This paper reviews ideas about depression and mourning from various quarters, particularly from psychoanalytic writings, from the work of George Brown on the social origins of depression and from some of the work in behavioural psychotherapy on guided mourning. Its essence is foreshadowed in a statement of Winnicott's: “If in an individual the depressive position has been achieved and fully established, then the reaction to loss is grief, or sadness. Where there is some degree of failure at the depressive position the result of loss is depression”.

Addicts who use illicit drugs despite receiving a maintenance prescription present a difficult management problem for drug dependence clinics. This study looks at a small group of such addicts and at their response to the provision of a temporary increase in their prescribed opiates. The results indicate that this increase led to a reduction in illicit drug use and to improvements in social functioning. These and other findings are discussed. It is suggested that clinics should be more prepared to consider such temporary increases, but the need for careful monitoring and for the involvement of more than one member of the treatment team is stressed.

The modern conceptualization of paranoia depends largely on the work of Emil Kraepelin. After him, German psychiatry concentrated on detailed descriptions of psychopathology in paranoid states, but there were few diagnostic or therapeutic advances till lately. A revival of interest is apparent, but this may be stultified by inaccurate criteria for paranoid disorders in DSM III, whose influence, at least in North America, appears assured for a considerable time.

This study evaluates the tactile extinction rate in acute and chronic schizophrenics by means of the Quality Extinction Test (QET) proposed by Schwartz in 1977. This procedure is successful in detecting ipsilateral abnormal extinction rates in neurological patients with dominant frontal lesions. Sixty schizophrenics and sixty controls were tested. The results suggest adominant temporo-parietal dysfunction in acute patients and a dominant frontal dysfunction in chronic patients.

Fifty-one schizophrenic patients diagnosed using the New Haven Schizophrenic Index and 29 other patients who did not score enough on this index for a diagnosis of schizophrenia were studied for depressive symptoms using the Present State Examination. There was no significant difference in the frequency of depressive symptoms in the two groups.

Patients were randomly allocated to treatment with either low energy pulses, high energy pulses, or high energy sinusoidal wave ECT and, despite the induction of convulsions of similar duration, were found to respond at different rates and to a different degree, depending on whether low or high energy currents were used. It is suggested that the quantity of current, as well as the induction of a convulsion, is relevant to therapeutic outcome with ECT. A reexamination of previous work shows that this is not necessarily inconsistent with these findings, which also explain the contradictory results in recent controlled trials of ECT.

Electroconvulsive therapy was compared with imipramine in the treatment of endogenous depression in a double blind randomized controlled trial. Both treatments produced equally significant improvement which was equally maintained till the end of six months. However ECT produced its effects quicker with lesser subjective side effects to the patient. ECT did not cause any organic brain dysfunction as assessed at the end of three and six months.

Eleven drug free patients meeting Research Diagnostic Criteria for Major Depressive Disorder have been treated with desipramine and given a clonidine infusion after 0, 1 and 3 weeks of treatment. The sedative and hypotensive effects of clonidine were significantly inhibited after three weeks of treatment with desipramine: a similar interaction was seen after one week of treatment although this just failed to reach statistical significance. The growth hormone (GH) response to clonidine was initially impaired, but increased significantly after one week of treatment. A significant reduction in the GH response occurred during the second and third weeks of treatment with desipramine. This last finding is interpreted as evidence of adaptive change of α2 adrenoceptors: the other changes can be explained by the known ability of desipramine to block the re-uptake of noradrenaline.

The effect of abrupt discontinuation of amitriptyline, desipramine, or imipramine) on norepinephrine turnover and specific symptoms in seven depressed patients was examined. Turnover, as determined by plasma and urinary 3 methoxy-4-hydroxy-phenylethylene glycol (MHPG), was increased to a peak during the second week following discontinuation. There were no changes in blood pressure or heart rate. Two of the seven patients experienced clear increases in anxiety. The implications for the role of noradrenergic function is discussed.

Between one third and one half of schizophrenic patients appear to benefit from treatment with lithium carbonate. An even higher proportion of schizo-affective patients benefit some showing complete recovery. Current unfavourable views on the use of lithium in schizophrenia are contested. Lithium as well as neuroleptics have a place in the treatment of schizophrenia.

Six schizophrenic patients treated with lithium and neuroleptics for at least two years had their lithium medication stopped. Two patients relapsed within two weeks, and four did not after one year of follow-up.

Four healthy people on lithium for manic depressive liability relapsed within 14 days of the drug being secretly replaced by placebo. Their new manic attacks were at least as severe as any of their previous episodes.

The most relevant psychological and neuropsychophysiological effects induced by lithium in healthy volunteers or in patients during the free interval are changes of vigilance and possible changes in patients' personality. In EEG terms lithium acts as a “chopper” and induces left-hemispheric asymmetry. Interesting concepts for description of personality changes are the typus melancholicus of Tellenbach and the psychoanalytical view of depression. Effects in an individual patient are heterogeneous and cannot be predicted. Primary and secondary psychological effects may influence compliance, and a detailed analysis of compliance seems necessary.

N-acetyl-β-glucosaminadase (NAG) is a renal enzyme which is an early, sensitive and reliable indicator of renal damage. NAG assays of midstream spot urines were not significantly different in a group of controls when compared to patients starting lithium for the first time, or to a group of patients who had been taking lithium for more than one year. However, a small number of lithium-treated patients may have evidence of renal damage, identifiable by NAG assay.

Much of the psychiatric morbidity which presents to general practitioners remains hidden, especially when the patient offers somatic symptoms or is already suffering from an established illness (Goldberg and Blackwell, 1970). This failure to recognize patients who need psychiatric help stems largely from inadequacies in the practitioner's interviewing skills (Goldberg and Huxley, 1980). Deficiencies in the content of their consultations which correlate with low recognition include the failure to screen for the possibility of psychiatric symptoms and the absence of any questions about the patient's family. Interviewing skills associated with a high detection rate include the establishing and maintenance of good eye contact, clarification of the patients' presenting complaints, picking up verbal and non-verbal cues, using open questions, and the ability to control the course of the interview.