A quantitative analysis was used to examine the efficacy of lithium augmentation in the acute treatment of depressed patients resistant to a standard trial of an antidepressant. Effect sizes were measured by the odds ratio using the Mantel–Haenszel method. Only controlled trials were included in order to minimise bias in method. A highly statistically significant effect for lithium augmentation was found, the pooled odds ratio being 0.146 and its 95% confidence interval 0.05–0.44 (i.e. the odds of remaining ill are reduced by between 56% and 95% with the use of lithium treatment). While these results support the case for lithium augmentation in treatment-resistant depression, there remains considerable uncertainty over the duration of treatment necessary to see and sustain the treatment response.

Although there has been no truly satisfactory study of the association between antisocial behaviour and psychosis, a variety of sources suggest a greater than chance association between the two (Taylor, 1987), and in particular there is evidence of a substantial increase in violent behaviour in association with schizophrenia (Taylor & Gunn, 1984). There is also evidence of the possibility of over-representation of mentally ill people in arrest statistics, because of an increase in police concern (Teplin, 1985; Taylor, 1987). Studies in this area may concern rates of psychiatric disorder among persons in judicial circumstances (e.g. Taylor & Gunn, 1984), but the Harrow study provided an opportunity of examining the extent and nature of behaviour leading to police contact in a large, unselected sample of schizophrenic patients followed up for up to 13 years.

Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10–56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

Clinicians have reported a link between sexual abuse and eating disorders, but research evidence to date has been equivocal in supporting that link. This study presents data on reported sexual abuse from 67 anorexic and bulimic patients. Bulimics were substantially more likely to report a history of unwanted sexual experience than anorexics. The method used (clinical interview v. questionnaire) did not affect reported rates of abuse. It is suggested that sexual abuse per se may not cause eating disorders, but may determine the nature of those disorders when they have been prompted by other factors.

Positive and negative symptoms at admission and discharge of 401 unselected schizophrenic patients from four psychiatric hospitals around China were studied. On admission, 58% of patients had prominent negative symptoms and the overall severity of negative symptoms was similar to that of positive symptoms; at discharge, negative symptoms were more prevalent and more severe. The severity of negative symptoms was not significantly correlated with duration of illness or with dosage of medication; 48% of first-episode, drug-naive patients had prominent negative symptoms on admission. Negative symptoms responded to standard neuroleptic treatment, but the improvement was less marked than that in positive symptoms (47% v. 80%). The proportion of patients classified as positive type, negative type, and mixed type schizophrenia altered dramatically with treatment. These findings highlight the importance of negative symptoms in the assessment and treatment of both acute and chronic schizophrenia.

In the mid-19th century, the Commissioners in Lunacy continued the direction of the earlier reform movements, but depended upon local magistrates for the execution of their ideas. The early development of a single county asylum is described from its beginnings, as are some of the personalities involved.

C. J. Jung and the Humanities: Toward a Hermeneutics of Culture (Routledge, London, £25, 372 pp., 1990) is edited by Karin Barnaby and Pellegrino D'Aciernio. The book is a selection of essays and discussions from a conference in 1986 jointly sponsored by Hofstra University and the C. G. Jung Foundation of New York. Karin Barnaby has taught comparative literature at Hofstra University and is now at New York University, She has published an article on Schiller and Jung and is associate editor of Quadrant. Pellegrino D'Acierno is Associate Professor of Comparative Literature and Director of Italian studies at Hofstra University. He is the author or translator of several books on comparative literature.

The psychiatric section, entitled ‘Mental, Behavioural and Developmental Disorders‘ of the International Classification of Diseases, is currently in the process of revision, and ‘ICD—10‘ will shortly become available. This revision will be based partly on its immediate predecessor, the 9th Revision of the International Classification of Diseases (ICD—9; World Health Organization, 1978), and also upon the American Diagnostic and Statistical Manual (DSM—III—R; American Psychiatric Association, 1987). ICD—10 describes and lists symptoms required for making each specific diagnosis and it also refers to inclusions and exclusions. The symptoms themselves, however, are not defined nor described, and an ill-informed method of evaluating symptoms or a lack of thoroughness in their ascertainment will result in mistaken diagnoses. The descriptive psychopathologist clearly has a part to play in encouraging accurate usage.

