A raised blood sugar level no more defines a single entity than does a raised bilirubin or a low haemoglobin. Diabetes is a heterogenous group of disorders whose only common factor is hyperglycaemia (Tattersall et al, 1980). The classification of diabetes is being revised, although the changes are of more relevance to epidemiologists than clinicians. Previous standards of normal glucose tolerance were set too low, so that some people were labelled diabetic who had no symptoms and have proved on follow-up not to be at risk of developing complications such as retinopathy (i.e. they had a non-disease). Epidemiological evidence suggests that the cut-off point for ‘true’ diabetes (i.e. a condition which leads to complications and shortening of life span) is a blood glucose level two hours after a 50 G oral glucose load of 11.1 mMol/L (National Diabetes Data Group, 1979). This corresponds to a fasting blood glucose level of 7 mMol/L or below. Hence, a single blood glucose value, either in the fasting state or two hours after a 50 G glucose load, is enough to diagnose diabetes and glucose tolerance tests should hardly ever be necessary.

In the past, birthplace has frequently been omitted in completing the Sheet, but in 1976, over 91 per cent of all first admissions to psychiatric hospitals in South-East England were analysed by birthplace, sex, age-group and marital status. First admissions for schizophrenia were five times the expected number for immigrants from New Commonwealth America (the West Indies), four times the expected number for immigrants from New Commonwealth Africa (mostly ethnic Asians) and three times the expected number from India. Immigrants from Pakistan and the remaining New Commonwealth Asian countries did not show a significantly higher than expected number of admissions for schizophrenia, and their first admissions for alcoholic psychosis and alcoholism, psychoneuroses and personality and behaviour disorders were significantly fewer than expected. First admissions for schizophrenia were also significantly more than expected among immigrants from Ireland, Germany and Poland, but not from Italy.

Immunoglobulins, IgG, IgA and IgM were quantified in cerebrospinal fluid (CSF) and plasma from chronic schizophrenic patients and controls using an immunofluorescent antibody technique. A generalized reduction in immunoglobulin levels was observed in the schizophrenic patients compared with controls. While this study supports other reports of abnormal immune functioning in schizophrenia, it failed to replicate previous findings of elevations in CSF IgG and elevations in serum IgA. The aetiology and significance of these findings are hypothesized but remain elusive.

Similarities between language disorders in aphasia and formal thought disorder in schizophrenia are explored in 24 schizophrenic, 5 manic and 5 depressed psychiatric in-patients, and 28 normal controls. Eight sub-tests from the Boston Diagnostic Aphasia Examination, a picture naming test and the Token Test were administered. Schizophrenics with formal thought disorder showed significant abnormalities compared to all other groups, particularly on the Token Test and the repetition of phrases test. These deficits are suggestive of language comprehension and repetition dysfunctions in a substantial minority of rigorously defined schizophrenics.

Data from Chapman's anhedonia and perceptual aberration scales are presented for groups of schizophrenics and hospital staff control subjects. Differences between the two groups are found for both anhedonia scales and for the perceptual aberration scale, but the difference for physical anhedonia is only marginally significant. The anhedonia scales do not differentiate between the two groups sufficiently well to be useful diagnostically.

Forty-two subjects, 20 with and 22 without clinically diagnosed tardive dyskinesia (TD), were rated for TD on the scale of Simpson et al. They also performed a tongue protrusion test and had the presence of tongue movements within the buccal cavity observed. Fifty per cent of the severe or definite TD subjects as classified by rating scale were unable to maintain tongue protrusion for a minimum of 30 seconds, and 85 per cent of them had abnormal tongue movements. In 45 per cent of the possible TDs and in 9 per cent of the doubtful subjects, the movement test was also positive.

Jaspers' (1963) concept of delusions proper is founded on the fact that patients suffering from schizophrenic and paranoiac psychoses experience these mental events as ego alien and completely unlike previous modes of thinking, feeling and perceiving. This disruption in the continuity and quality of mental life has been taken to indicate that, in contrast to delusion-like ideas, delusions proper do not have psychological antecedents. Such a view has never been acceptable to psychiatrists who favour a developmental approach to mental pathology. According to Minkowski (1927), Katan (1954) and Ey (1969), whose writings are based on Jackson (1894), Freud (1911) and Ribot (1920), it is possible to understand and resolve this disturbance in the continuity of the content of the mental life of those who succumb to schizophrenic and paranoiac psychoses.

The paper reports a controlled study of the impact of social skills training within a longer treatment approach to patients with anorexia nervosa. Under these circumstances social skills training was not found to be a very powerful form of intervention. Possible reasons for this are touched on.

Following the method of Brown and Harris 30 Kenyan patients suffering from depression and 40 community non-psychiatrically-disturbed controls were studied for contextual and reported threat due to short-term and long-term life events. It was found that the patients did not over-rate threat due to events (in ‘search for the meaning’) nor did the controls under-rate the threat of life events. Some theoretical issues on the ‘contextual threat’ of life events are raised.

The influence of beta-adrenoceptor antagonism on the effects of a simple experimental stress was investigated in 12 healthy volunteers, using a double-blind protocol. A single oral dose of 80 mg propranolol reduced the stress-induced increase in heart rate and systolic blood pressure to 49.9 per cent and 8.3 per cent respectively compared to 61.0 per cent and 17.4 per cent with placebo. The rise in diastolic blood pressure was small and unaffected by beta-adrenoceptor blockade. The rise in temperature of the skin of the trunk was significantly reduced by propranolol. The self-rating of anxiety, alertness and concentration by the subjects was unaffected by propranolol.

The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.

The corpus callosum, a cerebral commissure of 200,000,000 fibres, is thickened in chronic schizophrenia and several neuropsychological and neurophysiological techniques have suggested poor links between the two cerebral hemispheres. The interhemispheric conduction time across the corpus callosum, measured in 12 schizophrenics, using the ipsilateral/contralateral latency differences of the early somatosensory evoked response, was found to be effectively zero. It is suggested that schizophrenia is a split-brain condition akin to agenesis of the corpus callosum, unrecognized through the use of compensatory ipsilateral sensory pathways.

Pseudocyesis is rare in childhood and adolescence. Moreover, in all age groups, there has been little written on its therapeutic handling. We describe a case of pseudocyesis in a fifteen-year-old girl and discuss the therapy in some detail.

A survey of the practice of electroconvulsive treatment, ECT, in Great Britain was made during 1980–81 for the Royal College of Psychiatrists, supported by grants from the Department of Health and Social Security and the Scottish Home and Health Department. This paper is a summary of the main findings together with suggestions from the authors.

This paper analyses the pattern of use of and the response to electroconvulsive therapy (ECT) in an Indian rural teaching general hospital between 1977 and 1980. ECT was used in 503 cases (14.3 per cent of 3,517). Three-quarters of the patients to whom it was given were schizophrenic, one-fifth depressed and 6 per cent suffering from post-partum psychosis. Though the treatment gave the best results in depression it was also effective in many schizophrenics and post-partum psychotics. The commonest side effect was memory impairment. Following unmodified ECT severe confusion and excitement were frequent while thrombophlebitis, bronchospasm, prolonged apnoea and peripheral circulatory collapse occurred only with the modified technique. The usefulness of ECT in developing countries like India is highlighted.