Studies demonstrating the linkage to separate chromosomal locations of Alzheimer's disease, manic depression, and schizophrenia require re-evaluation of our ideas of their genetic aetiology. This article reviews the findings, and explores the increasing contribution of the ‘new genetics' to our understanding of the organic and functional psychoses.

Recent research into the dementia of Parkinson's disease has exposed a complex area in which it has not always been possible to match clinical and pathological observations. Certain neuropsychological deficits result from a disruption of basal ganglia and frontal lobe interactions. These are unrelated to a global dementia, the prevalence of which exceeds twice that in the normal population. The associated pathological lesions comprise cortical pathology, either Alzheimer's disease or Lewy bodies, in combination with moderate degeneration of the subcortical, cholinergic, basal nucleus of Meynert.

Concern has been growing about a cyclical pattern or ‘periodicity’ in mental health care over the past 300 years, in which large-scale policy decisions have been made, and then reversed, paying little attention to the particular needs of differing patient groups. Turner (1985) drew attention to the reckless course followed by psychiatry, and how the “discipline that has lost its way” (Lancet, 1985) may have done so owing to a poor grasp of its past history. In the movement towards community care, ‘difficult’ or the so-called ‘unrewarding’ (to use Scott's (1970) term) patients are a particularly vulnerable group (Aviram & Segal, 1973; Bachrach, 1980). Increasingly, community services are compelled to cater for less disturbed patients through being selective about whom they will accept. To a degree, forensic services on both sides of the Atlantic have partially filled the gap so created in service provision. For this and other reasons, it is difficult to make a general statement about the effectiveness of deinstitutionalisation and community care. To be more specific, there are basic conceptual difficulties in defining continuity of care and identifying subgroups for which it has different implications (Bachrach, 1981), and there are major methodological difficulties impeding an analysis of such a diffuse and fragmented provision. Scull's (1984) description of the overnight abolition of state facilities for juvenile offenders in Massachusetts in the US between 1969 and 1973 points to the impossibility of making a comparison ‘before and after’, when so much dissolution and decentralisation of services has occurred (see also Jones, 1982). A few model alternatives were described soon after the closures, and Bachrach (1980) has written about the dangers of generalising from model programmes, highlighting the differences between demonstration efforts and reality. It is proposed here that the difficult and offender population might act as a ‘litmus paper’ for the efficiency, or otherwise, of community care in general.

To assess the future requirements for long-stay psychiatric beds, every consultant psychiatrist in Glasgow was asked to consider whether long-stay patients in his or her wards would be fit for rehabilitation and return to the community. For the purposes of the survey, long stay was defined as a single admission of at least six months, but patients with an organic diagnosis who were aged over 65 were excluded. It was estimated that, with rehabilitation, almost a third of the patients surveyed could return to the community, and that, with more participation in self-care, over 15% might be able to manage in a ward or hostel within the hospital. Patients judged fit to return to the community were preponderantly younger patients with a shorter period of inpatient care, and those suffering from a functional psychotic illness.

The relapse and readmission rates of schizophrenic patients who participated in a controlled trial of a nine-month behavioural family intervention trial based on the EE status of their relatives are presented at two years. The patients who received the behavioural family intervention had lower rates of relapse and readmission than patients from high-EE homes who had received a short educational programme or routine treatment. The relapse rate of the behavioural family intervention group (33%) was the same as that of the low-EE group (33%), and significantly lower than that of the non-intervention high-EE group (59%).

Ventricular size was measured from CT scans in 48 patients meeting RDC for schizophrenia who had a first-degree relative with a history of treatment for major psychiatric disorder, in 48 age- and sex-matched schizophrenic patients with no such history in first- or second-degree relatives, and in 48 matched, healthy controls. There was no difference in ventricular size between those with and without a positive family history, although both groups showed ventricular enlargement with respect to normal controls. Ventricular enlargement was demonstrated in the subgroup of 23 patients with a family history of schizophrenia, but not in the subgroup of 18 patients with a family history of affective disorder. These observations provide further evidence that schizophrenics with a family history of affective disorder may constitute an aetiologically distinct subgroup.

Seventeen patients with schizophrenic symptoms were assessed before and after ECT to elicit possible factors predictive of outcome. The strongest associations with good outcome were shown by short duration of illness and paucity of premorbid schizoid personality traits; significant associations were also shown by short duration of current episode, paucity of paranoid premorbid personality traits, and the presence of perplexity. The diagnosis of schizoaffective disorder was not related to outcome. Questionnaires completed by 16 patients after ECT showed their attitudes to be generally favourable to the procedure.

A family study was carried out in two groups of patients fulfilling RDC for schizoaffective disorder: in one, a full affective and a full schizophrenic syndrome were simultaneously present; in the other, affective and schizophrenic features appeared within a polymorphic and rapidly changing clinical picture, with depersonalisation/derealisation and/or confusion. In the first-degree relatives of patients of the former group, the risk of major psychiatric disorders was not significantly different from that of relatives of schizophrenics, whereas in the first-degree relatives of patients of the latter group a low risk for both schizophrenia and major affective disorders, and a relatively high risk for schizoaffective disorders, were observed.

