Cross-cultural studies on immigrants from Pakistan and the New Commonwealth are reviewed, with emphasis on epidemiology and differences in clinical presentation. Their referral to the psychiatric service is also examined and deficiencies are noted. Awareness of transcultural issues among health professionals need to be increased in order to achieve diagnosis and improvements in health care.

The dexamethasone suppression test was administered to 12 mentally handicapped depressed patients. One of the four patients with major depressive disorder, but none of those with other diagnoses, failed to suppress Cortisol production. The International Classification of Diseases and the Newcastle Diagnostic Index were found to be unreliable for use with severely mentally handicapped patients. Modifications are proposed which would allow the Research Diagnostic Criteria and Hamilton Rating Scale for Depression to be applied to patients with any degree of mental handicap.

To examine how the measure of expressed emotion relates to family life, 30 relatives of schizophrenic patients were assessed for EE and then observed in ten-minute discussions with the patients. It was found that high-EE relatives express more negative emotional statements than low-EE relatives when face-to-face with the patient; they also talk more rapidly, and this speech rate is correlated with the patient speech rate. Whereas low-EE relatives expressed few criticisms or intrusive statements, high-EE over-involved relatives were more intrusive, and high-EE critical relatives were more critical as well as more intrusive in direct interaction. These findings emphasise the importance of understanding divergent EE sub-styles and the complementary behaviour of patients. The findings of an earlier Los Angeles study were replicated.

Wrist motor activity was continuously recorded by a solid-state monitor in 12 patients with major depression throughout their stay in hospital; their clinical state was evaluated using three scales. During the day, activity troughs and immobility peaks occurred before noon and around 1500 hrs. Activity level progressively increased, while the duration of immobility decreased, with clinical improvement. The immobility measurement appeared to be a valuable index of depression and is more sensitive than the activity level, mainly for agitated depressed patients. Immobility episodes during the day could suggest the release of an ultradian sleep-wake rhythm in depression.

Of 81 patients receiving ECT during a period of 24 months, 21 ate or drank something, against medical advice, shortly before ECT was due. Compared with controls, the fast-breakers were less often married; were more likely to be detained under a section of the Mental Health Act; had an unfavourable view of ECT; and had often not given consent for ECT. Fast-breaking was more likely to occur after four or more ECTs. Amongst the fast-breakers there was a significant correlation between age and (a) number of previous ECTs; (b) treatment at which the fast-break occurred. The more drugs the patient was taking the more likely it was that the fast would be broken early in the course of ECT.

Twenty-three consecutive married and sexually active Chinese women treated for breast cancer were compared with a randomly selected group of 34 female patients suffering from different kinds of malignancies. A structured interview was used to study both groups. The breast cancer group were found to be less depressed and more emotionally stable than those suffering from other malignancies, suggesting that the diagnosis of malignancy was the more important factor in the psychosocial morbidity of these patients.

Secondary school pupils and their parents were investigated using the scaled version of the General Health Questionnaire (GHQ–28) and by a questionnaire designed to study attitudes involved in inter-generational conflict in psychiatric patients. Parent-pupil and interparental conflict in answers to the attitude questionnaires were taken as measures of inter-generational and intra-generational conflicts respectively. The former significantly exceeded the latter. Parent-student conflict was higher when the students involved were females, Kuwaiti, or had less educated fathers. The tendency of the number of reported GHQ symptoms to be higher in members of families with higher inter-generational conflict did not reach statistical significance. There is an apparent discrepancy between this finding and the prominence of inter-generational conflict in clinical material.

The Piedmont Health Survey interviewed 3798 adult community residents in a region of North Carolina. Current major depression was nearly three times more common in the urban than in the rural counties; rural residence decreased the risk of major depression for some, but not all, demographic subgroups. The risk of major depression was decreased for young rural residents, compared with their urban age peers; rural residence was more protective for young women than for young men. Rural residence appears to be a buffer against major depression.

Two patients are described in whom an obsessive-compulsive disorder began just after the onset of epilepsy. Neurological factors in OCD are then reviewed, and clinical reports of patients with OCD and co-existing brain pathology, EEG abnormalities, CT scan changes and electrical stimulation of the brain discussed. It is concluded that neurological factors are present in only a minority of cases of OCD. Successful behavioural treatment is independent of such factors.

The dexamethasone suppression test was performed on 79 patients with a diagnosis of generalised anxiety disorder. A non-suppression rate of 27% was obtained, comparable to that found in out-patient major depression but notably higher than previous reports in panic disorder. No good clinical predictors of non-suppression were discovered, nor was the co-occurrence of depression sufficient to account for the finding.

