Some authorities view the history of science as a sort of saltatory process in which periods of modest gain and of plodding ‘normal science’ are interrupted by dramatic leaps forward and episodes of ‘revolution’ (Kuhn, 1962). If this is so then genetics has, for the past several years, been in a phase of remarkably sustained and continuous revolution. The advent of the ‘new genetics' of recombinant DNA has resulted in new discoveries occurring at a breath-taking pace, many of which have important clinical implications. Recent findings of psychiatric relevance have included the localisation of the gene for Huntington's chorea on the short arm of chromosome 4 (Gusella et al, 1983) and the use of DNA probes in predictive testing (Harper, 1986). Advances have been achieved in the understanding of the molecular biology of Alzheimer's disease, and at least some of the familial forms of the condition appear to be linked to a gene on chromosome 21 (St George-Hyslop et al, 1987). However, perhaps the most exciting development for most psychiatrists has been the report (Egeland et al, 1987) of a major gene for manic-depressive illness linked to a marker on the short arm of chromosome 11. Could this signal the leap of biological psychiatry into a revolutionary phase? It is perhaps appropriate before attempting to answer this that we give some consideration to the recent historical background.

Recently, there has been a dramatic rise in the number of case reports of multiple personality disorder (MPD). The phenomenology of the disorder is described and theories on aetiology are discussed. A review of the recent literature reveals a poverty of information on reliability of diagnosis, prevalence, or the role of selection bias. It is argued that iatrogenic factors may contribute to the development of the syndrome. There is little evidence from genetic or physiological studies to suggest that MPD represents a distinct psychiatric disorder. It is assumed that MPD is an hysterical symptom, and an attempt is made to catalogue the predisposing factors and influences that may lead to the clinical presentation.

Five cases of psychiatric illness, presenting as functional psychosis, occurring in male homosexuals with human immunodeficiency virus (HIV) infection are described and compared with similar cases in the literature. The association between psychosis and infection with HIV is discussed with particular emphasis on the significance of functional versus organic presentation.

The child whose mother is killed by his or her father has to cope with the trauma of violence, the grief associated with the loss of both parents simultaneously, dislocation and insecurity regarding where and with whom they will live, stigma, secrecy, and often massive conflicts of loyalty. These issues and how they affected the 28 children of 14 families in which the father had killed the mother are examined. Recommendations for practice based on this clinical experience are proposed.

An increasing number of psychiatric services have non-seclusion policies. Evaluation of a policy of using specified observation levels instead of seclusion was made over a two-year period. The number of violent incidents recorded in health service facilities was low (exactly 50). Community responses elicited from police, probation, and prison services were not generally critical of the policy. Medication levels used were not excessive as determined by peak levels of major tranquilliser and anti-Parkinsonian drugs used. No patient was excluded from the unit because of his or her level of actual or potential aggression, but two were transferred from it for this reason.

The paper describes a special hospital-based treatment programme for male mentally handicapped offenders, comprising a package of practical and personal skills training coupled with a socialisation programme based on token-economy strategies within a controlled and structured environment. Twenty patients admitted to the programme and followed up after discharge for an average of 3.3 years were studied in detail. All had committed serious or persistent offences and showed a high level of psychosocial pathology. A good or fair response to the treatment programme was made by 85%, and 65% were judged well adjusted or reasonably well adjusted at last follow-up contact. A good outcome was associated with more than two years' in-patient care, a good response to the treatment programme and stable residential placement, regular occupation and regular supervision and support in the community. Offenders against the person (sex and assault) had a better prognosis than and showed other interesting differences from property offenders (property and arson).

The study examined the mortality experiences of a population of mentally handicapped in-patients between 1983 and 1987. Demographic data and factors related to terminal illness and cause of death were considered. The findings suggested a continued trend towards increased longevity and indicated a number of groups at risk of early death.

In the short term, both antidepressants and exposure therapy usually improve agoraphobia/panic (AP) and obsessive–compulsive (OC) disorders and are accepted by most patients; psychological methods omitting exposure are not consistently helpful. Antidepressants have a broad-spectrum rather than specific anti-agoraphobia/panic or anti-obsessive–compulsive action. For long-term efficacy, there is good evidence for the value of exposure, but none for drugs. Because of relapse on ceasing drugs, and their side-effects, medication is less useful as the first line of treatment for chronic agoraphobia/panic or obsessive-compulsive disorder than is the lastingly helpful approach of exposure. Antidepressants are worth trying when patients refuse or fail with exposure therapy, or are dysphoric.

