“Objective – To assess the severity of psychiatric symptoms among residents of hostels for homeless people. Design – Survey of residents in two hostels in Oxford, comprising three weeks of background fieldwork, a demographic questionnaire, and rating behaviour over two weeks with a behavioural rating scale (REHAB) and mental state with the brief psychiatric rating scale. Setting – Two hostels for homeless people in Oxford. Subjects – 146 Medium to long term residents, of whom 48 were selected by hostel workers by the following criteria: continuous residence for at least two months, signs of persistent severe mental disability, and difficulty in coping independently in the community. Two subjects died during the study; three (previously long term psychiatric inpatients) declined to be assessed on the psychiatric scale. Main outcome measure – Behavioural disturbance and mental state. Results – Only a third of the total sample had been born in Oxfordshire. Subjects had been accepted into the hostel either by arrangement with the local psychiatric service (22) or straight off the streets (26); 43 had had a previous (non-drug related) psychiatric admission. Subjects were significantly more likely than other residents to have spent longer (> 80 weeks) in a hostel in the past three years (p<0.02). With reference to norms for deviant behaviour, the 46 subjects assessed showed considerable deviant behaviour (average weekly scores: 0(11 subjects), 1 (14), 2–3 (16), and ≥4 (5)) not significantly different from that expected in moderately to severely handicapped psychiatric inpatients (χ2 = 1 · 3, df = 3, p > 0 · 7); 22 had scores equivalent to those in most severely handicapped inpatients. Of the 43 subjects assessed with the psychiatric rating scale, 16 had symptoms of neurosis, 29 of florid psychosis, and 32 of a deficit state. Symptoms of deficit state were positively correlated with ratings of low social activity on the behavioural scale (Spearman's rank correlation coefficient 0 · 30, p = 0 · 03). Conclusions – Hostels are having to care for long term severely affected psychiatric patients discharged into the community. The suitability of the services offered to such subjects should be assessed.”

Forty-nine chronic psychiatric out-patients (ten were schizophrenic) with tardive dyskinesia (TD) were examined monthly for a mean of 40 weeks (range 1–59 months) after discontinuation of neuroleptic medication. Complete and persistent reversibility of TD was rare (2%), but many patients showed noticeable improvement in movements within the first year of discontinuation, which was sometimes interrupted by psychological relapse. Using three separate outcome measures and appropriate model-fitting techniques for each, we identified several predictors of improvement in TD, including an affective or schizoaffective psychiatric diagnosis, chronic (over 20 years) psychiatric illness, being employed, younger age, and increased neuroleptic dose before discontinuation. Consistent findings emerging from these analyses suggest that the type and history of psychiatric illness affect the course of TD.

This systematic study of 112 consecutive referrals of normal-weight bulimic women from a circumscribed urban catchment area found that eight patients (7%) reported sexual abuse involving physical contact. Four (3.6%) of these described incest, but only in two cases (1.8%) did the incest occur in childhood. Just over 5% of the sample reported unlawful sexual intercourse in childhood or gross indecency. Eighteen additional patients reported incestuous fantasies and two of these were partly acted out. The study indicates that incest and sexual abuse reported by bulimics is usually in those multi-impulsive patients who also abuse alcohol or drugs as well as food. The reported prevalences of incest and indecency in normal-weight bulimic women are only slightly higher than figures derived from general population surveys.

Gull and Lasègue are usually credited with the first description of anorexia nervosa. In general, however, the work of the French neuropsychiatrist has been underestimated, and English-speaking colleagues who refer to Lasègue's writing on ‘hysterical anorexia’ almost exclusively rely on the translation of his French paper, which in 1873 appeared in a British medical journal, the same year as the original publication. However, some important passages had been omitted from the translation, and this has not previously been noted.

In a double-blind placebo-controlled trial of 18 patients, methohexitone blocked objective signs of opiate withdrawal caused by a bolus injection of naloxone. Furthermore, in continuing the naloxone therapy for 48 hours, no withdrawal signs appeared. Levels of withdrawal distress returned to normal levels within six days. This approach can be regarded as an effective and well tolerated withdrawal therapy with low drop-out rates.

A self-report questionnaire completed by 177 out-patients showed that hypochondriasis and amplification had a zero-order correlation of 0.56, and in stepwise multiple regression amplification accounted for 31 % of the variance in hypochondriasis, after sociodemographic variables had been accounted for. Fears of ageing and death, and a childhood history of illness in the family, increased the R2 to 0.50. Amplification was more powerful in women than in men and was also a significant (although weaker) correlate of somatisation, explaining 12% of the variance. Somatisation also correlated with being female, the propensity to seek medical care, and a diminished sense of efficacy over one's health. Our findings are consistent with the possibility that somatosensory amplification occurs in hypochondriasis.

Advanced maternal and paternal age were investigated as putative risk factors for AD in 198 clinically diagnosed Alzheimer patients and in 198 randomly selected healthy controls. No significant differences in average age of fathers and of mothers at birth of the subject were observed. The risk of AD was not significantly different across categories of maternal and paternal age. The association with parental age was not different for sporadic and familial AD. These findings do not support the view of a maternal or paternal age effect on AD.

