Multiple deficiencies of vitamins and trace metals have been demonstrated in Down's syndrome. The picture is complex, especially since not all individuals are affected equally. Deficiencies are not age-related, but appear to be lifelong. The brain in Downs's syndrome does not develop adequately; one area, the hippocampus, which is concerned with memory, is poorly developed and is also involved in the pathological changes of Alzheimer's disease. The role of nutrients is discussed in relation to damage to the mature brain, and to the ageing process.

Twenty-three patients who believed they suffered from food allergy were studied at the time of their presentation to an allergy clinic. The presence of organic food hypersensitivy could not be confirmed in 19 who attributed common neurotic symptoms to allergy; this group was almost identical, in terms of psychiatric symptomatology and general characteristics, with a group of new psychiatric out-patient referrals. There was no evidence of psychiatric disorder or food-related psychological symptoms in four patients with proven food-related atopic symptoms. The study failed to find evidence that psychological symptoms might be the result of organic reactions to foods.

Fifty schoolchildren, admitted as medical emergencies after poisoning themselves, were compared with 50 matched controls, resident in the same area of London, referred for psychiatric help for other reasons. The dependent measures were based upon systematically recorded clinical information in both groups. The self-poisoners showed more psychiatric symptoms and more disturbed family relationships than did the psychiatric group; they were more likely to meet criteria for depressive disorder and to come from families showing little warmth. This form of self-injury is not trivial or wholly culturally determined, and it warrants psychiatric intervention.

The factors making for therapeutic engagement were examined in a series of 50 schoolchildren who had deliberately poisoned themselves. Of these 28 kept an appointment for psychiatric treatment: they were characterised by high levels of psychological symptoms, especially those of depression. The kind of treatment offered was not predictive, but parental attitudes and background contributed to the likelihood of returning for treatment. Psychiatric treatment, if effective, would be appropriate for many such children, and should be offered to them.

Sixteen consecutive patients with anorexia nervosa were studied and compared with a control group of other patients coming to an adolescent service, matched for sex and admission status. The anorexic group were not significantly different from the controls in social class and I.Q., and had a male-to-female ratio of one to four. However, they were significantly more likely to have perfectionistic personality traits and to profess to be happy with their families; these families had few external stresses, were very close, and had a high degree of exclusivity.

Six normal subjects were given clonidine infusions after 0, 1 and 3 weeks of treatment with desipramine (2 mg/kgm) and at 1 and 3 weeks after withdrawal from desipramine. The sedative and hypotensive effects of clonidine were inhibited after one and three weeks of desipramine treatment, and returned to normal after stopping treatment without any rebound increase. Such a time-course can be explained in terms of the acute effects of the drug, no adaptive changes at receptors need be invoked.

By contrast, the growth hormone response to clonidine tended to be increased after one week of desipramine, reduced after three weeks of treatment, and further reduced after discontinuation. Such a time-course is consistent with an adaptive down regulation at α2 adrenoceptors in response to their acute stimulation, due to noradrenaline re-uptake blockade.

A double blind cross-over comparison of testosterone and placebo injection was carried out in two groups of men with normal circulating testosterone levels, 10 complaining principally of loss of sexual interest and 10 complaining principally of erectile failure. A significant increase in sexual interest was produced by testosterone in the first group. There was no effect on erectile function in either group. These results support previous findings from hypogonadal men that testosterone influences sexual interest but not erectile function, and indicate that increasing plasma testosterone can effect sexual interest even in men with pre-treatment testosterone levels within the normal range.

Three hundred and twenty-three patients were referred by psychiatrists for scanning with a 160 x 160 matrix CT 1010 Head Scanner at the Maudsley Hospital during the first year this machine was in use (1977/1978). Two hundred and one referrals were for clinical and 122 for research reasons, 50% of the former and 57% of the latter showed some abnormality on their scans. Review of the patients' notes identified data that were significantly predictive of abnormal scan results; and the referring psychiatrists were significantly more able to predict the scan results correctly during the second six months of the study. Diagnosis, management, and/or prognosis were influenced in 11.7% of those patients scanned for clinical reasons.

Daily levels of anxious and depressed mood, as well as motor and speech activity were monitored for five depressed and four hypomanic patients during the courses of their in-patient treatment. The data were compared with results from nine matched control subjects. Motor activity was assessed using the actometer—a wrist watch which translates activity into movement of the watch hands—and the speech activity by recording the pause, phonation, and total times taken to recite the digits from one to ten. Validity data for the actometer and for total and pause time were found to be encouraging as outcome monitors for the treatment of depressive affect; the significant results from the total time measure suggest that this simple method is worthy of more widespread use in clinical settings.

