Late-onset schizophrenia remains an understudied area. Neuroimaging techniques, which have been widely employed in the study of earlier-onset schizophrenic patients, have only recently been applied to patients with a later onset of illness. This paper reviews current knowledge about brain abnormalities in late-onset schizophrenia, and attempts an integration of the findings with clinical, genetic and epidemiological factors which pertain in such disorders. Suggestions are made for future research regarding this group of patients.

Brain alterations have been sought since the beginning of the century to explain the ‘dementia’ of dementia præcox. Kraepelin suggested in 1913 that it might have its internal origins in early childhood, while Southard (1915) considered likely a congenital or early acquired basis for the development of the disease. Afterwards, degenerative processes were described for decades until neurodevelopmental theories emerged recently (Lewis, 1988).

Using pneumoencephalography, Jacobi and Winkler (1927) first reported that some patients with schizophrenia presented enlarged ventricles. Johnstone et al (1976, 1978), in CT-scan studies, observed an increase in mean lateral ventricular size in a group of institutionalized schizophrenic patients. This finding has been replicated by other studies (Weinberger et al, 1983) but challenged by others (Gluck et al, 1980; Jernigan et al, 1982).

The paper describes the construction and validation of a brief self-rating scale for social integration in the elderly: the 17-item Social Integration and Independence Questionnaire (SIIQ). The questionnaire was tested on a sample of 160 individuals over the age of 65. Principle component analysis elicited four factors accounting for 48.8% of the cumulative variance: ‘Independence’, ‘Social Integration’, ‘Familial’ and ‘Depression’ (20.7, 10.6, 9.0 and 8.4% of the cumulative variance). The four factors measure the adjustment of elderly people in the community.

To characterize the neurophysiological profile of patients with Subcortical Vascular Encephalopathy (SVE) we compared the quantified electroencephalogram (qEEG) of 15 consecutive patients, demented and non-demented, with leukoaraiosis and multiple lacunar infarcts on tomographic scan and magnetic resonance investigation, with those of 30 patients with Alzheimer’s disease (AD) and 30 controls. The investigation was carried out using an EEG fast Fourier transform program, and the data obtained were transformed into mean frequency (MF), calculated in the left occipital derivation, and in percent difference (PD), calculated in eight derivations. The data obtained were compared with the scores of the mini-mental state examination (MMS). The results demonstrate that the patients with SVE displayed a different qEEG pattern in comparison with AD patients and controls, with a prevalence of EEG slowing in frontal derivations, and with good correlation between PD values and MMS scores. The qEEG may detect subtle and/or early changes in patients with SVE. The use of adequate spectral parameters may give valuable data for a better classification of dementia syndromes.

The relationship between growth hormone (GH) response to clonidine and the Minnesota Multiphasic Personality Inventory (MMPI) was assessed in 20 major depressive inpatients. GH response to clonidine was negatively correlated with the depression, the psychasthenia as well as the social introversion MMPI scale scores, and positively correlated with the hypomania scale scores. In contrast, the Carroll depression scale did not exhibit any relationship with either GH response to clonidine or MMPI depression scale. These findings support the role of the clonidine test and several MMPI scales as trait markers for depressive illness.

Four patients are described whose presenting complaint - panic attacks associated with atypical chest-pain and varying degrees of avoidance; improved substantially following a simple paradoxical intervention. Three months’ follow-up suggested lasting benefits.

Twelve outpatients with seasonal affective disorder were treated by 1-h morning bright light exposure for 5 days. The light treatment intervention produced a significant phase advance of self-rated sleepiness rhythm, a significant decrease of the mean level of subjective sleepiness, and a significant reduction of depression scores. No significant objective circadian rhythm phase shift nor amplitude changes would account for the antidepressant effect.

Two clinical observations of mianserin abuse by psychiatric out-patients are described. A previous history of substance dependence was found in both cases. Mianserin should be used with caution in predisposed patients, before further studies on the subject are carried out.