Fifteen children who developed anorexia nervosa aged 13 years or less were followed up at least three years later (mean 5.3 years). Outcome measures included the Morgan & Russell Outcome Schedule and the PSE. The general outcome was good in seven, intermediate in four, and poor in four, one of whom had died. A high incidence of psychiatric symptoms at follow-up, which has been suggested in other studies, was not confirmed in the 11 subjects who completed the PSE. Where onset was very early (11 years and under) and where hospital stay was prolonged, outcome tended to be poor.

Various areas of social adjustment were compared using the Social Adjustment Scale in 27 remitted bipolars, 24 remitted unipolars and 25 normal controls matched for age and sex. Scores for global adjustment and for social and leisure activities were significantly worse in patients than in controls. The maladjustment in social and leisure activities appeared only in ‘contact with friends' for bipolar patients and ‘diminished social interactions' for unipolar patients. Unipolar patients differed significantly from controls on the items investigating sexual adjustment. In unipolars, social maladjustment seemed to be independent of the course of the disease; in bipolars, it was partly related to the mean number of lifetime episodes and current residual symptoms.

Creativity and Madness: New Findings and Old Stereotypes, by Albert Rothenberg, is published by The Johns Hopkins University Press, Baltimore (£16.50, 199 pp., 1990). Professor Rothenberg is Clinical Professor of Psychiatry at Harvard University and Director of Research at the Austen Riggs Center in Stockbridge, Massachusetts. He is principal investigator for the project ‘Studies in the creativity process'.

In a case-control, cross-cultural study of the psychiatric morbidity of systemic lupus erythematosus in an Oriental population, 30 patients suffering from SLE and 29 controls with rheumatoid arthritis were interviewed. The SLE patients in Singapore exhibited greater psychiatric morbidity than their Western counterparts. Significant correlation was observed between psychiatric morbidity and the clinical disease activity. The patient's perception of the severity of arthritis, myalgia and dermatological lesions was an important aetiological factor. Culturally determined, disease-related psychological stresses also contributed to the psychopathology.

“And the end of our exploring Will be to arrive where we started And know the place for the first time.” (Eliot, 1952, p. 145)

In preparing this report I made the mistake of looking back in the literature, the literature not only of delusions, but also including some more general works of the earlier clinical writers, such as Birnbaum (1923), Conrad (1958), Jaspers (1963) and Kretschmer (1927). It was a humbling experience; these were obviously people who knew something about patients and about the realities of symptoms. For these writers, notions such as delusions were not just abstractions, not even just abstractions with operational definitions. These authors described real experiences of people, and their descriptions reflect the importance of studying patients from close clinical contact.

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

Drinking is an activity determined partly by oropharyngeal stimulation and gastrointestinal sensations as well as biochemical changes, and thirst need not be involved. It is sometimes disturbed in mania or depression. Overdrinking (polydipsia) is common in long-stay in-patients, but only gives rise to water intoxication when there is a variable functional renal abnormality such as SIADH causing water retention. In contrast, in affective disorders, disturbance of sodium retention may be seen, possibly representing failure of nervous vascular control as part of the mental illness.

The literature on household-based measures of mental health in developing countries is limited. Much emphasis is currently placed on the physical well-being of mothers in relation to child care, yet their mental well-being receives little attention. The present study measures maternal mental health in the largest squatter settlement of Rio de Janeiro, Brazil. The proportion of mothers who were probable cases of mental ill-health was 36%.

Of 250 patients newly referred to the mental illness services of South Manchester, almost two-thirds were referred directly by their GPs; a further third were referred by hospital doctors. Non-medical sources of referral accounted for only 2% of new cases. Patients with somatic problems had the longest interval between seeking care and referral to the psychiatric services. Being employed was associated with a longer delay before seeking care; among women, those living with their husbands or children had longer total intervals between the onset of the problem and arrival at the psychiatric services.

Of 120 pathological gamblers randomly allocated to imaginal desensitisation (ID) or to other behavioural procedures (60 to each group, all procedures administered over one week) 63 subjects were contacted two to nine years later. Twenty-six of the 33 who received ID reported control or cessation of gambling compared with 16 of 30 who received other behavioural procedures. This difference was significant, indicating ID had a specific effect additional to that of the other behavioural procedures. It is suggested the other procedures could be regarded as placebos. As the response at a mean of over five years to one week of ID is comparable with that reported to more intensive therapies, after briefer follow-up, it is suggested ID is a cost-effective therapy for pathological gambling, and is worth considering when resources are limited.

