Man and animals are sporadically exposed to mycotoxins (the secondary metabolites of moulds), which include those produced in damp and cool environment by the almost ubiquitous soil-microfungi, the Fusaria. Perinatal exposure to the mycotoxins may cause damage to many organs, including the CNS and those which are targets for oestrogenic agents. Depending on the levels of the mycotoxins and the time of their action, the effects may manifest themselves as neonatal abnormalities, or as neurological and behavioural anomalies and chronic disorders later in life. The relationship between the anatomical and behavioural development of individuals and their perinatal exposure to fusarial mycotoxins requires further investigation.

There cannot be many hospitals and medical schools owing their origins to the visual hallucinations and grim forebodings of a depressed monk. Yet that is precisely the story of how the venerable institution of St. Bartholomew's Hospital was founded. The monk Rahere, on a journey to Rome to obtain forgiveness for his sins, “fell ill and thought his last hour was drawing nigh. He burst into tears and vowed a vow that if he should be allowed to return to his own country he would there build a hospital for the recovering of the poor” (Moore, 1918). On his way home, he had a vision of St. Bartholomew who instructed him, among other things, to build a church in Smithfield. Was it, asks Moore, a fantastic illusion, such as men have in their sleep, or was it a heavenly oracle? Was the illness, he might have added, a depressive illness given the melancholic mood, tearfulness, feelings of impending doom, and gradual recovery? And why a vision of St. Bartholomew? The saint is associated with medicine, or more accurately with surgery. The fact that he was flayed alive and thereafter has tended to be protrayed pictorially with his skin draped in folds about his bones has suggested to some a distinctly ‘barber-surgeon’ flavour, and he is indeed the patron saint of butchers. Less well-known is the fact that he exorcised a devil from King Polimius's daughter—a therapeutic action which entitles him to be regarded as the patron saint of nervous diseases, (Dawson, 1957).

Compulsive water drinking is associated with a broad spectrum of psychopathology, from mild neurosis to psychosis. Since the normal kidney is capable of excreting large volumes of fluid rapidly, water intoxication requires both a pathological basis and a psychiatric explanation of why so much water is being taken. Excessive water consumption can be dangerous, so that the fluid intake of patients with a history of polyuria together with a low urinary specific gravity should be closely observed. Four cases of water intoxication resulting from psychogenic polydipsia are described, three of them in chronic schizophrenics, where inappropriate ADH secretion might represent part of the psychosis.

Forty-three patients with non-endogenous depressive disorders were assessed shortly after psychiatric referral, and reassessed at six and at 20 weeks. The pattern of improvement appeared to be set shortly after the initial consultation, but could be most clearly predicted by the degree of improvement at the end of the third week. Key baseline factors predicting a more marked improvement at each follow-up were a more severe depression, the break-up of an intimate relationship, and the presence of weight loss. Positive life events occuring after the initial assessment predicted improvement at six and at 20 weeks, while the presence of a neutralising event (which negated an earlier threatening life event) predicted improvement at 20 weeks.

A survey was made of academic difficulties among undergraduate students at Ain Shams University, Cairo, during the academic year 1979–1980. Almost 6% of students dropped out before graduating and a further 8% required substantial extra time to complete their course of study: these figures were almost identical for both sexes. Psychiatric disorders were diagnosed in 42% of male students with academic problems (compared with 9% among the academically successful), with neuroses accounting for nearly half of the cases and schizophrenia for a quarter. Serious psychiatric illness was nearly four times as frequent among 3rd-year students as among 1st-year students.

We compared 178 students with academic problems with 77 academically successful students. Academic difficulty showed highly significant associations with low socio-economic status, over-crowded housing, paternal behaviour problems and a poor relationship between the parents; also significant associations with family history of psychiatric disorder and living away from home. Academic achievement at school was no guide to university performance. Failed students had fewer friendships, especially with women, amd more limited recreational activities. They also scored significantly lower on tests of verbal and non-verbal IQ, and worse on the Bender Gestalt and trail-making tests. EPQ results suggested that university students, particularly those with academic difficulties, are more neurotic and introverted than the general Egyptian population.

Annual age-standardised first admission rates from 1969–78 for Scottish mental hospitals were calculated for schizophrenia, paranoid states, reactive psychoses, all affective psychoses, mania, and depressive neuroses. Significant decreases were found in the diagnosis of schizophrenia (P <0.001) and, to a lesser extent, affective psychoses (P <0.01) and depressive neuroses (P <0.02). The incidence of paranoid states, reactive psychoses, and mania did not change significantly.

Several factors possibly contributing to the decline in diagnoses of schizophrenia are discussed, but it is concluded that the figures probably reflect a genuine fall in incidence. The decline in the categories of affective disorder is likely to reflect trends towards increasing provision of community-based care.

