Opposition to homosexuality in Europe reached a crescendo in the 19th century. What had earlier been regarded as a vice evolved as a perversion or psychological illness. Official reviews of homosexuality as both an illness and (for men) a crime led to discrimination, inhumane treatments and shame, guilt and fear for gay men and lesbians. Only recently has homosexuality been removed from all international diagnostic glossaries.

To review how British psychiatry has regarded homosexuality over the past century.

Review of key publications on homosexuality in British psychiatry.

The literature on homosexuality reflects evolving theories on sexuality over the past century. The assumptions in psychoanalysis and the behavioural sciences that sexuality could be altered led to unscientific theory and practice.

Mental health professionals in Britain should be aware of the mistakes of the past. Only in that way can we prevent future excesses and heal the gulf between gay and lesbian patients and their psychiatrists.

Alcohol misuse, as well as being a major form of psychiatric morbidity, is also commonly associated with other psychiatric disorders. A greater understanding of the brain mechanisms underlying the adverse effects of alcohol is now possible, thanks to significant research advances made over the past decade.

To elucidate for psychiatrists the growing knowledge of the importance of specific neurotransmitter interactions in the effects of alcohol.

A survey of the literature, extracting current knowledge of interest to psychiatrists.

There is good evidence that the acute effects of alcohol are mediated through interactions with amino acid neurotransmitters plus parallel changes in amines such as noradrenaline, dopamine and serotonin. Neuroadaptive responses at amino acid receptors probably underlie significant components of the withdrawal syndrome and probably also contribute to neuronal death found in chronic alcoholism.

An understanding of the pharmacology of alcohol use may lead to greater ability to treat psychiatric consequences of alcoholism, and may also prevent some of the secondary psychiatric comorbidity and later brain damage.

Preliminary studies have suggested that paroxetine may be effective in social phobia/social anxiety disorder.

To assess the efficacy and tolerability of paroxetine in the acute (12-week) treatment of social phobia.

Two-hundred and ninety patients with social phobia were assigned randomly to paroxetine (20–50 mg/day flexible dose) or placebo for 12 weeks of double-blind treatment. Primary efficacy outcomes were the Liebowitz Social Anxiety Scale (LSAS) total score (patient-rated) and the Clinical Global Impression (GGI) scale global improvement item. The secondary efficacy variables included CGI scale severity of illness score and the patient-rated Social Avoidance and Distress Scale.

Paroxetine produced a significantly greater reduction in LSAS total score (mean change from baseline: –29.4 v. –15.6; P 0.001) and a greater proportion of responders (score $2 on CGI global improvement) (65.7% v. 32.4%; P < 0.001) compared with placebo at the end of the 12-week study period. Both primary efficacy variables were statistically significant compared with placebo from week 4 onwards. Paroxetine was generally well tolerated.

Paroxetine is an effective, well-tolerated treatment for patients with social phobia.

A previous report by Crow of a left-sided increase in temporal horn volume in schizophrenia implies a left-sided loss of tissue.

To elucidate the structural nature of schizophrenia.

The volume of grey matter in the temporal pole and inferior, middle and superior temporal gyri was measured, in addition to the total volume of grey and white matter, in the temporal lobes of the brains of 29 patients with schizophrenia and 27 controls.

We found a significant left-sided reduction in the superior temporal gyrus in both males and females with schizophrenia, which was related to increasing age of onset in the males. The total volume of temporal lobe grey and white matter was also significantly reduced. Although being more marked on the left than the right, the lateralisation for these total grey and white measures (by contrast with the superior temporal gyrus alone) did not attain formal statistical significance.

Confirmation of a lateralised reduction in the superior temporal gyrus, which is differentially related to age of onset according to gender, adds to evidence that the changes in schizophrenia are in systems that are lateralised. The findings implicate language as the relevant function.

Low cognitive ability and developmental delays have been implicated in the causation of mental illness.

To examine the prevalence, socio-demographic characteristics, psychopathology and social functioning profiles of people with low intelligence and recurrent psychotic illness.

