In a pair of male monozygotic twins discordant for schizophrenia, MRI revealed no abnormality in the ill proband, but extensive white-matter damage of likely congenital origin in the psychiatrically normal twin. These findings are difficult to reconcile with multifactorial models of schizophrenia, and raise the possibility that some forms of brain damage may preclude expression of the schizophrenia genotype.

A study of deviant eating behaviour among mentally handicapped adults in community placements is reported. Those individuals with a psychiatric disorder showed more deviant eating behaviour. Depressed subjects, in particular, showed an excess of the amount eaten and time spent searching for food, as well as the tendency to eat all sweet food presented to them. Non-food pica was uncommon, even among the autistic subjects.

We report a case of a man with recurrent depression and persistent second-person auditory hallucinations telling him to kill himself. Using an audiotape cassette and headphones the duration of the hallucinations decreased significantly. Helpfulness of the audiotape continued at 15 months follow-up

DSM–III has largely been based upon essentialist notions of increasingly accurate and ‘valid’ definitions of diseases. A nominalist approach would facilitate study of aetiological factors and variables in the natural history of diseases.

“In a cluster of illness reported among students at an elementary school parents mentioned many signs and symptoms including headache, pallor, dark circles under the eyes, nausea, and vomiting – which they attributed to exposure to recurrent leaks of natural gas at the school. It is likely that the parents spread among themselves the notion of toxic exposure at the school. A questionnaire revealed no spatial clustering, but increased reports of symptoms were related to intense media coverage. A thorough environmental and epidemiological investigation was negative, there being no evidence of a continuing gas leak or other potential causes. At a strictly biological level, the complaints in this reported ‘cluster’ apparently represented the sporadic occurrence of common childhood illnesses. The possibility of an epidemic from toxic exposure at the school caused intense parental concern and led to a major public health problem. The established term ‘mass sociogenic illness' seems inapplicable here because complaints did not come principally from the students and the apparent epidemic illness was not transmitted among them. The term ‘mass sociogenic illness by proxy’ is proposed to describe this incident, in which transmission in one group (the parents) resulted in reports of an epidemic in another group (students).”

Anticholinergic psychosis was observed to follow ingestion of proprietary antidiarrhoeal preparations by a 63–year-old woman. Possible abuse or accidental overuse of such medicines in the acutely psychotic patient should always be considered.

The coping strategy of claimed simulation of insanity observed at the onset of psychotic episodes in a manic patient is reported here. There is a need for systematic research on coping strategies in affective psychosis in order to develop techniques to help contain or prevent relapses.

Two patients with moderately severe AD, when asked directly, could identify their own images in a mirror, but also consistently misidentified their own reflections as that of another person. Both patients were paranoid and mildy depressed at times, but had no evidence of other concurrent psychotic symptoms. It appeared that mood substantially modified the nature of the symptom and the patients' reaction to it over time. These cases illustrate the ability of an organic symptom to be modified by a concurrent affective state, indicating the importance of the interaction between biological and psychological factors in the expression of such symptoms.

When Kraepelin formulated the concept of dementia praecox, he lumped together a number of diagnostic categories. One of his reasons for doing so was that he had seen many patients who ended up in the same kind of demented state, even though their initial symptoms might have been quite different. He noted that even some cases presenting with mania, or melancholia, took the same downhill course as did the more classic cases of dementia praecox. Kraepelin, aware of the striking paradigm of general paresis, stated that “a single morbid process” explained the downhill course (Kraepelin, 1983, p. 68).

In a 1982 community survey, 23 elderly respondents were rated as having a depressive disorder by catego. Twenty survivors were followed up three and a half years later. The depression had remitted within one year in seven cases but nine were still depressed. There is a need for ongoing education of GPs about the recognition and course of depression in the elderly.

A 59–year-old man experienced priapism five days after taking neuroleptics and abnormal liver function after 28 days. These side-effects are possibly explained as hypersensitivity reactions to the drug.

A 52-year-old woman presented exclusively with delusional misidentification of inanimate objects in the context of a short-lived acute psychotic episode. Certain theories are useful in understanding the formation of delusions of doubles in the patient (e.g. processes intrinsic to the depersonalisation/derealisation phenomena may have been aetiologically significant), but the actual choice of objects remains difficult to explain.

Firesetting in children and adolescents is commonly associated with other antisocial acts that comprise conduct disorders. Asperger's syndrome is a rare pervasive developmental disorder. In the case presented we argue that the firesetting arose from the disabilities inherent in Asperger's syndrome. This also indicates that antisocial acts may be symptoms in other psychiatric syndromes as well as a specific conduct disorder.

The medical notes of 91 women who had a psychiatric illness requiring admission within nine months of childbirth were studied. The incidence of post-partum psychosis was 3 per 1000 births, of which 66% were affective psychoses.

The Edinburgh Post-natal Depression Scale (EPDS) was validated on a community sample of 702 women at six weeks post-partum using Research Diagnostic Criteria for depression. The estimates of sensitivity, specificity and positive predictive value, being based on a large random sample, offer improved guidelines for the use of the EPDS by the primary care team.

“A considerable proportion of the variance in the liability to develop schizophrenia may be genetic, but segregation analysis, to establish a mode of transmission, has not produced a consistent result. One of these studies was carried out in Iceland and made use of the large family size and extensive genealogical information present in that country. Here we demonstrate genetic linkage of two DNA polymorphisms on the long arm of human chromosome 5 to schizophrenia in seven British and Icelandic families with multiple affected members. The results indicate the existence of a gene locus with a dominant schizophrenia-susceptibility allele. Inheritance of the allele in the families studied suggests that it may also predispose to psychiatric conditions such as schizophrenia spectrum disorders and a variety of other disorders. This report provides the first strong evidence for the involvement of a single gene in the causation of schizophrenia.”

A patient with AIDS developed the Capgras' syndrome as part of an acute confusional state resulting from an opportunistic infection. Neuropsychological testing suggested non-dominant hemisphere dysfunction with impaired facial recognition. Serial CT scanning showed a right parietal lesion which resolved after the psychosis improved. These findings provide further evidence for the hypothesis that selective visuospatial deficits underlie the development of Capgras' syndrome.

A 25–year-old man with a history of Tourette's syndrome presented for treatment of OCD symptoms. Fluvoxamine worsened tics, led to coprolalia, and did not help the OCD. The addition of pimozide dramatically reduced both OCD and Tourette's symptoms. Double-blind sequential discontinuation of fluvoxamine and pimozide confirmed that pimozide alone reduced only tics and the combination of fluvoxamine and pimozide was required for the improvement in OCD. Tics may reflect a subtype of OCD. Some OCD patients unresponsive to a 5–HT reuptake inhibitor alone may benefit from the addition of a dopamine antagonist.

Capgras syndrome in a patient with migraine is reported. It is difficult to establish whether this association, which has only been reported once before, had aetiological significance or was coincidental. Investigating all cases of Capgras syndrome for organic pathology by MRI is suggested.

The effects of biperiden and piroheptine on the serum level of zotepine were studied in 15 schizophrenic and 6 mentally retarded in-patients. Neither of these anticholinergic drugs affected the serum level of zotepine nor caused significant side-effects. In the schizophrenics the total scores on the BPRS did not change significantly with either combination of drugs.