Although family intervention programmes to instruct relatives in management and coping skills are often effective in reducing schizophrenic relapse, many families either fail to be engaged or withdraw from treatment at an early stage. Some possible reasons for this are described and some suggestions for increasing adherence are made. Adherence with interventions may be viewed as a complex behaviour pattern, and factors increasing or decreasing the probability of such behaviour occurring and being maintained can and should be investigated to maximise the clinical potential of family intervention programmes.

Political change in Eastern Europe has its catchwords: democracy, pluralism, human rights. Taken at face value, they seem to convey convincingly that a steady and consistent transition has been set in motion, with a clear purpose in mind: the de-structuring of stagnated totalitarian regimes and their replacement with more viable and flexible systems. I do not intend to discuss political change at this macro level, not because it lacks importance or interest, but because the events in question so directly affect my immediate human world and me as an individual that attempting to step out of their stream and judge them impartially is impossible for me.

It was a common view among 19th century historians and clinicians that the study of delusions was the study of insanity itself (Ball & Ritti, 1881). At the beginning of the 20th century, Jaspers rendered this insight into a cliche (Jaspers, 1963). The nature of the link between delusion and insanity, however, has continued to confuse scholars, particularly those writing in the English language (Ireland, 1885; Arthur, 1964; Moor & Tucker, 1979; Winters & Neale, 1983). German (Huber & Gross, 1977), French (Ey, 1950) and Spanish (Cabaleiro Goas, 1966) writers have fared better; unfortunately, much of their work remains inaccessible to English-speaking psychiatrists. This is one of the reasons why, in Anglo-Saxon psychiatry, it has been suggested that the ‘definitive‘ view on delusions started with Jaspers and the Heidelberg school (Hoenig, 1968). This suggestion is misleading (Berrios, 1991), for by 1912, when Chaslin published his great work on descriptive psychopathology, all the distinctions nowadays attributed to Jaspers had already been made. Indeed, the rare efforts made to escape from the ‘pathological belief view were ignored (Southard, 1916).

A total of 275 successive referrals to a university child psychiatry unit out-patient department were examined using the Child Depression Inventory. Of these, 95 children were examined further by a structured clinical interview, and the relationship between different instruments for the assessment of depression in childhood was investigated. Just over one-third of the children (35%) had significant depression, and it was found that depression may be missed unless children with other psychiatric diagnoses are examined closely. Multivariate analyses of the clinical data provided factorial validation of diagnoses when employing different clinical diagnostic schemas.

In a controlled follow-up study into adulthood of 32 children diagnosed ‘schizoid’, three-quarters fulfilled DSM–III criteria for schizotypal personality disorder and two developed schizophrenia. Overall their psychosocial adjustment was somewhat, but not markedly, worse than that of other attenders at a child psychiatry clinic, although as a group they remained more solitary, lacking in empathy, oversensitive, with odd styles of communicating, and often with circumscribed interests.

The aims of this study were to identify and trace all schizophrenic patients discharged from in-patient and day-patient psychiatric services in Harrow between 1 January 1975 and 1 January 1985, to examine the patients in terms of their mental state, cognitive functioning, extrapyramidal function and social disability, and to relate their current status in those terms to demographic, historical and treatment variables. The data collection was conducted between 1 February 1987 and 1 January 1990. The project was devised against the background of developing community care policies for psychiatric patients. In the UK, policies of closure of the mental hospitals have been advocated for a considerable time (Tooth & Brooke, 1961). In the US the plan of closing the mental hospitals and replacing in-patient care with care in the community was partially adopted (Scharfstein, 1978; Fink & Weinstein, 1979; Winslow, 1979). In Italy it was carried out in a much more complete way, at least in some areas (Jones & Poletti, 1985, 1986), but problems appear to have arisen in both of these countries (Donovan, 1982; Papeschi, 1985).

The admission pattern of under-65s during the first seven years of Kidderminster's District General Hospital Psychiatric Department was compared with the last seven years of the mental hospital (Powick Hospital) which it superseded in July 1978, and with its nearest mental hospital (Barnsley Hall Hospital). In Kidderminster the average length of patient's hospital stay was half that at Barnsley Hall. There were more admissions per head of population, more which lasted less than a week, and more patients with over six admissions to Kidderminster than Barnsley Hall. The retrospective comparison with Powick Hospital showed that these differences were not due to the superior community facilities in Kidderminster since there was no real change in hospital bed use with the development of community services; this supports the view that there is a bed-rock of illness which will always need in-patient care however comprehensive the community resources.

Alzheimer's Disease. The Concept of Disease and the Construction of Medical Knowledge (Thesis Publishers, Amsterdam, $31, 357 pp., 1990) is by Rob Dillmann. The book is based upon his dissertation.

Serotonin (5-HT) interacts with multiple brain 5-HT receptor subtypes to influence a wide range of behaviours. Three main families of 5-HT receptors (5-HT1, 5-HT2 and 5-HT3) have been described which differ in their binding affinity for selective ligands, their receptor-effector coupling mechanisms, and the behavioural processes they regulate. Nevertheless, manipulation of several different 5-HT receptor subtypes (5-HT1A, 5-HT1c, 5-HT2 and 5-HT3) may produce anxiolytic effects; 5-HT1A and 5-HT2 receptors may be involved in the aetiology of major depression and the therapeutic effects of antidepressant treatment; and 5-HT3 receptors have been linked to reward mechanisms and cognitive processes. These advances offer therapeutic possibilities, the value of which can only be satisfactorily assessed by controlled clinical trials.

