It is no exaggeration to say that, in the 30 years since antidepressants were introduced, they have revolutionised the management of depression, thus fulfilling, at least for depressive illness, Paracelsus' prophetic wish. We now have a group of drugs which can induce remission in a disease which is disabling and not infrequently fatal. Despite intensive research, however, our understanding of the mechanism of action of these drugs is still largely hypothetical. Even our methods of evaluation are sufficient only to enable one to decide whether an antidepressant drug is effective or ineffective; there is no experimental method which can rank them in an overall order of potency, and perhaps this should not be the aim, since there must be subgroups of depressed patients who will respond differently to any one agent.

A syndrome of subcortical dementia has been described in conditions predominantly affecting the basal ganglia or thalamus, structures that have also been implicated in the pathogenesis of schizophrenia. There are similarities between subcortical dementia and the type II syndrome of schizophrenia, in terms of clinical features, pattern of neuropsychological deficits, pathology, biochemistry and data from brain-imaging studies. These similarities raise the possibility that certain schizophrenic symptoms, particularly negative symptoms and disturbance of movement, may reflect subcortical pathology. Neuropsychological deficits of presumed frontal lobe origin have been reported in some schizophrenic subjects. The occurrence of such deficits in a condition in which frontal lobe pathology has not been clearly demonstrated may be explicable in terms of a subcortical deafferentation of the pre-frontal cortex.

We examined the relationship between the dates of births of schizophrenic patients admitted to hospitals for the first time in England and Wales between 1970 and 1979, and the occurrence of influenza epidemics between 1939 and 1960. Our results indicate that exposure to influenza epidemics between the third and seventh month of gestation is associated with schizophrenia in adult life. The hypothesis that maternal viral infection is an important cause of schizophrenia can explain many aspects of the enigmatic epidemiology of the condition.

Fluctuating asymmetry provides a measure of an organism's capacity to buffer adverse factors that could disturb its development. It is estimated from the differences between theoretically identical right- and left-sided structures. Dermatoglyphic fluctuating asymmetry has been recently used to investigate developmental disorders. Fingerprints and palm prints of schizophrenic patients, which had been the subjects of an earlier report of conventional dermatoglyphic trait frequencies, were reanalysed to determine their level of fluctuating asymmetry. A review of the diagnostic protocols and clinical records used in the original study indicated that most of the 482 subjects would have met DSM–III–R criteria for schizophrenia. The schizophrenic sample had significantly higher levels of fluctuating asymmetry on four dermatoglyphic traits, the finger-ridge counts, fingerprint patterns, the palmar atd angles and palmar a-b ridge counts, than controls. This finding supports the results of two earlier studies, and its relevance to the roles of genetics, foetal insults, and developmental anomalies of the brain in the aetiology of schizophrenia is discussed.

Thirty-four schizophrenic patients in an acute in-patient hospital were compared with 24 in-patients with major affective disorder and 19 non-patient controls on a role-play test of social skills and a test of affect perception. The role-play test consisted of 12 simulated conversations in which the subject was confronted by parents and friends expressing high-EE criticism or non-critical dissatisfaction. Schizophrenic patients lacked assertiveness and social skills in all conditions, but they did not show any differential impairment when presented with high EE. They consistently lied and denied errors rather than responding assertively or apologising, whether confronted with high-EE or benign criticisms. On the affect perception test, schizophrenic patients consistently underestimated the intensity or negativeness of negative emotions, but they were not deficient in perception of positive emotional displays. The data do not support the hypothesis that schizophrenic patients are poor at dealing with high-EE behaviours, but do indicate that their ability to cope with even mild negative affect is impaired. Possible explanations for this impairment include limited attentional capacity, a neurologically based perceptual deficit, and a self-protective mechanism to reduce or avoid stress.

Videotaped social interactions were shown to a population of schizophrenics and controls who were asked to comment on the emotional state of the principal protagonist. Their free responses were subjected to a content analysis to examine which of three possible explanations of known schizophrenic inaccuracies on this task were responsible: formal thought disorder, selective avoidance of psychological factors, or perceptual/attentional deficits. Neither selective avoidance nor marked thought disorder were found to explain these errors. The schizophrenics as a group rated much the same, irrespective of clinical profile. Their judgements of personality were less clear-cut than the controls.

We report a series of 15 patients with delusional (paranoid) disorder as defined in DSM–III–R. All were supervised by a forensic psychiatry service after violent or threatening acts. We hypothesised that delusions and actions in these patients would be congruent with an abnormal mood characterised by fear and anger. Informants and the patients indicated a pervasive and persistent abnormality of mood (fear and defensive anger), with delusions and actions that were congruent with this mood during the offence and for over a month before. Other behaviours, such as fleeing or barricading to avoid delusional persecutors, were also consistent with congruence of mood and delusions. In all cases, violent acts and mood were congruent, but in three cases the violent act was unrelated to delusions. Although a study such as this does not demonstrate that the mood abnormality is primary, we believe moods of fear and anger in delusional disorder are not sufficiently recognised as part of the disorder.

A new community psychiatric service in Nottingham based on general practice clinics was compared with a conventional hospital-orientated model. Despite providing treatment for an inner-city population of significantly greater social disadvantage, the community service was associated with similar levels of symptom morbidity as assessed by the CPRS and the SFS. It also involved greater use of day-hospital facilities, more extensive multidisciplinary care, and a commitment to longer-term follow-up of chronically ill patients. Such a model is offered as a basis for future developments of urban community psychiatric services.

