Patients diagnosed in the late 1960s as suffering from either endogenous or neurotic depression, or as presenting with depression but discharged with another neurotic diagnosis, were followed for 15 years. Diagnosis at index admission did not predict overall outcome, but patients with endogenous depression, an apparently stable diagnosis, had longer index admissions, were readmitted sooner, but spent less time ill than patients in either of the neurosis groups. Personality abnormality accounted for 20% of the variance in outcome in the neurotic groups and only 2% of the variance in the endogenous group. Thus there is evidence that endogenous and neurotic depression are two illnesses and that, in the neuroses particularly, prognosis will depend on the extent to which these personality abnormalities are modified by treatment.

A postal questionnaire inquiring about postgraduate training was directed to all consultants appointed to a post in general psychiatry for the first time between 1 October 1985 and 30 September 1986. Compared with previous surveys there is, overall, more expressed satisfaction with training in psychogeriatrics, supervised ward consultations, individual psychotherapy, work in the community, and with medico-legal experience. Diminished satisfaction is expressed in training in child and adolescent psychiatry, epidemiology, psychology, and neurology. An improved system of monitoring by the Royal College of Psychiatrists and the Joint Committee for Higher Psychiatric Training is suggested in order to further improve training.

In a study comparing depressive disorders detected in a field survey (n = 90) with patients referred to a specialist treatment setting (n = 63), the clinical features and demographic correlates of ‘cases' of affective disorders proved to be similar. However, those in treatment settings appeared to have more people achieving definite case status. Hospital-referred cases were also more likely than community cases to be older and single, and this difference persisted even after controlling for chronicity of symptoms.

A system of outcome indicators for mental health care is urgently needed in order to ensure that clinicians, district health authorities, and directors of public health can monitor and evaluate mental health care. Theoretical aspects of health care indicators and the various classes of outcome measures available can be used to draw up a preliminary system of indicators of health care input, process and outcome for the major categories of mental illness, including schizophrenia, affective psychosis, neurosis, dementia, mental handicap, child psychiatry, forensic psychiatry, alcohol and drugs. Such a system is not intended to be definitive or exhaustive but rather to form a basis for development by clinicians, researchers and planners for their own requirements.

Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them. In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff.

In 1965/66, a consecutive series of 89 in-patients with depression were interviewed, given two personality tests (the EPI and LOI), and were accorded a score on a neurotic-psychotic continuum (Dl). Eighteen years later, the series was followed up and the predictive power of the original data was determined. High neuroticism scores on the EPI on recovery and particularly when ill but referring to the pre-morbid state were associated with poor overall outcome and chronicity. High obsessional interference scores on the LOI on recovery were also associated with poor long-term outcome, impaired social adjustment, more time spent in hospital, and with the subsequent development of schizophrenic or schizoaffective episodes. High psychotic scores on the Dl were also associated with poor long-term outcome, a greater length of time spent in hospital, and with bipolar affective disorder, and this effect was independent of the personality measures.

One hundred and twelve alcoholic patients treated by an intensive one-month residential programme were followed up for one year. As a group, they were socially disadvantaged and highly dependent on alcohol. Outcome of treatment was assessed at six months and one year following discharge by multiple measures which included assessments of drinking behaviour, measurements of social stability, neuroticism and self-esteem, and self-ratings of satisfaction with important aspects of day-to-day living. During the first six months following treatment, 37% were abstinent or drinking in controlled fashion; during the second six months, 53% achieved this status. Improvement in drinking status was positively related to improvements in all other outcome variables.

X-ray computerised tomography (CT) has revolutionised diagnostic radiology, particularly neuroradiology, since its inception (Houndsfield, 1973). It has been used widely in the systematic examination of brain structure in schizophrenia since the first study, 15 years ago, by Johnstone et al (1976). Several good reviews of the findings appeared in the mid-1980s (e.g. Reveley, 1985a; Shelton & Weinberger, 1986). Since then, although the spate of published studies has slowed, the quality of more recent published studies has in general been higher than the earlier ones, and it is time to look at the field again. This review examines the methodological pitfalls in CT research in schizophrenia and then attempts to draw some conclusions in the light of these.

In a consecutive clinical series of 538 subjects with primary mood disorders the male: female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes. Females also exhibited more anxiety and somatisation, and were more likely to endorse psychopathological items on self-report instruments, which were not reflected in objective measures. Finally, they were more likely to have been admitted to hospital. These gender differences could in part be explained by the higher prevalence of the depressive temperament in women, and of the hyperthymic temperament in men.

In a cohort of 50 465 Swedish men conscripted for military service in 1969–70, the relative risk for suicide was 3.1 (95% CI 2.3–4.0) among those who had a psychiatric diagnosis at conscription, and 16.7 (95% CI 13.8–20.1) among those who had a psychiatric diagnosis in in-patient care during a 13-year follow-up. Of the diagnoses at conscription, only neurotic disorder, personality disorder and drug dependence were associated with a significantly increased risk for future suicide. Among those who were admitted to hospital, almost all inpatient diagnoses were associated with a significantly increased suicide risk. Although a psychiatric diagnosis in in-patient care was a strong predictor of suicide, only 44% of all 247 men who committed suicide had ever been treated in in-patient psychiatric care.

