The principles underlying the development of the Present State Examination and the instruments and computer programmes associated with it are discussed in the light of comments made in three recent papers by psychiatrists trained in the German tradition of clinical phenomenology. Many of their comments are cogent and highly relevant to the future development of the system. Some common misunderstandings are also considered; in particular, those that lead to results being interpreted outside the limits of the specifications laid down. The potential for improvement in the system is emphasized and the next stage of development briefly described.

The aim of the study was to explore the way psychiatric symptoms might influence independent psychiatric assessment of outcome one year after stereotactic subcaudate tractotomy. In a sample of 34 patients consecutively accepted for psychosurgery the results showed that both ‘good’ and ‘poor’ outcome groups improved overall. No patients were significantly worse and the symptoms which improved most were nervous tension, depressed mood and somatic anxiety. It was not possible to identify symptomatic predictors of outcome because the preoperative symptom profiles of both groups were so similar. The reason why symptomatic outcome is so variable despite a basically identical psychosurgical technique is discussed.

An index of brain tissue density was obtained from the CT scans of 37 elderly depressed patients by measuring Hounsfield Units (HU) in 12 predefined brain areas. Comparisons were made with 23 patients suffering from senile dementia and 36 healthy controls. As a group the depressed patients resembled the dements more than the controls, although analysis of variance indicated differences between all three groups, controls showing the highest HU values and dements the lowest. In the depressed patients ventricular dilatation, which had already been shown to predict increased mortality, was also associated with lower HU levels. The significance of these and other findings is discussed.

Cerebral blood flow is known as an indicator of cerebral metabolism. Using the 133Xenon inhalation method, we studied the regional cerebral blood flow (r-CBF) in patients with different subtypes of depression and in remission. A left frontal hypervascularization and a right posterior hypovascularization were found in major depressives, compared to normal subjects, minor depressives, and normothymic bipolar patients. These results tend to confirm the existence of cerebral dysfunction in both hemispheres in major depression, as reported by other authors using different techniques.

Three hundred male Irish alcoholics were selected from 508 consecutive alcoholic admissions to hospital. Using well defined diagnostic criteria, they were divided into three subgroups (1) primary alcoholics, (2) alcoholics with secondary affective disorder and (3) those with primary affective disorder and secondary alcoholism. Although the three groups reported differences in past history and family history of affective disorder and in time spent in hospital for both alcoholism and affective disorder, there was little to distinguish them in behaviour associated with alcoholism or in family history of alcoholism. The implications of these findings and their significance for the relationship of affective disorder and alcoholism are discussed.

Assessment of drug-induced movement disorders was carried out regularly on 104 psychiatric patients requiring antipsychotic medication on admission to hospital. The data relevant to motor restlessness were subjected to a principal components' analysis. According to their component scores, patients were then classified into two main groups: an akathisia group and an illness-related-movement group, the former group showing the clinical and pharmacological characteristics expected of akathisia. Clinical features which distinguished between the two groups, and between grades of akathisia severity, were identified, so an objective, phenomenological description of the akathisia syndrome was possible. Our observations suggested two distinct types of acute akathisia; one related to severe parkinsonism and one not. The implications of these findings are discussed.

A double blind, placebo controlled trial was carried out to examine the contribution of propranolol as an adjunct to neuroleptic medication in the treatment of chronic schizophrenic patients whose florid symptoms had not remitted with neuroleptic medication alone. Propranolol was shown to have a more beneficial effect than placebo, but the results were much less dramatic than those which have been described in previous studies. Recent work has shown that there may be a pharmacokinetic interaction between propranolol and neuroleptics, and this should be considered as one possible explanation of our findings.

EEG potentials evoked by tactile stimulation of the forearm (tactile-evoked potentials or TEPs) were recorded simultaneously from both cerebral hemispheres in a group of schizophrenics and a group of healthy control subjects. Differences between the groups were found for the early waves of the TEPs: in the control subjects the first two positive waves (P25 and P50) and the first negative wave (N35) recorded from the hemisphere on the same side as the stimulation were slower (i.e. had longer latency) than those recorded from the hemisphere contralateral to the stimulation. This lateralization effect’ was not seen in the schizophrenic subjects. It was concluded that the TEPs recorded from the hemisphere ipsilateral to the stimulus were not being transmitted from the other hemisphere via the corpus callosum and must therefore have been transmitted via direct ipsilateral pathways from the periphery.

In a second experiment the drug pindolol was administered to schizophrenic subjects but differences in P50 latency between ipsilateral and contralateral hemispheres were found equally in both drug and placebo groups. We also found slight evidence to suggest that the more severely ill the patient the more similar the TEP latencies recorded from the contralateral and the ipsilateral hemispheres.

This study compared the effects of social-skills training, remedial drama and group discussion on the conversation skills of chronic schizophrenic patients. After 16 one-hour treatment sessions only the social-skills training resulted in significant improvement, which was maintained at two-month follow-up. Although there was little evidence to support generalisation, the results are seen as indicating the usefulness of social-skills training in improving the performance level of chronic schizophrenic inpatients and in maintaining their social functioning. The implications for future rehabilitation practice are discussed.

To test the hypothesis that suicidal and self-destructive behaviour correlate with subjective and objective measures of hostility and violence, these behaviours in hospitalized schizophrenics were correlated to self-report (Buss-Durkee) and observer-rated (Lion Scale) measures. Self-destructive acts were significantly correlated with six of the seven of the Buss-Durkee self-report hostility subscales. The observed measures of hostility and violence correlated with seclusion and with restraint as a self-protective measure. Neither the Lion nor the Buss-Durkee measures correlated with depression measures. Thus, our data indicate that self-destructive acts in hospitalized schizophrenics may be better predicted by feelings of anger and hostility than by depression, a finding with relevance for clinicians who treat schizophrenic patients.

Obsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.

The perceived parental rearing practices and attitudes of social phobics, agoraphobics, height phobics and non-patient normal controls were investigated, employing the EMBU, an inventory for assessing memories of upbringing. Findings revealed that, as compared with the controls, social phobics and height phobics scored both parents not only as lacking in emotional warmth, but also as having been rejective and overprotective. Agoraphobics reported both parents as having lacked emotional warmth, but only their mothers as being rejecting. Interestingly, the perception of negative rearing practices of parents appeared to be stronger in height phobics than in either social phobics or agoraphobics.

In a sample of young mothers an association was found between a depressed mood and the recall of poor parental relationships during childhood. Women who had been depressed but had recovered by the time of questioning did not recall a poor relationship. A second retrospective measure of a childhood experience, based on more factual details, was unrelated to current mental state.

A four-year follow-up of clinically selected hyperactive boys with and without associated conduct disorder investigated their outcome during early adolescence and was taken from a structured behavioural interview and standard psychological testing.

Boys originally diagnosed as “purely” hyperactive continued to be inattentive and impulsive at follow-up, but showed very few aggressive and antisocial behaviours. Hyperactive boys who had earlier been undersocialized and aggressive continued to have problems with attention and impulsivity, were reported to be aggressive, noncompliant, egocentric, exhibiting antisocial behaviours and using alcohol. These findings suggest that antisocial and delinquent behaviour often reported in follow-up studies of hyperactive boys may be linked to childhood aggression and unsocialized behaviour, rather than the syndrome of hyperactivity.

There has been attention drawn recently to those parents who deliberately harm their children in relatively unusual ways such as poisoning (Rogers et al, 1976; Lorber et al, 1980; Kempe and Heifer, 1980). Prognosis has been poor, with a high mortality rate for the children unless removed, and parental denial precluding any form of family rehabilitation.