Medical Technology and Society: An interdisciplinary Perspective is published by the MIT Press, Cambridge, Massachusetts (£15,95 (pb), £26.95 (hb), 571 pp., 1990). Its publication is sponsored by the Affred P. Sloan Foundation as part of a New Liberal Arts Program for undergraduates. The authors, Joseph D. Bronzino, Vincent H. Smith and Maurice L Wade, are university teachers-Bronzino and Wade at Trinity College, Hartford Connecticut, and Vincent Smith is Professor at Montana State University.

The present study examined the socio-demographic, clinical, cognitive, social behaviour and social network characteristics of the 97 patients in contact with the COSTAR programme – a mobile treatment and case management service for the long-term mentally ill in inner-city Baltimore. Compared with shorter-contact patients, those in contact for more than one year showed no change in symptoms, or in cognitive or global function. They did manifest improved social function, especially for slowness, personal hygiene and posturing. The long-contact group showed improvements in the quality and quantity of their social networks. Our results suggest that a home-based treatment system can help patients to reverse a vicious cycle of social isolation and to establish supportive social contacts.

A family with a multigenerational history of proven or suspected early-onset Alzheimer's disease (AD) consistent with autosomal-dominant inheritance is described. To date, the pedigree comprises five generations in which there are 13 known affected individuals. The mean age of onset of cognitive deficits in those for whom data are available (n = 11) is 47.6 (s.d. 3.0) years and the mean age of death (n = 10) is 58.8 (s.d. 4.0) years. The variability in the extent and quality of available data illustrates the diagnostic difficulties encountered in ascertaining such an extended pedigree, and the need for caution in interpreting the evidence.

The monodelusional disorders correspond closely to the Kraepelinian description of paranoia (Kraepelin, 1921), and to the DSM—III—R category of “delusional (paranoid) disorder” (American Psychiatric Association, 1987). The essential feature is a stable delusional system, and the encapsulated quality of the delusion is characteristic. The rest of the personality is notably well preserved, but the delusional system, despite its encapsulation, takes over much of the individual's way of life. There are profound and striking secondary changes in affect, attitude and logic when the patient switches from the normal to the delusional mode or vice versa.

The basic concept characterising the delusional misidentification syndromes (DMS), particularly the Capgras variety, is the concept of double, or its equivalents. It seems that this concept is prominent in all cultures and this explains the amazing universality of these delusions. Cases of DMS have been reported in practically all parts of the world. In fact, most patients actually mention the word double (or σωσιας, sosie etc.) or refer to transformations (metamorphose, μεταμoρΦωσεις and the like). The preoccupation, and even enchantment, of man with the notion of doubles from time immemorial in all cultures, as reflected in the myths, traditions, literature, beliefs and metaphysical motions, has been dealt with extensively elsewhere (Christodoulou, 1986a).

In a prospective study of 144 consecutive male patients with psychosexual disorders, comprising 93 with Dhat syndrome with or without impotence or premature ejaculation, 21 with premature ejaculation, and 30 suffering only impotence, the commonest associated psychiatric illness was neurotic depression (39%) followed by anxiety neurosis (21 %), while 31% did not receive a psychiatric diagnosis. The common presenting symptoms of Dhat syndrome were weakness (71 %), fatigue (69%), palpitations (69%), and sleeplessness (62%). After random allocation into groups, four types of treatment were given: an anti-anxiety drug, an antidepressant, a placebo, or counselling. The best response was seen with the anti-anxiety and antidepressant drugs. Twenty-one patients dropped out of treatment; 15 of whom were from the counselling group.

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12–month follow-up. NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.

A new psychosocial/biological model of the psyche is proposed, in which the affects play a central role in organising and integrating cognition. The psyche is understood here as a complex hierarchical structure of affective/cognitive systems of reference (or ‘programmes for feeling, thinking, and behaviour’), generated by repetitive concrete action. These systems store past experience in their structure, and provide the functional basis for further cognition and communication. Affects endow these programmes with a specific qualitative value (such as motivation), connect cognitive elements synchronically and diachronically, and contribute to their storage and mobilisation according to context. They also participate in differentiating cognitive systems at higher levels of abstraction. These assumptions are supported by recent findings on the role of the limbic and hypothalamic system for the regulation of emotion, on neuronal plasticity, and on the phenomenon of state-dependent learning and memory. Refutable hypotheses are formulated for further research on the interaction of emotion and cognition.