“The history of man for the nine months preceeding his birth would, probably, be far more interesting and contain events of greater moment than for all the three score and ten years that follow it.” Samuel Taylor Coleridge (1885)

Depressive disorders are more common in the relatives of depressed probands than in the population at large, and there is compelling evidence that the familial aggregation of bipolar disorder and severe unipolar depression is at least partly due to genetic factors. However, the evidence concerning ‘non-endogenous' depression is less clear, and family environment probably plays a stronger role. Much current research is focused on two areas: firstly, the mode of inheritance of manic-depressive illness, with the use of molecular biological techniques to detect and localise major genes; and secondly, the ways in which familial predisposition and environmental insults combine to produce depressive disorder.

The dopamine hypothesis still provides a valuable approach to the study of schizophrenia and its treatment by drugs. Although the neuroleptic drugs appear to act via an inhibition of dopamine receptors, measurements of dopamine metabolites in vivo, or of the transmitter and its receptors in postmortem brain tissue, do not provide unequivocal evidence of a hyperactivity of dopaminergic neurotransmission in the disease. Nevertheless, increased dopamine function might be a consequence of a primary neuronal abnormality in another system. Recent imaging studies and neuropathological reports suggest that, in some patients, there may be a deficit and/or disturbance of neurons in certain temporal limbic regions, and this is supported by some neurochemical investigations, particularly of neuropeptide and amino-acid transmitter systems. A loss of such neurons could conceivably lead to a disinhibition of limbic dopamine neurons, providing the means whereby neuroleptic drug treatment might ameliorate the effects of a neuronal deficit in schizophrenia.

A sample of 890 people aged 65 years and over living at home in the Lewisham and North Southwark Health District was interviewed using a structured schedule containing CARE organic brain syndrome and depression scales, and items dealing with anxiety symptoms. Total prevalence rates were 4.6% for cognitive impairment, 13.5% for depression, 3.7% for generalised anxiety, and 10.0% for phobic disorders. Cognitive impairment increased exponentially with age, and was associated with lower occupational class. There was no significant association between occupational class and depression, generalised anxiety, or phobic disorder in this sample. Cognitive impairment, depression and agoraphobia were associated with significantly higher levels of dependency in the tasks of daily living.

Systematic and detailed psychopathological examination of 400 consecutive primary major depressives failed to confirm common clinical stereotypes which ascribe greater somatisation, hypochondriasis, agitation, psychotic tendencies, and chronicity to old age. Those above 65 were more likely to suffer from single episodes of depression that were often precipitated, whereas subjects whose illness began earlier were more likely to express depression as part of a recurrent unipolar or bipolar disorder, with higher rates of affective temperamental pathology and familial affective illness. The acute clinical picture was relatively uniform in older and younger depressives and, taken together with the other findings, tends to favour a spectrum model of primary mood disorders.

One hundred and ten consecutive new patients presenting with major affective disorders were divided into five categories according to pattern of presentation: recurrent manic disorder, recurrent depressive disorder, bipolar disorder, single episodes of manic disorder, and single episodes of major depressive disorder. Manic patients predominated, and recurrent manic disorder was much more frequent than either recurrent depressive or bipolar disorder. The manic and bipolar patients were younger. Females predominanted in all five groups of patients. The two manic groups were less likely to be married, but this was probably a reflection of their younger age. No differences were demonstrated with regard to educational status or occupation. There were no significant differences with regard to sibship position, family size, or polygamous/monogamous parents. Manic patients were more likely to have suffered permanent separation from one or both parents before the age of 12 years. A relatively low proportion of the patients had a positive history of mental disorder among first- or second-degree relatives. Manic and bipolar patients tended to present in hospital relatively early in their illness.

Urinary 6-sulphatoxymelatonin (αMT6s) excretion was measured after one day and one, two and three weeks of desipramine treatment in eight depressed patients. There was a significant increase in the urinary excretion of αMT6s after one week of treatment, and at no time was there any decrease in αMT6s excretion. These findings are opposed to the hypothesis that desipramine reduces noradrenergic neurotransmission in the human pineal. In a further five patients whose depression was resistant to desipramine alone, urinary αMT6s excretion was measured during treatment with adjunctive L-triiodothyronine (T3). There was no change in αMT6s excretion, and thus the previously reported potentiation of the efficacy of tricyclic antidepressants in combination with T3 does not appear to be mediated through an alteration in noradrenergic neurotransmission.

Patients aged 18–64 years, in hospital more than one but less than six years, were followed up five years after identification: 22% had died, 50% remained in-patients, and 28% had been discharged; only 10% of first admissions with organic brain disease had left hospital. Of those discharged, 37% had no contact with after-care services. Of those remaining in hospital, 39% did not require in-patient care. Patients' level of functioning had improved over the five years.