A multi-centre randomised controlled trial of case management provided the opportunity to explore associations between mental illness and borderline intellectual functioning (assessed using the National Adult Reading Test)

Overall prevalence of borderline intelligence was 18%. Significant positive associations were shown with: being Black Caribbean; having a father who worked in a manual occupation; lower educational achievement; having had special education; longer course of illness. Those with borderline intelligence had greater disability and were more likely to suffer extrapyramidal side-effects and show evidence of negative symptoms. Educational achievement, history of special education and social class were the best socio-demographic predictors of intellectual level.

Many patients who attend generic psychiatric services have considerable intellectual deficits. This may lead to difficulties in other domains of adaptive functioning, and merits further investigation as well as clinical vigilance.

There are concerns that memories recovered during therapy are likely to be the result of inappropriate therapeutic techniques.

To investigate systematically these concerns.

One-hundred and eight therapists provided information on all clients with recovered memories seen in the past three years, and were interviewed in detail on up to three such clients.

Of a total of 690 clients, therapists reported that 65% recalled child sexual abuse and 35% recalled other traumas, 32% started recovering memories before entering therapy According to therapists' accounts, among the 236 detailed client cases very few appeared improbable and corroboration was reported in 41%. Techniques to aid recall were used in 42%, but only in 22% were they used before memory recovery started.

Some of the data are consistent with memories being of iatrogenic origin, but other data clearly point to the need for additional explanations.

Anorexia nervosa is a mental disorder with a high long-term mortality. Patients are ambivalent about treatment and often avoid it. Of necessity, compulsory treatment sometimes must be considered. A report from the Mental Health Act Commission has helped to reduce previous confusion.

To identify the premorbid and clinical features that predisposed to compulsory admissions, the short-term benefits of the treatment and the long-term mortality rates (derived from the National Register)

Eighty-one compulsory patients were compared with 81 voluntary patients.

Predisposing factors to a compulsory admission were a history of childhood sexual or physical abuse or previous self-harm. Detained patients had more previous admissions. Detained patients gained as much weight during admission as voluntary patients, but took longer. More deaths among compulsory than voluntary patients (10/79 v. 2/78) were found 5.7 years (mean) after admission.

Compulsory treatment is effective in the short term. The higher long-term mortality in the detained patients is due to selection factors associated with an intractable illness.

The Operational Criteria Checklist (OPCRIT) generates diagnoses according to 12 operational diagnostic systems (e. g. DSM–III, DSM–III–R, Research Diagnostic Criteria, ICD–10)

To examine the agreement between diagnoses generated by the OPCRIT, as completed by the interviewer, with a best-estimate lifetime procedure using the OPCRIT.

Subjects came from large mufti-generational bipolar or schizophrenia pedigrees (n=100), and from a sample of unrelated subjects with schizophrenia (n=40). We analysed the diagnostic agreement between OPCRIT diagnoses generated by the interviewer and our best-estimate OPCRIT diagnoses, according to DSM–III–R and ICD–10, using Cohen kappa statistics.

Excellent agreement was found between interviewer OPCRIT diagnoses and OPCRIT diagnoses made by the best-estimate lifetime consensus procedure for DSM–III–R (κ=0.83) and ICD-10 (κ=0.81)

Results suggest that this procedure for diagnostic assessment is an efficient alternative to classic best-estimate diagnosis procedures.

The opioid addiction test is based on the measurement of pupil dilatation in opioid-dependent people in response to conjunctivally applied naloxone hydrochloride. A positive response (pupil dilatation) indicates that the subject is dependent on opioids.

To evaluate the test in an out-patient setting and to identify factors affecting its outcome.

Pupil size was measured using binocular pupillometry in 100 new patients attending an out-patient clinic for assessment and treatment of opioid use. Measurement was repeated 40 minutes after the unilateral instillation of naloxone drops into the conjunctival sac.

We performed 127 tests, of which 103 (81.1%) were positive. Males, and those not on methadone at the time of the test, were more likely to have a negative test result.

The opioid addiction test proved to be a very useful tool for the rapid diagnosis of opioid dependence in the out-patient clinic. Specialist pupillometric equipment increases the number of patients correctly identified as opioid-dependent on the first visit, but is not essential.

The meaning of post-stroke depression is controversial.

