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In a study of 18 patients with manic symptomatology and 31 patients with melancholic symptomatology the Bech-Rafaelsen Mania Scale (BRMS) and the Hamilton Depression Scale (HDS) have been compared. The results showed that the inter-observer reliability of the BRMS was adequate compared with the HDS. Both scales are constructed for assessing the severity of manic or melancholic states, and no difference was found in the total BRMS or HDS score between the various diagnostic groups, when the patients were classified by an index of the course and symptomatology otive disorder, using the Multi-axial Classificetion System for Affective Disorders (MULTI-CLAD). The homogeneity of the BRMS seemed more adequate than that of the HDS, when each item was correlated to the corresponding total score. Although the homogeneity of the BRMS needs to be evaluated by other statistical models than correlation analysis, our results seem to indicate that the improvement in assessing manic-melancholic states quantitatively is a matter of redefining items or incorporating new items in the melancholic rather than the manic part of these rating scales.

Mean adrenaline concentration in cerebrospinal fluid measured by a sensitive and specific isotope-derivative assay was significantly lower in 15 depressed patients during illness compared with 18 control subjects. At the time of recovery cerebrospinal adrenaline levels had increased markedly to normal levels. Cerebrospinal fluid noradrenaline did not differ in patients compared with controls. The present findings suggest that adrenaline as a neurotransmitter may be involved in affective disorders.

A psychiatric rating scale is a method directed towards standardization of the recording of clinical data. Depending on the various levels of information such scales can be divided into questionnaires, observer scales and interviewing or case-recording scales.The most commonly used observer scale is the Hamilton Depression Scale (HDS) which consists of 17 items or symptoms. The sum of the scores of each item is intended to give the rating for the patient's state. However, our previous work with the HDS has shown that the scale is not a one-dimensioned measure of the depressive state. Our statistical evaluation of summing the HDS-items will include both homogeneity (the consistency of a scale across items) and transferability (the consistency of a scale across patients). On this background the construction of our own depression scale will be discussed.The unreliability of psychiatric diagnoses has enhanced the interest for methods to standardize the observation of clinical phenomena. Rating scales are such methods. Depending on the various levels of information rating scales can be divided into questionnaires, observer scales, and interviewing or case-recording scales.The most commonly used observer scale in the field of depression is the Hamilton Depression Scale (HDS) which consists of 17 items or symptoms. The inter-rater reliability of the HDS has been found high in the various settings (e.g. Hamilton (1976)), but useful information about its validity has been very rare, e.g., until now there have been no standardized values for the scale.According to classical psychometric theories (e. g. Nunmlly (1%7), Fhankr (1970)) a standardization should have indicated (1) that the mean of the total scale-score for the population on which the scale has been used did not differ too much from the theoretical mean score; (2) that the total scale-score spread throughout the theoretical range; (3) that the scale-score correlated adequately with other tests measuring the same phenomena (empirical or concurrent validity); and (4) that scale validity was supported by factor analyses (theoretical or construct validity).When Hamilton (1960) introduced his scale, he described some factor analytic results, but gave no information about the scale score distribution, or about the empirical validity of the scale. Most of the subsequent investigators have maintained Nunnally, J. C. (1967): Psychometric theory. McGraw-Hill, New York.