This paper reviews the literature on the effect of severe mental illness on other members of the patient's family. The burdens of caring for a patient at home are considerable. They often affect the caring relative's social and leisure activities, and financial problems arise frequently. Relatives have difficulties in understanding and coming to terms with illness-related behaviour. ‘Negative’ symptoms are often a particular problem. Despite their burden, relatives do not complain much, although they receive little support, advice or information from the professionals engaged in treating the patient; much is now known about the difficulties relatives face, but we still need to know how they can best be helped. Failure to do this will have bad effects on both relatives and patients.

Interviews were conducted with the co-resident supporters of 79 elderly subjects. Forty of these elderly subjects had been diagnosed as being demented (20 mildly, 12 moderately and eight severely) following psychiatric assessment. The supporters were screened for psychological well-being with the 60-item General Health Questionnaire (GHQ) and the Relatives' Stress Scale (RSS). Supporters of demented relatives showed significantly raised levels of stress on the RSS, but no increase in psychiatric morbidity on the GHQ, when compared with the supporters of non-demented relatives. The implications of these findings are discussed.

In a general practice population, 274 elderly married couples completed the Mental Status Questionnaire (MSQ), the 60-item General Health Questionnaire (GHQ) and the Leeds General Scales for the Self-assessment of Depression and Anxiety. The only relationship detected between cognitive impairment on the MSQ and psychiatric morbidity in the partner was a fairly weak negative correlation between the wives' MSQ and the Leeds Depression score of their husbands. These findings differ from those of previous studies, which have found high rates of psychiatric morbidity in the relatives of demented patients, and the possible reasons for these differences are discussed. Most importantly, other studies have involved the relatives of patients referred to psychiatric services, and these families may be quite different from those in which the demented relative is not referred to a psychiatrist.

A community sample of elderly married couples completed the 60-item General Health Questionnaire and the Leeds General Scales for the Self-Assessment of Depression and Anxiety. Significant concordance was demonstrated between the spouses' scores on these scales. Concordance was higher for depression than for anxiety. There was little to support previous findings that wives are more likely than husbands to be concordant with an ill spouse. The spouse concordance rates for psychiatric morbidity were similar to those found in studies of younger married couples.

An investigation of the suicide rate in the decade 1975–1984 in England and Wales revealed an increase in rate for males of all ages, and a small decrease for young females. The increase for males has been greatest in the 25–54 years group. There has been a decrease in the number of suicides by poisoning with solids and liquids (including overdoses) for both sexes. Rates for poisoning by vehicle exhaust gas and by hanging, strangulation and suffocation have increased substantially during this period. In males, suicides by these methods now exceed those due to poisoning by solids and liquids.

Twenty-six in-patients satisfying DSM-III criteria for major depressive episode were assessed using the Newcastle Diagnostic and ECT Predictor Scales and the dexamethasone suppression test (DST), prior to commencing a course of electroconvulsive therapy (ECT). The Newcastle ECT Predictor Scale was successful in predicting both immediate outcome and outcome over the 6 months following ECT; the DST was unsuccessful in predicting either immediate or 6-month outcome.

The autosomal dominant mode of inheritance of Huntington's Chorea (HC) has been established for over 100 years. Strong psychological defences against the acceptance of this knowledge are commonly found both in professionals and in Huntington families and relatives who are at risk. One consequence of maintaining these defences is the continuing transmission of the gene, and therefore the disease, to succeeding generations. The defences of professional persons protect them from the difficult and unsettling task of providing genetic counselling to healthy relatives at risk. An increase in awareness of the psychodynamics involved may lead to constructive thinking about the current deficiencies in care and counselling services provided for these families.