A prospective study was conducted of all referrals to the emergency psychiatric service of an inner-London hospital over one year. There were 53 individuals who presented with the specific and spontaneous complaint of suicidal ideation without any accompanying act of self-harm. The main diagnoses in this group were personality disorders (40%) and alcohol dependence (15%); only 13% were suffering from depressive illness. Members of the group differed from the other 369 presenters to the service in that they were less likely to be accorded a diagnosis of a defined mental illness, twice as likely to have a criminal record, and more likely to have a previous history of deliberate self-harm. A quarter of the suicidal complainants were admitted to hospital following assessment.

Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; ‘fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.

The mean suicide rate among 10–19–year-olds in Greece from 1980 to 1987 was 0.98/100 000 per year (male 1.07, female 0.89). Girls and boys demonstrated the greatest suicide rate at 16 and 19 years, respectively. The combined suicide rate was significantly higher in the rural areas (1.48) than in Athens (0.48) and the other urban areas (0.98). Boys committed suicide more frequently than girls in Athens and other urban areas, whereas girls did so in the rural areas. The suicide rate declined during the last three years of the study. Differences in the methods used and the reported reasons for suicide were observed among the adolescents in Athens, other urban areas, and the rural areas. Greek adolescents appear to be relatively protected from suicide, particularly those who live in the urban areas.

We present evidence that analgesic (as distinct from anaesthetic) nitrous oxide is superior to placebo in the treatment of the alcohol withdrawal state. ‘Carbogen’ as a placebo is as effective as oxygen or medical air. However, placebo alone offers a means of treating the alcohol withdrawal state with a minimum of pharmacological intervention. Analgesic nitrous oxide for those not responding to placebo is a very rapid, effective, and extremely safe treatment which also reduces the use of highly addictive sedative pharmacological agents. This therapy also provides a rapid method of screening those patients requiring intensive monitoring and treatment in hospital from those who might benefit from out-patient therapy alone.

A Prince of Our Disorder. The Life of T. E. Lawrence by John Mack, an American psychiatrist and psychoanalyst, is published by Oxford University Press, Oxford, as part of Oxford Lives Series (£9.95, 561 pp., 1990). It was first published in hardback in 1976. Lawrence of Arabia, by Jeremy Wilson, a leading British authority on T. E. Lawrence, is published in paperback by Minerva, London (£9.99, 1188 pp., 1990).

In recent years there has been increasing interest in the sociocultural aspects of psychiatric disorders, particularly schizophrenia (World Health Organization, 1975; Sartorius et al, 1986). This has extended from multicentre international studies of prevalence, through national incidence or phenomenological studies in different ethnic groups (Cochrane, 1977; Teggin et al, 1985), to outcome assessments in different cultures (Sartorius et al, 1986, 1987).

Who are mad, those in lunatic asylums or the rest of us, pruning our inane rituals outside? What is reality, what delusion? These are the basic questions of the human predicament posed by Pirandello's play Henry IV, now revived on the London stage with Richard Harris's mesmeric central performance as the alienated Everyman, who finds fulfilment in posing as the tormented medieval king.

Progress in science depends upon the fertility of inspiration, the acuteness of observation, and the accuracy of instruments to measure those observations. It is with respect to the last of these that progress in psychiatry has lagged. Instruments in plenty have been devised, many have been acclaimed and some accepted as a standard against which the other measures are judged; some have even come to be used as a definition of the disorder to be measured, the achievement of a certain score indicating that the disorder is present.

This report concerns 532 patients with schizophrenia. Many items of information have been recorded and the results have been quickly drawn together for publication. It is likely that more detailed analyses of the data will be conducted in time, but this publication reports the central facts derived from this extensive investigation. They can be simply stated. The disorder remains very common. Five hundred and thirty-two individuals with schizophrenia as defined by the Feighner criteria were discharged from Harrow services over 10 years. It was possible to trace the great majority of these patients. In many cases the illness was clearly associated with recurrent or persistent problems. The mean number of admissions required was 5.37 (Fig. 1) and on average patients spent 13.7 of the 120 months between 1975 and 1985 in hospital (Fig. 2).