Regions of the brain involved in language and attention were studied using [18F]-fluorodeoxyglucose in PET. In nine chronic DSM–III schizophrenic patients who had persistent auditory hallucinations, ten who had recovered from hallucinations and ten normal controls. In none of the regions examined was metabolic activity significantly different in hallucinating patients compared with that in other groups. However, a pattern of seven significant correlations of metabolic activity between language regions and between frontal and parietal cortex characterised the hallucinating but not the other groups. Three of the seven correlations were significantly greater in hallucinating patients than in the two other groups, and six were greater in hallucinating patients than controls. Metabolism in Broca's region and its right-hemisphere homologue correlated positively and significantly in the hallucinating group, as it did in anterior cingulate and left superior temporal areas, and in right frontal and parietal areas. Hallucination ratings correlated with metabolism in the anterior cingulate region.

Menstrual health questionnaires were completed by a self-selected sample of the readership of a woman's magazine (n = 5457). Sixty-one per cent of subjects described themselves as suffering from pre-menstrual syndrome (PMS) and this was largely corroborated by ratings of symptoms pre-menstrually, menstrually and post-menstrually for the most recent cycle. Mood symptoms were more strongly implicated than physical ones. Self-report of PMS was found to be modestly associated with aspects of parity and oral contraceptive use, but strongly and positively related to the duration of ‘natural’ menstrual cycles (i.e. uninterrupted by pregnancy or steroidal contraception) and to psychosocial stress. There were interactions among psychosocial factors and between psychosocial load and duration of natural cycles.

Before receiving psychodynamic group psychotherapy at the Uffculme Clinic four groups of out-patients were assessed on the Claybury Selection Battery and the SCL 90, and therapists were asked to predict their progress. Outcome was assessed at about three months and one year by patients' self-reports of symptom change on the SCL 90 and therapists' ratings of progress. Only one of the three Claybury questionnaires, the TEQ, which measures attitudes to treatment, was significantly correlated with outcome, along with therapists' predictions. This result is different to that of a previous study which also found that outcome correlated with direction of interest (DIQ) and conservatism (C). The C and DIQ scales may provide useful predictive information only in a small proportion of cases.

The relationship of a full range of psychiatric symptoms to EE was examined in 40 men with BPRS and SANS diagnoses of schizophrenia or schizoaffective disorder. Patients from high-EE families had significantly higher ratings of positive symptoms, anxious depression, and overall psychopathology, but not negative symptoms, than did those from low-EE families. In predicting relapses of schizophrenia, account may need to be taken of an interaction between subtle differences in symptoms and relatives' attitudes.

Of 178 patients with AD, at least one depressive symptom was reported by 63%, 24% were rated as being depressed by a trained observer, and 43% were considered depressed by their relatives. Ten per cent had a previous history of depression. Elevated mood was rare, occurring in only six patients (3.5%). Subjects with depressive symptoms had less cognitive impairment and less ventricular enlargement on CT compared with those without symptoms. Widening of the interhemispheric fissure was associated with symptoms of mania but was inversely related to presence of depressive symptoms.

Of two groups of 20 patients accepted for gender reassignment surgery, one was offered early operation and therefore had had surgery by follow-up two years later, while the second was still awaiting operation at two-year follow-up. Although the groups were similar initially, significant differences between them emerged at follow-up in terms of neuroticism and social and sexual activity, with benefits being enjoyed by the operated group.

The SSEPs obtained from 19 schizophrenics defined by RDC, DSM–III and PSE criteria Were compared with those from a control group of healthy volunteers. Previous findings of an abnormal lack of lateralising response in schizophrenic patients were not replicated. No significant difference in either amplitude or morphology between the traces obtained from the two groups were recorded. Ipsilateral and contralateral latencies for stimulation of the left and right index finger showed no significant difference in peak latency for any component between patient and control group. When mean peak-to-peak amplitudes were plotted the contralateral component was always greater in amplitude than the ipsilateral one. An objective measure of the degree of lateralisation, the percentage lateralisation quotient, showed no lateralisation differences between the patient and control groups. A case of myogenic contamination of ipsilateral components was observed calling into doubt findings where no temporal region monitoring has been performed.

Of 40 depressed and anxious patients who received treatment during the Sheffield Psychotherapy Project, 31 completed the BDI and SCL-90 at two-year follow-up. At both group and individual levels, outcomes were very similar to those obtained at the completion of treatment. Substantial minorities of patients reported major life events and seeking further help for psychological problems during the two years, but these reports were not reliably associated with symptoms at follow-up. Patients recalled very different elements in prescriptive and exploratory therapies as helpful, with a notable emphasis upon prescriptive therapy's relaxation and anxiety management as a source of problem solution.

A standardised clinical examination which focused on neurological soft signs (NSS) was used by a neurologist blind to diagnosis to assess the presence of neurological soft signs. A comparison of NSS score was made among three groups of subjects consisting of 58 DSM–III schizophrenics, 31 of their healthy first-degree relatives and 38 normal controls. The schizophrenic group had significantly higher NSS total scores than normal controls but did not differ significantly from their first-degree relatives' group. The relatives' group showed higher NSS total scores than did normal controls although to a lesser extent than schizophrenics.