The admission records of 271 long-stay chronic schizophrenic patients, resident in a large psychiatric hospital, were examined in order to identify those who had presented in stupor at the onset of their illness. Twelve patients were found (ten men and two women). When compared, in terms of current mental state and behaviour, with a similar sample of schizophrenics in whom stupor had been absent, significant differences between the two groups were detected, with those presenting in stupor demonstrating a less favourable outcome.

The studies reported had two purposes: (a) to identify psychological symptoms commonly experienced by mothers in the first few days after childbirth; (b) to use psychometric methods to develop a questionnaire for detecting and measuring these symptoms. A draft 49-item questionnaire was derived by asking 100 newly delivered mothers to volunteer suitable items. The number of items was systematically reduced to 28 while testing the questionnaire on two further samples of newly delivered mothers (n = 100 and n = 50). Cluster analysis of the 28 items yielded seven clusters, the robustness of which was established in a further sample of 87 newly delivered mothers. The validity of the 28-item questionnaire was established. The questionnaire was quick and easy to administer, suitable for repeated administration on consecutive days, and well accepted by mothers.

A new scale for the detection and assessment of maternity blues was completed by 56 women daily for ten days after elective gynaecological surgery. When their responses were compared with those of 87 post-natal women, they differed significantly in frequencies of different symptoms at different times. The findings suggest that post-natal mood changes (‘maternity blues’) are characteristic of the puerperium and not simply non-specific reactions to physical and emotional stress.

One hundred and six women were assessed psychiatrically in the 14–16th and 36–38th weeks of pregnancy and the 12th week after childbirth. They also completed a maternity blues questionnaire daily in the ten days after delivery. Blues scores were significantly associated with: neuroticism; anxiety and depressed mood during pregnancy; fear of labour; poor social adjustment; and retrospective severity of pre-menstrual tension. Blues scores were not associated with obstetric factors, with previous history of psychiatric disorder, or with case status on the PSE in pregnancy or 12 weeks after delivery.

Sexual anxiety was examined in 98 patients presenting with sexual dysfunction and 68 of their partners at a psychosexual clinic using the SOMA questionnaire. All patients had raised values for heterosexual anxiety. Female partners had raised values while male partners did not. This provides further evidence for the role of heterosexual anxiety in the aetiology and treatment of sexual dysfunction.

By use of latent-trait item analysis (the Rasch model), the internal validity of the behaviour section of the MRC-HBS schedule was analysed. The set of behavioural symptoms in this rating scale was found to measure a one-dimensional structure. Thus addition of item scores provides a meaningful index. Such a numerical measure for the degree of behaviour disorder facilitates comparison between different patients or groups, and furthermore, forms the basis for quantitative description of the outcome of therapeutic intervention. A diagnosis of behaviour disorder was established in 17.2% of 302 mentally-handicapped adults. However, some kind of deviant behaviour was found in 41%, and was correlated with origin and degree of retardation, epilepsy, and place of living. The distribution of the symptoms strongly indicates that organic brain damage is a major aetiological cause.

A register of violent incidents showed a progressive increase in in-patient violence from 1976 to 1984, followed by a slight decline to 1987. The case notes of all 137 in-patients committing assaults during 1982 were analysed and compared with those of matched controls. Violence was often repetitive. The most common victims were nurses and then patients. The violent patients were more likely to be schizophrenic, deluded and hallucinated, and to have been repeatedly admitted. The violent and control groups had similar backgrounds, and both showed high levels of social isolation and unemployment. Violence tended to be repetitive, and the violent patients were usually identifiable from previous aggressive and disturbed behaviour. There was a high proportion of Afro-Caribbean patients who tended to be younger, more psychotic, and more seriously violent. Afro-Caribbeans were particularly likely to be detained compulsorily and treated in a locked ward.

“We cannot command nature except by obeying her” (Bacon)

Our confidence in being able to offer successful treatment of paedophilia remains low. A multifaceted cognitive/behavioural treatment approach is described in the hitherto successful treatment of a man with a 13-year history of sexually interfering with young children of both sexes.

Musical hallucinations had caused an 86-year-old deaf woman to become anxious and depressed. She was admitted, and tranquillising and hypnotic drugs afforded some slight improvement. The use of her hearing aid to increase ambient noise levels reduced the intensity of the hallucinations, and the patient improved.

An individual with agenesis of the corpus callosum associated with recurrent severe sweating and hypothermia developed a social phobia. Phobias may be adaptations to real and potentially dangerous physiological events.

A family with clinically diagnosed Alzheimer's disease in three siblings is described. The inheritance of Alzheimer's disease in this pedigree is consistent with autosomal dominant inheritance.