Defining chronic depression as persistent symptoms for 2 or more years, a prevalence of chronic depression of 12–15% is found in the literature. A four-part classification of chronic depression is proposed: Chronic Primary Major Depression; Chronic Secondary Major Depression; Characterological or Chronic Minor Depression (Dysthymic Disorder); and ‘Double Depression’. The literature indicates several factors predicting chronicity in primary major depression: more at risk are female patients, particularly those with premorbid neurotic personality traits, individuals with unipolar disorders, and those with higher familial loading for such disorders. Other factors are the adequacy and appropriateness of the treatment given, and the length of illness episode prior to treatment being received. Larger studies with well-matched controls are needed.

The meaning of ‘melancholia’ in classical antiquity is opaque and has little in common with 20th-century psychiatric usage (Drabkin, 1955; Heiberg, 1927). At that time, melancholia and mania were not polar opposites (i.e. one was not defined as having opposite features to the other). Melancholia was defined in terms of overt behavioural features such as decreased motility, and morosity (Roccatagliata, 1973; Simon, 1978). Hence, in medical usage, ‘melancholia’ referred to a subtype of mania and named, in general, states of reduced behavioural output. These included disorders that might “exhibit depressed, agitated, hallucinatory, paranoid and even demented states … the ancient diagnosis of melancholy has no correct analogue in modern psychiatric practice …” (Siegel, 1973, p. 274).

A study of women in Islington confirms earlier findings of a high rate of reported marital violence (25% experiencing it at some time in their lives). Women who had experienced marital violence tended not to repeat the same pattern in subsequent relationships. Violence was associated with childhood neglect, but not early violence. Premarital pregnancy and teenage marriage were links between early neglect and marital violence, and were also important correlates of later marital violence, irrespective of such earlier lack of care. These early-adult experiences were also related to spending longer in a violent relationship. Women experiencing marital violence were more likely to have been depressed, and to have had low self-esteem, in the 3-year study period.

One unknown factor in the link between crime and mental illness is whether or not mentally ill offenders are more liable than others to arrest. Ninety-one mentally ill, and 76 normal, criminally offending men were asked about the circumstances of their offence and arrest. A majority of mentally ill men had been arrested at the scene of the crime, and more than a quarter of the schizophrenic group had reported themselves to the police. We argue that when many offenders are either unreported or undetected, the increased vulnerability of the mentally ill to detection and arrest makes them disproportionately liable to detection. Attempting to assess the relationship between crime and mental illness is thus extremely difficult.

There is a paucity of literature in English about those people who persistently complain. In Germany and in Scandinavia, a diagnosis of querulent paranoia may be made, although this interesting and uncommon syndrome is rarely recognised in the UK. Five cases of litigiousness or persistent complaining are reported, to illustrate the typical psychopathology and the types of diagnosis that occur. Four of these people are barred from further litigation by the courts (vexatious litigants) and were contacted directly for the purpose of this study.

Ninety-two Danish manic–depressive patients with a first psychiatric admission between 1969 and 1983, who committed suicide before 1 July 1986, were considered. Information on any prophylactic or continuation treatment at the time of the suicide was obtained. In 64 of the patients, every precaution seems to have been taken: 28 patients committed suicide during ongoing treatment; 10 while not receiving prophylactic treatment (not indicated); 7 while not in prophylactic treatment because the patients refused or did not tolerate such; and 19 while in prophylactic treatment with antidepressants (10), or lithium (6), or both (3), in usually adequate dosage. In 28 of the patients, suicide might have been obviated. Guidelines for improvement of suicide prevention in manic–depressive illness are presented.

The result of, and difficulties in, applying a range of existing criteria for mild dementia to a random sample of community elderly aged 70 years and over is examined. By one or more criteria, 25% had mild dementia, and almost 30% of these had additional psychiatric disorders, mostly depression. Prevalence rates for mild dementia varied widely according to the different criteria. Rates of mild dementia increased with age. Poor specification of diagnostic criteria was a major problem. These criteria should be standardised and detailed, and prospective longitudinal studies conducted to elicit the natural history of this condition.

Forty-six patients, 9 male, 37 female, presenting to an ear, nose and throat department with a principal complaint of globus sensation were investigated by radiology, manometry, endoscopy and prolonged ambulatory pH monitoring to exclude a physical basis for their symptoms. Patients also underwent assessment by the Eysenck Personality Inventory (EPI) and General Health Questionnaire (GHQ). The only organic abnormalities detected were an abnormal degree of oesophageal acid exposure (seven patients) and oesophageal spasm (one patient). Female patients were neurotic introverts on EPI testing; males were stable ambiverts. High GHQ scores were present in 13 females (35%) and one male and there was a significant correlation between N scores (in the EPI) and GHQ scores. We propose that globus is a useful, single-symptom model for the study of conversion disorders.

Using clonidine, naltrexone, and diazepam, 60 withdrawals from heroin and other opioids involving 56 addicts were carried out with only one patient dropping out. In the last 23 cases, we used a modification of the standard technique, giving significantly higher doses of naltrexone and clonidine on the first day. This significantly reduced the average withdrawal time from 3.30 days to 2.32 days, despite lower clonidine dosage and significantly lower diazepam dosage on the second day. The speed, effectiveness, economy, and high acceptability of this withdrawal technique have implications for both private and state-funded treatment programmes.

