Australian & New Zealand Journal of Psychiatry

Revolutionary advances in social and medical knowledge and technology have radically changed the conditions which precede death for an increasing number of people. The fear of death is being replaced by the dread of too-prolonged life, a feature of which is a widely documented incidence of both pain and physical and mental distress. This situation has produced the accelerating social demand for euthanasia (a painless inducement of death, preferably by medical means) to be legally available to a suffering person earnestly desiring it.

The attitudes of medical workers are ambivalent, trapped as they are between a changing society and intransigent law. Psychiatry, however, and its concern for the whole person, is potentially an ally of those who desire to educate the community to a healthier view of death, even a planned death, as a part of life and a responsible conclusion to it.

A double-isotope derivative dilution procedure for measuring plasma levels of Nortriptyline is described. The assay is specific, sensitive, precise and reproducible. Studies on the variation in steady-state plasma levels are described on a fixed oral dosage of nortriptyline. Between individual variations in steady-state plasma levels are large. Between day within individual variation is 15–20%. Dosage regime, time of blood sampling after hist oral dose and the method of blood handling are unlikely to affect the steady-state plasma levels. Within an individual, the oral dose, duration of treatment and concomitant drug treatment are all important determinants of the steady-state plasma level.

Recent studies of hypothalamo—pituitary—adrenal (HPA) suppression in depressed patients indicate that these subjects often show abnormal early escape of plasma cortisol levels following an initial suppression. Non-depressed psychiatric inpatients usually show normal sustained HPA suppression. The responses of 49 depressed and 30 non-depressed patients have been analysed to develop criteria which can make the dexamethasone suppression test suitable for outpatient studies. The cortisol levels measured in a 24-hour urine collection and a single blood sample post-dexamethasone were sufficient to enable 61% of the depressed patients to be identified correctly at a confidence level of 90%, on the basis of at least one abnormal cortisol value. When both cortisol values were abnormal 35% of the depressed patients were identified correctly at a confidence level of 100%. Patients with “endogenous” depressive profiles had the most abnormal results. A normal response to this test will not necessarily exclude the diagnosis of primary depressive illness. An abnormal response to the test may be of help in confirming the diagnosis. With the simplified procedure outpatient studies may become possible.

A. R. Jensen's hypothesis concerning genetically-determined differences in intelligence between North American blacks and whites is summarised. Problems involved in the application of heritability statistics to IQ data are discussed. The concept of “intelligence” is reviewed from a cross-cultural perspective, and an alternative model of potential, competence and performance is proposed. Finally, the questions of scientific freedom and social responsibility are touched upon, and the implications of the great debate for scientists and educators discussed.

A comprehensive life event inventory suitable for questionnaire or interviewer administration has been constructed.

Two sets of matched scalings of these life events have been derived from the responses of an Australian urban population. Each of the scalings were consistent across the sociodemographic groups in the population.

The two scales allow the significance of life events to be scaled in conceptually different ways. The first follows Holmes concept of the extent of life change produced by the event, the second the Paykel concept of the amount of distress caused by the event.

The inventory and the scalings are suitable for use in an Australian urban population.

One of the most alarming and potentially serious complications of Lithium Carbonate therapy is the emergence of central nervous system toxicity. This paper discusses the clinical changes that may occur with illustrative case histories. The role that such factors as serum Lithium levels, sodium balance, organic brain damage, clinical typology, concurrent physical illness and drug interaction play in the genesis of this disorder is discussed. Permanent neurological damage following Lithium poisoning is discussed and guidelines for appropriate use and monitoring of Lithium in psychiatric disorders is outlined.

The rural Xhosa people of South Africa have retained social cohesion through traditional custom, purity of language and the dominant role of ancestor worship, traditional medicine and witchcraft in lifestyle, beliefs and ceremonies. Abstract concepts are limited and ego defence mechanisms include projection, displacement and rationalization but cognitive disturbances per se are not regarded as important. Major attention is paid to severe conative and affective disturbances, ascribed to object or spirit intrusion, witchcraft or sorcery, which necessitate treatment by a traditional “witchdoctor”. Therapy is community orientated as far as possible unless uncontrollable violent behaviour necessitates referral to a mental hospital.

Fifty-three patients suffering from depressive illness were classified as ‘responders’ or ‘non-responders’ on the basis of an “amelioration score” of the Hamilton Rating Scale for depression after six weeks treatment with nortriptyline hydrochloride at 150 mgs. daily. A multivariate analysis of variance was performed on the four psychological rating scale scores used, to determine whether rating scales could predict treatment response to tricyclic antidepressants. There was a significant difference between the two groups after adjustment for age. Subjects were then classified as ‘non-responders’ and ‘responders’ on the basis of their discriminant scores. The prediction of response to tricyclic antidepressants was found to be at 75% probability.

The wealth of material on depressive classification provides both researcher and clinician with a sorting task of monumental proportions. Moreover the criticisms which have been fired at studies of depressive classification using symptoms as a data base, also require systematic sorting and elucidation.

An attempt has been made to review the major studies of depressive classification in a systematic way, together with the principal criticisms which have been made of them. The survey is not exhaustive but aims at providing a relatively ordered overview of the area.

The most critical issue, that of subjectivity of data collection is taken up, and it is suggested that biological measures may form a more objective data base for studies of depressive classification than ratings of symptoms and behaviour.