The nature and extent of psychological and social disability following head injury remain issues of considerable practical and theoretical interest. Practical because of the size of the problem and the resulting burden of care; theoretical because head injury should provide a powerful model for an improved understanding of the relationships between cerebral disorder and psychological impairment. (Lishman, 1973)

Recent research on the factors that mediate the emotional wellbeing of the caregivers of dementia sufferers is reviewed. The roles of such factors as the caregiver's attributional style and coping strategies, the caregiver's relationship with the dementia sufferer, and levels of formal and informal support are discussed with reference to identifying those caregivers who are particularly vulnerable to emotional disorder or strain.

The use of electricity in British psychiatry during the second half of the 19th century is examined. An account is given of the clinical and theoretical aspects of electrical therapy. Factors leading to its use and eventual decline are considered.

Two groups of patients admitted to psychiatric hospital in Dumfries were studied, drawn from the periods 1880–1889 and 1970–1979. Feighner criteria were applied to make three diagnostic categories – depression, mania and schizophrenia – and the occurrence and content of delusions were noted for each. A significant decline in the prevalence of delusional depressive illness was found between the two periods, and a similar trend was noted for delusional manic illness. In contrast, the prevalence of delusional schizophrenic illness was stable. This decline is taken to reflect a change in the phenomenology of affective illness since last century in South West Scotland. The content of delusions is also discussed.

All referrals from two general practices to psychiatrists in hospital and primary-care out-patient clinics were examined. Women in all diagnostic groups were preferentially referred to the primary-care clinics, which provided especially for psychotic and chronic illnesses, and at which attendance rates on first and subsequent appointments were substantially higher than at the hospital clinics. The hospital crisis-intervention clinic dealt particularly with acute psychosis and personality disorder. Patients referred to the traditional hospital out-patient service were those with the less common neuroses and personality disorder. These results are reviewed in the context of the criticism that psychiatric clinics in primary care serve only the “worried well”.

Chronically ill day patients were followed up 3 years after identification in the catchment areas of 13 psychiatric hospitals serving 54% of the Scottish population. Five per cent had died, 6% were in-patients, 56% remained day patients and 14% were supported by community psychiatric nurses or attended an out-patient clinic; contact had been lost with 19%. Over 3 years, 32% had had at least one admission to in-patient care; a wide range of other services was also used. There was little change in the level of disability; a typical patient in contact at follow-up was single, schizophrenic, and rather disabled.

The validity of premorbid IQ estimates provided by the National Adult Reading Test (NART) and Vocabulary sub-test of the Wechsler Adult Intelligence Scale were evaluated, by comparison with matched, healthy control subjects, in Korsakoff psychosis, alcoholic dementia, dementia Alzheimer type (DAT), multi-infarct dementia (MID), Huntington's disease, and closed head injury (CHI). There was no significant difference in NART performance between control subjects and the alcoholic dementia, DAT, MID, and CHI groups. Although there appeared to be a decline in NART performance in the Korsakoff and Huntington's groups, it did provide a significantly higher IQ estimate than the Vocabulary sub-test. All clinical groups, with the exception of the CHI group, performed at a significantly lower level than the control group on the Vocabulary sub-test.

A study on neurological conditions was performed in the Republic of San Marino, which is the smallest independent state in the world (60 km2, 21 792 people). We personally examined or collected information on all people born in 1898, 1903, 1908, 1913 and 1918 and living in the Republic of San Marino on 31 July 1985. We found 29 people out of 488 with mild to severe dementia. Frequency of dementia increased progressively with age, from 1.8% among 67-year-olds to 25% among 87-year-olds. In women the increase was due mainly to primary degenerative dementia, whereas in men other types of dementia were involved. Our study shows a female/male ratio of more than 2:1 for primary degenerative dementia even considering mild dementia, and this form of dementia represents about 50% of all types of dementia. We found an association between severe auditory loss and primary degenerative dementia.

Thirty-nine patients with DSM–III diagnoses of schizophrenia were examined for age disorientation, an inability to produce one's correct chronological age upon request. Six patients were age-disoriented and demented (as defined by Mini-Mental State evaluation), while two patients had delusions concerning their age, but were not demented. Age-disoriented, demented patients had very large cerebral ventricles and very low Mini-Mental State scores. This group differed on the cognitive and neuroanatomic variables from other demented, but not age-disoriented, patients, as well as from non-demented patients who were age-oriented. The age-disoriented patients appeared to be at an extreme end of the dementia spectrum in schizophrenia.

Schizophrenic in-patients with and without a family history were identified prospectively. The two groups did not differ with respect to clinical variables, ventricular enlargement, prevalence of cortical sulcal widening, or a history of obstetric complications, even when a variety of definitions of familiality were used.

Fifty-four acutely manic patients were allocated to treatment on a double-blind basis with either carbamazepine or lithium carbonate. The short-term effects of treatment were studied over a period of six weeks and the longer term, prophylactic, effects over a period of up to a year. Additional ‘rescue’ medication was allowed when clinically indicated. There was a high drop-out rate from the trial. Despite this, it appeared that valid comparisons between the two treatments could be made. No statistically significant differences were found, but carbamazepine appeared slightly less effective as a treatment for acute mania and more effective as a prophylactic treatment in this group of patients. Possible predictors of individual responsiveness to each treatment are discussed.

Plasma renin activity (PRA), aldosterone (aldo) levels, electrolyte levels, and blood pressures were measured in 16 patients with affective disorders taking lithium prophylactically, and in 16 age and sex-matched control subjects. PRA and aldo levels were significantly elevated in the lithium-treated group. There was no difference between the groups in plasma electrolytes or erect and supine blood pressures, arguing against secondary aldosteronism. In the lithium-treated group, there was a significant positive correlation between both PRA and plasma aldo vs serum lithium. We postulate that lithium inhibits the action of aldosterone on the distal tubule in the kidney. Activation of the renin angiotensin system maintains normal blood pressure and plasma electrolytes.

Twenty-nine overweight schizophrenic patients maintained on depot neuroleptic injections who wished to lose weight took part in a double-blind, placebo-controlled trial of 30 mg d-fenfluramine. All subjects received dietary advice. Sixteen patients completed the 12-week trial. Rate of weight loss was significantly greater in those taking d-fenfluramine. Side-effects were reported, but no deterioration in mental state was noted.

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

A straightforward test for detecting clustering in patterns of parasuicide in individual patients is described and applied to data from the Edinburgh Regional Poisoning Treatment Centre.

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20–24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.

A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.

A double-blind, cross-over, placebo-controlled study of dydrogesterone (10 mg b.d.) in the treatment of premenstrual syndrome is described. Two groups of women were studied: secondarily referred hospital clinic patients, and self-referred patients. Only one-third of patients screened completed the study. All patients showed significant improvements in symptom scores during the course of the study, the only significant difference between placebo- and dydrogesterone-treated patients being an increase in frequency of breast tenderness and a decrease in pain with menstrual bleeding in the latter.

Predicting who will relapse after behavioural or dynamic psychotherapy is important. A search for variables likely to predict individuals at risk of relapse was conducted in two groups of successfully treated stutterers. The most powerful predictors were the attainment of three goals by the last day of treatment; namely, skill mastery as evidenced by no stuttering, normal attitudes to communication, and an internalisation of the locus of control. Of the subjects who achieved these three goals, 97% maintained their improved speech in the long term. No subject who failed to achieve any of these goals remained fluent, while those who achieved one or two goals had intermediate outcomes. No single goal was necessary and none alone was sufficient to maintain improvement. Both actual and perceived mastery over stuttering appear to be important if the long-term outcome is to be satisfactory.