Sixty-two schizophrenic patients completed the Parental Bonding Instrument (PBI), a measure of perceived parental characteristics, rating their parents on care and protection. PBI ratings were related to a one-year course of illness. Patients who perceived their parents positively tended to experience a milder course of illness if they were in frequent contact with them, and a more severe course if they were not; the reverse was true for patients who perceived their parents negatively. PBI ratings were unrelated to the age at onset of illness. This suggests that patients' perceptions of parental attitudes influence the course of schizophrenia by a current stress effect. The PBI, used alone or in conjunction with other predictors, distinguished good- and poor-outcome cases and appears to be a potentially clinically valuable tool.

A review of treatment trials with DTγE revealed widely discrepant results. Relevant variables were the variety of measures employed for monitoring psychotic symptoms, and the different criteria used to judge the degree of improvement. The authors suggest a uniform outcome criterion for early trials of new treatments, which would generate more consistent and comparable results between studies, and give a stronger indication of the value of the treatment under test. When the data from the various treatment trials of DTγE were re analysed, applying a uniform outcome criterion of improvement of a change of 80% or more on rating-scale score, the results were more consistent than would have been suspected from the original reports.

Previously, the addition of lithium to haloperidol has been reported to be of modest benefit to schizoaffective patients. To test this treatment on a different sample, 36 mainly schizophrenic patients were subdivided on the basis of the median of their initial depression score on the BPRS into depressive and non-depressive schizophrenic subjects. Each group randomly received haloperidol plus placebo or haloperidol plus lithium for 8 weeks. The schizophrenic patients who were on the depressive side of the median BPRS depression score were found to be the most resistant to neuroleptic treatment alone, and benefited from the addition of lithium.

Data deriving from the Mental Health Enquiry were obtained from the Department of Health and Social Security (DHSS) for all 186 000 admissions in England in 1981 to test the ‘ethnic density hypothesis'. This hypothesis has been used to explain variations in rates of mental illness between ethnic groups in other countries, and suggests that there is an inverse relationship between the size of ethnic groups and their admission rates. The data analysed in the present paper for the main foreign-born immigrant groups to England not only failed to support the ethnic-density hypothesis, but in some cases, showed a significant positive relationship between group size and admission rates. Some possible reasons for these findings are explored.

Forty-two first-episode RDC schizophrenic patients were matched on sociodemographic variables with an equal number of control subjects. The life-event histories of both groups for 6 months before onset or interview were compared. Onset of illness was not preceded by an increase in life events. The only significant observation was that control subjects had experienced more events in the month previous to interview. These were reported mainly by male control subjects, involved the family, and were possibly related to the period when the control subjects were interviewed. The observations are discussed within the context of the Nigerian culture.

The demography, psychiatric morbidity, and motor consequences of long-term neuroleptic treatment in the 14 children born to a father with a family history of chronic psychiatric illness and a mother with a late-onset affective disorder resulting in suicide are documented. Twelve siblings lived to adulthood, nine of whom were admitted to a psychiatric hospital in their second or third decade, and required continuous in-patient care; five remaining in hospital, with long-term exposure to neuroleptics, had chroniC., deteriorating, schizophrenic illness and emergence of movement disorder. Two siblings showed no evidence of psychosis but developed a late-onset affective disorder. The implications for the issues of homotypia, vulnerability to involuntary movements, and interaction with affective disorder are discussed.

Depot neuroleptics are now commonly used for maintenance therapy of schizophrenia. Their physicochemical composition makes them ideal for such use because they are long-acting and show stable blood levels for prolonged periods. Their absorption from the site of injection may, however, be affected by local muscle factors. This paper describes three such factors in relation to fluphenazine decanoate: varying the site of injection; massage of the injection site; and effects of muscular exercise. Our results suggest that fluphenazine pharmacokinetics are not significantly affected by any of these factors.

A case of weight loss from food avoidance and vomiting in a young Ethiopian torture victim is described, and possible aetiological factors discussed.

Adult hexosaminidase A deficiency is a form of GM2 gangliosidosis with autosomal recessive inheritance. Only 35 cases (mostly among Ashkenazic Jews) have been reported worldwide. Symptoms include, in a third of the cases, psychosis. A 27–year-old sufferer with no prior psychiatric history, developed a post-partum psychosis, with affective and hebephrenic components, 3 days following her first delivery. She responded to lithium within 10 days of initiating treatment; the full episode lasted 1 month. We conclude that lithium is the preferred treatment for psychosis in such adult patients, especially in light of possible long-term neurological deterioration caused by phenothiazines. Ashkenazic Jews with atypical neurological syndromes presenting with psychosis should be tested for hexosaminadase A deficiency.

The present study extended an earlier report of USA states with high levels of schizophrenia also having high levels of multiple sclerosis (MS). A high correlation (r=0.81) between schizophrenia and MS rates in the districts of Italy was found.

The experience of visual images appearing as well-described persons and objects, either familiar or unfamiliar to the patient, has frequently prompted psychiatric evaluation for apparent psychotic or schizophrenic disorders. A case of apparent psychotic depression is reported, in which the symptoms were due to the patient's experience of palinoptic images. Answers to particular questions in the initial interview can obviate the need for psychiatric consultation, as various consistencies have been reported in the non-psychiatric symptom of palinopsia.