A detailed and critical discussion of John Home, a certified inmate of the Royal Edinburgh Asylum during 1886–87, is presented from a historical perspective which is sensitive to the respective positions of the practitioner and the patient. Particular attention is paid to the letters Home wrote during his confinement and their significance for understanding asylum life during this period. Some interpretative difficulties surrounding the use of medical records, patient letters and other related evidence are also examined.

The neuropathological results from a prospective, systematically assessed, series of 56 schizophrenic patients and 56 age- and sex-matched normal controls have been presented.

When compared with the normal controls, the brains of the schizophrenic subjects showed a significant reduction in brain weight and brain length with a concomitant increase in ventricular size. (All findings relate to measurements made after formalin fixation). In addition, the brains of the schizophrenic patients contained significantly more non-specific focal pathology and fibrillary gliosis than the controls.

After exclusion of cases with moderate and severe Alzheimer-type change, cerebro-vascular disease and all forms of focal pathology, the structural brain changes (i.e. decrease in brain weight and brain length) continued to distinguish the schizophrenia group from the controls. Furthermore, an analysis of the clinical data showed that the structural brain changes were correlated in the schizophrenic patients with a measurement of pre-morbid function.

The findings and their possible aetiological implications have been discussed.

The growth hormone (GH) response to desipramine was measured in ten patients meeting criteria for post-stroke depression (PSD), eight age-matched post-stroke (PS) nondepressed patients and eight healthy controls. Responses were significantly blunted in patients with PSD. These findings suggest diminished alpha-2 adrenoceptor function may be an important marker for PSD.

All major psychiatric disorders aggregate in families. For most disorders, both genes and environmental factors play an important role in this aggregation. While recent work has tended to concentrate on the importance of genetic factors, this report focuses on the potential importance of environmental risk factors which themselves aggregate in families. In particular, this article examines how much of the familial aggregation of a psychiatric disorder may result from the familial aggregation of a risk factor. The model is illustrated and then applied to putative familial risk factors for schizophrenia and depression. The results of the model suggest that if parental loss and exposure to pathogenic rearing practices are true risk factors for depression, then they could account for a significant proportion of the familial aggregation of depression. By contrast, the model predicts that even if obstetric injury and low social class are true risk factors for schizophrenia, they together would account for only a very small proportion of the tendency for schizophrenia to aggregate in families.

Twenty-five male and 13 female patients with alcoholic Korsakoff's syndrome (AKS) were compared with age- and sex-matched non-Korsakoff chronic alcoholics and healthy volunteers in a neuropsychological study, which included computer-administered tests of cognitive function. The performance of male Korsakoff patients was significantly inferior to that of healthy male controls, not only in tests of memory, but also in visuo-perceptual tasks with a speed or motor component, and on category sorting and verbal fluency measures. Compared with male alcoholics, the performance of male Korsakoff patients was again inferior on similar tests. Female Korsakoff patients showed more extensive deficits compared with female controls, but differed less from matched female alcoholics.

The results suggest that, in addition to their amnesia, many Korsakoff patients have sustained widespread cognitive deficits, affecting particularly visuo-perceptual and abstracting functions, which are sensitive to cortical lesions. The range of deficits falls short of what may be regarded as ‘global’ in male, but probably not in female, Korsakoffs. The implications for a dual aetiology of AKS involving thiamine deficiency and other features associated with alcoholism, probably direct alcohol neurotoxicity, are discussed.

Forty patients suffering from a major depressive disorder, for whom electroconvulsive therapy (ECT) was clinically indicated, were assigned to one of three electrode placement groups: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparisons of these groups in terms of cognitive status showed that the BF placement, which avoided both temporal regions, spared both verbal and nonverbal functions. These differential effects, which were independent of the degree of clinical depression, were not, however, evident three months after the last ECT.

Resource theory predicts that the relative memory deficit shown by depressed patients should be greater with unstructured than structured material. Previous data using semantic categories word lists supports this, but lists approximating to text have produced the opposite result. Both types of structure were studied in this experiment. The prediction from resource theory was found to hold only when comparing medium and high levels of structure, and to hold more clearly for word lists approximating to text than for semantic categories lists. When word lists of low and medium levels of structure were compared, depressed patients showed relatively greater deficit with the more structured material. Ways in which this could be accommodated in a revised version of resource theory are discussed.

Levinger & Clarke (1961) found that subjects tended to forget more word associations to emotional rather than neutral words. Kline (1981) regarded this study as providing “irrefutable evidence for the Freudian concept of repression”. On the other hand, results from Kleinsmith & Kaplan (1964) suggested that this effect may reverse after a delay. The present study attempted to replicate Levinger & Clark's result using stimulus words balanced for concreteness and frequency. In addition, recall was tested immediately and after a delay. Associations to emotional material were more poorly recalled immediately than associations to material which was low in emotional valence, but tended to be better recalled a month later. There were no differences in recall of pleasant versus unpleasant material. Results do not support the repression hypothesis, in that emotional material becomes more memorable over time. Moreover, repression should differentially apply to unpleasant rather than pleasant material but no such differences were found.

