One of the targets of Durkheim's criticism, in his masterly book Le Suicide (1897), is the view upheld (according to him) by all 19th-century French alienists that suicide was, in all cases, a form of madness (henceforth, the ‘absolutist’ or ‘psychiatric’ hypothesis). Durkheim's view is important, particularly among sociologists, and lest they, and other readers, are led uncritically to accept his version of 19th-century French psychiatric views on suicide, it would seem important to put the historical record straight. The relevant literature is vast, and only representative writers are included in this paper. It is not the purpose of this paper to deal, in any way, with Durkheim's sociological views. (This is being done by Mohanna & Berrios (1990)).

The present state of knowledge of the possible relationship between depressive illness and multiple sclerosis is described. Problems of the research methodology are identified and suggestions made for useful areas of inquiry.

Schizophrenia is clinically heterogeneous but it is not known whether this is due to the existence of discrete subtypes. For the purpose of explication, ‘indicators' of schizophrenia are divided into three levels: phenomenology, pathophysiology, and aetiology. Five heterogeneity models and a number of quantitative approaches are described. It is imperative to apply rigorous methods of study to the comparison of unitary models and competing heterogeneity models of schizophrenia.

Ten years after the passing of the Italian psychiatric reform bill, the author assesses the state of the national mental health services. Albeit slowly, the decrease in the number of in-patients in mental hospitals is accompanied by a numerical increase in district and out-patient services. However, the quality of care provided and the regional distribution of services are not acceptable. The reorganisation has benefited hospital and out-patient services, but community care facilities remain inadequate. The mental health of the general population seems to be unaffected by the ongoing transition in psychiatric care.

The effects on outcome of research into the course of psychiatric illness are controversial. This study examines a cohort of research patients involved in an outcome study in which the research and clinical teams were kept separate. While research intervention of this nature would not be expected to influence outcome, the research cohort had fewer readmissions than non-research controls. This occurred despite the presence of factors which would be expected to be associated with a contrary result. It is stressed that the confounding effects of research need to be taken into account when designing follow-up studies and evaluating outcome results.

The case notes of 295 suicides (98.3% of the total) in prisons in England and Wales between 1972 and 1987 were studied. This period has witnessed an increase in the suicide rate far in excess of the rate of rise in the prison population. The most common method of suicide was by hanging, usually at night. There was a frequent past history of psychiatric treatment and self-injury. People charged or convicted of violent or sexual offences were over-represented, as were those serving life sentences. There was an association between suicide and both guilt for the offence and being charged or convicted of a homicide offence. Some suicides occurred many years after reception into prison. Routine enquiry about previous suicide attempts must be implemented, along with better, ongoing, active communication between staff and inmates.

Suicides in England and Wales among immigrants of Indian ethnic origin were analysed for the period 1970–78. There were excess suicides among young Indian women, these being disproportionately more among the married. Burning was a common method of suicide among Indian women. Suicide rates were low in Indian men and the Indian elderly. A large proportion of the male suicides were among doctors and dentists.

Clusters of phenomena were obtained by two clustering techniques, using the form and content of obsessions and compulsions. Significant clusters which emerged involved washing, checking, thoughts of past, and embarrassing behaviour. Depression occurred as a discrete cluster. Eighty-nine per cent of subjects could be fitted into at least one cluster; over half could be fitted into only one cluster. Washers and checkers made up more than half of the sample studied.

Fifty obsessive–compulsives were treated by behavioural therapy (self-exposure in vivo and response prevention) either with their partner directly involved in all aspects of treatment or without their partner. The two treatment formats were equally effective. Although a substantial number of obsessive–compulsives were found to have marital problems, behavioural treatment directed at the obsessive–compulsive disorder resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner.

Two hundred couples referred to a sexual problems clinic were assessed in a standardised way for their suitability for sex therapy. The assessment focused on the nature of the sexual dysfunction, motivation for treatment, marital and relationship problems, psychiatric status, and physical problems. Approximately one-third of the couples were found to have significant marital and relationship problems, and more than 30% were suffering from psychiatric disorders, although these were usually of mild to moderate intensity. A third of males and 18% of females were suffering from physical disorders likely to contribute to the sexual dysfunction. Patients who were offered sex therapy and who completed their course of treatment were more likely to show high levels of motivation and an absence of physical disorders, marital relationship problems and psychiatric disorder. There should be careful assessment of couples suffering from sexual dysfunction before specific treatment is offered.

