An instrument for assessing and evaluating what relatives know about schizophrenia was evaluated as both a pre- and a post-test for an educational programme. The Knowledge About Schizophrenia Interview (KASI) places emphasis on the functional value of the reported knowledge rather than on the recall of information; it is quick, easy to administer, can be rated reliably, and has face-validity for the relative. The educational programme increased scores from pre-test to a post-test one week after the programme. Relatives with high criticism ratings on the Camberwell Family Interview had lower scores at both tests. Relatives of less chronic patients showed lower scores at pre-test and acquired significantly more information from the programme, while relatives of more chronic patients were less influenced by the information sessions.

Abnormal auditory brain-stem responses (ABRs) were recorded in 10 out of 20 schizophrenic in-patients. The response abnormalities did not show any correlation to the degree of psychopathology, sub-group of schizophrenia, age, sex, or cerebral ventricular enlargement. Nor was there any correlation to previous neuroleptic treatment: a pathological ABR was recorded in 5 of the 8 patients who had never received such medication. A statistically significant relationship was found between ABR pathology and auditory hallucinations: 9 of the 11 patients who admitted having hallucinations exhibited brain-stem response abnormality, whereas ABR abnormality was recorded in only 1 of the 9 patients who denied having hallucinations. The data imply that brain-stem dysfunction is involved in the psychopathology of schizophrenia, and that interference with the auditory pathways in the brain-stem may induce auditory hallucinations in schizophrenic patients.

The Quality Extinction Test was used to detect lateralised abnormalities of hemispheric functions in schizophrenic patients. Course of illness significantly affected the distribution of tactile extinctions, chronic patients showing more left-side extinctions than sub-chronic ones. Age significantly affected the number of left extinctions, and sex the number of right extinctions. The importance of clinical and epidemiological characteristics of the patients in determining the quality and degree of hemispheric dysfunction in schizophrenia was confirmed.

A group of 118 patients with a hospital diagnosis of schizophrenia was reviewed. The incidence of suicide attempts was significantly correlated with more frequent past psychiatric admissions, more frequent past diagnoses of schizophrenia, and poor work function. The apparent relationships could be spurious or based on a reversed causal sequence; for example, suicide attempts are likely to be followed by psychiatric admissions.

A historical review of suicide in Fiji shows that rates for people of Indian descent have always been higher than those of other groups, yet until now this phenomenon has attracted little official or public attention. Recent changes in the incidence and methods of suicide have led to the introduction of some preventive measures, but the emphasis has been on eliminating some of the methods rather than the reasons for suicide. The continuing high incidence of suicide by hanging involving some sectors of society appears to have been overlooked. Possible causes of this apparent lack of interest are examined, such as the low status historically of Indian immigrants and concepts held about them by other groups in Fiji, and the ‘invisibility’ of groups of people such as rural women and the aged.

Variations in clinical features associated with unemployment among a sample of male parasuicides were examined. Employed and unemployed persons did not differ in mean scores on the Suicidal Intent Scale, but the unemployed were rated significantly worse on measures of depression (Beck Depression Inventory) and hopelessness (Hopelessness Scale). A covariance analysis showed that hopelessness, rather than depression, is the important discriminator. Different patterns of relationships between the three clinical measures were observed in the two groups. Hopelessness may be a key social-psychological variable for inclusion in any model of the pathways which link unemployment with parasuicide.

The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.

Family-genetic studies of child and adult psychiatric disorders have become increasingly fashionable over the past decade. The development of structured diagnostic interview schedules, the emergence of uniform diagnostic criteria such as DSM-III, and the use of refined design and analytic techniques from the field of chronic disease epidemiology have made substantial contributions to the methodology of such studies. Advances in molecular genetics, particularly our emerging capacity to perform chromosomal linkage studies throughout the human genome, have renewed hope that the constitutional underpinnings of some psychiatric disorders can be identified and that the pathophysiology of these disorders can be elucidated. Family-genetic techniques in child and adult psychiatry are discussed with a particular focus on their potential value in validating diagnostic categories spanning developmental epochs.

As part of a larger study, a brief rating-scale was developed which focusses on the mid-adolescent phase of development. Completed by teachers, the questionnaire has an inter-rater reliability of 0.78, with a test-retest correlation of 0.82. When the performances of various screening instruments were compared it became clear that no single questionnaire was obviously more efficient than the others at detecting potential disturbance in an urban adolescent population. Indeed, different questionnaires seemed to highlight particular facets of functioning. The Newcastle Adolescent Questionnaire proved to be a reliable and valid screening measure.

