Psychiatry has an advantage over other medical disciplines in that its skills are ones that can be practised in almost any setting. Although this is a truism it is worth repeating as psychiatry is still strongly associated with hospital treatment in the public mind. This view is endorsed by the activities of most psychiatrists, who spend their working lives in psychiatric hospitals or in extensions of them such as out-patient clinics or day hospitals. The reasons for this are at least partly historical. The great mental hospital building programme of the 19th century was planned deliberately to set up hospitals in isolated areas away from the centre of the community they served (Scull, 1979). Many countries are still left with this legacy of mental quarantine and find it difficult to overcome its geographical handicaps. Although it is appreciated that more patients can be treated successfully outside hospital it is often easier to follow the maxim, “if in doubt don't keep them out” and admit patients who seem to need further assessment. This is understandable whilst most personnel are based within the hospital and is certainly easier than setting up alternative systems of care away from the hospital base.

The present status of monoamine oxidase inhibitors in the treatment of depression is reviewed. With adequate doses they are effective antidepressants, but dosages have in the past been too low. Provided proper dietary precautions are taken, the incidence of fatality from dietary interactions is very small and should not deter doctors from using these drugs, especially in those depressed patients who do not respond to tricyclic-type antidepressants. The present status of combining monoamine oxidase inhibitors with tricyclics is discussed, as are the newer specific inhibitors particularly clorgyline and deprenyl.

During the investigation of somatosensory evoked cortical potentials arising from a complex vibro-tactile stimulus to the forefingers, an abnormal lack of lateralisation of response was found in 10 out of 21 schizophrenic patients. Eight patients with severe affective illness all had the expected degree of lateralisation of cortical potentials, as did 12 out of 15 normals. Three normals and 3 schizophrenic patients had a loss of lateralisation of the evoked response on stimulation of one hand but a normal lateralisation on stimulation of the other. The considerable technical problems of this and related techniques are discussed, but it is suggested that further exploration of this technique is justified. At this stage, no conclusion can be drawn about the cause of the abnormalities.

The two-year follow-up results are reported of a trial of social intervention in families of schizophrenic patients in high social contact with high-expressed emotion (EE) relatives. For those patients who remained on antipsychotic medication throughout the two years, the social intervention significantly reduced the relapse rate. In those experimental families where relatives' EE and/or face-to-face contact was lowered, the relapse rate was 14%, compared with 78% for control patients on regular medication (P = 0.02).

Seventy-nine patients with a diagnosis of hysteria were compared, on a number of variables, with a control group of neurological patients without psychiatric morbidity, and with psychiatric patients free from somatic complaints. Demographic information was obtained, and rating scales for the assessment of personality and mood, were administered, as well as Pilowsky's Illness Behaviour Questionnaire. The data confirm the high incidence of affective disturbance in particular, depression and anxiety in patients with hysteria. There was no link between hysteria and early hospitalisation, although associations were found with sexual disturbances, a past history of vague or undiagnosed illness, affective inhibition, and denial. Relationships between personality and illness behaviour reveal links between personality dimensions and the reporting of illness.

Retrospective questionnaire information was sought from 175 Royal Air Force officers who had survived ejection from an aircraft and 88% replied. A profile of risk factors, both objective and subjective, was found in the 40% who subsequently experienced prolonged emotional disturbances. Confidential counselling of ejection survivors should therefore be routine. Consultation between involved medical staff and a Service psychiatrist can increase awareness that surviving aircrew may not be as composed and unaffected as they seem, while appropriate counselling can reduce prolonged emotional morbidity.

It has been claimed that the diagnosis of histrionic personality disorder is inherently sexist. To estimate the extent to which psychiatrists are influenced by sexist prejudice in their judgements about self-dramatisation (the central trait in the histrionic cluster), we conducted a study in which male and female subjects rated the degree of self-dramatisation portrayed in videotaped vignettes. The results did not support the sexist hypothesis that dramatic behaviour would more often be attributed to a woman than to a man, especially by male raters.

This paper analyses the legal and other social conditions under which the concept of ‘psychopathic personality disorder’ continues to play a strategic part in both the repeated imprisonment of female petty offenders and in the justifications put forward for the rigidity of the disciplinary regimes in women's prisons.

This study investigates whether three-year-old children whose mothers had been depressed after their birth showed more behaviour disturbance than children of mothers who were not depressed at that time. Ninety-one of 103 mothers who took part in an earlier prospective study of postnatal depression were reinterviewed three years later to determine their present mental state, and to assess their child's behaviour, using Richman's Behavioural Screening Questionnaire.

No relationship was found between a prolonged postnatal depression and behaviour disturbance in the child, but children whose mothers had brief postnatal depressive episodes showed more behaviour disturbance than those whose mothers had not been depressed since childbirth.

