Despite his acknowledged pre-eminence among British psychiatrists of the 19th century, Henry Maudsley (1835–1918) remains a ‘shadowy figure’, a name known through the Hospital and annual lecture funded by his beneficence. Apart from the homage paid by Sir Aubrey Lewis in 1951, there has been no recent attempt at any biography nor any critical reappraisal of Maudsley's life and work. On the basis of reviewing his role in the Medico-Psychological Association (MPA), his rather pessimistic and degenerationist philosophy, his undoubted wealth and his ‘hypercritical nature’, it is possible to define an alternative view of his significance and influence.

‘…comical, almost pitiable at times, is the ludicrous display of vanity by men of great eminence…they leave behind them carefully preserved letters and elaborate memoirs of what they thought and felt’. (Maudsley, 1918)

This paper surveys the measures taken against mental patients in Germany during the National Socialist regime. It covers the eugenic sterilization programme, the killing of handicapped children, the so called Action T4 (the killing of adult psychiatric patients) and the second phase of Action T4 after its official termination, i.e. between 1941 and 1945. The possible social and political causes of these measures, and the attitude of German psychiatrists to them are discussed. In particular, attention is drawn to a prevalent fear of national degeneration, to social Darwinism, and the ideas of Binding & Hoche on ‘permission for the extermination of worthless life’.

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.

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.

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.

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.

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.

Body weight in 42 obese and normal weight subjects was measured using a video TV monitor. Tasks included a continuous task where subjects manipulated the width of their body image on TV, and a discrete task, where they judged the accuracy of their TV image which was presented as either normal, too heavy, or too thin. Subjects rated their full body, body regions which included face, waist, and thighs, and two inanimate control objects. Results from the continuous task revealed that obese subjects overestimated body size more than normals. There was also a significant difference in the ratings of the four body regions, with all regions overestimated. Judgements were more accurate for body regions and control objects on ascending trials where the subjects had to increase the width of the image. No differences were obtained between obese and normals on judgements of the control objects. On the discrete discrimination task, a signal detection analysis revealed sensory sensitivity differences between obese and normal weight subjects. Obese subjects were poorer at detecting size distortions of the body regions. The thin/normal discrimination was more difficult than the heavy/normal discrimination. No response criterion differences were found between obese and control subjects, although subjects adopted a more strict criterion with the thin/normal discriminations. Implications of these findings for clinical intervention in eating disorders are discussed.

Several previous studies have reported increased rates of schizophrenia among Afro-Caribbean immigrants, although doubt has been cast upon the value of case-note diagnoses and retrospective case-finding. A prospective study was therefore undertaken, including all patients of Afro-Caribbean ethnic origin with a first onset psychosis presenting to the psychiatric services from a defined catchment area. Utilizing several diagnostic classifications, rates for schizophrenia were found to be substantially increased in the Afro-Caribbean community, and especially in the ‘second generation’ British born. Mode of onset and symptom profiles of psychoses suggest that atypical syndromes, and by implication ‘misdiagnoses’, do not account for reported higher rates of schizophrenic illness in these patients.

A survey was conducted to investigate the presence of psychiatric symptoms and associated factors affecting psychiatric impairment among 2190 Japanese tax workers. The Japanese translated version of the General Health Questionnaire (GHQ) was used as a measure of psychiatric symptomatology. Several sociodemographic and psychosocial factors (interpersonal factors and perceived stress) were examined as being related to psychiatric impairment. As with all other language versions, the percentage distribution of the GHQ scores was considerably skewed. Females exhibited more psychiatric symptoms than males. No significant differences were found among four age-groups for both sexes. Perceived stress related to the workplace was correlated more with psychiatric impairment than with other psychosocial factors. It was also observed that the ‘long-distance marriage’ (‘business bachelorhood’) peculiar to Japanese occupations had little influence on the impairment levels.

In this study it was possible to prove the Werther effect in suicides after watching fictional models for the first time. A twice-broadcast (1981, 1982) six-episode weekly serial showing the railway suicide of a 19-year-old male student provided a quasi-experimental ABABA design to investigate differential effects of suicide imitation. Imitation effects were most clearly observable in the groups whose age and sex were closest to those of the model. Over extended periods (up to 70 days after the first episode), the number of railway suicides increased most sharply among 15- to 19-year-old males (up to 175%); the effect steadily decreased in the older age groups, so that no effect was observable for males over 40 years and females over 30 years. Also, the imitation effects remained detectable for longer periods in the groups closest in age to the model. The increases observed after the first and second broadcast for males aged > 30 years closely corresponded with the respective audience figures for the two showings.

Cohort analysis has become a popular method of examining national trends in suicide rates. Most of the studies investigating this phenomenon have reported a cohort effect to be present. Using a graphical approach, this paper places cohort analysis within the broader framework of age-period-cohort analysis. It is shown that published reports may have failed to identify cohort effects due to using only portions of the available data. With a simple mathematical model it is demonstrated that what appears to be a cohort effect may be a period effect, and conversely. It is recommended that suicide rates be examined for both period and cohort effects before conclusions are drawn regarding trends, and that the complete data set be used for this purpose.

Studies relying on subjects' retrospective reports have recently been interpreted as indicating that individuals born since World War II are at increased risk for a diagnosis of lifetime major depression. Examining the validity of this ‘cohort effect’ is essential, given the potential importance of such a phenomenon for research and policy. Among a number of artefactual explanations for the cohort effect is the possibility that older individuals are less likely to recognize depression as a mental disorder, and hence are less likely to remember depressive episodes as such, or to report these episodes in interviews on mental health. To test whether age was related to the recognition of major depression as a mental problem, we analysed responses from 152 randomly selected community residents on whether a vignette describing DSM-III major depression represented a psychological or emotional problem. Older respondents were much less likely to characterize major depression this way, even controlling for other factors. Such an age effect may provide a partial explanation for the apparent cohort effect, although the issue is complex and further research is needed.

Recent research has shown that suicidal patients are not only biased in the speed with which they can remember positive and negative events from their past, but that they also find it more difficult to be specific in their memories. That is, they tend to recall sequences of events, or time periods, rather than single episodes. This tendency has been found to be more evident with positive than with negative events. This paper examines whether the same phenomenon can be observed in patients with a diagnosis of primary Major Depressive Disorder. Twenty depressed patients and twenty matched controls were presented with positive and negative cue words and asked to retrieve specific personal memories. Results showed that depressives (unlike controls) took longer to respond to positive than to negative cues. In addition, the depressed patients were less specific in their memories, especially in response to positive cues. These results are explained within a ‘descriptions’ theory of autobiographical memory, and the remedial implications are discussed.

Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.

On the background of the recent discussion about the appropriateness of linear difference and ratio models for testing interaction effects of social support and stress, it is argued that interaction effects are basically unstable when dichotomized continuous variables are analysed. A data set with known interrelationships of the continuous variables ‘stress’, ‘social support’, and ‘depression’ was simulated and analysed in tabular format. It is shown that the choice of cut-points for the independent variables crucially determines the size and presence of interaction effects in ratio analysis models.

A meta-analysis of studies was carried out to compare treatment by specialist mental health professionals in the general practice setting and ‘usual GP treatment ’. Overall, treatment by specialist mental health professionals had a 10% greater success rate.