A common denominator can be found permeating thought disorder at various levels – the lack of executive planning and editing. With data available from aphasiology and neuropsychology, certain features of thought disorder can be reinterpreted as being consistent with dysfunction of the frontal lobe. It is hypothesised that thought disorder may reflect a dysfunction of the cortical–subcortical loops that project into the pre-frontal cortex. The hypothesis predicts that thought-disordered patients will have impaired performance on tests of frontal lobe function, regardless of diagnosis.

The distinction of positive and negative symptoms in describing schizophrenic patients has become popular. It presupposes that symptoms cluster in two dimensions, fitting together not only theoretically but empirically. Factor analysis of three published studies of 93, 62 and 52 schizophrenic patients and a large pooled sample showed that more than two distinct dimensions are required to categorise symptoms in schizophrenia. This result is consistent across methods and samples, and with previous literature. The added dimensionality resulted from a splitting of the positive symptom domain into more distinct factors.

The assessment of catatonic symptoms, unlike that of other schizophrenia symptoms, has not acquired accuracy and phenomenological rigour, and their distinction from extrapyramidal side-effects is not always easy. The Modified Rogers Scale can rate abnormalities in movement, volition, speech, and overall behaviour in schizophrenia. It is detailed, reliable and valid, and permits the isolation of a score for non-extrapyramidal and hence presumably catatonic phenomena.

An alternative to the conventional separation of extrapyramidal and catatonic symptoms exists in the ‘conflict of paradigms' hypothesis, which proposes that there is a relative rather than absolute distinction between the two. The hypothesis predicts that a clinical association should exist between extrapyramidal and catatonic symptoms in schizophrenia. After rating 75 schizophrenic patients, a highly significant correlation between scores on the two classes of disorder was indeed found. This was composed of separate correlations between tardive dyskinesia and ‘positive’ catatonic phenomena, and Parkinsonism and ‘negative’ catatonic phenomena. The associations were not easily attributable to confounding factors and they were supported by factor analysis.

The variety and complexity of schizophrenic movement disorders renders them difficult to assess. In particular, the complex disorders of motility that appear to reflect disturbance of the will demand an evaluation of the purpose of the movement. The difficulties of assessment are compounded by the fact that the antipsychotic drugs used to treat the illness can produce motor disorders that resemble the disorders intrinsic to the illness. In advancing his ‘conflict of paradigms' hypothesis, Rogers (1985) implied that emphasis on the distinction between intrinsic and drug-induced movement disorders might be misplaced because of overlap not only in the observable characteristics of these disorders, but also in the underlying neuropathology.

A battery of neuropsychological tests sensitive to frontal lobe impairment was administered to 43 chronic schizophrenic patients to delineate the abnormality of mental processing associated with the syndromes of psychomotor poverty and disorganisation, which had been identified in a previous study of the segregation of schizophrenic symptoms. Psychomotor poverty was found to be associated with slowness of mental activity, including slowness of generating words. The disorganisation syndrome was associated with impairment in tests in which the subject is required to inhibit an established but inappropriate response.

The striatal D2 receptors of 19 untreated schizophrenics and 14 normal control subjects were investigated with PET and 76Br-bromolisuride. The ratio of radioactivity in the striatum to that in the cerebellum was taken as an index of the striatal D2 receptor density. There was no significant difference between the control and the schizophrenic groups, nor any difference between subgroups of patients defined by clinical type or course of illness, and no relationship between the striatum:cerebellum activity ratio and SANS or SAPS ratings of symptoms. Unlike in the controls, this ratio was not correlated with age in schizophrenics. This study suggests that there is no quantitative abnormality of striatal D2 dopamine receptors in schizophrenia.

The effects of physostigmine on patterns of rCBF in patients with pre-senile Alzheimer's disease were studied using 99mTc-labelled HMPAO SPECT. Regional CBF increased in the left cortex relative to right, with the most significant effect in left frontal and higher frontal regions. Measures of regional brain function, such as SPECT, are an important complement to psychological test batteries in understanding the effects in brain of putative antidementia drugs. SPECT brain imaging could extend our understanding of the action of psychotropic drugs in other major psychiatric illnesses.

Thirty elderly demented subjects were assessed in 1985 using a neuropsychological test battery which included tests of parietal lobe function that are allegedly predictive of outcome. Four years later, 29 out of the 30 subjects were followed up. Twelve had died. There were no differences between survivors and deceased in terms of age, pre-morbid intelligence, years of full-time education, or scores on parietal tests. However, proportionally more of the women had died, and those subjects with more global cognitive impairment in 1985 were significantly more likely to have died by 1989. Those who scored lower on an aphasia measure in 1985 were more likely to have died. None of the variables differentiated between survivors and deceased Alzheimer subjects.

An in-patient behavioural psychotherapy unit is described that emphasises self-treatment, teaching relatives to become cotherapists while resident in the unit, routine collection of outcome data, minimising use of medication, and absence of night nurses. Patients are referred from all over the UK, mostly with chronic disabling OCD. Treatment includes self-exposure and self-imposed response prevention. A year's cohort (52 patients) showed substantial improvement that consolidated during six-month follow-up (83% decrease in total ritual time per day, 58% fall in target ritual scores, better social adjustment), and families noted relief of burden; eight patients dropped out. Further such units are needed in the UK, perhaps on a regional basis; they could be run as specialist hostels.

