For a long time, monoamine oxidase inhibitors (MAOIs) have been the Cinderella drugs of psycho-pharmacy. Although they were introduced just before the tricyclic antidepressants (TCAs), they rapidly became second-line treatments. Several factors contributed to this, in particular the dietary restrictions, the scattered reports of death from overdose and/or toxic interactions, and the unfavourable reports on the efficacy of phenelzine in depression from, among others, the Medical Research Council trial (1965). For a number of years afterwards, prescription of these drugs was limited to a few enthusiasts. More recently, however, their popularity has increased owing firstly to a re-evaluation of their effectiveness in tricyclic-resistant depression and in anxiety disorders, and secondly to growing awareness of the exaggerated claims made about their dangerousness (Pare, 1985).

Brain damage can induce anomalous neuronal connections in experimental animals, which can sometimes result in maladaptive behaviour, particularly when damage occurs early in development. Anomalous patterns of neuronal connection can also arise from genetic disorders. In humans, neuronal misconnections could be involved in a variety of psychiatric disorders. For example, they may account for the link between hyperkinesis and childhood hemiplegia, and for the link between schizophrenia and ‘alien tissue’ lesions of the temporal lobes. Predictions from misconnection hypotheses can potentially be tested in neuropathological, neurophysiological, and clinical studies.

Findings on the efficacy of day-hospital and community treatment for acutely ill psychiatric patients have been contradictory. This review confirms the methodological problems previously noted, but highlights the variation in feasibility of day care: staffing levels and the attitudes of staff appear to have been responsible, along with the severity and chronicity of illness. The comparison of day and in-patient care to see which is 'superior’ has been unrewarding, and further research is needed. Day-hospital treatment is unlikely to be more widely used for acutely ill patients until: (a) there is clear evidence that certain patients are best treated in this way; (b) the social and clinical characteristics of such patients are defined; (c) adequate staffing is achieved (i.e. day care is not regarded as a cheap option); and (d) day centres are available for chronic patients.

Genetic factors in the aetiology of Alzheimer's disease (AD), are now being intensively investigated. The homogeneity of AD is under investigation. There are a few large kindreds with early onset of AD in whom transmission appears to be typically autosomal dominant, and 65% or more of the remaining cases at any age may have genetic aetiology. Both multifactorial and autosomal dominant inheritance with age-dependent expression have been proposed, but the late onset and death of unaffected relatives from competing causes make it difficult to choose between them. Lifetime risk gives the best estimate of incidence in family studies, but clinical and pathological criteria are not clear enough for confident diagnosis of AD in late old age. A role for external factors is indicated by twin studies, and the role of aluminium is currently under investigation. Molecular genetics promises to resolve many questions. The clinicians' role will be to provide well documented families for interdisciplinary research and to help in clarifying diagnosis in late old age.

The majority of patients with bipolar affective disorder relapse at least once during their lifetime, most several times, often with disastrous consequences. In this review we examine those factors which appear to play a facilitatory and in some cases, a causal role in determining whether a relapse will occur and, if so, when. Such factors include: the season of the year, with most admissions for mania in the British Isles occurring in the summer months; change in endocrine status, as after childbirth or when there is impaired thyroid function; treatment with drugs affecting central monoamine, particularly dopamine, neurotransmission; untoward life events. We evaluate the relative efficacy of treatments for the prevention of relapse, such as lithium, carbamazepine and antipsychotics, in the context of social and psychological support systems.

Severity of psychiatric illness was assessed using standardised clinical and social measures in 69 in-patients and 41 day patients admitted consecutively from the community. Day and in-patients differed little in terms of psychiatric symptoms and social disability, especially if compulsory admissions were excluded. Protection of self or others was a common reason for in-patient admission given by clinicians, who were otherwise prepared to treat seriously ill patients in the day hospital. Very few of the day patients had to be transferred to the in-patient facility, and at three months and one year the two groups showed similar improvements. It is concluded that day treatment is feasible for some seriously ill psychiatric patients, but a random-allocation study is required to assess more completely the efficacy of day treatment, and define the characteristics of those who require in-patient admission.

This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging.

Seventy-eight opiate abusers were followed up after successful in-patient detoxification in order to examine renewed opiate use. The greatest number of initial lapses occurred within a week of subjects leaving in-patient treatment. Eleven categories of lapse precipitant were identified: cognitive, mood, external, withdrawal, interpersonal, leaving a protected environment, drug availability, drug-related cues, craving, priming, and social pressure. Cognitions, negative moods and external events emerged as the most commonly mentioned factors; these often occurred together, either in clusters or in a sequence. Implications of these results for models of relapse and for treatment approaches are discussed.

This study investigates and compares the responses of 132 opiate addicts to a 10-day or a 21-day in-patient oral methadone withdrawal regime. For both groups, symptom severity (on the Opiate Withdrawal Scale) steadily increased through the methadone withdrawal phase, and peaked near the point of completion of the prescribed drug, declining slowly thereafter. Patients on the 10-day programme reported significantly higher peak withdrawal scores than those on the 21-day programme. Although the proportions who completed detoxification were similar, there was a significantly higher drop-out rate immediately after detoxification for the 10-day group. The possible benefits and handicaps of the two withdrawal schedules are considered and recommendations are proposed for further refinement of the present widely adopted approach.

A study was conducted using data obtained from the first stage of a community survey in Spain, in which the 60-item version of the GHQ was administered to 1224 adults. Three hypotheses concerning respondents aged under 55 years were tested. The first was that in the context of a principal-components analysis, a greater proportion of the explained variance would be accounted for by the first (general) factor in women than in men. This was supported. The second hypothesis was that the intercorrelations between the GHQ-28 subscales would be greater for women than for men. This was refuted. The third hypothesis was that the differentiation between anxiety and depression would be greater in men than in women. This was supported. The differences investigated were found not to apply among respondents aged 55 years and over.