A study of cerebral ventricular size measured as ventricle to brain ratio (VBR) using computerised tomographic brain scan in chronic schizophrenics provided no support for suggestions that there are significant differences between patients who fall into different clinical subtypes. We found no significant difference in VBR between patients with and without a family history of schizophrenia or between those with or without paranoid symptoms. Applying Crow's classification, contrary to expectations, Type 1 patients had significantly larger ventricles than those with ‘mixed’ symptomatology (both Type 1 and Type 2 features). We also applied a variety of operational criteria which attempt to define schizophrenia as a whole: of these only Schneider's first-rank symptoms (FRS) yielded conclusive results - FRS-positive patients had significantly larger mean VBR than those without such symptoms. Previously, it has been suggested that ventricular enlargement is more closely associated with ‘negative’ than with ‘positive’ symptoms.

Forty-nine first episode schizophrenics were identified and considered to be representative of the parent schizophrenic population. Patients were rated before treatment with the Present State Examination. Findings are presented with regard to Catego classes, prevalence of first rank symptoms, conformity to ICD diagnoses, Feighner and Research Diagnostic Criteria and presence of a depressive syndrome. Physical examination revealed isolated neurological signs; in addition two neuroleptically naive patients had abnormal involuntary movements.

In a randomised double-blind study, 46 first episode schizophrenics were given pimozide or flupenthixol for up to 5 weeks; the mean daily dose at the end was 18.8 mg pimozide and 20 mg flupenthixol. There were no significant between-drug differences in the effect on mental state or behaviour; positive schizophrenic symptoms responded to treatment, negative symptoms did not. Most patients required anti-Parkinsonian medication. Poor response was associated with ‘organicity’. A switch to maintenance therapy after 5 weeks, the outcome of successful treatment and patient cooperation, was achieved in only 54%. There was no relationship between plasma prolactin levels and severity of schizophrenic symptoms in unmedicated patients. Pimozide produced greater elevation of plasma prolactin. Plasma neuroleptic levels showed drug compliance was satisfactory throughout in only 54%.

There was no relationship between plasma prolactin levels and severity of schizophrenic symptoms in unmedicated patients. Pimozide produced greater elevation of plasma prolactin. Plasma neuroleptic levels showed drug compliance was satisfactory throughout in only 54%.

Cognitive performance in 46 first episode schizophrenics was assessed within 1 week of admission to hospital by Progressive Matrices, Mill Hill Vocabulary Scale, Block Design and Similarities subtests of the Wechsler Adult Intelligence Scale, and Digit Copying Test. Patients' intellectual performance was at a dull normal level, just within one standard deviation from the mean. There was an association between the presence of anxiety and depression and lower scores on psychological tests. Patients assessed by the Present State Examination as belonging to the ‘uncertain psychosis' category performed more poorly.

An assessment of 31 main care-giving relatives living with schizophrenics was carried out using the General Health Questionnaire and the Social Adjustment Scale by Self Report. More than 75% of relatives had a high probability of themselves being a psychiatric case. Relatives also showed social role dysfunction and impairment especially marked in social and leisure activities. Relatives' distress was related to the level of symptoms in patients, as assessed by the Present State Examination.

A sample of 100 schizophrenic patients admitted to London area psychiatric hospitals were examined as part of the International Pilot Study of Schizophrenia. Clinical and social outcome were variable. At 5-year follow-up, 49% had good symptomatic outcome and 42%, good social outcome. Poor social functioning at inclusion was predictive of poor symptomatic outcome. Illness history (IH), occupational functioning (OF), social relationship functioning (SRF), negative and non-specific symptoms (NNS) at initial evaluation, and their interaction with sex and race accounted for 32% of the 5-year symptomatic outcome variance (n = 84; F=3.48; P<0.001). OF, SRF, housing status, NNS and their interaction with sex, race and age accounted for 47% of the social outcome variance (n = 62; F=2.62; P<0.007).

Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. In this study we have examined the impact of clomipramine on food and activity in anorectics engaged in a treatment programme enabling them to regain normal body weight. Consumption of the drug was associated with increased appetite, hunger and calorie consumption during the early stages of treatment. There was no impact on ultimate outcome. In this study it was evident that the drug was unnecessary for weight gain, but it may be helpful in other programmes, both short and long term, where the patient has sufficient trust (to tolerate the enhanced hunger experience) but is not involved in the same behavioural constraints. However, its possible value in such programmes has not been proven here. Meanwhile, we take our findings as further evidence that clomipramine increases drive behaviour and appetite in humans and may be beneficial in the treatment of affective disorders because of this effect.

Memory impairment is a salient and early feature of developing dementia, but in practice is often not recognised until it has reached an advanced stage. The operation described is of a Memory Clinic opened on an experimental basis at the Geriatric Research Unit, University College London, in 1983, with the aim of identifying the causes of memory impairment in the elderly, with particular reference to the early detection of dementia. It proved possible to identify a group of people with early dementia who had previously been undiagnosed, and also to reveal deficiencies in the utilisation of existing services. Memory clinics would be a valuable addition to geriatric and psychogeriatric services.

Bilateral palmar skin conductance and heart rate were measured throughout a series of psychological tests and during both sitting and ambulant social interactions in 14 right-handed men with chronic schizophrenic disorder and 12 healthy volunteers matched for age and handedness. Miniature radio telemetry equipment was used to collect the physiological data. The schizophrenic group was effectively unresponsive to 70-dB auditory stimuli, while all but one of the control group responded and habituated to a nil response by the tenth tone in sequence. The schizophrenic group showed some evidence of increased skin conductance activity at rest, and in socially demanding conditions skin conductance level and variability were increased in the right hand. The present group of electrodermal ‘non-responders' was not in general autonomically underactive. Asymmetry of skin conductance activity during social interaction may be a characteristic of chronic schizophrenic disorder.

Reaction time, set index, critical flicker frequency, two-flash threshold, a sustained performance task and psychophysiological parameters from people with chronic schizophrenic disorder (n = 14) and a control group (n = 12) were analysed to assess the association between arousal, attentional dysfunction and social dysfunction in schizophrenia. Shorter reaction time, rated ability to mime and, in the schizophrenic group, scores on Venable's ward activity scale correlated with each other. In the schizophrenic group, prolonged reaction time latency correlated positively with skin conductance level in the right hand and negatively with skin conductance variability in the left hand, the latter being in the opposite direction to that for the control group. The results may provide support for the hypothesis that lateralised cerebral dysfunction is associated with performance deficits in people with chronic schizophrenic symptoms.

Of 30 agoraphobic married women undertaking home-based behaviour therapy, 15 each had a female friend as co-therapist and 15 had their own husband as co-therapist. At 12 months follow-up, women spent a mean of approximately 40 minutes a day more outside the home alone than at baseline. Women assisted by female friends made somewhat more behavioural gains than those assisted by husbands. Women in both groups whose husbands had been more depressed 2 months after the beginning of therapy did less well at 6 months. Husbands who become more depressed may retard their wives' progress in therapy, but the effect was small, and was outweighed by other considerations.

The term ‘depression’ is now used to cover a wider range of emotional disturbances than was the case when psychiatrists confined their attention to patients referred to psychiatric hospitals. There is considerable confusion about the variety of meanings and the loose terminology leads to claims and counter-claims about aetiology and treatment. The current classificatory systems and the variety of rating scales do not clarify issues concerning appropriate management. The guidelines for a clearer definition of a biogenic form of the concept of depression, which is likely to respond to antidepressant drug therapy, would be of considerable value to psychiatrists, non-psychiatric physicians and others who try to treat or help people in states of disordered emotion. Such guidelines are proposed.

Hypercalcaemia, whether due to undiagnosed hyperparathyroidism or some other cause, can lead to clinical depression. The patient described here developed a severe depressive illness in the setting of hypervitaminosis D after 15 years of inappropriate therapy with calcium gluconate and strong calciferol. The importance of monitoring serum calcium levels in anyone on vitamin D therapy is stressed.