The results are reported of a two-year follow-up of a trial of family sessions in the home (including patients) (12 families) versus a relatives' group (excluding patients) (11 families). Subjects were patients with schizophrenia living in high face-to-face contact with high-EE relatives. Patients were maintained on neuroleptic drugs for two years where possible. Relatives' critical comments and hostility were significantly lowered by nine months, but no significant changes occurred subsequently. Relatives' overinvolvement reduced steadily throughout the trial, and reduction in relatives' EE, either alone or in combination with reduced face-to-face contact, appeared to be associated with a lower relapse rate. The relapse rates for patients in the family-therapy and relatives’-group streams were 33% and 36% at two years. When these data were combined with the results of a previous trial, it was found that patients in families assigned to any form of social intervention had a two-year relapse rate of 40%, significantly lower than the 75% relapse rate for patients whose families were offered no help. We therefore recommend that relatives' groups are established in conjunction with some family sessions in the home for patients at high risk of relapse.

Out of a sample of 178 patients with AD, aggression was present in 20%, wandering in 19%, binge-eating in 10%, hyperorality in 6%, urinary incontinence in 48%, and sexual disinhibition in 7%. Behavioural abnormalities were greater in those with more severe dementia. Temporal-lobe atrophy correlated with aggression, and widening of the third ventricle with hyperorality. Features of the Kluver–Bucy syndrome were commonly seen, but the full syndrome occurred in only one subject. Patients with at least one feature of the Kluver–Bucy syndrome had greater temporal-lobe atropy than those without any of the features.

The relationships between childhood experience, measured by the PBI, and adult defence mechanisms, evaluated through the DMI, were examined in 114 subjects. There were modest but significant correlations between the primitive defences of ‘turning against others' and ‘projection’ on the one hand, and a lack of parental care, as experienced by the subjects, on the other. ‘Principalisation’ (e.g. intellectualisation, isolation and rationalisation) and ‘reversal’ (e.g. negation, reaction formation, denial and repression) were positively associated with parental care. These findings account for only a small portion of the variance but show that, as with certain personality traits, actual or perceived childhood experience contributes in a recognisable fashion to the patterns of adult defences and behaviour.

Of 106 patients attending a gender-identity clinic, 73% satisfied DSM–III criteria for transsexualism. These DSM–III positives had a significantly younger age of onset and were less likely to experience sexual arousal with cross-dressing than those who did not satisfy DSM–III criteria. They were also significantly more likely to fulfil a definition of ‘core transsexualism’. ‘Core transsexualism’ may represent a subgroup within DSM–III criteria for transsexualism and its defining features in this study were an early age of onset, low sexual activity, lack of sexual arousal with cross-dressing and homosexual orientation. Of the whole sample, 23% were referred for gender reassignment surgery, of whom 100% were DSM–III positive and 60% were ‘core transsexuals'.

Obstetric complications were more common in the histories of those schizophrenic outpatients without a family history of psychiatric disorder, and were associated with an earlier onset of their illness. Those patients with tardive dyskinesia were more likely to have a family history of psychiatric disorder, less likely to have experienced obstetric complications, and showed greater cognitive deficit. Obstetric complications should be considered in juxtaposition with genetic factors in evaluating the putative familial-sporadic distinction in schizophrenia. Additionally, familial/genetic factors appear to contribute to vulnerability to tardive dyskinesia.

“A neuroendocrine hypothesis to explain the clinical activity of convulsive therapy is described. The hypothesis is based on the diabetes/insulin model and suggests that hypothalamic dysfunction with an insuffiency of a mood-maintaining peptide is the basis for affective disorders. Repeated seizures enhance the production and release of the hypothalamic peptide antidepressin – the active principle that relieves both neuroendocrine and behavioral abnormalities.”

Of 146 elderly subjects suffering from Alzheimer-type dementia, 44% were found to have significant extrapyramidal signs. Although extrapyramidal signs were more common in those who had taken neuroleptic drugs in the preceding six months, 22 subjects (15%) who were drug free also had extrapyramidal signs. Scores for cognitive function and for ‘frontal lobe’ signs (verbal fluency, evidence of perseveration, and primitive reflexes) were found to correlate well with scores for extrapyramidal signs, suggesting that they reflect changes in a common substratum. It is tentatively suggested that this might be an abnormality in the dopamine system.

Computerisation of case records has been slow to take place in child psychiatry, partly because of the amount of detailed and sometimes complex information required. A program for storing case records has been developed and it has proved of great value in epidemiological work, for example, regarding patient age structures and family compositions.

In this multicentre study, the clinical efficacy of citalopram was investigated in 98 patients with moderate AD/SDAT or VD using a combined double-blind and open technique with placebo and citalopram. Analyses were made for each diagnosis after four weeks of double-blind treatment. Patients with AD/SDAT treated with citalopram showed a significant improvement in emotional bluntness, confusion, irritability, anxiety, fear/panic, depressed mood and restlessness. Those improvements were not found after treatment with placebo. There were no significant improvements in patients with VD. No improvements were recorded in motor or cognitive impairment. Citalopram provoked few and comparatively mild side-effects. None of the changes observed during the double-blind withdrawal period were identified as withdrawal symptoms or rebound phenomena.

A questionnaire was developed to help the assessment of patients who take overdoses. Twenty-four house physicians in Southampton university hospitals were randomly divided into a group who used the questionnaire and another group who asked whatever questions they felt appropriate. One hundred and fifty patients who had taken overdoses were included in the study. After the house physician's assessment, a research assistant interviewed all of the patients and the two assessments for each patient were then compared. There was greater agreement between the research assistant and the house physicians who used the questionnaire than those who interviewed patients in an unstructured way with respect to assessments of severity of depression, purpose of the act, suicidal intent, diagnosis, and future management.