Absence of patients without leave is common in psychiatric hospitals, and causes anxiety to staff, relatives, and the lay public. Such incidents are difficult to predict. This study attempted to identify the characteristics of patients absconding from a UK hospital over one year. Numbers were small, as those patients discharged against advice and failing to return from leave were excluded. Absconders were predominantly male, young, compulsorily admitted, and discharged with a diagnosis of schizophrenia. They tended to be single, had many previous admissions, and a longer total length of stay, and the police were more often involved in their admission. Reasons for absconding and the implications for management of newly admitted psychiatric patients are discussed.

To determine the usefulness of the DST in differentiating depression from dementia, the test was administered to three diagnostic groups of psychogeriatric patients: depression; dementia; and dementia with depression. Clinical assessments were supplemented by ratings on the HRSD and SCAG, as well as by EEG and CT. All three groups showed a high incidence of abnormal DST results unrelated to presence or severity of affective symptoms, but showing a better association with SCAG and its ‘organic’ subsets. The mechanism(s) underlying these abnormal results may reflect organic brain disease. The usefulness of the DST in differentiating depression from dementia in the elderly was not confirmed.

Two-stage screening for minor psychiatric morbidity was carried out with a consecutive sample of 256 patients aged 15–69 consulting an experienced GP in a semirural setting over a seven-week period. Patients completed a short GHQ, and the GP made a standardised assessment of the reason for consultation and the degree of psychological disorder. A 40% random subsample were evaluated using PROQSY, a newly developed computerised psychiatric assessment based on the CIS. PROQSY is acceptable to patients in general practice, and yields an estimate of the prevalence of minor psychiatric morbidity (33%), and validity indices for the 12-item, 28-item, and 30-item GHQs, comparable with those found in similar studies, when the CIS has been administered by an interviewer. PROQSY may be recommended as a research tool, providing a criterion measure of minor psychiatric morbidity in general practice, where it may reduce time and manpower, and eliminate interviewer bias.

Further analysis of outcome data from the Sheffield Psychotherapy Project suggested that one of the principal therapists was responsible for most of the reported advantage of Prescriptive over Exploratory treatment.

Thirteen patients presenting with morbid jealousy were treated using a cognitive approach adapted from Beck's cognitive therapy for depression. Cognitions in morbid jealousy showed the characteristics of automatic thoughts as described by Beck, and were based on faulty assumptions derived from interpretations of past experiences. The cognitive treatment directed mainly at the faulty assumptions resulted in improvements in ten patients and no change in one; two patients dropped out of treatment. The results are considered encouraging.

Life events in 82 self-poisoning subjects were studied using the Bedford College LEDS to see whether there was a difference between those who had a clear depressive syndrome (according to the Present State Examination) and the remainder. Equally high levels of severely threatening events were found in the depressed and non-depressed groups, but the former were older, had experienced more chronic difficulties and had been treated more often in the past for depression. Greatest numbers of life events were found in those with high levels of extrapunitiveness (recorded on the HDHQ), whereas those who had not experienced a severe life event showed predominance of intropunitiveness. Suicidal intent was not related to experience of life events, but has previously been shown to be associated with high intropunitiveness. The findings are discussed in the light of current theories linking life events, depression and parasuicide, and emphasise the need for longitudinal studies to examine these factors in relation to repeated parasuicide.

Expressed emotion (EE) in key relatives of 21 patients with bipolar affective or schizoaffective psychoses was assessed by the CFI. All patients had been on prophylactic lithium for at least three years and were without psychotic symptoms at interview. The relationship between relatives' EE status and patients' course of illness was studied both retrospectively and prospectively. Two critical remarks designated high EE. The relatives' EE status was not related to number of hospital admissions or to severity and length of recurrences if the entire period of lithium treatment is considered as a whole. However, patients living with high-EE relatives showed a significantly poorer response during the three years before interview, and an even poorer response in the nine-month follow-up.

Gastric emptying of a mixed meal was measured in 22 patients with anorexia nervosa, ten with bulimia nervosa and ten controls. Ratings on a visual analogue scale (VAS) were made during the test. Patients with anorexia nervosa felt fuller and less hungry than controls, although satiety was not related to gastric emptying rate. Controls showed a correlation of about 0.6 between gastric contents and reported hunger and satiety. Patients with anorexia nervosa had significantly lower correlations between gastric contents and hunger, but normal correlations with fullness. Significant correlations were often observed between gastric contents and symptoms of eating disorder in both anorexic and bulimic groups, but not in controls.

“Functional psychosis is conventionally subdivided into schizophrenia and manic depressive psychosis. Response to treatment is assumed to be a validating criterion for these diagnoses. The efficacy of pimozide (a dopamine antagonist neuroleptic), lithium, and a combination of the two was compared with that of placebo in a 4-week trial in 120 functionally psychotic patients, each of whom was assessed for psychotic symptoms, manic symptoms, and depressive symptoms. The sample was subdivided into patients with predominantly elevated mood, predominantly depressed mood, and no consistent mood change. Pimozide reduced psychotic symptoms in all groups of patients. The only significant effect of lithium was to reduce elevated mood. Thus dopamine blockade seems relevant to the resolution of psychotic symptoms in all types of ‘functional’ psychosis, but the mode of action of lithium in psychotic patients concerns only mood. Application of standardised classifications of functional psychosis to these data did not change this conclusion.”