In order to assess some psychometric properties of Marks & Mathews' (1979) short Fear Questionnaire, a Dutch translation of this form was administered to 143 phobic outpatients: 100 women and 43 men. There was a special interest in assessing validity by comparing the scores of agoraphobics, social phobics and simple phobics. The findings were that all scales have sufficient internal consistency, although the Total Phobia scale does not seem to add meaningful information to its subscales. Most scales are significantly related to neuroticism, and the Social Phobia subscale is strongly related to social anxiety. The Agoraphobia and Social Phobia subscales discriminate between categories of phobics in the expected way. For the Blood/Injury subscale the relevant comparisons could not be made. The data presented in this study can be used to develop FQ norms for phobic patients.

There has been a growing number of reports of psychiatrists moving out into primary-care settings. We report a survey of consultant psychiatrists to assess the extent of this practice in Scotland. Some time spent in the primary-care setting was reported by 56%, the figures being highest in rural areas. An equal number of non-consultant medical staff were involved. Most schemes were initiated by psychiatrists, over half of whom had had some postgraduate general-practice experience. A similar survey in England and Wales showed that only 19% of consultant psychiatrists spent time in primary-care settings, a smaller proportion of non-consultant staff being involved. The value of working in primary-care settings has yet to be assessed.

The literature indicates that whether or not schizophrenic patients are reported to have significant lateral ventricular enlargement depends on control, and not schizophrenic-group values. This discrepancy does not result from differences in age, the ratio of males to females, the number of control subjects used in each study, or whether control groups are comprised of normal subjects or medical patients. However, medical-patient controls tend to have smaller ventricles than do normal individuals. Thus, we assessed lateral-and third-ventricle size and the degree of cortical atrophy in 30 normal volunteers, 30 medical patients, and 30 chronic schizophrenic patients. The use of a medical control group seemed to result in underestimates of ventricle and sulcal size in the normal population and, therefore, overestimates of these values in schizophrenic groups.

Although the incidence of the recurrent psychoses (bipolar affective illness and schizophrenia) in the two sexes is approximately equal, gender influences a number of aspects of major psychiatric disease: unipolar depressive illness is twice as common in females, onset of schizophrenia is earlier and outcome is worse in males, and pairs of psychotic first-degree relatives are more often than expected of the same sex. In addition, sex chromosomal aneuploidies (e.g. XXY and XXX) are more frequent in patients with psychosis. Some of these findings can be explained if there is a major locus of predisposition to psychiatric disease in the ‘pseudoautosomal’ region of the sex chromosomes – that distal segment of the short arms in which there is genetic exchange between X and Y chromosomes at male meiosis. A gene located here would be transmitted in an autosomal manner, but would be passed above chance expectation to children of the same sex when inherited through a male. In that this segment of the sex chromosomes is subject to a high rate of recombination (which could generate new mutations), and may include determinants of brain lateralisation, it appears that the pseudoautosomal region could carry the genes which predispose to the major psychoses.

Basal serum cortisol and dexamethasone suppression test (DST) results were studied in 21 pathological gamblers who varied on the Beck Depression Inventory and selected scales of the Minnesota Multiphasic Personality Inventory, which had previously been shown to be related to depression in gamblers. All subjects were suppressors on the DST. There was a significant relationship between fluctuation in 08.00 h and 16.00 h basal cortisol levels and the psychological measures, suggesting a subtype of pathological gambler with potential clinical significance.

Ambulant, transcutaneous PCO2 monitoring has been used to show that hyperventilation precedes exacerbation of asthma in a patient. Brief treatment was shown to give him greater control of his breathing and enable him to avoid attacks of asthma.

A case of childhood affective disorder with episodes of depressive stupor in a 13-year-old pre-pubertal boy is described. Changes in the patient's clinical state were accompanied by changes in the dexamethasone suppression test. A family history of affective illness on the maternal side, with phenomenological similarities, is noted.

A patient who resumed sleep-walking as an adult is described. The failure to diagnose his disturbed nocturnal behaviour as sleep-walking kept him from his work for over 8 months, and led to a treatment which exacerbated the behaviour. The diagnosis was made when the patient attempted to strangle his wife.

The Capgras delusion has long been held to be specific for close personal relationships. This paper presents evidence that this is not the case and the implications of this for accepting psychodynamic explanations of the phenomenon are discussed. Parallels are drawn with the condition prosopagnosia and a hypothesis presented that any specificity is apparent rather than real. It is proposed that both prosopagnosia and the Capgras symptom represent abnormalities of visual perception occurring at different stages of this neurophysiological process.