There has been great variability and inconsistency in the reported effects of neuroleptic drugs on cognitive and psychomotor function in both patients and normal controls. Experimental design rather than any particular cognitive or psychomotor test appears to have determined the sensitivity of detection of neuroleptic drug effects. In general, sedative phenothiazines have been found to depress psychomotor function and sustained attention, but higher cognitive functions are relatively unaffected. In the majority of studies of schizophrenic patients, both cognitive function and attention improve with neuroleptic treatment, in parallel with clinical recovery. Negative symptoms are not increased and usually show slight improvement with neuroleptic treatment. Controls are more sensitive than schizophrenic patients to neuroleptic drug-induced impairments. Tolerance has been seen in patients but has not been demonstrated in normal volunteers. The way in which neuroleptics produce their beneficial effects in patients remains unknown. Three main hypotheses to replace early arousal theories are proposed: normalisation of attention, facilitated indirectly by suppression of ‘released’ limbic dopamine hyperactivity; normalisation of asymmetrical temporohippocampal function; or direct improvement of attentional processing. Studies of the effects of new antipsychotic drugs with selective actions and the development of more reliable and selective tests of psychomotor and cognitive functions are required.

It has been hypothesised that community cases of depression compared with clinic cases: (a) have fewer symptoms; (b) have milder symptoms; (c) have different symptoms; (d) are of shorter duration; (e) are less incapacitating; (f) are more environmentally and less biologically caused; and (g) respond better to psychological than pharmacological intervention. A review of the literature indicates that some of these hypotheses have not been tested, others have not been adequately tested, and none has been unequivocally confirmed. Further investigations of these important issues are required.

Many of the functions of large psychiatric hospitals were those of asylum. As the structure of services has changed and the role of the large hospital has diminished, the necessity to continue to cover their functions has tended to be forgotten, partly because it has been thought that, even at best, they were purely protective. Such a point of view cannot be sustained. The functions of asylum have always been both refuge and recuperation. ‘Community care’ will come to deserve the odium now attached to the worst practices of former times if the tradition of asylum practised in the best of the large hospitals is not (with appropriate modification) acknowledged, properly placed in the psychiatric curriculum, and given high priority in service planning.

In a study comparing depressive disorders detected in a field survey (n = 90) with patients referred to a specialist treatment setting (n = 63), the clinical features and demographic correlates of ‘cases' of affective disorders proved to be similar. However, those in treatment settings appeared to have more people achieving definite case status. Hospital-referred cases were also more likely than community cases to be older and single, and this difference persisted even after controlling for chronicity of symptoms.

In a consecutive clinical series of 538 subjects with primary mood disorders the male: female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes. Females also exhibited more anxiety and somatisation, and were more likely to endorse psychopathological items on self-report instruments, which were not reflected in objective measures. Finally, they were more likely to have been admitted to hospital. These gender differences could in part be explained by the higher prevalence of the depressive temperament in women, and of the hyperthymic temperament in men.

Observations of long-stay patients in a club in a psychiatric hospital were carried out unobtrusively over several months. Much of the social activity that went on was stimulated by an economy based around the purchase and exchange of tea and cigarettes, and the borrowing and lending of small change. Most patients could be fitted into one of four social categories: helpers, friends, nuisances, and the asocial. The inter-rater reliability of the observations was found to be 0.95. A close correspondence emerged between the observations of patients' social behaviour and material reported by patients when interviewed with the Social Network Schedule.

The Social Network Schedule was successfully completed on 489 (64%) of 770 long-stay patients in Friern and Claybury Hospitals and the data on 3774 social contacts of the patients subjected to log-linear modelling. This showed that the category ‘confidant’ was salient in understanding the data. Latent-class analysis highlighted the importance of the nature of the social interaction between patients and their contacts. In particular, non-verbal exchanges of goods and services emerged as important in creating social bonds.

Social functioning as an outcome variable in family interventions with schizophrenic patients has been a relatively neglected area. The requirements of a scale of social functioning to measure the efficacy of family interventions include: the measurement of skill/behaviour relevant to the impairments and the demography of this group; the ability to yield considerable information with an economy of clinical time; and the establishment of ‘comparative’ need through comparison between subscales and with appropriate reference groups. Results from three samples show that the Social Functioning Scale is reliable, valid, sensitive and responsive to change.

