There is a strong prima facie case linking the abuse of psychiatry with difficulties about the concept of mental illness. However, a survey of recent Soviet literature showed that the concept of disease employed in the former USSR (where abuse was for a time widespread) was similar to its counterparts in the UK and USA in being strongly scientific in nature. A number of factors - legal, bureaucratic and professional - are important in abuse becoming widespread. These, however, fail to explain why psychiatry, rather than physical medicine, should be vulnerable to abuse. It is here that the concept of disease could be important. A scientific model of disease suggests that a significant vulnerability factor is the relatively underdeveloped status of psychiatry as a science. This leaves room for poor standards of scientific work in clinical research and practice, factors which are recognised as important in the Soviet case. In addition to the scientific element, there is an evaluative element of meaning in the concept of disease. Hence a second vulnerability factor could be the evaluatively problematic nature of judgements. of mental illness. It is concluded that a failure to recognise this factor greatly increases the vulnerability of psychiatry, not only to gross abuses, but also to inadvertent misuses of involuntary treatment in everyday practice. This conclusion, far from undermining the role of science in psychiatry, is a step towards clarifying its proper role.

Preferences for sugar/fat mixtures were examined in 12 anorectic females and in 14 normal-weight volunteer controls. The subjects, recruited at an eating-disorders clinic in Paris, were tested after an overnight fast and 2 hours after lunch. Anorectic patients disliked the taste of foods rich in fat more than did controls. Perceptions and preferences for sweet taste did not differ between anorectic females and controls. After lunch, taste preference ratings were equally reduced in both groups, suggesting that satiety aversion to sucrose is present even in anorexia nervosa.

A heuristic model to account for the development and maintenance of problem gambling is provided with the aim of directing clinical management and future research. Previous explanations of problem gambling have been limited in two main ways. Firstly, the models have been primarily descriptive, and secondly they have generally lacked clinical value. Most explanations have ignored the mechanisms through which this behaviour becomes problematic, and have not identified the relationships between different variables.

Mental handicap includes specific behavioural phenotypes apparently caused by single enzyme errors or deletions, for example, compulsive self-mutilation and hypoxanthine-guanine phosphoribosyl transferase deficiency in the Lesch-Nyham syndrome. In Down's syndrome, the possession of additional genetic material is found to be linked to various physical abnormalities (premature cataract formation and hypothyroidism). These close associations between types of behaviour, illnesses, and known genetic abnormalities offer promising avenues for research. In this article we concentrate on the well known link between Down's syndrome and presenile dementia.

In a double-blind crossover study of 26 long-stay schizophrenic patients, no correlation was found between caffeine consumption and levels of anxiety and depression. No significant changes in patients' behaviour or levels of anxiety and depression occurred when the wards changed to decaffeinated products. Serum caffeine levels confirmed compliance. No evidence was found to support a removal of caffeinated products from this group of patients.

Three cases of blood-letting in association with bulimia nervosa are reported. This association has not previously been described.

Clozapine-induced agranulocytosis is usually reversible after discontinuation of the drug. A patient who developed agranulocytosis after termination of clozapine therapy responded to treatment with granulocyte macrophage colony stimulating factor.

Vignettes representing mentally ill people were presented to about 2000 randomly selected residents in Bromsgrove, served by a mental hospital, and Malvern, served by a community-based psychiatric service. They were asked about the likely cause of the condition, what action they would take, and what agencies were most likely to help. In Malvern, residents seemed more enterprising in involving various agencies and more tolerant. It is possible to derive simple ‘action scores' as an indicator of such tolerance. Although there were significant demographic differences between subgroups, overall identification of vignette subjects as mentally ill was surprisingly low, and so was knowledge both of community psychiatric nurses as an agency, and of the location of dispersed treatment facilities in both areas.

Of 51 long-term female in-patients receiving psychotropic drugs, 62% were overweight or obese, and 73% were centrally obese to a degree which could be dangerous to their health. The patients also had waist: hip ratios which were significantly higher than expected for their age and obesity (P < 0.01).