Sexual dysfunction in male subjects is a multifaceted illness, not appropriately classifiable by any of the current diagnostic systems, in most of which a major disadvantage is their poor inter-rater reliability. This results in over-or underestimation of minor biological (e.g. hormonal) disturbances, which occur in conjunction with the disorder, but are unlikely to be only its pathophysiological correlate. These biological factors can be important in some cases, however, as they indicate therapeutic strategies (e.g. correction of a minor hormonal deficit). The broad acceptance of classificatory systems with multi-axial dimensions has prompted the construction of a new system. In accordance with DSM III this consists of seven equivalent axes and sub-axes, supplemented by five sub-types, from which the diagnostic attribution can be derived.

Post-dexamethasone cortisol and platelet monoamine oxidase (MAO) activity levels were examined in 50 depressed patients. The incidence of non-suppression was significantly greater in patients with high platelet MAO activity than in those with low activity. Similar results were obtained when males and females were analysed separately. The mean 4 p.m. post-dexamethasone cortisol level was significantly higher in those patients who had high MAO activity than in their low MAO counterparts. Moreover, a statistically significant positive correlation was observed between platelet MAO activity and 4 p.m. post-dexamethasone cortisol levels.

This study concerns 250 marriages of 40–49 year-old women from a psychiatric patient and general population series. Psychiatric patients' marriages involved less exchange of affection, were husband-dominated, and were of poor quality. In general population marriages, poor quality was related to wife domination. Affection given (AG) and affection received (AR) scores were significantly associated, being high in good marriages and low in bad ones. Zero or near-zero domination was associated with high AG and AR scores and with good quality marriages. Husband domination was linked with wives having high (MMPI) dependency scores. Terminated marriages, compared with bad but non-terminated marriages, had significantly lower AR scores.

A 20 year follow-up on 133 alcoholics was carried out. Tracing methods are outlined and the difficulties reviewed. A questionnaire was completed by 40 subjects concerning drinking outcome, aids to recovery and morbidity. Mortality data are outlined and discussed for the 53 subjects who died during the follow-up period.

Seventeen fasting patients with anorexia nervosa and 15 who also binged were compared in terms of their psychosocial functioning and associated psychiatric symptomatology, using the Delusions Symptoms and States Inventory (Foulds & Bedford, 1975). Both groups scored very highly on the state of anxiety, depression, and elation sets of the DSSI, but less highly on the compulsive and ruminative symptoms sets and on the phobic dissociative and conversion symptom sets. The bingeing anorexic group was significantly older and heavier than the fasting group and experienced more feelings of self-harm and guilt. The bingeing group reported sexual interference during childhood, and currently experienced a desire to vomit during sexual activity to a significantly greater degree than the fasting group.

Recently there has been an increase in the number of reports of anorexia nervosa in non-Caucasian subjects. This paper describes three patients of Afro-Caribbean extraction with anorexia nervosa and/or bulimia nervosa seen at a specialist eating disorders clinic at the Maudsley Hospital between 1981 and 1983. No cases had been seen prior to this. The key clinical features were found to be, in the main, typical.

Twenty-one children who conformed to DSM-III criteria for anorexia nervosa, and who were aged 13 or younger at onset, were followed up after several years (mean = eight) using a range of outcome parameters. Comparison of these results with previous studies of later onset cases suggests that the age of onset of anorexia nervosa carries no prognostic significance.

A case of erotomania (de Clérambault's syndrome) in a female with Schneider-positive schizophrenia is presented. The factors in her environment which may have precipitated the illness are discussed. The secondary nature of the syndrome is further illustrated by a discussion of the literature. In erotomania, the deluded victim, usually a woman, believes that a man, unattainable because of his social status, is in love with her. The nosological purity of the syndrome, despite its relative rarity, remains a subject of considerable debate. We present a case of erotomania in a female with schneiderian first rank symptoms (FRS) of schizophrenia (Schneider, 1959).

The case is presented of a twelve-year-old boy suffering simultaneously from Tourette Syndrome (TS) and a manic episode. The problems of this unique clinical association are discussed from the point of view of differential diagnosis, treatment, and possible biochemical basis. The case also illustrates the usefulness of the expanded concept of TS as a neuropsychiatric disorder with dys-regulation of perceptual, motor, and cognitive functioning.

The phenomenon of the vampire is ancient, ubiquitous, and fascinating; moreover, it can only be understood adequately within the context of more general blood reliefs and rituals. (See Prins, 1984 for a review). References to vampires and associated phenomena may be found in the world's great literature long before Bram Stoker created his notorious and evil Count (Summers, 1960, 1980). Belief in the vampire's actual physical existence was probably encouraged by the prevalent practice of premature burial during times of plague, by the large numbers of itinerants and beggars that abound at such times, and by the fact that many of them took refuge in vaults and graveyards. In addition, the myth was probably given more tangible reality by such physical explanations as Erythropoietic Protoporphyria or its variants. This disorder is said to induce the body to produce an excess of porphyria, which results not only in excess redness of the eyes, skin and teeth, but also a receding of the upper lip and cracking of the skin, which bleeds when exposed to light. It has been suggested that physicians of the day could only treat sufferers by secluding them during the day and by persuading them to drink blood to replace that lost by bleeding (Illis, 1964; Milgrom, 1984; Prins, 1984). In more modern times, there have been accounts of people seeking to protect themselves from vampiric attentions (Farson & Hall, 1978).