Publications on the acquired immunodeficiency syndrome (AIDS) have reached such a pitch that leading medical journals have received letters of protest (Kubin, 1989), and some have been forced to defend themselves for the space they devote to the subject (Lock, 1989). While some consider that their problems have been ignored and that AIDS is attracting too much money and publicity (Adler, 1987), others believe AIDS research and clinical services are grossly underfunded (Rogers, 1989). Perhaps because modern medicine has rarely encountered such a completely ‘new’ disorder the fascination is great, no less in psychiatry than in other fields. An editorial in the Lancet (1989), just before the annual International Conference on AIDS, reminded us bluntly of the crucial questions: how many cases of HIV infection had been prevented in the year since the previous conference, and how many would be prevented before the next?

“All tragedy is the failure of communication”

(Wilson, 1956)

From time to time, general psychiatrists are asked to supervise offender patients who have been conditionally discharged into the community either by direction of the Home Secretary or by a Mental Health Review Tribunal (Mental Health Act 1983, sections 42(2) and 73(2)(4b)). In addition, they may be asked occasionally to provide psychiatric management for offenders released by the Home Secretary on life licence (Criminal Justice Act 1967, section 61). The effect of a conditional discharge following compulsory admission to hospital care by a court under a restriction order (Mental Health Act 1983, sections 37/41) is similar to that of a life licence.

Behaviour therapy and benzodiazepines are directed towards common problems and are often used in combination. At present we know little about the beneficial or adverse interactions of these two treatments. This paper reviews the available literature and suggests that there are important theoretical and clinical issues to be resolved.

A prospective inquiry of a largely working-class sample of women with children considers the effect of employment on risk of developing clinical depression. The hypothesis was that there would be a direct protective effect arising from employment once quality of other support was taken into account. In fact full-time working mothers were at high risk. This appeared to be explained by either prior work strain or a severe event involving ‘deviant’ behaviour on the part of husband/boyfriend or child. Neither factor was relevant for part-time workers. The severe events appeared to be particularly depressogenic for full-time workers because they represented either failure in the motherhood role or a sense of entrapment in an unrewarding work/domestic situation. However, those in part-time work had a low rate of onset compared with non-workers, and the difference appears to be related to non-working women feeling less secure about their marriages.

Dr Montagu Lomax worked as an assistant medical officer at Prestwich Asylum for two years from 1917. His book, The Experiences of an Asylum Doctor, was published in 1921. He was condemned by the psychiatric establishment for his description of inhuman, custodial, and antitherapeutic conditions. Access to previously confidential official papers, to the archives of Prestwich Hospital, and to Professor George Robertson's correspondence has permitted a reconstruction of the Lomax affair. Lomax was a dedicated and sincere clinician. Senior Ministry of Health officials regarded Lomax's book as “temperate”, “well founded”, and an opportunity to secure public support for long needed legal and administrative reforms. Through his book, Lomax made a lasting contribution to the cause of mental health reform.

A sample of 46 subjects experiencing musical hallucinations was analysed – 10 new cases in addition to 36 culled from the literature. When compared with controls, it was found that musical hallucinations are far more common in females, and that age, deafness, and brain disease affecting the non-dominant hemisphere play an important role in their development. Psychiatric illness and personality factors were found to be unimportant.

Based on evidence from patients with epilepsy who develop a schizophrenia-like illness, it is argued that the first-rank symptoms of Schneider are closely related to temporal lobe pathology, particularly in the dominant hemisphere. It is suggested that the first-rank symptoms should be seen as signifiers of temporal lobe pathology, as opposed to being pathognomonic for schizophrenic illness.

This study analyses the relationship between contextual processing ability and symptom and social status in schizophrenia. The results showed that current symptom status is related to occupational status, and contextual processing is related to current symptom status and employment history. Current symptom severity in chronic schizophrenics may indicate an increased frequency and/or duration of symptom episodes in the past, and therefore an increase in the periods in which contextual processing was disturbed, which would therefore account for the observed decrease in work achievements.

A computer-assisted analysis of samples of free speech from acute schizophrenics (n = 50), chronic schizophrenics (n = 27) and normal subjects (n = 50) enabled a comparison of the linguistic profiles of the three groups. The chronic group consistently emerged as the most impaired, on measures of complexity, integrity (error) and fluency of speech, with the acute patients performing less well than normal speakers but better than chronic patients. Demographic differences could account for only a small number of the linguistic differences. A comparison of chronic schizophrenics from the community and those from long-stay wards suggested that their poor linguistic performance was in some way related to the illness process and not to institutionalisation. Three possible explanations for these results were considered, particularly the possibility that low complexity of speech, negative symptoms and poor outcome are in some way related.

