Society's attitude to psychiatry has always been ambivalent. When, as a young doctor, I announced my intention to take up this discipline to my then chief, who was a distinguished clinical pathologist, his face turned a deeper shade of purple, and he muttered something about “mumbo-jumbo and guesswork” before stalking off into his den. Much more recently, I broke a lifelong tradition by actually entering into conversation with a stranger on a British railway train. Somehow or another, he extracted from me the information that I was a Professor of Psychological Medicine. “Well, well, he murmured, “and I always thought that was the stuff they put into those huge bottles of red and blue liquid you sometimes see in the windows of the older chemist shops”. That gentle twitting is small beer by comparison with the grave reservations expressed by many individuals and groups.

The overvalued idea, first described by Wernicke, refers to a solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer's life. Disorders conforming to his definition are well documented, though their recognition as such has been variable, and they may not be as rare as is often thought. As well as sharing a distinctive phenomenology, the conditions develop in similar settings and carry a uniformly poor prognosis. Their pathogenesis is obscure and difficult to account for in conventional terms.

A cohort of 120 patients, comprising all those who met the St Louis criteria for a diagnosis of schizophrenia, discharged from a mental hospital over a five-year period, were followed-up in the community after an interval of five to nine years; 105 were traced and 94 were alive. Of those, 66 were living in UK, out of hospital, and willing to be seen. Their mental states, and social functioning and circumstances were assessed by interview with the patients and those with whom they lived; 18% had recovered to the extent that they had no significant symptoms and appeared to function satisfactorily. More than 50% had definite psychotic features. No patients and few relatives sought a return to hospital care, but severe emotional, social, and financial difficulties were commonplace; 27% of the sample had no contact with medical or social services, a further 14% saw only community nurses, and 24% only their general practitioners. The findings emphasise the limitations of community services in dealing with the chronicity and severity of the impairments resulting from schizophrenic illness.

The dexamethasone suppression test (DST) was administered shortly after admission to 102 consecutive in-patients with a Hamilton depression score ≥16. Post-dexamethasone cortisol exceeded 6pg/dl in 16 cases, and levels correlated significantly with Hamilton scores; with the AMP syndromes ‘hypochondria’, ‘apathy’ and ‘catatonia’; and with the IMPS ‘retarded depressive’ syndrome. The criterion of suppression/non-suppression did not distinguish significantly between diagnostic categories (RDC or ICD), nor between endogenous and neurotic depression. (Newcastle scale). Both base-line and post-dexamethasone cortisol levels were reduced by prior treatment with minor tranquillisers, but not by major tranquillisers or antidepressants. DST results cannot be used as straightforward indicators of prognosis.

The distribution of in-patient psychiatric admissions throughout the city of Bristol during the period 1978–1981 is described. High rates were found from the central urban areas of low social class and with a high concentration of immigrants. The findings suggest that immigrant groups (mainly of West Indian origin) are no more likely than others living in the city centre to become psychiatric hospital in-patients, but when they do so, they are more likely to require compulsory admission.

Three groups of patients admitted compulsorily from populations with markedly different rates of compulsory psychiatric admissions were compared on a range of social and clinical data. Whilst West Indian and white patients from inner city areas differed in many respects, they were both more likely than other patients to be referred to the psychiatric services through police agencies, with little GP involvement and were often admitted from public places following disturbed behaviour. However, levels of violence and threatening behaviour were no higher among inner city patients, black or white, and once admitted, these groups showed similar treatment compliance to white patients who had been admitted compulsorily from suburban areas. Implications for primary care and delivery of psychiatric services are discussed.

The condition known as AIDS (Aquired Immune Deficiency Syndrome) was first described by the Centre of Disease Control (CDC), Atlanta in June 1981. A subsequent nationwide survey soon revealed that similar cases had been occurring since 1979. At the time of writing, 3064 cases have been reported to the CDC of which 1,292 (42.2%) have died; 1,275 (41%) have occurred in New York City.

The depression and lability of mood which have been previously reported on the fifth day after childbirth are largely restricted to women with high neuroticism scores. The pattern of day-to-day mood changes is the same after Caesarian section as after vaginal delivery, but there is no ‘day five’ phenomenon after hysterectomy. Post-partum mood disturbance is less prominent in women who return home 48 hours after delivery.

All chronic day-patients (n = 422), defined as patients aged 18–64 years attending a day facility of a psychiatric hospital or general hospital psychiatric unit continuously for more than a year, were identified in hospitals and units serving 56% of the Scottish population. The number of day patients was 14.8 per 100,000 of the general population, but the range between hospitals was very great—0 to 37.7 per 100,000—indicating the patchy development of such care. A typical day patient was a rather chronic middle-aged male schizophrenic, who lived on his own or with ageing parents. Most patients' accommodation was satisfactory, but the occupational activity of more than a third was inappropriate; 18% could have attended a local authority sheltered workshop if one had been available.

Evidence concerning the impact of the violence in Northern Ireland on psychiatric morbidity is limited to studies examining admission rates and psychotropic drug prescribing rates; their results varied from suggesting no effect to indicating that greater levels of violence are actually equated with higher levels of mental health. The present study is the first to use a community sample, in which respondents (797) from two towns, which have experienced contrasting levels of violence over the last ten years, completed the 30-item version of the General Health Questionnaire (GHQ), and also indicated their perception of the level of violence in their area and how safe they felt this was to live in. Those who lived in the more violent town scored higher on the GHQ, as did women compared to men and those who perceived that their area had experienced more violence. There was also a two-way interaction, such that the small number of people, who perceived much violence in their area and who also lived in the more violent town, scored more highly on the GHQ. It is possible that the majority of people in Northern Ireland deal effectively with stress generated by the political violence, but do so by denying the existence of this violence around them.

