Although the clinical presentation and course of schizophrenia is highly variable, it is unclear whether this reflects heterogeneity at an aetiological level. The genetic evidence is reviewed concerning ‘traditional’ clinical subtypes as well as more novel categories derived from multivariate statistical methods and Crow's type I-type II classification. Recent data based on a twin series and reanalysis of older published family material suggest that attempts to divide up schizophrenia have resulted in splits between two or more categories of disorder which occupy different positions on the same continuum of liability. Thus, apparent heterogeneity is more likely to be due to quantitative difference in familial-genetic loading rather than qualitative differences. Similarly, the hypothesis that schizophrenia can be broadly divided into two groups, one genetic and the other non-genetic has little to support it. It seems improbable that any further useful and genetically relevant subdivision of schizophrenia can be effected on purely clinical grounds. Further progress awaits developments in the discovery of endophenotypes and the application of molecular genetic marker strategies.

It is widely believed by psychiatrists that patients who require behavioural psychotherapy need to be referred for such treatment to a specialist in the subject. Two assumptions underlie this idea. One is that behavioural treatment requires a detailed knowledge of learning theory which is possessed by few psychiatrists. The other assumption is that behavioural methods are too time-consuming for a busy psychiatrist in a routine outpatient or primary care clinic.

Over 70 prevalence studies of schizophrenia published since 1948 are reviewed. Despite problems of method, the studies suggest that there may be significant differences in prevalence among different populations and that prevalence may change over time. Further research is needed on how much differences in diagnosis or the course of schizophrenia contribute to the variable prevalence rates. The paper suggests the following as areas for additional enquiry: a possible north-south gradient, special populations (e.g. American Hutterites, northern Swedes, western Irish, castes in India) and ongoing case registers in areas of suspected high and low prevalence.

The evidence for an association between hostility and deliberate self-poisoning is reviewed. Although the concept of hostility is poorly defined and different measuring instruments may not measure the same entity, self-poisoning subjects as a group appear to have very high levels of hostility. However, depression is also associated with hostility and when studies have taken into account the psychiatric diagnosis of overdose patients it is outwardly-directed hostility which distinguishes these individuals from other psychiatric patients or normals. A model is proposed to show the inter-relationships of hostility, depression and self-poisoning.

Information on 19 women convicted of indecency and 62 women convicted of other sex offences was examined. Those convicted of indecency offences often had poor social skills and had a high incidence of mental illness, mental handicap and alcoholism. Two were convicted of indecent exposure, a rare offence in women. In 39 (63%) of the sex offences with individual victims, the victims were children and in 9 cases the offender was the mother or step-mother. In 25 cases the women were convicted of aiding and abetting a male offender. Of those convicted of indecent assault on persons under 16 and of gross indecency with children, 48% had a previous history of psychiatric disorder.

There is little information available on psychiatric disorder in homeless women. This study compares clinical casenote information of all homeless women admitted to an East London psychiatric hospital from 1971–1980 inclusive, with information on a cohort of homeless men admitted during the same period. The results show that the women appear to have been socially more stable than the men prior to admission and yet they have less satisfactory admissions to hospital. Possible reasons for these apparent inconsistencies are discussed.

The limited literature on the pedigrees of tiqueurs, including those with Gilles de la Tourette's syndrome, is reviewed. Most statistical analyses have been restricted to affected family members without specifying the unaffected ones. The present statistical analysis of a series of child tiqueurs, including 91 probands and 1293 first- and second-degree relatives, 46 of whom were tiqueurs, predicts the odds on being a tiqueur for individuals, and establishes how those odds are affected by certain explanatory variables using log-linear models. The data do not confirm a familial pattern beyond reasonable doubt, but if the suggested prevalence of tics in the population is 10% then the figure for parents is large enough to support a familial hypothesis. The pedigrees do not indicate a simple mode of genetic transmission. Further research is needed to confirm that there is a connection between childhood tics and Gilles de la Tourette's syndrome, to establish that the predisposition to tics is familial, and, if so, whether there is a complex genetic mechanism involved, or some other environmental aetiology so far undisclosed.

This study describes 47 cases of paranoid psychosis occurring for the first time after the age of 60. Cases were drawn from the Camberwell catchment area and were followed up for 10 years or until death. The clinical picture of patients showed few differences from those described in earlier studies. Subgroups are described with contrasting clinical features and differing outcome. The findings suggest that late paraphrenia is a heterogenous syndrome giving the appearance of a spectrum of overlapping conditions with paranoid delusions.

A review of all known schizophrenics (n = 142) in Nithsdale, Scotland, found 50% were living with relatives or friends. Of these, 32% had high contact with a relative showing high expressed emotion (EE); put another way, 87% of all Nithsdale schizophrenics were not living in a high contact/high EE family. Parents were more critical than spouses, and more showed emotional over-involvement. A retrospective review showed a trend, not of statistical significance, towards a higher admission rate to in-patient care in patients from high EE homes. Of relatives believed by a consultant psychiatrist to be neither critical nor hostile, 80% fell into the low EE category, but only 44% thought hostile or critical belonged to the high EE category; that is, the clinician had a wider view of high EE than the Camberwell Family Interview. Relatives' scores on a short patient-rejection scale were higher in high EE than in low EE relatives, but the wide scatter of scores suggested the scale could not be used to identify an individual relative with high EE.

A brief educational intervention with families living with a schizophrenic relative is described and evaluated in terms of benefits for relatives' well-being and patient recovery. Education led to considerable knowledge gains and to reductions in relatives' reported stress symptoms and fear of the patient. There was a trend for relatives to be more optimistic concerning their role in treatment. At 6 months follow-up, only knowledge gains were maintained; however, relatives' perceptions of family burden were significantly reduced. The evidence suggests that family education may be useful both as a cost-effective intervention in its own right and in facilitating a more receptive attitude to subsequent family intervention.