A review of the evidence shows that there is no convincing support for a separate clinical diagnosis of ‘cannabis psychosis'. Cannabis can, however, produce brief acute organic reactions and, in moderate to heavy doses, psychotic episodes in clear consciousness. Ingestion in naive users or increasingly heavy use in habitual users can precipitate a schizophreniform episode. Heavy users may have an increased risk of developing schizophrenia in the subsequent 15 years. Well controlled, longitudinal studies are required to explore these associations further and their possible aetiological significance.

Case-control studies involve ‘cases' being compared to ‘controls' with respect to ‘exposures', possible aetiological (or associated) factors. Associations between a disease and an exposure can be explained by chance, reverse causality, confounding and biases or, lastly, by causality. However, confounders as well as information and selection biases can be adjusted for at the design (or analysis) stage of the study. The strength of an association can be measured by means of relative risk, calculated indirectly using the odds ratio. Well conducted control studies should produce accurate estimates of relative risks in many psychiatric investigations.

When 54 Afro-Caribbean and 49 white British consecutive psychotic in-patients were prospectively studied for clinical differences in course of illness and pattern of symptoms, no major differences were found. This does not support the hypothesis that misdiagnosis within the psychoses can explain the higher admission rates of schizophrenia calculated for Afro-Caribbean populations.

Before undergoing interview, parents reported that a computer-assisted interview would lack the friendly and personal approach of one conducted by a clinician but, after completing the interview, parents showed more acceptance of the procedure. Computer-assisted interviewing has the potential to play an important role in the collection of clinically relevant information from both parents and children referred to child psychiatry services.

The ability to measure the behaviour of protons when influenced by a magnetic field has been known to scientists since the early work of Purcell et al (1946) and Bloch (1946). The application of this technique to man, with the ability to reconstruct the data to create an image, is however a more recent innovation. Early work in this area was carried out by Damadian (1977) and Lautebur (1979) in New York, Mansfield & Maudsley (1977) in Nottingham, and Mallard et al (1979) in Aberdeen. The general principles of all these systems are similar, although the technical approaches have differed.

To compare the crime rate of schizophrenics with that of the general population, data from the Central Swedish Police Register on 790 schizophrenic patients discharged from hospitals in Stockholm in 1971 was analysed for the period 1972–86. Relative risk of criminal offence was assessed by comparing the observed number of offences committed with the expected number (estimated from official statistics). The crime rate among male schizophrenics was almost the same as that in the general male population, whereas among females it was twice that of the general female population. The rate of violent offences was, however, four times higher among the schizophrenics. The violence recorded was almost exclusively of minor severity.

Psychiatry's lack of understanding of the pathogenesis of mental disorders has resulted in the attempt, within the antipsychiatry movement, to persuade the world that mental disorder does not exist (Szasz, 1961). Progress towards understanding the underlying biological bases of psychiatric syndromes has been impeded by two factors: (a) a most effective physical barrier – the skull; and (b) dichotomous thinking of structure on the one hand and function on the other.

Attitudes towards eating, weight and shape were examined in 479 Caucasian, Afro-Caribbean and Asian British women. The Asian women were found to have significantly more disordered eating attitudes than the Caucasian women, but no difference was found between the three groups in their concern with their body weight and shape. However, while in the Caucasian group disordered eating attitudes were significantly positively correlated with feelings of anxiety and depression, this was not true in the other two groups. Although the concerns of British Afro-Caribbean and Asian women are similar to those of the Caucasian women, there may be ethnic differences in the relationship between feelings about eating, weight and shape and mood.

Supervised administration of disulfiram is one of the very few treatments that can significantly reduce alcohol consumption, yet it is rarely used, despite being simple and cheap. Disulfiram is not ‘aversion therapy‘, but a technique for facilitating exposure and response prevention, and it fits comfortably into a behavioural, social-learning model of addiction (or dependence) and its treatment. The availability of other effective antagonists, notably to opiates, suggests that an approach that is demonstrably effective in alcohol dependence may be helpful in treating other addictions. The reasons for the unpopularity of this approach appear to be largely ideological.

Observations of long-stay patients in a club in a psychiatric hospital were carried out unobtrusively over several months. Much of the social activity that went on was stimulated by an economy based around the purchase and exchange of tea and cigarettes, and the borrowing and lending of small change. Most patients could be fitted into one of four social categories: helpers, friends, nuisances, and the asocial. The inter-rater reliability of the observations was found to be 0.95. A close correspondence emerged between the observations of patients' social behaviour and material reported by patients when interviewed with the Social Network Schedule.