Forty-six patients with obsessive-compulsive disorder undergoing a double-blind controlled study of clomipramine and placebo were interviewed to assess changes in sexual function. Of 33 patients with previously normal orgasm, nearly all of the 24 on clomipramine developed total or partial anorgasmia; none of the 9 on placebo did so. Anorgasmia persisted with minimal tolerance over the five months that clomipramine was taken. Men and women were equally affected. Sexual side-effects are easily missed without a structured interview, and can detract from the value of drug treatment.

A case report is presented of the genital retraction syndrome, koro, associated with alcoholic hepatitis, avitaminosis and urinary tract infection, occurring in a Zulu male. Treatment of the physical conditions resulted in resolution of the koro symptomatology.

The nosological status of koro is discussed and it is proposed that the condition be regarded as a symptom-complex reaction to a variety of psychological or physical stressors rather than as a purely culture-bound syndrome.

We report the case of an 11-year-old girl who had been living with only her mother, a woman with chronic schizophrenia. The girl had been caught shoplifting with her mother, and had a long history of non-attendance at school. The case emphasises that adult psychiatrists should always consider the impact of chronic parental psychiatric disorder on children, particularly in one-parent families.

A case of erotomania in a 75-year-old female with senile dementia of Alzheimer type (SDAT) is described. This case demonstrates the presence of an elaborately systematised delusion in SDAT, and the influence of the progression of SDAT on this delusion.

A retrospective study was carried out of all heroin abusers admitted to an acute psychiatric unit to examine their use of the facility of in-patient care. The compliance with treatment was low. Most patients discharged themselves or were discharged prematurely for using drugs while in the ward; only 21% were discharged as planned. The value of hospital admission in the management of opiate abusers may have to be reconsidered in view of the increasing prevalence of heroin abuse and the limited number of psychiatric beds.

It is well established that psychosis may arise in the context of the abuse of certain prescribed or illicit drugs. Two cases of paranoid psychosis are described in which proprietary preparations containing amphetamine-like drugs were abused. The role of these drugs is discussed with reference to previous case reports, and it is emphasised that initial clinical assessment and urinary screening for drugs may fail to reveal the relevant history with respect to proprietary medicines.

Nine patients have been treated by subcaudate stereotactic tractotomy for bipolar affective disorder resistant to drug treatments. In the majority, after the operation there was a reduction in frequency and severity of depressive and manic episodes. There was a trend for the operation to have more effect on the manic than on the depressive phases. Drugs which had been inert previously sometimes became therapeutically useful after surgery.

A case of Capgras syndrome in a black Zimbabwean patient is described. The syndrome occurs in the setting of a schizophrenic illness, but psychodynamic factors are readily identified despite the patient's different cultural background.

The literature on the Ganser syndrome is reviewed, and a case history is described. A brief hospital admission is worthwhile for patients with this syndrome, but planning and persuasion are needed.

Two cases of catatonic stupor are described due to presumed encephalitis lethargica. Catatonic and obsessional phenomena in the setting of a depressive psychosis associated with a movement disorder may constitute a post-encephalitic syndrome.

A woman with Capgras and de Clérambault's syndromes transmitted persecutory, erotic, and somatic delusions to her son in a folie à deux. Capgras and de Clérambault's syndromes appear together more commonly than is apparent in the literature. Review of these cases shows a strong association with severe affective disorder.

A patient with early-onset Huntington's chorea is described. The diagnosis had been overlooked during previous contacts with psychiatric services because there was no family history, and features typical of the adult disease were absent. Distinctive findings on CT scan and electroencephalography were observed.

Two female patients with longstanding bipolar affective disorder demonstrated de Clérambault's paradigm of erotomania during the euthymic phase of their illness. Although a diagnosis of schizophrenia or paranoid disorder is often given, a review of the literature shows that many cases have features of a major affective disorder, probably bipolar affective disorder and its spectrum.

Mentally handicapped people are increasingly being subjected to the stresses of everyday life, and bereavement represents a particularly potent stress. This report considers the case of a mentally handicapped woman whose difficulty in mourning and expressing and sharing grief had a profound effect on her recovery from bereavement and led to her developing an affective psychosis.

A case of Ganser syndrome occurring in an 11 year-old Indian boy is described, and the psychodynamics and nosological status of the syndrome discussed. Ganser syndrome should be regarded as a hysterical state, and should not be confused with the similar picture observed in organic brain syndromes and psychoses.

Two patients with erotomania (de CIérambault's syndrome) associated with epilepsy and head trauma are presented. The delusion appeared during periods of mania or hypomania and partially remitted during depression or euthymia. Erotomania may be seen in a wide variety of psychotic conditions, including those that are organically based.

Recent literature reports suggest that the presence of Down's syndrome precludes the development of mania. A case of bipolar affective illness in a man with Down's syndrome is presented.

During 100 routine psychiatric hospital electroconvulsive treatments the medical staff administering treatment experienced little difficulty in deciding that a fit had occurred. The judgement was based on simple clinical observation of a succession of clonic bodily movements, and high inter-rater agreement was found for the measurement of fit duration. The cuff technique was also used, but it tended to underestimate fit duration and is not recommended for routine ECT practice.