This clinical trial of a new antidepressant, fluoxetine, shows it to be as effective as a standard tricyclic drug, imipramine. It is effective as a single daily dose and is free of any significant side-effects. It is less sedative and appears to cause fewer problems of weight increase. The three scales used to assess efficacy showed a very positive correlation.

Three studies are reported. In study 1, vanadium concentration was estimated by neutron activation analysis in hair, whole blood, serum and urine from 13 patients suffering from depressive psychosis and then when on recovery- Vanadium concentration of hair, whole blood and serum decreased significantly with recovery, but there was no significant change in 24-h urinary excretion or in renal clearance of vanadium. In study 2, vanadium concentration was estimated by neutron activation analysis in serum and urine of 31 patients with depressive psychosis and of 27 normal controls. Mean renal clearance of vanadium was significantly lower and mean serum vanadium concentration significantly higher in depressed patients than in controls. Mean 24-h excretion of vanadium did not differ between the two groups. Vanadium excretion did not correlate with urine volume, with serum concentration or with age. In study 3, erythrocyte Na-K ATPase activity and serum vanadium concentrations were estimated in 58 patients. There was a strong negative correlation between the two, supporting the suggestion that changes in tissue vanadium concentration may explain the changes in sodium transport which occur in depressive psychosis.

Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period resulted in 54 087 births: 120 psychiatric admissions within 90 days of parturition. The ‘relative risk’ of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia.

A systematic endocrine investigation in dementia, depression and control subjects showed that plasma growth hormone (GH) was higher in the morning and plasma TSH concentrations were higher throughout the day in Alzheimer-type dementia (ATD) than in age-matched depressed patients (MDD), and plasma TSH concentrations were also higher throughout the day in female ATD compared with age-matched female control subjects. The increased plasma TSH concentrations could not be due to reduced negative feedback because plasma T3, T4 and rT3 were in the normal range. Plasma concentrations of oestrogen-stimulated neurophysin (ESN) were lower throughout the day in ATD compared with MDD and controls and lower in the morning compared with other dementias. The high plasma GH and TSH concentrations in ATD may reflect the reduced hypothalamic content of somatostatin in ATD, and the reduced concentrations of ESN may reflect reduced cholinergic activity in ATD prain. These selective hormonal changes provide a useful diagnostic test for Alzheimer's disease.

Basal plasma luteinising hormone concentrations and the LH responses to LH-releasing hormone injection were higher in 11 young men after recovery from mania than in 15 control subjects. Since plasma concentrations of testosterone and sex hormone binding globulin were similar in the recovered manic compared with the control subjects, the increased LH response to LHRH is likely to have been due to the priming effect of LHRH consequent on an increased release of LHRH into hypophysial portal vessel blood. Abnormal control of LHRH, and thereby LH release, is a state-independent feature in male patients with mania and may be a useful trait marker for this disorder.

In a double-blind trial lasting 4 months in 42 mentally handicapped patients, the effect of lithium on aggression was assessed in comparison with placebo. In the lithium-treated group, 73% of patients showed a reduction in aggression during treatment. There were significant differences in mean weekly aggression scores and in the frequency of aggressive episodes between the lithium and placebo groups. Side-effects were noted in 36% of the lithium group (and 20% of the placebo group), but were mainly transitory. There were no episodes of toxicity, and no patients had to be withdrawn from the trial. Lithium appears to be worth a 2-month trial in such patients, where repeated aggression has not been relieved by more appropriate placement, occupation or company.

A case of mania subsequent to head injury is presented. The literature reporting cases of mania after head injury is reviewed. It is suggested that the concept of Secondary Mania be broadened to include cases occurring after head injury. It is also suggested that a true bipolar illness can be secondary.

Kennedy (1946) stated that “A compensation neurosis is a state of mind, born out of fear, kept alive by avarice, stimulated by lawyersand curedby a verdict”. This theme, supported by Miller's influential paper in 1961, has ensured that genera tions of patients havebeenregardedwith suspicion if they daredto presentwith psychologicalsymptoms following an accident. The view remained un challenged for over a decade and is still often presentedto, and acceptedby, our Courts, despite the fact that Miller reached his conclusions after examiningpatientwsho presentefdorlegarleports in whose casesit was not surprising that he found a relationship betweencompensation and psycho logical sequelae The psychological effects of proceeding litigation on the victim of an accident remain a matter of current debate. McKinley et al (1983), reported differences betweenthose patients suffering a severeblunt headinjury claimingcompen sation and those not claiming compensation. The reports givenby relativesof changesin both patients werevery similar. However, reports given by patients themselves differed with claimants reporting slightly more symptoms than non-claimants. In a study by Whitein 1981, the author followed up 163 victims of accidents admitted to the Birmingham Accident Hospital (76 burns and 87 general accidents). One year after their accident, psychological sequelaewere found in approximately two-thirds of the group, one third being moderately-to-severely psychologically affected. There was no statistical difference between those victims in whom the accident had given rise to litigation and in whom the case was still proceeding and those victims where compensation was not an issue.

Oxygen saturation was measured during anaesthesia and electroconvulsive therapy (ECT) using ear oximetry. Significant hypoxia occurred during some treatments; desaturation related to the number of ventilations performed after muscle relaxation and prior to the shock. Desaturation did not correlate significantly with seizure duration. These findings highlight the need for adequate oxygenation during ECT.

A case of anorexia nervosa associated with gastric rugal hyperplasia in a 36-year-old male is reported and some speculations are made about the relationship between these two conditions.