Throughout the history of schizophrenia as a psychiatric concept, opinions have differed sharply over its essential nature and its causes, giving rise to a wide range of explanations that have drawn upon ideas from almost all of the social and biological sciences. Only one fact has truly survived the vicissitudes of argument about the condition: that genetic factors contribute to its aetiology. Even that conclusion, first reached in the very early days of schizophrenia research, sank temporarily out of sight during the radical psychiatry challenges of the 1960s. However, the continuing collection of family, twin, adoption and other data over that period put the genetic hypothesis beyond reasonable doubt (McGuffin, 1988).

The spongiform encephalopathies are unusual in several respects. Firstly, they are transmissible, and in some cases inheritable. Secondly, variants of these disorders occur in many species and can be transmitted by consumption of infected material; this has led to concern as to the potential risk from eating contaminated animal products. Thirdly, increasing evidence suggests that a ‘prion’ protein is central to their aetiology and pathogenesis, and that no nucleic acid is involved in the infective process. The role of the prion gene and its protein is outlined and proposed as the basis for an improved classification of the transmissible dementias.

Age of onset was examined for 139 members of 30 families affected by early-onset AD. Most (77%) of the variance of age of onset derived from differences between rather than within families. The constancy of age of onset within families was also observed in an analysis restricted to families derived from a population-based epidemiological study with complete ascertainment of early-onset AD. Furthermore, we observed clustering of age of onset within those families that support linkage to the predisposing locus on chromosome 21. Our data are compatible with the view that allelic heterogeneity at the AD locus may account for the similarity in age of onset within families. This finding may be of value for scientific studies of AD as well as for genetic counselling.

A review of the literature shows that there are strong associations of treated prevalence rates of psychiatric disorder with social class, sex, marital status, ethnic group and living alone; and moderate associations with living in inner-city areas and a high degree of residential mobility. The Jarman-8 index of social deprivation correlates with psychiatric admission rates for patients aged less than 65 years (R2–0.38). Individual census variables can themselves account for up to 0.71 of the variance in the admission rates, while combined in a stepwise multiple regression the census variables will account for over 0.95 of this variation. Multiple regression models using individual census variables and derived indices should be applied next on a wider geographical basis, and to narrower age, sex and diagnosis-specific psychiatric morbidity rates.

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

Family size, sex of siblings and birth order were examined in 225 bulimic patients of normal weight, all stemming from the same circumscribed catchment area. Although bulimia can occur in any size family, all-female sibships were significantly over-represented. In small families at least, the bulimic patient was highly likely to be the only or eldest daughter. In small sibships, a bulimic who was first-born was significantly more likely to have a younger sister; if second-born she was more likely to have an elder brother. Despite the very large sample size, no final conclusion can be made on birth order.

Forty-one patients with anorexia nervosa, admitted to the Maudsley Hospital between 1959 and 1966, were followed up after a mean of 20 years. An assessment of general outcome (based on the Morgan-Russell scales) yielded three outcome categories: ‘good’ (n = 12), ‘intermediate’ (n = 13) and ‘poor’ (n = 15). Six patients (15%) had died from causes related to anorexia nervosa; at least 15% had developed bulimia nervosa. There was a general consistency between the follow-up at 20 years and that previously conducted five years after admission, although with a few individual patients there were serious prognostic errors at the earlier follow-up. A poorer outcome was associated with a later age of onset, a history of neurotic and personality disturbances, disturbed relationships in the family and a longer duration of illness.

This article reviews eight published studies that describe clozapine's effects on TD and examines the outcome of 30 patients with TD treated with clozapine for up to 36 months. These data indicate that TD response to clozapine is variable but that approximately 43% of cases, particularly those with dystonic features, improved after clozapine treatment. Methodological limitations of the studies described, however, preclude definitive conclusions, which must await appropriately controlled trials.

Using a double-blind procedure, 68 patients with putative benzodiazepine dependence were randomly allocated to one of three groups given lorazepam (n = 22), diazepam (n = 23) or bromazepam (n = 23) in doses equivalent to those of the patients' original benzodiazepine. After four weeks the dosage was reduced in 25% quantities until no further benzodiazepines were taken. A total of 23 patients dropped out during the study, ten on lorazepam (one of whom committed suicide), seven on diazepam and six on bromazepam. There were few differences in withdrawal symptoms between the three groups but, despite the higher dropout rate, these symptoms were somewhat less marked in the lorazepam group. Withdrawal symptoms were greater in patients who had taken a benzodiazepine for > 5 years and were most marked in those with personality disorders, predominantly dependent ones.

We studied retrospectively a consecutive series of 40 Afro-Caribbean patients and compared them with 40 non-Caribbean patients matched for age, sex, and diagnosis. There was no overall difference in initial or cumulative doses of neuroleptic medication in the early treatment of psychosis. However, a small subgroup of Afro-Caribbean patients received higher peak dosages. Clearly recorded episodes of behavioural disturbance were more frequent in Afro-Caribbean patients generally. They were more likely to be admitted compulsorily, discharged earlier, and prescribed depot medication.