The psychological health and adjustment to life in Britain of a sample of first- and second-generation Chinese immigrants were measured. It was predicted that problems with the English language, inadequate social support, value differences, and unfulfilled expectations would induce more symptoms of psychological distress and depression in first-generation than in second-generation Chinese immigrants. Overall psychological hearth, and hence adjustment, was good. There was evidence for language problems and unfulfilled expectations, but not social support and value differences, being linked to mental health in the second generation. Evidence linking mental health to other personal variables was found in both generations.

“Primary prevention trials which have shown that the lowering of serum cholesterol concentrations in middle-aged subjects by diet, drugs, or both leads to a decrease in coronary heart disease have also reported an increase in deaths due to suicide or violence. There has been no adequate explanation for this association. I have reviewed the relevant published work and describe a physiological mechanism that might account for this curious finding. One of the functions of serotonin in the central nervous system is the suppression of harmful behaviour impulses. When mouse brain synaptosomal membrane cholesterol is increased there is a pronounced increase in the number of serotonin receptors. Low membrane cholesterol decreases the number of serotonin receptors. Since membrane cholesterol exchanges freely with cholesterol in the surrounding medium, a lowered serum cholesterol concentration may contribute to a decrease in brain serotonin, with poorer suppression of aggressive behaviour.”

A case of Munchausen's syndrome was probably caused by brain damage sustained during a necessary cholecystectomy. Doctors should not be discouraged from seeking treatable disorder because of such patients' behaviour.

A 67-year-old man developed concurrent severe agranulocytosis and elevation of hepatic transaminases as a result of treatment with clomipramine. Although such adverse drug reactions can be considered rare events, the potentially serious nature of these reactions vindicate the routine monitoring of blood picture, and liver function tests, after initiation of treatment with tricyclic antidepressants.

The prefrontal cortex (PFC) consists of the cortex lying in front of the primary and secondary motor cortex, and includes the dorsolateral and orbital areas, frontal eye fields, and Broca's area. Not all of the functions of the PFC are known, but key ones are the maintenance of wakefulness and non-specific arousal, and the recruiting of various cortical areas required to deal with tasks in hand (Luria, 1973; Stuss & Benson, 1986; Fuster, 1989). Other roles include (Kolb & Whishaw, 1985) planning, sensory comparisons, discrimination, decisions for action, direction and maintenance of attention at a specific task, execution of associated scanning eye movements, and initiation and production of novel goal-directed behaviour (especially with speech). Of the senses, vision makes a particular demand of the PFC, and this is reflected by the frontal eye fields.

The present study compares adults with Gilles de la Tourette's syndrome (GTS) with depressed adults and normal controls on questionnaires measuring obsessionality, depression, and anxiety. The GTS and depressed groups scored significantly higher than the normal controls on all measures. The GTS subjects had similar scores on measures of obsessionality to those of the depressed subjects, but significantly lower scores on measures of depression and anxiety. This suggests that obsessionality is a prominent feature of GTS, and that the psychopathological profile is different to that of patients with major depressive disorder.

Four cases of lithium-induced neurotoxicity are presented which, taken with evidence from previous reports, indicate that specific risk factors for lithium-induced neurotoxicity at normal serum levels are rapid dosage regimes, concomitant neuroleptic therapy, pre-existing EEG abnormalities, undetected cerebral pathology, organic impairment, and genetic susceptibility.

A case of complete Ganser syndrome resolved after one week, but was immediately followed by a major depressive episode. The two disorders had a common cause, which is best encapsulated in a psychodynamic formulation.

As yet, there is no satisfactory model with which to understand steroid-induced mental disorder. It is suggested that a case of prednisone-induced psychosis in an adolescent female with Chrohn's disease can be best understood in terms of behavioural sensitisation to steroid therapy.

Stupor is a rare and dramatic presentation of a number of neurological and psychiatric conditions which can cause problems in both diagnosis and management. A case is described which illustrates these difficulties.