To investigate the hypothesis that major post-stroke depression (PSD) may be due to organic factors (left frontal lesions) immediately after the stroke, but to psychosocial factors in later stages.

We studied 153 consecutive stroke patients, categorised on the basis of time elapsed since stroke, lesion location and presence/absence of major PSD, Fifty-eight were examined in the first two months following the stroke, 52 between two and four months, and 43 after four months or more. The symptom profiles and anatomical–clinical correlates of major PSD were studied in each subgroup. A group of 30 patients affected by a functional form of major depression were also investigated.

The symptom profiles and anatomical–clinical correlates of major PSD were not different in the acute and more chronic stages. Clear symptom differences were, however, observed between major PSD and endogenous major depression. Motivated (reactive) symptoms prevailed in the former, whereas unmotivated symptoms prevailed in the latter.

Our data are more consistent with a psychological than with a neurological model of post-stroke depression.

In the past two decades the suicide rate in young people has risen in the UK and other countries.

To identify the characteristics of people aged under 35 who commit suicide.

Psychological autopsy study with case–control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtained through the general practices of the matched cases. Main variables: social, including employment status, marital status and living circumstances; life events and interpersonal difficulties; clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder.

A large number of highly significant social, interpersonal and clinical differences between suicides and controls was found. Factor analysis identified two groups of variables within each of the social, interpersonal and clinical domains which were independently linked to suicide, corresponding to: acute, severe mental disorder and chronic disorder of behaviour; rootlessness and social withdrawal; chronic and recent interpersonal problems.

A broad prevention strategy is needed to reverse the recent rise in the suicide rate in young people.

The vast majority of suicides suffer from at least one mental disorder at the time of death.

To identify risk factors for suicide, particularly those independent of current DSM–III–R Axis I disorder(s)

A case–control psychological autopsy study comparing suicides with matched community controls.

Independent risk factors for suicide included: Axis II (personality) disorder (particularly antisocial, avoidant and dependent); at least one of 12 life events (from the List of Threatening Experiences) during the previous 52 or 4 weeks (in particular, a ‘serious problem with close friend, neighbour or relative’); current unemployment; previous history of deliberate self-harm; and contact with a GP within 26 weeks. Relative to individuals with no current mental disorder, the estimated risk of suicide in those with Axis I–Axis II comorbidity (OR 346.0) was significantly greater than that in those with Axis I disorder(s) only (OR 52.4)

Suicide risk assessment may be enhanced by enquiry about the aforementioned independent risk factors, and attention to Axis I–Axis II comorbidity.

Cognitive–behavioural therapy has been shown to be effective in reducing psychotic symptoms, but few patients have access to these services. Group cognitive treatment may provide a less costly service with similar benefits.

To explore the effectiveness of group cognitive–behavioural therapy on insight and symptoms, particularly auditory hallucinations.

Twenty-one DSM–IV diagnosed patients with schizophrenia with treatment-resistant, distressing auditory hallucinations were referred to a group programme consisting of six sessions of cognitive treatment following a strict protocol which emphasised individual power and control as well as coping strategies.

There were significant changes in all three main outcome measures following treatment; those changes were maintained at follow-up and were greater than changes over the waiting-list period. Specifically, there were changes in perceived power and distress as well as increases in the number and effectiveness of the coping strategies.

Group treatment for auditory hallucinations needs further investigation but does look promising and may provide a less costly alternative to individual cognitive treatment.

The main psychotropic agent of the popular illicit drug ecstasy is 3,4-methylenedioxymethamphetamine (MDMA). In the light of animal studies and examinations of human cerebrospinal fluid, MDMA is suspected of causing neurotoxic lesions to the serotonergic system.

To postulate a relationship between ecstasy use and lasting alterations to the cerebral glucose metabolic rate.

Positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) was performed on seven ecstasy users and seven subjects without any known history of illicit drug use. Data were compared for a limited number of brain regions.

By comparison with the control group, the glucose metabolic uptake of the ecstasy user group was altered within the amygdala, hippocampus and Brodmann's area 11

The results suggest the possibility that ecstasy use has lasting effects on central neuronal activity in humans.