During the course of the psychoanalytical treatment of patients whose morbid jealousy is of the non-psychotic type it is possible to identify the unconscious causes of the pathological mental state. This material can provide an insight into the unconscious determinants of the contents of delusions of jealousy.

Thirty in-patients received one of three treatments – medication (nortriptyline) alone (MA), relaxation therapy plus medication (RT&M), or cognitive therapy plus medication (CT&M) (each n = 10) – along with ward milieu. The relaxation and cognitive therapy groups participated in 12 therapy sessions. Symptoms of depression and related cognitive variables were assessed at sessions 1, 6 and 12, and at discharge. All groups improved over the course of the study. CT&M and RT&M groups reported significantly fewer depressive symptoms and negative cognitions at discharge than the MA group. The number of subjects judged depressed at discharge was lower in the CT&M group than in the MA and RT&M groups. It is proposed that a consistent rationale for treatment is a significant facilitating factor in achieving behavioural and cognitive changes in depression.

The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1 – specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

A random community survey into psychiatric disorder among women in urban and rural New Zealand found urban women to be more often at age extremes, not married, better educated, in more paid employment, and to have better household and child-care facilities. There were no overall urban–rural differences in the GHQ-28 score, total PSE score or PSE case rates. A multiple regression found the same three factors accounted for most of the explained variance in both the urban and the rural total PSE scores: these were the quality of social networks, difficulties with alcohol, and the past experience of childhood sexual abuse. Low socioeconomic status, poor physical health, and adult experiences of sexual and physical abuse were also associated with increased psychiatric morbidity in both samples. Other individual sociodemographic items were correlated with psychiatric morbidity for the urban or rural sample only.

An investigation was carried out in 1986 of 41 patients, 39 female and 2 male, who had been treated for anorexia nervosa in a psychiatric ward at a general hospital between 1958 and 1980. A follow-up analysis was carried out, in which 30 subjects participated. Using the scores on the 40-item version of the EAT as outcome criteria, validated by the Morgan–Hayward outcome scales, the outcome distribution and rate of mortality was in agreement with previous findings. Further data concerning weight, menstruation, and nutritional, social and psychiatric status were based on a semistructured interview as well as on the scores on the EAT, the GHQ, and the MMPI. Prognostic variables were analysed, indicating that duration of illness, poor motivation for treatment, social withdrawal, and poor family relations were significant as predictors of poor outcome.

The 30-item version of the GHQ was administered to 102 adults with epilepsy, and four sets of variables (neurological, psychosocial, medication, demographic) were used to predict psychiatric distress. Psychopathology was found to be associated with increased perceived stigma, elevated number of stressful life events during the past year, poor adjustment to epilepsy, financial stress, vocational problems, external locus of control, and an earlier onset of epilepsy. Multiple regression procedures reduced this list to three independent predictors of psychopathology: an increased number of stressful life events in the past year, poor adjustment to epilepsy, and financial stress.

Four elderly schizophrenic patients who had never been treated with neuroleptics, and a fifth patient who had received only the briefest exposure to such drugs, had retained their distinct clinical characteristics. Involuntary orofacial movements and cognitive dysfunction were found more uniformly than any particular pattern of symptoms.

The prevalence of Schneiderian first-rank symptoms in 75 schizophrenic in-patients was found to be 67%. The commonest were somatic passivity, thought broadcast, and thought insertion. This suggests a considerable variation in the prevalence of first-rank symptoms and their individual frequencies in different cultures. First-rank symptoms thus have inherent weaknesses.

This is a report of the treatment of four patients suffering from a syndrome consisting of a single delusion in association with depression. The tendency of monodelusional syndromes to respond to a pimozide provides a rationale for nosological organisation.

A 35-year-old woman with persistent affective and phobic symptoms responded dramatically to a combination of isocarboxazid and amitriptyline, and this improvement was maintained over the next three-and-a-half years. Isocarboxazid was replaced by placebo, using double-blind procedure. The change to placebo was accompanied by a marked increase in anxiety and depressive symptoms, which resolved when active isocarboxazid was reintroduced. It is suggested that combined antidepressant therapy still has a place in the treatment of resistant neurotic disorder.