idea of why this revolution came about.

Fifteen general physicians were given profiles of symptom combinations representing 80 depressed patients. They were asked to judge the severity of the disorder and to prescribe. There were two phases to the experiment the formal structure of both being the same. In the first phase, all physicians based their judgments only on the cues of the Hamilton Depression scale; in the second, each physician defined his own cues. Multivariate regression analysis was applied to the observations. Agreement between the judges was low. Most had a more complex policy, in regard to both judgment of the severity of the depression and prescribing, when selecting their own cues than when restricted to textbook variables, but used it more consistently. The observations have important implications for training and research in psychiatry and in psychopharmacology.

A double-blind trial failed to demonstrate any significant short-term effects of clomipramine in doses recommended for use in general practice (in addition to the usual range of psychotherapeutic help) in the treatment of children with school refusal and neurotic disorder. Patterns of improvement were also studied for the sample as a whole irrespective of treatment. Neither age nor sex were significantly related to improvement, except on one behavioural measure where girls initially did better than boys. In addition, it was found that there was a rapid relief of depression but neurotic symptomatology tended to persist.

Abnormal sexual behaviour in pre-pubescent children is uncommon even in a psychiatrically referred population. Among 516 referrals there were 6 boys and 10 girls, the girls starting younger. The boys differed little in history or background from other conduct-disordered boys, but the girls were more commonly victims of sexual abuse and lacking a father in the home. The personalities of the girls suggested continued risk of sexual experimentation and possible development of personality disorder.

Five consecutive patients referred to a psychosexual clinic are described to illustrate the diversity of aetiology and pathology, and the need for a range of treatment techniques. Three patients responded to a cognitive-behavioural therapy which is described, and one to antidepressive drug treatment.

A prospective study was carried out on post-influenzal depression. Four hundred patients presenting with psychiatric illness for the first time took part. The results show that there is no correlation between depressive illness and the demonstration of influenza antibody titres, an indication of recent influenza infection.

This report describes an investigation into a possible relationship between barometric pressure and relative humidity, and depressive and manic admissions in the London area. A negative correlation between manic admissions and relative humidity was observed when the data were examined in several ways.

Pure erotomania was first described in 1920 by the French psychiatrist de Clérembault. It is a delusional condition, usually in a woman who believes that a man, unattainable because of his much higher social class or married state, is very much in love with her. The belief has a precise onset and occurs suddenly in a state of clear consciousness. Enoch and his colleagues (1967) claim that ‘some instances of this syndrome may be distinct from ordinary paranoid psychoses and deserve a separate place in psychiatric nosology’, while Arieti thinks that it is not a clinical entity but a symptom of paranoia or paranoid schizophrenia (Arieti and Meth, 1959).

Young women who had attempted suicide did not score in a more hysterical manner than women in a comparison group when assessed by the Hysteroid-Obsessoid Questionnaire. Those who made suicide attempts resulting in little physical harm more often demonstrated hysterical traits than those whose attempt involved a serious threat to life. However, even in those subjects the majority did not score in an hysteroid manner, and they certainly scored in a less hysteroid manner than subjects of the comparison group.

These results are in accord with the small literature using standardised assessments, and do not support the clinical view that young women who attempt suicide exhibit marked hysterical traits.

Disturbed and non-disturbed subjects were compared on a Repertory Grid measure of the differentiation of values, emotions and behaviours. The disturbed subjects tended to show either excessively tightened or excessively loosened relationships between values, feelings and behaviours. Tight relationships denoted a close correspondence between a subject's assessment of these three items; loose relationships denoted a poor correspondence. Non-disturbed subjects showed more moderate relationships. Among the disturbed patients, loosened relationships were found in schizophrenics rather than neurotics or personality disorders and tightened relationships in neurotics and personality disorders rather than schizophrenics.

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.

Patients with anorexia nervosa may minimize their symptoms with the result that doctors often fail to appreciate the distress they experience. The drastic avoidance of food is passed off euphemistically as ‘dieting’, and in later stages of the illness the patient's suffering is increased by depression, loss of concentration and insomnia. Much misery is also endured by other members of the family who observe with dread the young girl's progressive wasting and appear overwhelmed by feelings of helplessness. The illness usually runs a prolonged course even when the outcome is eventually favourable. An uncertain but sizeable proportion of patients enter a chronic phase with persistent preoccupations about food, uncontrollable overeating, self-induced vomiting, and even more severe depression (bulimia nervosa). Anorexia nervosa is therefore an illness which exacts a high toll in terms of human suffering. For this reason and in view of an increased incidence of the illness (Kendell et al, 1973; Crisp et al, 1976), it is desirable to improve methods of treatment and apply those currently available with the utmost skill.

Group psychotherapy is perhaps a misleading term and the concept of the group psychotherapies probably better represents the broad range of psychological treatments in psychiatry in which the group process is an essential component: from psychotherapy with a married couple to the large community group meeting in a psychiatric hospital. Group psychotherapy most commonly refers to the long-term treatment of neurotic out-patients in small groups, and this will be my main focus. Marital and family therapy have their own distinctive literatures, while the therapeutic community has been well covered in a previous column (Mandelbrote, 1979).