In the debates about the association between mental illness and the menopause, the psychiatric approach contradicts assertions by the gynaecological and psychoanalytic literature that the menopause has a negative effect on mental health. General population studies show that, if at all, psychiatric morbidity is more common in women in the five years before menopause. Sociocultural and family factors are more important in the aetiology of mental illness in menopausal women than physiological changes. Anxiety and depression in such women do not respond to oestrogen therapy, although some cases respond to antidepressants.

Attempts to draw a line of genetic demarcation between schizophrenic and affective illnesses have failed. It must be assumed that these diseases are genetically related. A post-mortem study has demonstrated that enlargement of the temporal horn of the lateral ventricle in schizophrenia but not in Alzheimer-type dementia is selective to the left side of the brain. This suggests that the gene for psychosis is the ‘cerebral dominance gene‘, the factor that determines the asymmetrical development of the human brain. That the psychosis gene is located in the pseudoautosomal region of the sex chromosomes is consistent with observations that sibling pairs with schizophrenia are more often than would be expected of the same sex and share alleles of a polymorphic marker at the short-arm telomeres of the X and Y chromosomes above chance expectation. That the cerebral dominance gene also is pseudoautosomal is suggested by the pattern of verbal and performance deficits associated with sex-chromosome aneuploidies. The psychoses may thus represent aberrations of a late evolutionary development underlying the recent and rapid increase in brain weight in the transition from Australopithecus through Homo habilis and Homo erectus to Homo sapiens.

The concept of insight into psychosis has received scant attention in the psychiatric literature. Drawing on sources such as phenomenology, clinical research and experimental psychology, it is proposed that insight is not an ‘all-or-none’ phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events (delusions and hallucinations) as pathological. A scheme is proposed to standardise the assessment of insight to assist further research.

Twenty-one schizophrenics with prominent negative symptoms were compared with 37 schizophrenics without them, 33 patients with major affective disorder and 20 non-patient controls on a battery of measures including a role-play test of social skills, the Social Adjustment Scale, and the Quality of Life Scale. The negative schizophrenics were most impaired on every subscale of each measure, followed in order by the non-negative schizophrenics, affective disorder patients, and non-patient controls. The social skill measures were not correlated with positive symptom levels, but were highly correlated with measures of community functioning. The results are consistent with the hypothesis that social dysfunction results from focal deficits in social skills.

The hypothesis that schizophrenic men have a lower familial risk for schizophrenia than schizophrenic women was tested using the DSM–III-diagnosed samples of the Iowa 500 and non-500 family studies. Survival analyses were used to test for differences in the risk for schizophrenia and spectrum disorders, for sex of proband and sex of relative, controlled for fertility effects and ascertainment bias. Male and female relatives of schizophrenic men had a significantly lower risk for schizophrenia, schizophreniform, and schizoaffective disorders than relatives of schizophrenic women. However, the effect was not significant for the full spectrum nor when analysed by sex of relative. Sex differences in the risk for other psychiatric disorders among relatives of schizophrenic probands were not significant.

Serial surveys of the prescribing practices of psychiatrists for schizophrenic out-patients over 1970–88 showed important changes. During the interval 1970–83, polypharmacy and the use of multiple neuroleptics were reduced. The total dose of neuroleptics prescribed fell and the proportion administered by depot injection increased. Since 1983, however, some of these favourable trends have been reversed. Prescribing practices may also vary between teaching and non-teaching hospitals.

The supporters of 120 demented elderly people completed rating scales of the frequency and severity of the problems they faced, the amount of strain they experienced and their psychological well-being. Problems and strain increased with the degree of dementia. Problems relating to physical dependency, forgetfulness and inertia were relatively common, while disturbed behaviours were relatively uncommon. Physical dependency and disturbed behaviour were less well tolerated than forgetfulness and inertia, but all problem categories were positively associated with measures of strain. Wives reported more problems and strain than husbands, and co-resident children were under greater strain than children who lived independently.

Data from a UK national sample showed differences between the sexes in age-specific inception rates for mania. Women had a higher inception rate than men during the middle years. The cumulative admission rates were nearly equal between the sexes.

The increase in violent incidents on an acute psychiatric ward over a 15–month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.