Jacobson's theory of affects and psychotic depression can be of benefit to the management of patients, even when recourse to physical therapies is required. Awareness of such psychodynamic issues would improve staff training, morale, and practice; rotation schemes for junior staff may have serious effects through the abandonment of patients and established therapeutic relationships.

No significant difference in the lateralisation of tactile-evoked potentials was found when a tactile stimulus was applied to the index finger of 14 schizophrenic patients and 14 age- and sex-matched controls. The early tactile responses, recorded from contralateral and ipsilateral parietal scalp electrodes, were compared. Our results differ from previously reported results.

Brain ERPs were recorded in ten unmedicated schizophrenic patients and age- and sex-matched healthy controls during a multidimensional listening task. Patients showed a marked reduction in a long-duration attention-related negative ERP component, termed ‘processing negativity’ (PN), which was elicited by attended stimuli. The amplitude of PN was significantly correlated with SANS and SAPS scores of schizophrenic symptoms. The P300 component was also reduced in amplitude in patients, and was significantly correlated with SANS ratings of negative thought disorder. These findings provide neurophysiological evidence of impairment in the maintenance of selective attention and the cognitive processes associated with target detection among schizophrenic patients. The reduced PN in schizophrenics implicates frontostriatal pathways in the aetiology of attentional deficits in schizophrenia.

The Home Office files of all 295 cases of defendants being found unfit to plead between 1976 and 1988 were evaluated. The majority were male and either schizophrenic or mentally impaired. Median age was 32 years. Two-thirds had past criminal convictions, and nearly 90% had past contact with psychiatric or social services, but only 28% were receiving psychiatric care at the time of their alleged offence; 14% were hospital in-patients. Offences of theft and violence predominated, but in most cases they were not of a serious nature: 34% were rated as mild or nuisance, 40% moderate, and 26% severe. In more than 80% of cases, evidence linking the accused with the offence seemed good. Less than one-third were admitted to special hospitals. Forty-six per cent of the population (135 patients) eventually regained their capacity to plead (within a median of four months), with 76 (26%) returning for trial. Of the remainder, 68 (23%) are still in hospital, 39 of whom have been there for more than five years. Time to discharge without trial reflected the severity of the alleged offence.

The prevalence of delusional jealousy in 8134 psychiatric in-patients was 1.1%. Delusions of jealousy were most frequent in organic psychoses (7.0%), paranoid disorders (6.7%), alcohol psychosis (5.6%) and schizophrenia (2.5%), while in affective disorder delusions of jealousy could be found in only 0.1%. Because schizophrenia and affective disorder were the most common diagnoses, most patients with delusions of jealousy were schizophrenics. In schizophrenia, women were more likely to suffer from delusional jealousy, while in alcohol psychosis, men were more likely than women to suffer from delusional jealousy.

One hundred medical and surgical patients admitted to an accident and emergency ward were screened for psychiatric disorder. A psychiatric diagnosis was made in 37 patients, 32 of whom were correctly identified by the GHQ. Psychiatric morbidity was associated with being single, lower social class, unemployment, homelessness and living in Bloomsbury Health District or north-east London. It was also associated with not being registered with a GP. The 14 overdose patients were no more likely to receive a psychiatric diagnosis than other patients, yet constituted most of the psychiatric referrals. Few patients were asked by medical staff about emotional worries or problems. A desire to be asked such questions and a past psychiatric history were associated with a psychiatric diagnosis. Routine screening of psychiatric morbidity in both medical and surgical patients and appropriate psychiatric referral of identified patients is recommended. A system of facilitating GP registration is necessary, as much of the morbidity identified could be contained within primary care.

Patients with Alzheimer disease (AD) had reduced regional cerebral blood flow (rCBF) in the posterior parietotemporal region compared with controls, as determined with technetium-99m hexamethyl propyleneamine oxime and single photon emission tomography. Central cholinergic stimulation with physostigmine produced a focal increase in rCBF in the posterior parietotemporal region in the patients with AD but not in controls.

Oncogenes are genes whose expression has been associated with malignant transformation of cells in tissue culture and with neoplastic change in vivo (Bishop, 1987). Much of the current understanding of their nature and action has stemmed from work, over the past 20 years, on tumour viruses (Temin, 1971; Rapp, 1983). One group of tumour viruses, the retroviruses, are unique in possessing an enzyme, reverse transcriptase, which transcribes to the cell DNA a copy of the viral RNA genome (Marks, 1987). After the discovery of viral oncogenes, such DNA copies were used as probes in hybridisation studies (Stehelin et al, 1976; Frankel & Fischinger, 1976). These probes, capable of annealing to complementary DNA sequences, revealed the existence of the latter in normal, unaffected cells (Willecke & Schäfer, 1984). These sequences, called cellular or proto-oncogenes, exist in a wide range of eukaryotic organisms, from yeast to man.