The performance of CAMCOG, the cognitive section of the CAMDEX, is compared in a non-random sample of 222 elderly people with diagnoses based on agecat and on DSM–III criteria, and with the MMSE and some short rating scales. With a cut-off point of 69/70 and agecat organic syndrome as the criterion, the sensitivity of CAMCOG was 97% and the specificity 91%. However, 21% of DSM–III diagnoses of dementia scored above this cut-off; these were mostly mild cases. The correlation between CAMCOG and MMSE scores was 0.87, and the advantage of CAMCOG may be more apparent in longitudinal studies. Multivariate analyses showed that CAMCOG scores are affected by age, sociocultural factors and hearing and visual deficits in addition to dementia, but not by depression. There was a suggestion that individual subsections are differentially affected.

“I think you ought to leave your head to the College of Surgeons to ascertain what wonderful impressionable substance it contains instead of brains” (G. B. Shaw to a correspondent, 1926).

The extent of the similarities and discrepancies in the reporting of depressive symptomatology by children and their mothers was examined. Child-parent agreement was not always impressive, particularly for more subjective symptoms. It is suggested that direct psychiatric assessment of children provides a more accurate picture of their mental state regardless of presenting disorder, but particularly where depression is suspected.

The social disadvantages for schizophrenic patients in terms of unemployment, impaired relationships, social isolation and downward social drift have been well described (Cooper, 1961; Goldberg & Morrison, 1963; Cheadle et al, 1978; Taylor, 1987). The problems experienced by their caring relatives have been shown to be substantial (Stevens, 1972; National Schizophrenia Fellowship, 1979; Creer et al, 1982). It is important to examine these issues in a large representative sample, and for this reason the social outcome in the 532 patients who form the subjects of the Harrow study of the disabilities and circumstances of schizophrenic patients was examined in some detail.

Delusions are among the most common psychiatric symptoms, but the psychological processes involved in their formation and maintenance remain a matter of controversy. This paper briefly reviews competing theories, particularly those involving abnormalities of perception and reason. An investigation of reasoning in deluded schizophrenic and paranoid subjects is presented, followed by a tentative model of belief formation in which abnormalities or biases in reasoning and perception, implicated in the formation of some delusions, are highlighted.

The principles of measuring anxiety are reviewed. Scales of anxiety differ in their time focus: state-anxiety scales measure the present or recent past, whereas trait-anxiety scales measure the ways the subject generally feels. Commonly used scales have adequate validity, but there is incomplete agreement on the boundaries of the construct of anxiety. There are consistent differences in sensitivity among anxiety scales, and they vary greatly in the number of items, number of cues and in the method of scoring. For self-rating scales a large number of items with only two cues (e.g. ‘yes’ and ‘no’), or only two scores for each item, increases the sensitivity of the scale for screening as well as for detecting differences between drug and placebo. A large number of cues decreases the sensitivity of a self-rating scale; it is unknown whether a large number of cues is advantageous in group research, but a small number of items is adequate both for rating and self-rating scales.

Ties that Bind: Essays on Mothering and Patriarchy (University of Chicago Press, $14.95 (pb), $29.95 (hb), 306 pp., 1990) is a collection of essays that originally appeared in Signs: Journal of Women in Culture and Society. It is edited by Jean F. O'Barr, Director of the Duke University Women's Studies Program and Editor of Signs, Deborah Pope, Associate Professor of English at Duke University and an Associate Editor of Signs, and Mary Wyer, Managing Editor of Signs.Women and Madness. The incarceration of Women in Nineteenth Century France, by YannicK Ripa, is published by Polity Press, Cambridge (£29.50, 175 pp., 1990). Dr Ripa teaches history at the University of Paris, Jussieu.

The direct costs to the mental health services for patients who participated in a trial of a behavioural family intervention to reduce schizophrenic relapse were estimated. Comparisons were made between two patient groups from households of high expressed emotion (HEE): one group received a nine-month family intervention (HEE Intervention) and the other group routine treatment (HEE Control). A third group consisted of patients from low-EE households (LEE Control). The significant decrease in relapse rates in the HEE Intervention group compared with the HEE Control group has previously been reported; the analysis of costs indicates that any increase in costs due to the family intervention is outweighed by a decrease in usage of the established mental health services. The intervention resulted in a decrease of 27% in mean cost per patient.

The childhood case records of 32 ‘schizoid’ children and 32 matched controls were analysed. ‘Schizoid’ children were characterised by solitariness, unusual fantasies, special interests, and specific developmental delays, especially of language-related skills. They were of average or above-average IQ, and half presented with other, common, child psychiatric syndromes. It is important to distinguish ‘schizoid’ children from children with reactive psychiatric disorders.

Evidence is presented concerning the concurrent validity of the Interval General Health Questionnaire. This was used to describe the timing and course of spells of depression and anxiety symptoms in first-year medical students over their initial six months at university. A small subgroup of students who were continuously symptomatic were distinguished from other groups by the presence of a number of factors: they were slow to make friends, had inappropriate support from relatives, had a tendency to have rows, had steady girl/boyfriends and had ‘vulnerable’ personalities. By contrast, a large subgroup who were well throughout had experienced caring childhood backgrounds, seldom had girl/boyfriends, showed little tendency to have rows and had ‘resilient’ personalities. Other subgroups are also described. It is suggested that students who suffer from chronic minor symptomatic distress could be recognised early on and offered appropriate support from counselling services.

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.