This paper defines and tests a typology of addicts defined through assessment of the sequence of three types of key events: (a) traumatic childhood events such as death of a parent or child abuse; (b) onset of regular delinquent activity; and (c) initiation of illicit drug use. By evaluating the sequence of these events three groups are defined: (a) an initial childhood trauma group; (b) an early delinquency group; and (c) an initial drug use group. Data derived from a sample of treated opiate addicts are used to define and differentiate these three groups.

A sample of patients with puerperal mental illness requiring hospital admission were diagnosed retrospectively according to the criteria of DSM III. Comparisons were made with controls matched for diagnosis on a number of features of past history, symptoms, management and outcome. Puerperal illness was associated with more frequent puerperal and less frequent non-puerperal previous admissions, more frequent delusions and greater use of ECT.

Previous studies attempting to support unipolar mania as an entity distinct from bipolar disorder, have produced conflicting results. The present study reports on a chart review of 247 patients admitted to the University of Iowa with a history of at least one manic episode; 87 of these had apparently never experienced a depression. A subgroup of 92 patients, who met DSM III diagnostic criteria and had a history of at least two episodes of affective disorder, were also examined. There were few clinically meaningful differences between patients with unipolar mania and bipolar disorder on demographic, symptomatic, or familial variables. An earlier report that unipolar manics were more likely to be male and have a family history of unipolar depression was not confirmed. Unipolar mania is not supported as a separate entity from bipolar disorder.

A prospective study of 45 cases, 25 of whom had had previous episodes of affective disorder, predominantly manic, showed further episodes in 14 cases. A positive history of psychotic disorder in 1st-degree relatives, not always affective, was obtained in only eight cases. There was a history of drug abuse in seven patients. The clinical presentation in the Nigerian patients was similar to that described in the classical literature, but, flight of ideas was uncommon.

Plasma Cortisol suppression after dexamethasone administration in 113 consecutively hospitalized patients (54 patients with primary depression, 41 with secondary depression and 18 non-depressed controls) showed early morning hypersecretion of Cortisol and Cortisol non-suppression after dexamethasone mainly in patients with primary depression. The sensitivity of the dexamethasone suppression test was 79 per cent in unipolar and bipolar primary depressed patients, specificity 79 per cent and diagnostic confidence of a positive test 82 per cent. Non-suppression to dexamethasone was observed in 81 per cent of patients with psychotic depression but only 37 per cent of those with non-psychotic depression. Age, sex and severity of depression, menopausal status, or benzodiazepines did not influence results. There was no association between Cortisol non-suppresssion and any genetic subgroup of affective disorder.

Plasma Cortisol levels examined at 16.00 hours after dexamethasone in 31 controls and in 34 psychotic patients with various diagnoses, suggests that the ranges of such levels may help to discriminate among subtypes of psychotic patients. They were significantly higher in the unipolar depressed psychotic group than in control subjects or in psychotic patients with bipolar depression or schizophrenia. Moreover, the distribution of values differed between groups. Whereas 8 of 14 psychotic patients with unipolar depressive illness had post-dexamethasone Cortisol values ≥ 14 μg/dl, none of the remaining psychotic patients had similarly high values. Implications of these data are discussed.

The relation of childhood separation experiences to adult depression, anxiety and ‘general psychological morbidity’ was assessed in a random population survey. Four causes of separation were examined in each of three age groups: childhood illness, parental illness, parental marital discord and wartime evacuation. Childhood separations occurring up to five years of age bore no relation to depression, anxiety nor to incidence of morbidity generally. From five to ten years of age, separations caused by parental illness and marital discord were related to morbidity, and in the latter instance were more likely to cause depression than anxiety. From 11 to 15 years, only separations due to parental illness were related to morbidity generally.

CSF and plasma GABA was measured in patients with bipolar affective illness and matched controls. There was no correlation between CSF and plasma GABA in 10 pairs of simultaneously obtained samples. Plasma GABA was significantly lower in a group of 10 euthymic medication-free bipolar patients compared to 41 normal volunteers (P <.02). This finding was replicated in a second study involving 6 patients and 10 normal volunteers. Twin studies showed a high correlation between members of 11 monozygotic twin pairs (P <.008). Diurnal variation was minimal, but bimonthly sampling over one year revealed somewhat higher values in the late summer compared to late winter.