In any assessment of hospital life, the patients' view is indispensable, but there is no generally accepted way of seeking it. In this study, the views of 258 patients in four ‘traditional’ English psychiatric hospitals were obtained by a questionnaire of 45 items supplemented by freehand comments. Their experience of fellow patients, the staff and the material and institutional aspects of hospital care were explored. Some of the benefits and problems of questionnaire use in this realm are discussed.

All patients with puerperal psychosis admitted to the Royal Edinburgh Hospital within 90 days of childbirth during the periods 1880–90 and 1971–80 were compared. The majority of cases in both groups had an affective illness with an acute presentation and a fixed interval of onset. The 19th-century cases had a more florid presentation and a greater length of admission (mean, 151 days) to the hospital than the 20th-century ones (mean, 39 days). The incidence of the disorder rose from 0.34 per 1000 childbirths per year in the 19th-century group to 1.04 in the 20th-century one, but this could be explained by nosocomial factors. Most 19th-century cases occurred in mulitgravid women, which questions the association of puerperal psychosis with primiparae.

Linked hospital and death records for 10–20–year-olds admitted with a diagnosis of poisoning were analysed. Between 1980 and 1985 there was a significant decline in admission rates, which was mainly attributable to a decline among 16–20–year-old females. There was no evidence of a decline in the admission rates among 12–15–year-olds. Ten per cent of the study population had at least one further hospital admission for poisoning during the mean follow-up period of 3.6 years. Female admission rates were substantially higher than those in males but readmission rates, given a first admission, were similar. The death rate in the study cohort was significantly higher than would be expected in the general population of this age and nearly all the deaths were from violent or unnatural causes.

An out-patient alcohol detoxification service based in a psychiatric emergency clinic is described. Of 173 patients referred during the first year, 76 (44%) were accepted for the programme; 60 (79%) of these successfully completed detoxification with no medical complications. Compared with previous years, during the year of operation of the service there was a 50% fall in the number of in-patient admissions for detoxification to the local hospital. We conclude that a structured out-patient detoxification programme is safe and effective, and may obviate the need for many patients to be admitted, freeing psychiatric beds for other uses.

Overnight plasma melatonin level was measured in ten healthy women before and after a 4300 kJ (1000 kcaI) diet in which they lost an average 3.1 kg. This weight loss did not significantly alter melatonin levels.

Recently, research into the connection between vitamins and psychiatric disorder, particularly affective changes, has been in the doldrums, with the exceptions perhaps of studies of folic acid and pyridoxine. The best way for research to proceed is first to establish that the association of a vitamin deficiency with a psychiatric disorder is beyond a chance finding. Then, questions should be asked about what mental symptoms it is linked with, and what the other associations (malnutrition, drugs, physical illness, etc) are. Lastly, queries should be raised about whether the association is causal or if the mental symptoms are merely secondary to the anorexia and poor diet so common in mental illness (or whether they are linked in a vicious circle as suggested by Reynolds et al (1971)). These questions became pertinent in the mid-1960s when reliable ways of assaying B vitamins such as folic acid became more generally available. In this review, I present evidence that deficiencies of folic acid, B12, thiamine, riboflavin, pyridoxine and ascorbic acid are not infrequently found in psychiatric practice. It should be remembered, however, that some ways of assaying vitamins are liable to give a larger proportion of spurious low results than other methods (false positives), although the adoption of more reliable ways of assaying vitamins should reduce this.

An unusual and rare variant of Capgras syndrome is reported in which a patient with depressive illness became preoccupied with doubles of inanimate objects. The patient responded to antidepressant therapy.

Seasonal affective disorder has not previously been linked with neuroanatomical abnormalities despite its relationship to biological rhythms. A 45–year-old woman is described with an arteriovenous abnormality in the right frontotemporal region who developed recurrent winter depression and summer hypomania.

Diagnosis of mental illness in mentally-handicapped people is often difficult and complex, because of atypical presentation and lack of clear diagnostic criteria. A patient in whom seasonal variation in behaviour and mood gave a clue to the diagnosis of manic–depressive psychosis is reported.

A case of depressive disorder in which treatment resistance was associated with the calcium-channel blocker nifedipine is described.

A fatal case of water intoxication in a schizophrenic female Chinese patient is described, including post-mortem findings.