We used SPECT to examine striatal D2 receptor binding in 20 antipsychotic-free DSM–III–R schizophrenic patients and 20 age- and sex-matched normal controls. Dynamic single-slice SPECT, at a slice chosen to include the basal ganglia, began immediately following intravenous injection of 185 MBq of 123I-IBZM. A semiquantitative approach was used to generate indices of specific D2 receptor binding in the basal ganglia. There was no overall elevation of D2 receptor binding between patients and controls. A male sex-specific left lateralised asymmetry of striatal D2 receptor binding was found in the patient group. Age-dependent decline of striatal D2 receptors was confirmed in controls, but not in patients. These results suggest that alterations in striatal D2 receptor distribution and density do occur in schizophrenia, and possibly reflect wider disruptions in prefrontal-striatal-limbic circuits.

Most in vivo studies of striatal D2 receptor (SD2R) density with positron emission tomography in schizophrenia have attempted to relate this variable to the diagnosis of the illness. In the present study, a relationship between SD2R and clinical dimensions of this psychosis was searched for in a highly selected group of young negative schizophrenics (8 drug-naïve and 2 drug-free). The SD2R density index measured in vivo using 76Br-bromolisuride and PET correlated negatively (r = 0.80, P < 0.01) with a psychomotor dimension of schizophrenia involving blunted affect and alogia. The mean SD2R index of the patients did not differ from that of age-matched control subjects. Therefore, this behavioural dimension accounts for the variance of the SD2R, suggesting that the striatal dopamine system modulates symptoms such as flattened affect and alogia.

This study represents the first attempt to study sexual jealousy in a random community sample. Jealousy was reported by all subjects. Men, when jealous, were particularly concerned about the potential loss of the partner, whereas women were more concerned with the effects of infidelity on the quality of the relationship. Behaviours such as searching the partner's belongings or inspecting their clothes for signs of sexual activity correlated with unusually intense jealousy. Men tended to cope with jealousy by using denial and avoidance, whereas women were more likely to express their distress and to try to make themselves more attractive to their erring partner. Greater jealousy concerns were expressed by young men who had either married early or were now living without a partner. Heavy drinkers and those reporting more psychiatric symptoms were also more prone to jealousy. A clear correlation emerged between lowered self-esteem and increased jealousy, which was particularly marked in women, for whom robust self-esteem was virtually incompatible with high jealousy concerns. The study supported the prosaic notion that those who are satisfied with their romantic attachments are less prone to jealous suspicions. This study offers a starting point for the clinician seeking information about the experience of jealousy in the community.

The paper describes a case-note and interview study of a cross-sectional sample comprising 25% of all women serving a prison sentence in England and Wales. A 5% sample of the male sentenced prison population was used for comparison. Diagnoses were assigned on clinical grounds and an assessment was made of the treatment needs of all ‘cases’. The prevalence of psychosis, around 2%, was similar in the two groups but women had higher rates of mental handicap (6% v. 2%), personality disorder (18% v. 10%), neurosis (18% v. 10%) and substance abuse (26% v. 12%). There is a need for closer links between the NHS and prison health services. Women's prisons lack a therapeutic community of the Grendon type, which may be of benefit to a substantial minority of inmates.

All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1983 Act to divert mentally ill, remanded offenders from prison.

In an institution, 57 people with mental retardation who had shown assaultive behaviour during the last year were compared with a control group of 57 people in the same institution, matched by sex, level of retardation and age. The study group were younger and had more people with a moderate level of mental retardation than the total population of the institution. Compared with the controls, the assaultive group had more resources available, had more psychopathology, consumed more psychotropic drugs, and had a higher frequency of other problem behaviour. We found no group differences in personal skills, including communication. Generally, the observed covariates of assaultive behaviour resembled that seen in other populations with assaultive behaviour.

A survey of child psychiatric disorders was conducted in a community sample of 2441 French school-aged children selected from 18 public and private schools; children attending special classes were oversampled. A two-stage survey design was used to identify disorders. Measures were the Child Behavior Checklist and the Rutter teacher scale for screening. The Isle of Wight parental interview was used in the second phase for 217 home interviews, along with the Children Global Assessment Scale as an index of impaired functioning. Response rates were excellent, and non-respondents in the screening phase were shown to have higher levels of psychopathology as gauged by their teacher scale scores. Several weights were used in the analysis to adjust for differential probabilities of selection and participation in each survey phase. The overall prevalence rate among 8–11-year-olds was estimated to be 12.4% (5.9% for more severe disorders), with roughly equal rates of disruptive and emotional disorders (6.5% and 5.9%). Prevalence was higher in boys (15.0%) than in girls (9.5%), owing to a threefold increase in their frequency of conduct disturbances. Rates of disturbance were twice as high among children with special educational needs, while no difference was found between private and public schools. The frequency of behavioural problems appeared to be similar in the urban and semi-rural subsamples.