The specificity and sensitivity of the HAD, 12-item GHQ and CIS were calculated by comparing the scores of dermatological patients on these tests with a criterion measure of disorder. Since psychiatry, along with many other branches of medicine, does not have an error-free criterion, it was assumed that the criterion was an underlying latent construct which was measured by all of the tests and could be derived by factor analysis from the scores on them. No differences were found between the two questionnaires (HAD and GHQ) in their ability to detect cases of minor psychiatric disorder although they were somewhat less reliable than the CIS.

A three-year follow-up study of 49 psychiatric patients, representative of those found in long-stay care, tested whether behavioural, symptom and demographic variables as well as response-processing difficulties could predict levels of psychiatric care. The researchers were blind to the criteria for allocating patients to particular forms of care and the staff responsible for care had no access to information collected by the research team. Not only was it possible, using only these few factors, to predict the form of care, but one factor, response processing, was related to whether patients moved to more independent forms of psychiatric care.

In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a ‘treatment-as-usual’ control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.

The relationship of a full range of psychiatric symptoms to EE was examined in 40 men with BPRS and SANS diagnoses of schizophrenia or schizoaffective disorder. Patients from high-EE families had significantly higher ratings of positive symptoms, anxious depression, and overall psychopathology, but not negative symptoms, than did those from low-EE families. In predicting relapses of schizophrenia, account may need to be taken of an interaction between subtle differences in symptoms and relatives' attitudes.

The SSEPs obtained from 19 schizophrenics defined by RDC, DSM–III and PSE criteria Were compared with those from a control group of healthy volunteers. Previous findings of an abnormal lack of lateralising response in schizophrenic patients were not replicated. No significant difference in either amplitude or morphology between the traces obtained from the two groups were recorded. Ipsilateral and contralateral latencies for stimulation of the left and right index finger showed no significant difference in peak latency for any component between patient and control group. When mean peak-to-peak amplitudes were plotted the contralateral component was always greater in amplitude than the ipsilateral one. An objective measure of the degree of lateralisation, the percentage lateralisation quotient, showed no lateralisation differences between the patient and control groups. A case of myogenic contamination of ipsilateral components was observed calling into doubt findings where no temporal region monitoring has been performed.

Of 146 elderly subjects suffering from Alzheimer-type dementia, 44% were found to have significant extrapyramidal signs. Although extrapyramidal signs were more common in those who had taken neuroleptic drugs in the preceding six months, 22 subjects (15%) who were drug free also had extrapyramidal signs. Scores for cognitive function and for ‘frontal lobe’ signs (verbal fluency, evidence of perseveration, and primitive reflexes) were found to correlate well with scores for extrapyramidal signs, suggesting that they reflect changes in a common substratum. It is tentatively suggested that this might be an abnormality in the dopamine system.

In this multicentre study, the clinical efficacy of citalopram was investigated in 98 patients with moderate AD/SDAT or VD using a combined double-blind and open technique with placebo and citalopram. Analyses were made for each diagnosis after four weeks of double-blind treatment. Patients with AD/SDAT treated with citalopram showed a significant improvement in emotional bluntness, confusion, irritability, anxiety, fear/panic, depressed mood and restlessness. Those improvements were not found after treatment with placebo. There were no significant improvements in patients with VD. No improvements were recorded in motor or cognitive impairment. Citalopram provoked few and comparatively mild side-effects. None of the changes observed during the double-blind withdrawal period were identified as withdrawal symptoms or rebound phenomena.

Gull and Lasègue are usually credited with the first description of anorexia nervosa. In general, however, the work of the French neuropsychiatrist has been underestimated, and English-speaking colleagues who refer to Lasègue's writing on ‘hysterical anorexia’ almost exclusively rely on the translation of his French paper, which in 1873 appeared in a British medical journal, the same year as the original publication. However, some important passages had been omitted from the translation, and this has not previously been noted.

A case of status epilepticus was secondary to water intoxication, which in turn was secondary to a depressive psychosis.

A manic–depressive patient developed leucopenia as a result of carbamazepine therapy, despite concurrent administration of lithium.

We report a case of a man with recurrent depression and persistent second-person auditory hallucinations telling him to kill himself. Using an audiotape cassette and headphones the duration of the hallucinations decreased significantly. Helpfulness of the audiotape continued at 15 months follow-up

A 52-year-old woman presented exclusively with delusional misidentification of inanimate objects in the context of a short-lived acute psychotic episode. Certain theories are useful in understanding the formation of delusions of doubles in the patient (e.g. processes intrinsic to the depersonalisation/derealisation phenomena may have been aetiologically significant), but the actual choice of objects remains difficult to explain.