Chronic schizophrenic patients in a long stay hospital were found to have low levels of intelligence (mean IQ of 80), which was attributed to the effects of substantial intellectual deterioration on below average pre-morbid levels of functioning. Patients with the lowest IQ scores had the least severe positive symptoms but symptomatology was not related to age or extent of intellectual decline. Speed of functioning was relatively more impaired than level of intellectual functioning, with cognitive speed being more affected than motor speed. The severity of negative but not positive symptoms was significantly related to the severity of bradyphrenia (cognitive slowing), a result which would be consistent with the notion of a subcortical pathology in patients with Type II schizophrenia.

Audio-taped interviews recorded in the Gottesman–Shields schizophrenic twin series (17 pairs of identical twins, 14 pairs of fraternal same-sex twins, and 12 unpaired twins) were rated for level of hedonic capacity. Schizophrenics who were not hospitalized at the time of their interview were rated significantly lower (more impaired) on hedonic capacity than their normal co-twins. A significant negative correlation was also found between hedonic capacity and severity of illness. Hedonic capacity was found to be genetically influenced, although it appeared to be less heritable than the global diagnosis of schizophrenia. These results are consistent with Meehl's suggestion that reduced hedonic capacity is a heritable personality trait which potentiates the development of schizophrenia among those who are genetically predisposed to the disorder. The results suggest that anhedonia is not a phenotypic vulnerability marker for schizophrenia.

Forty-four patients who met criteria for major depressive disorder were assessed for presence of dysfunctional attitudes and negative self-schema on admission. After six weeks, of sixteen patients who had shown high dysfunctional attitudes, six (35%) had not recovered. By contrast, of seventeen patients who had been equally severely depressed at the outset, but had low dysfunctional attitudes, only one (6%) had not recovered. The rating by the patients of themselves, as opposed to their attitudes, did not however predict. Thirty-one patients were tested six months later. Twenty-one (68%) remained asymptomatic, ten patients had relapsed or not responded to treatment, but neither type of admission measure predicted the state at this point. This is consistent with previous evidence which suggests that vulnerable attitudes assessed when symptomatic predict recovery, but that for prediction of relapse, cognitive measures need to be used when the patient is asymptomatic.

The occurrence and course of eating disorder in a large representative population of 15-year-old London schoolgirls has been assessed using a two-stage survey methodology. Attempts to control weight were common and often transient. Dieting was in the great majority of girls found to be a benign practice without progression to more extreme concerns about food and weight. However, a small proportion of dieters did become cases and formed the majority of new cases found at follow-up. The relative risk of dieters becoming cases was eight times that of non-dieters. Many factors conventionally associated with eating disorder were associated more with attempting weight control than caseness. These included pre-morbid personality, pre-morbid obesity and family weight pathology. Other factors, including social class, career choice and psychosexual development, had no association either with attempting weight control or caseness.

Jenkins et al. (1981) published data on rates of admission to three psychiatric hospitals for 12 large samples of people living near London's Heathrow Airport. The percentages of people who were classified as being affluent, living alone, males having moved within last five years, unemployed, and immigrants, as well as the levels of aircraft noise to which they were exposed, were given for each of the samples. Multiple-correlation analyses revealed the following: (1) movement of males in the previous five years was not generally associated with hospital admission rates; (2) immigrant status, living alone, and affluence were negatively, and generally statistically significantly, associated with admission rates; and (3) unemployment and level of exposure to aircraft noise were positively, and generally statistically significantly, associated with admission rates. Unlike the conclusion reached by Jenkins et al., it is concluded from the present analysis of their data that there are statistically significant associations between psychiatric hospital admission rates and level of exposure to aircraft noise. This difference in findings appears to be due to a more comprehensive assessment of the interrelations of all the tested socioeconomic and aircraft noise variables by the multiple-correlation procedure used in the present analysis, in comparison with the graphic modelling assessment applied by Jenkins et al. to a limited portion of the socioeconomic data. Together, the five socioeconomic and aircraft noise variables correlate at about 0·98 with hospitalization rates for most population groups.

In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality Disorder. The results indicate that this condition can be diagnosed reliably and that it is a valid construct. It has a prevalence of 2·1 % in a general population. Males and females are equally affected, suggesting that prior reports of an increased prevalence in females was an expression of ascertainment bias found in hospital-based studies. The diagnosis is associated with clear evidence of disturbance in the emotional, behavioural, and social realms. Individuals with this disorder tend to use health care facilities more frequently than others.

Two hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

Whakama is a psychosocial and behavioural construct in the New Zealand Maori which does not have any exact equivalent in Western societies although shame, self-abasement, feeling inferior, inadequate and with self-doubt, shyness, excessive modesty and withdrawal describe some aspects of the concept. It is an important construct in order to understand the interaction of the Maori with each other and with the Caucasian New Zealander, the behaviour of the Maori in cross-cultural settings, and the clinical presentations of some Maori patients. This paper examines some of the meanings of Whakama, its various behavioural manifestations and its possible causes. The clinical relevance to psychiatry is emphasized.

Waiho ma te whakama e patu!

‘ Leave him alone he is punished by whakama ’ (Maori saying)