By matching information collected from coroner inquest records with hospital admission and discharge registers, 27 suicides and 5 other unexpected deaths were identified over 30 months among persons who either were psychiatric in-patients at the time or had been up to eight weeks previously. The relevant consultant completed a questionnaire concerning assessment and management in each case. It is suggested that such an approach might usefully be adopted widely as an audit of unexpected deaths. In 20 of the suicides the seriousness of the risk was not fully recognised; 13 absented themselves from the hospital ward without leave. Misleading clinical improvement in the absence of corresponding alleviation of situational problems, and patient alienation appeared important hazards. The findings have implications for service development, particularly when major reduction of bed numbers is planned.

Between 1982 and 1987, 42 patients were selected who had been admitted three times in one week to the Regional Poisoning Treatment Centre in Edinburgh for the treatment of deliberate self-harm. Most (87%) of these admissions related to drug overdose. Most of the patients were young, unemployed, lacking a partner and from the low social classes. Three-quarters of the sample had at least one known conviction and more than a third were known to have served a prison sentence. There was only one patient in whom mental illness was thought to be relevant to the episode of self-harm, although five patients were mildly mentally handicapped. Case notes were reviewed to assess the outcome one year after the index admission. None of the patients had committed suicide, although 36 repeated self-harm during the follow-up year.

In the development and evaluation of a multi-ethnic inventory (the BSI) of somatic symptoms associated with anxiety and depression, symptoms were derived from psychiatric case notes of Pakistani and indigenous British patients with a clinical diagnosis of anxiety, depression, hysteria or hypochondriasis. The inventory was constructed simultaneously in Urdu and English. A pilot version of the BSI was checked against psychiatric case notes in north and south India, and Nepal. The revised BSI achieved over 90% coverage of all somatic symptoms recorded in each centre. The linguistic equivalence of the Urdu and the English versions was established in a bilingual student population in Pakistan. Conceptual equivalence of the BSI was explored using factor analysis of responses by functional patients presenting to medical clinics in Britain and Pakistan. Four principal factors (head, chest, abdomen, fatigue) were similar in both populations.

‘Prescription-event monitoring’ (PEM) is one of two national systems of post-marketing surveillance in operation in Britain. It identified 22 065 patients who had received NHS prescriptions for alprazolam, and data available on 10 895 of these were analysed. The main reasons for treatment with alprazolam were anxiety and depression. The patients provided 3360 patient-years of treatment and 7540 patient-years of follow-up. No serious events clearly associated with treatment were recorded. The main events reported during treatment, albeit infrequently, were drowsiness and depression, although depression is more likely to be due to the disorder being treated than to the drug. Some of the other alleged unwanted effects of alprazolam in published reports were not encountered. Since PEM is unable to determine the dependence potential of alprazolam, further evaluation of this problem is called for.

At three centres, 21 women at high risk for puerperal psychosis were given prophylactic lithium carbonate late in the third trimester of pregnancy or immediately after delivery. Only two of the women had a recurrence of their psychotic illness while on prophylactic lithium. One woman given lithium during third trimester had an unexplained stillbirth. Although a larger sample in a carefully controlled study is still required, there now seems to be grounds for the use of prophylactic lithium immediately after delivery in women not breastfeeding who have previously suffered from either puerperal psychosis or bipolar disorder.

A total of 2605 old long-stay patients, defined as those admitted to hospital before the age of 65 years and in hospital more than six years, were identified in psychiatric hospitals serving 83% of the Scottish population. The bed occupancy was 59 per 100 000 of the general population, with a range among hospitals of 19–123 per 100 000. Of all patients, 64% were schizophrenic and 15% had organic brain disease; most patients were male, single and over 60 years of age; 41 % had been in hospital more than 30 years; 61 % had either florid psychotic symptoms or symptoms of a deficit state in marked or severe degree, and the rehabilitation potential for 70% was low. An increasing prevalence of deficit symptoms in schizophrenics was associated with increasing length of stay in hospital; the difference was most marked between those admitted before and after 1953.

A total population study of children, aged 13 years and under, suggested that there has been an apparent rise in the frequency of autistic disorder and autistic-like conditions (excluding Asperger's syndrome) in one area of western Sweden over the last ten years. The frequency was 4.0/100 000 in 1980, 7.5/10000 in 1984 and 11.6/10000 in 1988 in the city of Göteborg. Even though the prevalence rates refer to slightly different age cohorts, it was concluded that the apparent increase is in part due to better detection, but also to new cases born to immigrant parents. Typical cases of autistic disorder accounted for 75% of cases, and 20% had normal or near-normal IQs.

A 40-year-old man suffered both a short-term memory defect and bipolar mood disorder. It is postulated that both conditions are due to progressive cerebral sarcoidosis affecting the limbic system. The need for early detection and treatment is emphasised.

Fifty patients with UC and 50 matched controls with urolithiasis were interviewed with the SADS (lifetime version) and completed the SCL–90. According to information given during the SADS, there was a history of psychiatric disturbance in 11 UC patients (22%) and 8 controls (16%). At the time of the interview a psychiatric disturbance was present in 31 UC patients (62%) and four controls (8%), the most frequent diagnoses in the former being minor depression and generalised anxiety disorder. Patients with UC scored significantly higher than the controls on all the different SCL–90 subscales.

In a cohort of five patients from the Middle East with the Gilles de la Tourette syndrome, family history of a tic disorder or the Gilles de la Tourette syndrome was positive in three cases. In one of these there was a multiply affected pedigree spanning six generations. The phenomenology of the syndrome is the same as that described in Western reports. The familial pattern of inheritance and cross-cultural similarity emphasise the biological factors in the aetiology of the syndrome.