To investigate whether language in schizophrenia deteriorated progressively, 11 schizophrenic subjects, 9 manic subjects and 9 controls were re-tested after an interval of three years using the computer-assisted syntactical analysis technique of Morice. In 13 of the 16 linguistic variables described as hallmarks of schizophrenic speech decline, deterioration was noted in schizophrenics in the direction predicted and relative to the manic and control groups. The deterioration was most pronounced in complexity and integrity of speech. One variable remained unchanged and two (semantic variables) showed marginal improvement. It was concluded that language, and in particular syntax, does deteriorate in the schizophrenic process.

Local cerebral uptake of glucose labelled with fluorine-18 was measured by positron emission tomography in 13 patients with schizophrenia and 37 right-handed volunteers. Patients received no medication for a minimum of 31 days and a mean of 30 weeks. The subjects were administered the labelled deoxyglucose just after the beginning of a 32-minute sequence of blurred numbers as visual stimuli for the Continuous Performance Test. In normal controls, task performance was associated with increases in glucose metabolic rate in the right frontal and right temporoparietal regions; occipital rates were unchanged. Patients with schizophrenia showed both absolutely and relatively reduced metabolic rates in the frontal cortex and in the temporoparietal regions compared with normal controls.

Thirty-two epileptic patients with RDC diagnoses of schizophrenia were tested for handedness on the Annett Handedness Schedule, and handedness was assigned on the basis of Annett–Maudsley criteria. They were compared with three other groups of patients. Five (15.6%) of the epileptic schizophrenic patients were mixed or left handed. The prevalence of mixed and left handedness did not differ between the samples studied. However, there was a significant reduction of mixed and left handedness in male epileptics with schizophrenia. Mixed or left handedness in male epileptics appears to be protective against the development of psychiatric illness in general.

Magnetic resonance imaging (MRI) was used in patients with epilepsy and psychosis. From 50 patients with epilepsy, a subgroup of 12 patients were categorised by the Present State Examination (PSE) as having nuclear schizophrenia (NS) and then compared with an epileptic control group with no psychiatric history. Further, patients with hallucinations were compared with patients without hallucinations. No differences in T1 relaxation times in any regions of interest were noted in the NS group compared with the other group. However, patients with hallucinations had a significantly higher T1 value in the left temporal lobe. These findings support the concept that specific abnormalities in limbic system structures relate to the phenomenology of the psychoses of epilepsy, especially left temporal lobe epilepsy.

Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department. This group was then randomly allocated to hospital admission (38 cases) or discharge home (39 cases). One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms, and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. This lends support to recent government recommendations, but caution should be exercised before such a result is generalised.

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14–20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.

In a medium-sized Canadian city, 581 randomly selected households were contacted and responded to a survey on the impact of parental alcohol problems. Twenty-two per cent of the respondents indicated that at least one of their parents had a drinking problem. The biological father was affected in 81%. Compared with the rest of the sample, the adult children of problem drinkers were younger but they did not differ in income or education. Adult children of problem drinkers were more likely to have parents who were divorced or separated; to be divorced, separated, or remarried themselves; to be heavy drinkers and have indications of alcohol problems; and to use more sources of help for problems with stress and anxiety and problems with alcohol. They did not differ from those without parental drinking problems on measures of current positive and negative affect.

Six patients who had delusional convictions that they were malodorous were followed up for between six months and four years. Difficulties encountered in clinical settings in differentiating overvalued ideas, delusions, and hallucinations arise from lack of clarity of psychopathological terminology. Schizophrenia and depression are closely related to the syndrome.

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice.

The stage theories of personality development, such as those of Piaget, Freud, and Erikson, are not currently popular, in part because of misunderstandings about the supposed restrictions of timing and of confines of developmental stages. But the stage theorists did draw attention to newly appearing, qualitatively different cognitive, emotional, and behavioural systems of interaction, which come into being sequentially as children grow up.

The main task of vocational rehabilitation facilities is to help people to return to work or, if they have never worked, to find a job for the first time. In the past seven years controversy has surfaced with regard to the role vocational rehabilitation plays in the economy. Some authors have claimed that it implicitly supports an ideology of individualism which actually acts against the interests of people with mental health problems looking for work. While accepting the need to offer a work adjustment service, these writers make a case for further socio-political intervention to help clients. The purpose of this article is to explore some of these ideas and examine their practical implications.