Although memory tests are commonly used to help differentiate organic conditions from depression, the extent to which depression might influence test performance is unclear. Comparison of the performances of normal, brain-damaged, and depressed subjects on a battery of verbal and visual memory tests revealed that the incidence of impairment amongst the depressed subjects was not significantly greater than amongst normal subjects on the majority of measures, and that within the depressed group, the degree of depression was not related to poor test performance. The brain-damaged group displayed a significant incidence of impairment on all measures, and a significantly greater incidence than the depressed group on the majority of measures. It is concluded that memory tests have a useful role to play in differential diagnosis.

Previous research has shown that nominal dysphasia occurs commonly as a language disorder in senile dementia (Alzheimers' type). This study provides evidence that the degree of nominal dysphasia shown by a patient may be a reliable index of the severity of dementia, as measured by both behavioural and cognitive rating scales.

Three samples of supporters of elderly infirm dependents who were either attending or about to attend day hospitals were given the 30-item General Health Questionnaire (GHQ) to complete. Prevalence levels of disturbance varied from 57% to 73%; female supporters (the majority) reported higher levels of distress. High scores were related to a diagnosable psychiatric condition, and were significantly associated with a combination of poor self-health ratings in the supporters, more frequent behaviour problems in the dependents, and a more negative view of the premorbid relationship between supporter and dependent. Reported amount of contact time and levels of formal and informal outside support were not related to GHQ scores.

A census was taken of all patients in psychiatric hostels and homes, psychiatric day care, and short-term in-patient care who also had at least one year's history of contact with services. During the following two years, 61% of the patients stayed continuously in day or residential care, while 17% were discharged from care within the first year and made no further use of day or residential services. Two main patterns of contact were evident–repeated short-term in-patient care or longer-term care in services outside hospital. Their most important determinant was whether a viable marriage still existed for the patient.

Subjects in Botswana were asked to state their preference between modern (doctor or nurse) or indigenous (traditional or religious healer) care for three case vignettes of epilepsy, psychosis, and tuberculosis. Nurses, medical patients, and a general village population were studied. Many subjects preferred modern care for all disorders, whilst a small number favoured indigenous treatment only. A significant percentage discriminated between disorders, choosing indigenous care for some and modern for others. Indigenous care was most favoured for epilepsy, and least for tuberculosis. Psychosis took an intermediate position. The size of the discriminating group varied between populations, but the overall pattern of attitudes remained the same. Neither demographic factors nor aetiological beliefs consistently identified those who choose indigenous care.

Medical journals are enlivened by case reports of bizarre and unusual syndromes. Although somatic delusions are relatively common in schizophrenia, reports of hallucinations and delusions of bicephaly are rare. For a patient to attempt to remove a perceived second head by shooting and to survive the experience for more than two years may well be unique, and merits presentation.

A case is described of anorexia nervosa arising in a mentally-handicapped 35-year old person with Down's syndrome. The late onset is accounted for on the grounds that adolescent challenges had only recently arisen in this instance. Removal of the patient from the provocative situation, coupled with some effective psychotherapeutic ‘grief work’ with the family, was associated with restoration of normal body weight and menstrual function, following the patient's acceptance of the usual re-feeding treatment programme.

Previous research has demonstrated a different psychophysiological response of schizophrenic patients depending on whether their key relative was rated high or low on Expressed Emotion (EE). A case assessment is described in which a young man suffering from schizophrenia, who lived with both a high EE and a low EE parent, was tested psychophysiologically in their presence using an ABAC design. The patient demonstrated a significantly higher amount of spontaneous activity in skin conductance level when the high EE parent was present. The high EE parent also demonstrated a greater perceived inability to cope, and a higher level of personal distress.

A retrospective study was carried out of 79 patients with subacute or chronic subdural haematomata. Forty-six (58.2%) had mental changes at admission which were categorised using DSM-III criteria. Delirium was the most frequent mental change, followed by dementia and coma. Three cases of organic affective syndrome were found. In those with mental changes, delirium was significant in older patients (P <.05) and coma in young patients (P <.001). Dementia was more common in the elderly. These findings confirm the presence of common mental syndromes in patients with subdural and haematomata and substantiate time-honoured clinical stereotypes.

There is currently a great deal of interest in whether or not circadian rhythms are capable of explaining certain psychiatric phenomena. This short review will briefly explain the concept of endogenous circadian rhythms and then go on to describe some of the attempts to relate this to psychiatry. It is not possible to give a complete discussion in the space available and interested readers are referred to two recent texts on circadian rhythms (Wever 1979, Minors and Waterhouse, 1981). The psychiatric aspects have been reviewed by Sampson and Jenner (1975).

Jerome Frank, notable psychotherapy researcher, emeritus Professor of Psychiatry at Johns Hopkins and persistent campaigner for nuclear disarmament published the first edition of Persuasion and Healing in 1961. The revised edition, extensively re-written, and the focus of this appraisal, came out in 1973.