Long-term outcome studies for people suffering from bulimia nervosa are few. Ten years after presentation, we followed up 50 patients (49 women, 1 man) who were originally involved in a double-blind, controlled trial of the antidepressant mianserin. Standardised interviews and questionnaires were used to assess eating attitudes and behaviour, psychiatric status and social functioning. A DSM–III–R diagnosis was given where appropriate. Sufficient information to make a diagnosis was obtained for 44 subjects (88%). Of patients traced, 52% had recovered fully and only 9% continued to suffer the full syndrome; 39% continued to experience some symptoms. Significant predictors of favourable outcome were younger age at onset, higher social class and a family history of alcohol abuse. Outcome for bulimia nervosa continues to improve over ten years with the majority of patients eventually making a full recovery or suffering only moderate abnormalities in eating attitudes. Although predictors of recovery were few, it would appear that intervention has a significant impact on ultimate outcome.

Forty-eight depressed panic-agoraphobic patients - clinically matched for severity of depression with 35 primary chronic depressives - had significantly better adjustment in most areas of social functioning, especially those related to interpersonal contact, work, leisure activities, and sexual life. Even when depressed, panic-agoraphobic patients appear to possess sufficient interpersonal skills - that is, by leaning on significant others - to engage in a range of social activities, both at home and beyond. These data, which are open to different interpretations, nonetheless suggest that anxiety and mood disorders differently affect certain key areas of social adjustment.

There has been increasing public concern about the risks of high-dose antipsychotic (neuroleptic) treatment, arising in part from an, as yet unproven, association between high-dose treatment and death in a small minority of patients. The clinical issues related to the use of neuroleptics in doses exceeding the maximum recommended in the British National Formulary (BNF) were discussed at the Psychopharmacology Subcommittee. When, if ever, should the recommended doses be exceeded?

“Study objective - The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. Design - Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. Setting - The study covers the whole of Croatia (4 601 469 inhabitants, 1981 census). Subjects - By the age of 31 years, out of 80 445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. Main results - Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. Conclusions - Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations.”

This study investigates sex differences in patterns of drug taking and related injecting and sexual behaviour among 355 patients attending a London community drug team. The majority of cases attending the service presented with heroin problems. Men were more likely to use heroin by injection and women were more likely to use heroin by inhaling/smoking (‘chasing the dragon’); there was no sex difference in the overall incidence of needle sharing. The delay between first use of the problem drug and first presentation to services was the same for both men and women. Women were more likely to have a sexual partner who was a drug user and to be living with another user than men. This closer social attachment to other drug users was seen as presenting a high risk factor for women with regard to prognosis and treatment.

This hypothesis-generating study had the objective of dissecting the process of psychiatric care in an attempt to understand outcomes for patients and their families. In all, 24 patients who carried a DSM–III diagnosis of major affective disorder were identified 12–18 months after hospital admission. The patients, their families, and their doctors were interviewed using instruments measuring delivery of treatment and achievement of treatment goals; findings were then correlated with resolution of the index episode and patient global outcome. Delivery of patient and family psychoeducation was associated with better resolution of the index episode and better global outcome.

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5–10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect.

Two depressive patients with systemic lupus erythematosus (SLE) and cerebral infarction, while being treated with corticosteroid, are described. In both cases, lithium was remarkably effective and no severe side-effects occurred. These findings suggest that lithium can be a useful antidepressant agent in the treatment of depressive SLE patients.

This study is a descriptive survey of financial difficulties in a consecutive series of patients who deliberately poisoned themselves. Over three months 160 such patients presented to the liaison psychiatry service at Leeds General Infirmary. Information was available on 147 of these patients, of whom 54 (37%) had problem debts. Patients in debt were more likely to harm themselves with greater suicidal intent and, after the episode, to report more symptoms of depression and hopelessness. Psychiatrists were more likely to diagnose mental illness in those in debt.