Thirteen patients with panic disorder with predominantly cardiorespiratory (CR) symptoms were compared with seven patients with predominantly gastrointestinal (Gl) symptoms in an experimental procedure that involved exposure to phobia talk and voluntary hyperventilation (VHV). The CR patients had not only higher baseline anxiety, but also during phobia talk had a greater fall in pCO2 and reported more respiratory symptoms than the Gl patients. Moreover, the CR group found VHV more unpleasant and more like their panic attacks than the Gl panickers, and reported more physical symptoms after it. These findings suggest that patients with PD are not only heterogeneous with respect to the system to which panic symptoms refer (CR or Gl) but that provoking arousal in one system is more likely to produce distress if that system is the major focus of complaint. These findings, if replicated, would not support the suggestion that panic disorder is a uniform illness.

An investigation in a large mental handicap hospital revealed that 24% of the in-patients were receiving antipsychotic drugs. Chlorpromazine and thioridazine prescriptions accounted for 62% of the total while 10% of patients received depot preparations. Fifty-five per cent of the patients receiving these drugs had no established psychiatric diagnosis; most of these could be categorised as having a behaviour disorder. Patients aged 30–50 received higher doses, and female patients received a significantly higher mean dosage than male ones. In the patients receiving neuroleptic drugs who had also been taking them four years previously, there was a significant reduction in the dosage of the drugs received and the extent of polypharmacy of these agents. A mandatory requirement to review all prescriptions annually, implemented in 1984, may be a reason for this.

A case of status epilepticus was secondary to water intoxication, which in turn was secondary to a depressive psychosis.

The present study compares the rate of weight gain during refeeding in 15 anorectic patients who were weighed daily with that of 15 who were weighed three times per week. There was no significant difference between the two groups.

The MRI T1 proton relaxation values were assessed in 14 patients with bipolar affective disorder and 10 with a unipolar disorder and a matched normal control group. The T1 values in the frontal white matter of patients significantly exceeded those of the controls. This difference was accounted for by an increase in T1 values in the frontal white matter of unipolar patients: the values for bipolar patients alone did not differ from those for controls. These preliminary findings support a hypothesis of frontal lobe dysfunction mediating pathological changes in mood.

A group of 16 psychiatric out-patients in remission, who had been taking lithium carbonate as their sole medication for at least three months, were compared with a control group of 22 healthy volunteers. On a computerised driving simulator which produced measures of reaction time, tracking ability and mistakes made, the patient group had a significantly slower reaction time. Patients should be warned therefore that lithium may affect their ability to drive or operate machinery and that psychomotor impairment and sedation are not synonymous.

Out of a sample of 220 British psychiatrists, 139 completed a questionnaire regarding a case vignette of a psychotic illness. The sex and ‘race’ of the vignette were varied and the responses compared. The Afro-Caribbean case was regarded as that of an illness of shorter duration, and requiring less neuroleptics than the white case. Respondents judged the Afro-Caribbean case as potentially more violent and thought criminal proceedings were more appropriate. The female vignette was perceived as less violent, less criminal, and less likely to need neuroleptics. Cannabis psychosis and acute reactive psychosis tended to be diagnosed more often and schizophrenia less often in Afro-Caribbean cases, refuting the claim that psychiatrists tend to overdiagnose schizophrenia in this group. Such ‘race thinking’ (a form of stereotyping which is distinct from ideological racism) could lead to inappropriate management.

Using the records of Churchill Hospital, Oxford, and those of genetics centres and other national institutions, the minimum prevalence of HD among immigrants from the Indian subcontinent was found to be almost half that found in the indigenous UK population. However, this observed prevalence was probably depressed, and therefore may not differ greatly from that estimated for European populations. All the identified cases were immigrants from Pakistan, the Punjab and Gujerat; none were from Bangladesh.

A woman aged 80 years had suffered with anorexia nervosa in adolescence and the condition was rekindled after 50 years of remission. The remission was seen in the light of affective disorder and a chronic grief reaction.

Three cases of prolonged abuse of Do-Do tablets, an over-the-counter remedy for “coughs, wheezing and breathlessness”, are reported. They have an amphetamine-like action and were used as easily obtained amphetamine substitutes, in one case to relieve social anxiety. Withdrawal symptoms similar to those following cessation of amphetamines occurred in two cases. Do-Do tablets are CNS stimulants and their abuse may be accounted for by the fact that they perhaps affect amine neurotransmitters.

Psychiatric services in Japan and England are compared using government statistics. In Japan, the number of in-patients per 100 000 population has increased from the 1950s, while that of England has decreased since 1954. Since 1972 the prevalence of in-patients has been higher in Japan than in England. The admission rate is lower in Japan than in England, and there are more long-stay patients. Most Japanese in-patients are admitted compulsorily, whereas most are admitted voluntarily in England. The attendance at out-patient clinics is higher in Japan than in England, but there are far fewer day-hospital places in Japan. Differing government policies are the main reason for these differences.

A manic–depressive patient developed leucopenia as a result of carbamazepine therapy, despite concurrent administration of lithium.

Three aspects of the approach to philosophy advocated by the Oxford philosopher J. L. Austin are outlined: his conception of the nature of philosophical problems, essentially as a mixed bag; his method of linguistic analysis, namely, clarification of our concepts by active observation of the ways in which they are actually used rather than by passive reflection on their meanings; and his views on the organisation of philosophical research, that in some areas it should be pursued rather as a science is pursued, as a corporate rather than merely individual venture. It is suggested that Austin's approach provides the basis for a potentially fruitful two-way relationship between philosophical theory and medical practice.