The author fundamentally questions the traditional concept of the disease-entity (or several disease entities) of ‘schizophrenia’ and discusses an alternative concept, based on vulnerability and information-processing. According to this, schizophrenia-like psychotic phenomena develop in three phases. In the first, premorbid phase, combined biological (genetic and possibly other organic) and psycho-social influences lead to a premorbid ‘vulnerability’, characterised by a low tolerance of cognitive and emotional stress, corresponding to an insufficient capacity for the adequate processing of complex information. In the second phase, stressful life-events can lead to unique or repeated acute productive psychotic episodes. The third phase, that of long-term evolution, depends more on psycho-social influences than on biological factors. Under unfavourable conditions, it may lead to predominantly unproductive residual states of various degrees, which can largely be understood as regulatory mechanisms to restrict stressful over-stimulation. There is no clearly delimitable disease entity of schizophrenia with constant causes, psychopathological picture, or course, but rather a multi-conditioned life-process, occuring in people with a particular vulnerability, interacting with complex life-events and circumstances. This new concept has important consequences for therapy and prevention.

Recent research has suggested that the absence of an intimate, confiding relationship may be a vulnerability factor in the development of depression in women living under adverse circumstances. This study demonstrates a significant association between severity of depression and deficiencies of marital intimacy; depressed patients with the lowest levels of marital intimacy failed to improve at one month follow-up, while 36% of the spouses of the depressed patients had symptoms of non-psychotic emotional illness. The depressed patients and their spouses' perception of their marital intimacy differ, but these differences appear not to be solely related to the spouse's depression.

Changes in appetite and weight were recorded in mild to moderately depressed out-patients during the course of clinical trials of various antidepressant drugs. After six weeks, differences due to treatment regimes were minimal. Patients who on becoming depressed experienced severe changes in appetite and weight in either direction, tended to return to normal. The significant associations of appetite and weight change during treatment were with weight, appetite, and carbohydrate preference at presentation, and also with the ‘appetite history’ and ‘weight history’. The associations with the degree of depression were relatively minor.

A marked elevation in human growth hormone (GH) following intravenous infusion of thyrotropin releasing hormone (TRH) was seen in three of seven adolescent male schizophrenic patients receiving neuroleptic drugs, and in one of five controls matched for age, sex, and developmental stage, receiving the same drugs. A positive family history for schizophrenia was noted in all three schizophrenic ‘responders' but in only one of the remaining patients. The response patterns of thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4 following TRH infusion were not significantly different in the two groups. No significant correlations were found between T3, T4, TSH, or GH response patterns and age of patient, duration of illness, medication dose or duration, weight change, or hours of sleep preceding testing.

The possible value of event-related potentials (ERPs) in the differential diagnosis of dementia was investigated in a group of 42 demented elderly patients, 29 non-demented elderly patients, and 10 healthy young controls. The auditory evoked potentials were elicited by using target and non-target auditory stimuli. There was no significant difference in N100 and P200 latency between these groups. Our results indicate an age-related increase of P300 latency of 0.3 msec/year in the non-demented subjects. There was no significant difference in P300 latency between demented and non-demented patients, and the latencies vary widely within the groups of elderly patients.

The hypothalamic - pituitary - gonadal axis was evaluated in men with paedophilia and non-paedophilic paraphilia, and in normal male controls, by infusion of 100 meg. of synthetic luteinising hormone-releasing hormone (LHRH). There were no significant differences among groups in age, height, weight, testosterone, baseline luteinising hormone (LH) and follicle stimulating hormone (FSH), and FSH response to LHRH. However, there was a significant difference between the paedophilic group and the other two groups in the LH response to LHRH. The paedophiles responded with a marked elevation of LH, when compared with the non-paedophilic paraphiliacs and controls. These data indicate a hypothalamic - pituitary - gonadal dysfunction in paedophiles.

Serum immunoglobulins were quantified in 85 consecutively admitted patients from an acute-care psychiatric in-patient unit. The patients were diagnosed as: major depressive disorder, 53; chronic schizophrenia, 12; schizophreniform psychosis, 4; substance abuse disorder, 12; and miscellaneous other diagnoses, 4. A small sub-group of these patients, which included six with major depression, one with chronic schizophrenia, and one with a personality disorder, were found to have low IgM concentrations. Immunoglobulin levels were not associated with use of medication or length of illness prior to this hospital admission. This study provides further evidence for suppression of humoral immunity in some psychiatric patients (approximately 10%).

Headache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

It has often been said—though sometimes tongue-in-cheek—that there is as much to be learnt from great works of literature about the malfunctioning of human thoughts and feelings as from the standard textbooks of psychiatry. This obviously over-simplifies the situation; very much more of psychiatric interest will be found in classic writings by one who knows what he is looking for, through knowledge of the discipline's basic texts. But it is true enough to make the ever-increasing emphasis on scientific and technical information in psychiatric training a matter of some regret. What shall it profit us, in trying to help patients, if we know more and more biochemistry and pharmacology, but at the same time lose the insight that artists and writers have recorded over centuries about the human condition?