Forty-eight undrugged hospital admissions with a present state examination (PSE) diagnosis of schizophrenia were subdivided by the direction of lateral differences in electrodermal response amplitudes to tones. The 29 with larger right-hand responses and the 19 with larger left-hand responses were compared on CATEGO syndromes and brief psychiatric rating scale (BPRS). The larger group had symptoms like those of classical Bleulerian schizophrenia—blunted affect emotional withdrawal, impaired social functioning, disorganized thought and retarded motility. The other group manifested florid symptoms including hypomanic affect pressure of speech, ideas of reference, depressive hallucinations and delusions, hypochondriasis, grandiosity and situational anxiety. The psychophysiological measures may provide an objective aid to diagnosis and implications for altered cerebral organization in psychotic patients.

A survey of 1507 mentally handicapped adults in a long-stay hospital, three-quarters of whom were severely subnormal, led to the identification of 42 (2.8 per cent of the total group) with a current typical affective illness. Non-verbal criteria were used so that such conditions could be recognized at any level. Schizophrenia could be diagnosed only on verbally expressed symptoms and was found in 27 (1.8 per cent) of the patients, none of whom was preverbal in mental level. Forty-one (2.7 per cent) had an atypical affective illness superimposed on an early childhood psychosis. Half of these patients were preverbal, so that the pattern of their illness was particularly difficult to recognize.

Suicide risks for psychiatric hospital in-patients may be described by empirical relationships that take account of sex, length of admission and diagnosis. Risks are highest in males, in the first week of admission, and in depressed patients. Hospital suicide rates do not follow the same pattern as those for the general population and it is suggested that this effect may be the result of current selection procedures. The standard mortality ratio, which compares hospital with general population suicides, has remained unchanged over fifty years.

The seasonal variation in suicides in Finland during the period 1961–1976 was examined using individual records from 16, 312 death certificates and time-series analysis. De-trended figures show that suicides are usually concentrated in early summer but a secondary rise in the late part of the year is noted, particularly in females, among those aged 15–24 years and in the highest and lowest (i.e. unknown) social classes. In modern occupations (technical, administrative, clerical, sales and service work) suicides usually occur in late autumn. It is suggested that the original seasonal peak in suicides lies in spring–summer, while the autumn peak is of later origin and typical of those living in a man-made environment.

The Hamilton Anxiety Scale (HAS) was administered to 51 patients with anxiety neurosis along with an independent criterion of severity. Each item from the HAS was significantly correlated with severity, and those items with the highest correlations were combined to form new anxiety scales. These scales were then used on a new group of 27 patients suffering from anxiety neurosis. All the new scales had better correlations with severity than the full HAS. The six-item scale was selected as being the most suitable to be a new Clinical Anxiety Scale.

Residents of homes for the elderly with a history of impaired memory compatible with senile Alzheimer dementia were assessed by a paired-associate learning test (PALT) and a word list recall test. The latter discriminated between groups of individuals categorized according to severity of cognitive impairment by the PALT. It may be suitable for the assessment of memory for new information in clinical practice and for the evaluation of change in clinical trials of treatments for dementia.

Schizophrenics show a deficit in a variety of verbal memory tasks, except recognition memory, and incidental learning when recall is preceded by an ‘orienting task’ which ensures effective encoding. These two exceptions provide experimental evidence for the currently prevailing theory that it is a defect in effective encoding which is responsible for the observed schizophrenic verbal memory deficit. The present review concludes that these two exceptions are probably artefacts of unmatched tasks, and cannot be used to support the theory.

Some two hundred psychiatrists from all corners of the globe were gathered together in April for a week in Copenhagen, under the auspices of the World Health Organisation and the Alcohol, Drug Abuse and Mental Health Administration of the National Institutes of Health of the United States Government (ADAMHA). This meeting was the culmination of a programme of several years preparatory work by representatives of these two organisations, which had its origins in an initiative during Dr Gerald Klerman's period as administrator of ADAMHA. The stated objectives of both the preparatory work and the conference itself were to review the current state of work in classification and diagnosis of mental disorders, to identify gaps in present knowledge, and to define priorities for future collaborative research. Implicit in this programme of work is a realisation that there are many fundamental aspects of diagnosis in psychiatry that can only be studied fruitfully by international collaborative studies. Acceptance of this principle is, in itself, a sign of the progress that has taken place in this field in the last 15 years or so.

In reading about Jungian theory and psychotherapy (for the two are inextricably intertwined, far more so than in orthodox Freudian theory) I find myself, as an academic, rather than practitioner, beset by two conflicting feelings: on the one hand I am sometimes carried away by the profundity of the ideas, the realization that truly important human topics are dealt with: on the other I am jolted into disbelief, by the lack of critical evidence, by the looseness of the language and the ultimate irrefutability of the concepts. My suggestions for readings reflect this conflict.