Observed impairments on tests of memory and planning suggest a global pathology for mania consistent with previous profiles for this disorder and similar to established profiles for depression. The results on the affective shifting task demonstrate the presence of mood-congruent bias and dissociable components of inhibitory control in mania and depression. Against a background of memory and planning impairments in the two groups, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood-cognition relationships.

Feelings that life is not worth living and thoughts of suicide are common in psychiatric patients, particularly in depressives (Beck, 1967). Very little information is available, however, regarding the occurrence of suicidal feelings in the general population. In contrast, the epidemiology of completed suicide has received extensive study (Dublin, 1963), and there have been some epidemiological studies of attempted suicide (Shneidman and Farberow, 1961; Mintz, 1964; Parkin and Stengel, 1965). However, this information cannot automatically be generalized to suicidal feelings. It has been emphasized in recent years that suicidal phenomena are diverse, and that completed suicide, suicidal attempts, and suicidal feelings should not be equated (Stengel and Cook, 1958; Neuringer, 1962).

SynopsisThis paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

SynopsisThe CANTAB battery of neuropsychological tests was used to compare the performance of 28 patients with unipolar depression with that of 22 age and IQ matched controls. The patients were impaired on almost all tests studied with deficits in pattern and spatial recognition memory, matching to sample, spatial span, spatial working memory and planning. Most of the patients showed at least some impairment and deficits were seen across cognitive domains. An important finding was the detrimental effect of failure on subsequent performance; having solved one problem incorrectly, patients were far more likely than controls to fail the subsequent problem. Superimposed on the general deficits, there were also specific deficits in executive tasks characteristic of frontostriatal dysfunction and deficits in mnemonic tasks characteristic of temporal lobe dysfunction. This combination of a specific form of motivational deficit, resulting in oversensitivity to negative feedback, and superimposed specific neuropsychological deficits were correlated with severity of depression. The most significant correlations were seen between mnemonic deficits and clinical rating scores. Comparisons of the deficits seen in the depressed patients in this study with other patient groups assessed with the CANTAB neuropsychological battery, showed that one of the hypotheses of the neuropsychological deficits in depression, that of ‘frontosubcortical’ or ‘frontostriatal’ dysfunction, was not supported. These findings are discussed in relation to the likely neural substrates of depression.

A 20 per cent prevalence of mild clinical depression was found in 120 women assessed at about six weeks postpartum. The strongest associated factor was occurrence of recent stressful life events. Previous history of psychiatric disorder, younger age, early postpartum blues, and a group of variables reflecting poor marital relationship and absence of social support were also notable. Poor marital support acted as a vulnerability factor, only producing an effect in presence of stressful life events. Previous psychiatric history produced a strong independent effect, both with and without life events. Postpartum blues were only associated with depression in the absence of life events, suggesting a small hormonal sub-group. Overall the findings indicate the importance of social stress in puerperal depression.