Data are presented on 24 patients with epilepsy and psychosis whose clinical presentation was rated using the Present State Examination (PSE). Seventeen had complex partial seizures and a diagnosis of temporal lobe epilepsy, seven had generalised epilepsy. An association between a CATEGO category of nuclear schizophrenia (NS) and a lesion of the left side was noted. No clear link between depressive symptoms and a right-sided focus was discovered. Affective disorders were noted in both groups of epileptic patients, although paranoid psychoses were commoner in the temporal lobe group. There was also a tendency for the latter to have more delusions of persecution, ideas of reference, and special features of depression. The group rated as NS appear less likely to show evidence of intellectual deterioration than the other psychotic patients; in addition, the interval between the onset of their epilepsy and the onset of their psychosis is shorter. Radiological assessment by CAT reveals few differences between groups, but the psychotic samples do show higher than expected values on a number of variables, in particular the bilateral septum-caudate distance and the size of the third and fourth ventricle.

The idea of massive unmet need for mental health services is a myth, generated and perpetuated by processes within the system which provides psychiatric care and within society. Diffusion of the traditional boundaries of mental health care, lack of norms and standards, medicalisation and ‘healthism’, specialoid practice and patient selection, diversion of resources from the longterm mentally ill and their absorption by better-functioning patients, substitution and development of new mental health service providers, and changes in the threshold for help-seeking all affect our assumptions of need. Needs are less massive, if the boundaries of psychiatry are defined so as to include only those disorders which the profession is best able to treat.

Fifteen patients with bulimia nervosa received fenfluramine (60 mg po) or placebo under double-blind, randomly ordered conditions. Two hours later food was presented. Significantly less food was eaten after fenfluramine and the quantity eaten was inversely correlated with serum fenfluramine levels. Significantly fewer patients reported bulimic symptoms during the test after fenfluramine, but no significant effect was demonstrated after leaving the ward. Fenfluramine caused drowsiness but did not reduce hunger ratings. Similarly, eating failed to reduce hunger ratings normally in the patients. These findings suggest that in patients with bulimia nervosa, hunger is reported abnormally and eating is suppressed by fenfluramine. Bulimic symptoms were probably reduced by fenfluramine, which may prove to be a useful treatment for bulimia nervosa.

As part of the Leicester electroconvulsive therapy (ECT) study, the role of ECT in schizophrenia was investigated in a double-blind trial. The Present State Examination criteria for schizophrenia were fulfilled by 22 patients, of whom 19 gave consent and entered the trial. Neuroleptic medication was restricted during the trial period. Patients were randomly allocated to eight real ECT or eight simulated ECT. At the end of the four-week trial period, patients receiving real ECT showed a significantly greater improvement when measured on the Montgomery-Asberg Schizophrenia Scale (MASS), the visual analogue global psychopathology scale, and the depression scale. The differences on the MASS and visual analogue global psychopathology scale were not due to improvement in depressive symptoms. The superiority of real ECT was not demonstrated at the 12- and 28- week follow-up, when treatment was not controlled.

Organic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxicmetabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.

The case notes of 24 children diagnosed as elective mutes were compared with those of 24 matched controls with diagnosed emotional disorders. One-third of the elective mutes (but none of the controls) had experienced delayed development of speech or difficulties in articulation. All the elective mutes lived in two-parent families, but marital discord was noted in half the families in both groups. Compared with the controls, the mute children were more often described as ‘anxious', ‘depressed’ and ‘manipulative’, and their mothers were characterised as ‘over-protective’, and tending to ‘spoil’ their children. Three unusual cases, of mutism at home, are described in detail. It is proposed that elective mutism is associated with particular personal and family characteristics and represents a condition different from any recognised emotional disorder.

Drinking practices and attitudes to alcohol among the members of a Southampton church were investigated by questionnaire (602 subjects) and by interviews (126 subjects). Teetotallers were older than drinkers, and included a higher proportion of women. They perceived their childhood upbringing and the teaching of the Bible as the main factors influencing them to abstain. Both teetotallism and alcoholism were more common among relatives of teetotallers than among relatives of social drinkers.

The offence of attempted infanticide has hitherto been unknown in English Law. A case is here described in which a woman was convicted of infanticide, and attempted infanticide, having been charged with murder and attempted murder. The relevance of this is discussed, together with an aspect of infanticide previously unreported in the English literature, i.e. repetition of the offence.

In a controlled study, intellectual capacity and memory functions were assessed using standard instruments in a sample of 16 patients with ‘brain-fag syndrome’. The intelligence of the affected group was found to be generally above average and not significantly different from that of the control group. However, the patients had more difficulty in learning new words and in retaining such learning. The psychopathology of the syndrome is discussed.