Three groups of torture victims were studied with the aim of establishing a concept of psychotherapy for such victims. Analysis of the first group, consisting of 200 case-reports made by Amnesty International medical groups, resulted in a general outline of the psychological methods of torture and their main impact on the victims. A second group of 24 torture victims was examined by the authors, and a quantitative assessment of long-term neuropsychological complaints and a qualitative insight into these symptoms achieved. In-depth interviews with victims in the third group which, consisted of the victims from the second group and six others, together with the results from the other two groups, formed the basis of a concept of psychotherapy for torture victims.

The results of applied relaxation training in patients with generalised anxiety and panic attacks are reported. ART was taught during one session, by means of participant demonstration, written instructions, taped instructions, or a combination of all three, with instructions to practise at home. All four methods proved superior to a waiting list control, but there were no differences between the treatment groups. There was some evidence for the non-specific effect of expectancy, but this did not completely explain the treatment effect.

Specific questioning and frequent observation of a 69 year-old woman with cyclic bipolar manic-depressive illness showed that she had disturbances of thirst, appetite, bowel and bladder function and dramatic changes in body weight, in association with different phases of her mental illness. Examination of one manic phase under constant diet and inpatient control showed cardiovascular changes, sodium retention, body weight gain, with raised aldosterone secretion but steady vasopressin. There appears to be a sub-group of manic-depressive patients with evidence of disturbed hypothalamic functions as part of their mental illness, as shown particularly by changes in water and electrolyte metabolism.

Anxiety attacks were included in the first descriptions of the syndrome of anxiety neurosis. Recently it has been suggested that such attacks (now usually called panic attacks) characterize a distinct form of anxiety disorder—panic disorder, it has also been proposed that panic attacks result from a biochemical disorder and require pharmacological treatment. Some of the evidence for these ideas is presented, and two other explanations for panic attacks are reviewed: that they are caused by hyperventilation, and that they result from a cognitive disorder. It is concluded that although it is not possible on the present evidence to choose between the three theories, there is strong indirect support for the cognitive theory and good reason to investigate cognitive factors more thoroughly. Future work on biochemical causes of, and pharmacological treatments for panic attacks should take account of such factors.

Gamma glutamyl transpeptidase and mean corpuscular volume are shown to be of little value in the assessment of patients admitted to psychiatric beds for problem drinking.

Practising psychiatrists' views about the treatment of schizophrenia were investigated as part of a Quality Assurance Project. A questionnaire which asked for treatment recommendations for each of four case descriptions of patients with schizophrenia was mailed to a one-in-six random sample of Australian psychiatrists; 90% responded. Psychiatrists almost uniformly advocated the use of antipsychotic drugs and usually recommended concurrent supportive psychotherapy or family/social intervention procedures. The recommendations varied systematically, according to the initial history obtained and to the initial response to treatment.

Post-traumatic stress disorder may follow combat stress or civilian psychological traumata. In 25 retrospectively studied patients, symptoms were severe in terms of number of DSM–III items fulfilled, chronicity, and severity of psychosocial disability. Antidepressants had good or moderate results in 67% of cases treated, but major tranquilisers were much less effective; response to drug treatment was not clearly related to somatisation symptoms, significant depression, or panic attacks. Pharmacotherapy appeared to have had a positive impact on psychotherapy in 70% of cases.

The late prognosis of childhood encopresis is unclear: our literature reviews have failed to reveal any studies of it. Halpern (1977), discussing the effectiveness of treatment, states that this is difficult to evaluate “since encopresis is a self-limiting symptom”. Bellman (1966) followed up 186 children with encopresis seen at two Stockholm clinics; their age range at follow-up was 6–19 years. She found a steady decline in encopresis from the age of six in boys and eight in girls. It disappeared by the age of 16, although there were two relapses—one at 17 and one at 19.

Clinical experience suggests that treatment with electroconvulsive therapy (ECT) produces an early improvement in psychomotor retardation. Warnings have been given of the increased risk of suicide when ECT-treated patients recover motor activity before their depressed mood is alleviated (Slater & Roth, 1977).

The management of aggressive and disruptive behaviour in mentally handicapped patients is a severe problem, and it is widely accepted that drug therapy is only one component in the range of measures required for a comprehensive regime, although the use of depot phenothiazines is widespread (Craft & Schiff, 1980). The evidence for their therapeutic effectiveness in the mentally handicapped is usually empirical, and sometimes based on anecdotal evidence. Clopenthixol decanoate is widely used in the management of aggressive and disruptive behaviour in such patients, probably as a result of experience of the use of this drug in schizophrenic patients. Carney & Rutherford (1981) reported a marked improvement in both aggressive and non-aggressive behaviour disorders in 20 chronic schizophrenic patients treated for 11 months with clopenthixol decanoate, while Visiwanathan & Rajhkowa (1982) stated that it was of undoubted value in the management of chronic in-patients, especially those with ‘positive affective’ symptoms such as hostility, aggression, suspiciousness, and irritability.