The prescribing of psychotropic medication to 96 attenders at a lithium clinic was compared with their prescriptions while inpatients. As outpatients, they received fewer psychotropic drugs fewer times a day. This suggests that psychiatrists do not adopt intransigent stances in favour of polypharmacy and irrational psychotropic prescribing, as previous studies have implied. Caution is advised before attributing apparently irrational prescribing to bad clinical practice, or advocating remedial action aimed at changing the habits of prescribers.

In both Beck's cognitive theory of depression and Brown & Harris's sociopsychological model, hopelessness is given unwarranted universality and centrality. Empirical evidence contradicting this element of the two theories has been ignored, and two new investigations are presented which suggest the existence of ‘non-hopeless' depression. A more complete account of the heterogeneous nature of depression is now required.

The incidence of postnatal depression is high, and dramatic changes in steroid hormones and prolactin occur in the postpartum period. In an attempt to correlate these events, 147 mothers, six to eight weeks after delivery of a healthy infant, completed standard psychological tests, including the Edinburgh, Montgomery-åsberg, and Raskin scales. They also provided matched samples of plasma for assay of cortisol, oestradiol, progesterone and prolactin, and saliva for assay of cortisol and progesterone. All steroid concentrations were within the appropriate normal ranges. Of the mothers, 14.9% were depressed on all three scales. Significant correlations were seen between depression ratings and salivary progesterone and prolactin. In bottle-feeders, salivary progesterone was positively associated with depression, whereas in breast-feeders it was negatively associated. Plasma prolactin levels were inappropriately low in depressed breast-feeders. These data indicate that differing therapies may be appropriate for depression in breast- and bottle-feeders.

In a systematic prospective study of 71 patients with acute spinal cord injury carried out in the acute and rehabilitation phases of treatment, 14 patients meeting the DSM-III criteria for major depressive disorder were identified. A further 13 patients had transient periods of depressed mood, while the majority of patients showed no clear evidence of depression. The BDI was found to be valid in this group of patients.

A rating scale for drug-induced akathisia has been derived that incorporates diagnostic criteria for pseudoakathisia, and mild, moderate, and severe akathisia. It comprises items for rating the observable, restless movements which characterise the condition, the subjective awareness of restlessness, and any distress associated with the akathisia. In addition, there is an item for rating global severity. A standard examination procedure is recommended. The inter-rater reliability for the scale items (Cohen's x) ranged from 0.738 to 0.955. Akathisia was found in eight of 42 schizophrenic inpatients, and nine had pseudoakathisia, where the typical sense of inner restlessness was not reported.

Alcoholics and heroin addicts were compared with a normal control group to determine whether there were differences in quality of parenting during childhood, assessed using the Parental Bonding Instrument. Maternal and paternal overprotection were reported more commonly by narcotic addicts. Maternal overprotection alone was implicated in alcoholics. Narcotic addicts seem to have more disturbed parenting than alcoholics, especially paternal parenting.

Anorexia nervosa is a geographically distinct psychiatric disorder; it is rapidly increasing in incidence in Western countries, while being virtually unreported in China, or in the Chinese community of Hong Kong. This is surprising when the Chinese preoccupation with food and their reported readiness to somatise dysphoria are considered. Three Chinese anorectics born and living in Hong Kong and exhibiting mostly typical clinical features are reported. The rarity of the disorder in the East could be related to protective biological and sociocultural factors specific to the Chinese, and while it may become more common, anorexia nervosa is unlikely to reach Western proportions.

Absence of sneezing or inability to sneeze was found in 2.6% of psychiatric patients, although only half complained of the symptom spontaneously. This was the most frequent of a triad of features, the others being infrequent attacks, of coryza and light-headedness. Endogenous depression was the commonest psychiatric diagnosis, followed by schizophrenia, but ‘asneezics' differed significantly from controls in their diagnostic distribution; they also tended to be older, poorer, and less educated. The course and outcome of the asneezic triad ran almost parallel to those of the primary psychiatric illness.

A 72-year-old man with a 30-year complaint of intractable insomnia had a positive family history of depression. He first came to psychiatric attention in 1958, after attacking his wife. He was prescribed barbiturates, and later was given meprobamate and nitrazepam, but with no effect on his complaint. The patient tended to increase the dosage of any drug given, of his own accord. EEG sleep recording confirmed the diagnosis of nocturnal myoclonus. It was hoped that at the case conference further treatment stratagems would be suggested.

It is argued that there are two kinds of benzodiazepine dependence: a therapeutic and a morbid kind. The therapeutic dependence is acceptable in that it mitigates the clinical manifestations in patients with long-standing and fluctuating anxious–depressive symptoms. The morbid dependence is an unfortunate complication which can arouse therapeutic concern because it ties patients to an excessive dosage, unless the penalty of a sometimes grim abstinence syndrome is paid on drug reduction. The present, often strident and threatening, damnation of benzodiazepines oversteps the mark and causes avoidable misery to patients whose well-being has become largely and therapeutically dependent on the drug.

In a retrospective analysis of 100 cases of mania (1981–1985), the incidence of subsequent depression was found to be 30%. Its occurrence was significantly associated with three factors: cyclothymic premorbid personality, family history of affective disorder, and past history of depression. By discriminant analysis, outcome could be predicted successfully in 81% of cases.

A woman who suffered multiple losses in childhood and adolescence became depressed 40 years later, after a series of new losses. Concomitant alexithymic features caused a masking of her depression by somatic symptoms. The relationships between alexithymia, masked depression and loss are discussed.