Out-patient referrals to the Edinburgh adult psychiatric service between 1981 and 1985 were studied using the Edinburgh Psychiatric Case Register. The hypotheses that primary-care clinics have more patients with less severe illnesses and fewer patients with psychotic illnesses were confirmed.

Catatonia is now accepted as a non-specific syndrome. Hysteria can very rarely be a cause. A case of hysterical catatonia developing twice in a year, and on both occasions responding to ECT, is presented. Initial diagnostic difficulties, and use of the sodium pentothal interview as a diagnostic test, are also described.

A 19-year-old woman, blind since birth, lost 26 kg over a 7-month period. This was achieved by restriction of food intake, excessive exercise, laxative abuse, and self-induced vomiting. Although the visual experience is often believed to be an integral component of body-shape perception and the overvaluation of thinness in contemporary society, it does not preclude the development of anorexia nervosa.

Two cases of lithium-induced hypothyroidism, presenting as carpal tunnel syndrome, are reported. This is believed to be the first report of such an association.

The concurrent appearance of the koro syndrome and pathology of the central nervous system is quite rare. A case of a patient with a diagnosed tumour in the genu of the corpus callosum, who displayed typical koro symptoms, is presented. A short series of electroconvulsive shock treatments brought about resolution of the koro symptoms. Neurological investigation of all sporadic cases of koro is deemed necessary, to exclude cerebral involvement.

A case of probable neuroleptic malignant syndrome (NMS) complicating l-dopa withdrawal in striatonigral degeneration is described. This case suggests that the hyperthermia of NMS is due to peripheral heat production associated with severe muscular rigidity secondary to withdrawal of striatal dopamine drive, rather than being centrally mediated by the hypothalamus, which is not involved in striatonigral degeneration.