Mood assessments were made after six months of 149 survivors taken from a register of all patients admitted to hospital with acute stroke. Using a General Health Questionnaire score of 12 or more as a criterion of important affective illness, its prevalence was 23%. There was no difference in risk of affective illness between left and right hemisphere strokes. Affective illness was strongly associated with functional ability, with limb weakness and with longer hospital stay in those with good functional recovery. Only 15% of those with high scores were receiving antidepressant drugs. The general practitioner is in the best position to detect psychiatric illness in stroke survivors; the use of mood rating scales such as the GHQ, in conjunction with clinical assessment may improve detection.

New psychiatric out-patients with depressive, phobic, and anxiety neurosis were randomly allocated to out-patient care or to one of two types of day hospital treatment one specialising in psychotherapy and the other offering all forms of day care. Of 106 patients who entered the study, 78 had assessments of psychiatric symptomatology and social adjustment both before treatment and after 4, 8 and 24 months. There was no significant difference in outcome between depressive, phobic, and anxiety neurosis, and no overall difference in response to treatment between the three types of care. Suicidal symptoms were significantly less common in out-patients. In many respects, neurotic disorder can be regarded as a single syndrome.

The relationship between cognitive function and violence in 76 remanded prisoners, without formal psychiatric illness, was investigated. The violent group tended to be of slightly lower general ability than the non-violent group, but not abnormally so in relation to the general population; no relationship was found between specific patterns of cognitive functioning and violence. The violent group reported significantly higher levels of neurotic symptoms than the non-violent group, and were more socially deviant. To a small extent general intelligence (reasoning ability), in interaction with many other factors, may be related to a propensity for violent behaviour, but no particular aspect of cortical functioning seems to be related to violence.

Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1, relaxation time rose immediately after the fit reaching a maximum 4–6 h later. The T1, values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

During 1984 there were 253 admissions to the in-patient drug dependence treatment unit at Tooting Bec Hospital. Of the 198 patients responsible for these admissions, 60% were male and 43% were over the age of 30 years. There were 151 patients admitted for opiate detoxification, and 75% completed the withdrawal schedule. However, only 15 out of 25 patients admitted for benzodiazepine withdrawals were found to be physically dependent. Other reasons for admission included stabilisation of the dose of opiate (24%) and the treatment of physical complications of addiction.

The ‘gains' of Munchausen syndrome cannot readily be understood on a rational level, and are presumed to be intra-psychic. The presenting fabrications often follow a remarkably similar pattern, and some psychodynamic insight might be gained by analysis of the general themes and contents. The case of one typical patient is reported here, and the aetiology and symbolic significance discussed.

The demographic features, clinical picture, antecedent events and family background in 13 male patients with anorexia nervosa are compared with those in a control group of 39 adolescent female anorectics; the general picture of the illness in males is similar to that in females. Focusing on a group of males, usually less vulnerable to anorexia nervosa, can highlight possible predisposing factors.

Data from a group of males aged 13 to 23, who as children exhibited extensive cross-gender behaviour, was analysed. In boyhood they frequently played with dress-up dolls, role-played as females, dressed in girls' clothes, stated the wish to be girls, primarily had girls as friends, and avoided rough-and-tumble play. The majority of the group evolved a bisexual or homosexual orientation; two types of behaviour, boyhood doll play and female role-playing, were found to be associated with later homosexual orientation. The findings suggest developmental associations between specific types of boyhood cross-gender behaviour and the objects of later sexual arousal.

Spinal fluid concentrations of the three major monoamine metabolites were examined in 25 infantile autistic children and 12 children with other childhood psychoses, and were contrasted with results obtained in normal children and in groups of children with neurological and neurodevelopmental disorders. Autistic children showed absolute and relative increases of the dopamine metabolite homovanillic acid. The group with other childhood psychoses also showed an increase in HVA level; in this group there were also indications of high levels of serotonin and norepinephrine metabolites. The results are discussed in the context of a pathogenetic model for autism involving hyperfunction of dopaminergic nerve fibres in the brain stem-mesolimbic system.

Psychiatric morbidity was assessed in a sample of 88 adult epileptic patients drawn from general practices in South London. Using the Clinical Interview Schedule, 48% emerged as psychiatric cases. When either total CIS score or caseness status was used for comparison, group differences were evident; patients with temporal lobe epilepsy and focal non-TLE did not differ, but each was significantly more impaired than those with primary generalised epilepsy. The groups also differed in their psychiatric symptom profiles. The results suggest that the increased prevalence of interictal psychopathology commonly associated with TLE may also be a feature of other forms of focal epilepsy.

The effects of nortriptyline, phenelzine, and placebo on 13 symptoms of depression were compared in 75 patients, aged 55 or over, who were suffering from major depression. Nortriptyline and phenelzine were more effective than placebo in treating depression mood, guilt feelings, suicidal ideation, agitation, anxiety, loss of energy, and a.m. diurnal variation of mood. Nortriptyline was better than phenelzine or placebo in improving middle/late insomnia. Most of the symptoms did not show significant improvement until the fourth week of treatment.