In the longitudinal cohort study of young adults from the Canton of Zurich in Switzerland, two groups of eating problems were defined: binge eating and weight concerns. Subjects with these conditions were interviewed at the ages of 27–28 and 29–30 years. The binge eaters, mostly women, differed both from subjects with weight concerns and from controls. They had more severe eating problems and more anxiety and depression. Follow-up as well as retrospective data suggest that eating problems are persistent for the binge eaters, and, to a lesser extent, also for subjects with weight concerns. Even so, professional treatment is rarely sought by subjects with eating problems. These findings encourage long-term studies on eating problems in community samples.

Increased spontaneous fluctuations in skin conductance (SC) in adult schizophrenics have been associated with high expressed emotion (EE) in their relatives. This is the first study in children where parental EE, parental psychopathology, and autonomic activity, indexed by SC levels and reactivity, have been assessed. The subjects were children and adolescents with disruptive behaviour disorders (DBD, n = 35), a psychiatric contrast group with obsessive–compulsive disorders (OCD, n = 42) and normal controls (NC, n = 45). Children living in homes with two high-EE parents had higher SC activity during rest period and slower adaptation to relaxation. Fathers' EE and maternal psychiatric diagnosis were related to higher SC activity, especially for the OCD group.

The déjà vu experience is a subjective phenomenon that has been described in many novels and poems. Here we review over 20 literary descriptions. These accounts are consistent with the data obtained from psychiatric literature, including various phenomenological, aetiological and psychopathogenetic aspects of the déjà vu experience. The explanations, explicitly formulated by creative authors, include reincarnation, dreams, organic factors and unconscious memories. Not infrequently, an association with defence or organic factors is demonstrable on the basis of psychoanalytic or clinical psychiatric interpretation. The authors recommend that psychiatrists be encouraged to overstep the limits of psychiatric literature and read prose and poetry as well.

The effects of moclobemide (300–600 mg/day), a reversible monoamine oxidase inhibitor – A (MAOI-A), were compared in a double-blind, multi-centre trial with those of clomipramine (100–200 mg/day) on 129 in-patients suffering from endogenous depression (according to ICD–9 and the Newcastle Scale). No significant differences in efficacy were seen between the two treatment groups. In the moclobemide group the mean scores on the MADRS were 36.4 on day 0 and 13.2 on day 42 (end-point analysis); scores were 37.4 and 10.9 respectively in the clomipramine group. An earlier onset of antidepressant activity was noted for moclobemide. Tolerability was significantly better for moclobemide, as shown by the Clinical Global Impression of Tolerance (CGIT). Anticholinergic effects, weight gain and orthostatic hypotension were more frequent in the clomipramine group. No biological treatment-related changes were observed.

Four self-rating scales of hypochondriasis and the Symptom Checklist-90 were administered to 100 general practice (GP) patients and matched non-psychotic psychiatric out-patients. In a stepwise linear regression, self-rated somatic symptoms and anxiety predicted hypochondriacal fears and beliefs; self-rated depression did not appear as a predictor. There were differences between males and females and between psychiatric patients and GP patients in the associations of these constructs. These results varied in part with the scale of hypochondriasis used. Various scales of hypochondriasis appear to measure different features of the hypochondriasis syndrome. Fear of disease (disease phobia) was associated with anxiety, whereas a false belief of having a disease (disease conviction) was associated more with somatic symptoms.

Applications of molecular genetic techniques to schizophrenia have shown great initial promise but have then proved disappointing. In order to maximise chances of elucidating the genetic mechanism underlying schizophrenia, diverse strategies and diverse perspectives must be adopted. Most studies begin with the premise that, although schizophrenia may be a heterogeneous collection of diseases, some subtypes will be primarily single-gene disorders. We are concerned that this single-gene hypothesis may be incorrect. Schizophrenia research may benefit from application of knowledge from other disciplines and from other diseases which, in terms of epidemiology and apparent genetic mechanisms, bear some resemblance to schizophrenia.

A female psychopath presented multiple forms of psychopathology, including features of ‘multiple personality disorder’. It is proposed that a diagnosis of borderline personality disorder, or the psychodynamic features of borderline personality organisation, should be the exclusion criteria for this condition.

British Journal of Psychiatry (1992), 160, 541–544

A 67-year-old anxious and depressed woman was withdrawn from a long-term course of a benzodiazepine and soon after was given ECT. This proved ineffective, but ECT given some months later was successful. It is suggested that the chronic administration of the benzodiazepine may have induced changes in the brain that interfered with ECT.

British Journal of Psychiatry (1992), 160, 545–546

A 54-year-old man developed an acute encephalitic illness and subsequently suffered from marked memory difficulties. Considerable improvement with anticonvulsant therapy was demonstrated using a ward-based observation programme and serial neuropsychological assessments. The case report highlights the prominent role played by epileptic activity in determining the severity of the patient's amnesia.

British Journal of Psychiatry (1992), 160, 546–549

Central pontine myelinolysis (CPM) is an uncommon disorder initially described in alcoholic or malnourished patients. Recent reports suggest an aetiological association with abnormalities of serum sodium. A physically unwell non-alcoholic chronic schizophrenic patient, whose symptoms led to psychiatric referral, died of CPM. A review of the literature reveals that psychiatric patients may indeed be at risk for CPM.

British Journal of Psychiatry (1992), 160, 550–552

An 18-year-old woman presented with SMAS: an additional diagnosis of anorexia nervosa was later made. Both conditions should be considered when an adolescent presents with weight loss and vomiting.

British Journal of Psychiatry (1992), 160, 552–554

Two cases of psychotic illness in association with the karyotype triple X showed specific diagnostic and management problems as well as obstetric complications, EEG abnormalities, and lack of a family history of psychiatric disorder. Routine karyotyping during the investigation of psychosis is becoming relevant to psychiatric practice as research reports increasingly feature genetic and chromosome anomalies in association with schizophrenic psychoses.

British Journal of Psychiatry (1992), 160, 554–557