When 42 cases of primary dissociative states from India were classified according to DSM–III–R and ICD–10 criteria, DSM–III–R was found to be unsatisfactory, with 40 (95.2%) cases receiving a diagnosis of dissociative disorder not otherwise specified. The majority fit well into simple dissociative and possession disorders. ICD–10 was found to be more satisfactory, with 36 (85.5%) patients fitting into specific subcategories, which, however, need to be defined and described more explicitly.

This paper reviews the phenomenology of delusional perception and discusses its differentiation from similar phenomena, its diagnostic value, and its pathogenesis. The study of delusional perception is of particular interest, because, unlike other delusions, its identification rests on form as well as content. Also, it is one of the first-rank symptoms of schizophrenia, and its mode of onset, which is an important part of the phenomenon, may help us to understand how other delusions develop.

First-admission rates to psychiatric hospitals, and data from certain psychiatric case registers suggest that there may have been a substantial decline in the administrative incidence of schizophrenia in recent years. However, data from the Nottingham case register show that rates for first-onset schizophrenia remained stable between 1975 and 1987. It is suggested that variations in trends between different parts of the UK may be partly explained by differences in the proportion of migrants and their children in the population at risk.

“This paper discusses the advantages and disadvantages of case management systems for the co-ordination of care of people with long-term mental illness living in the community. Many of the principles are equally applicable to other client groups with long-term needs, e.g. elderly people or people with learning difficulties. Some of the historical background to the emergence of case management concepts is discussed, culminating in the recent White Paper on Community Care. The underlying concept of case management is examined, together with a number of fundamental questions concerning who should act as case managers, what kinds of training they will require, problems of inter- and intra-agency co-operation, and the empirical evidence regarding its effectiveness. It is concluded that case management could be an important element in a comprehensive range of mental health services, but it is not a substitute for basic community provisions.”

The significance of delusions for psychiatry is well recognised. Scientifically respectable, delusions are reliably identifiable clinically (Wing et al, 1974), widely acknowledged across diverse cultural norms as genuine symptoms of illness (Wing, 1978), and central to the historical notion of insanity (Jaspers, 1913). What is not so well recognised, however, is that delusions are also highly significant for philosophy. This is not well recognised either by philosophers or by doctors. Yet the key to recognising it lies not in some obscure philosophical analysis of delusions but in a feature of their everyday clinical phenomenology.

A woman developed delusional parasitosis when taking phenelzine. The delusion occurred in an agitated hypomanic state and was preceded by an intense pruritus. It completely remitted following withdrawal of phenelzine combined with a low dose of haloperidol (1 mg/day) for several days. This unusual psychopathology is probably encountered more by dermatologists than by mental health professionals.

The overall psychiatric hospital admission rates in Jamaica were 136 per 100 000 in 1971 and 69 per 100 000 in 1988. The admission rate for schizophrenia was 69 per 100 000 in 1971 and 35 per 100 000 in 1988. The 49% reduction in admission rates over these 17 years is attributed to the introduction of an island-wide community mental health service with psychiatric admission to general parish hospitals in 1972. This admission rate for schizophrenia is five to six times lower than the rate reported for Afro-Caribbeans in the UK by a number of studies, and is more in keeping with the admission rate for schizophrenia reported for the general population in England.

The overall prescription rate of psychotropic drugs in a Nigerian teaching hospital was 33.1%. This was slightly higher among surgical than medical patients. It is suggested that more attention needs to be paid to psychotropic drug education in developing countries in order to ensure a more rational use of these drugs.

The purpose of this paper is prediction. It is bound to be proved wrong. Like long range weather forecasters and economists, psychotherapists are in an “impossible profession” (Freud, 1937), dealing with non-linear and therefore inherently unstable systems, unable to make accurate predictions about the future. But psychotherapists are familiar with uncertainty, and indeed perhaps actively cultivate it in order to work more creatively. Also, the development of chaos theory (Gleick, 1988) has now made vagueness a respectable topic for scientific inquiry.

Although a large growing literature indicates that monosymptomatic hypochondriacal psychosis is more common than previously thought, little contribution has been made from psychiatrists working in developing countries. Fifteen patients are described who presented with the delusion of emitting a foul smell.

A case of secondary erotomania co-existent with Capgras' syndrome presented with features that have not been reported before. The case is suggested to be a variant of de Cléambault's syndrome. The role of cultural factors in altering the clinical picture is insignificant.

Loxapine was introduced to the British market two years ago although it has been used in North America for eight years. We report the first probable case of neuroleptic malignant syndrome (NMS) secondary to loxapine in Britain. Two previous cases have been reported in North America (manufacturer's data).

Post-traumatic stress disorder (PTSD) is described following a road traffic accident in which the patient suffered a severe head injury. The stress reaction was associated with intrusive thoughts and avoidance of cognitive and physical events associated with consequences of the accident. The condition was successfuly treated by behavioural intervention. It seems clear that PTSD can occur even where there is loss of consciousness and organic amnesia for the event and its immediate sequelae.

One hundred and fifty mentally handicapped people (100 from hospital and 50 from the community) with epilepsy were studied along with an individually matched control group of 150 (100 from hospital and 50 from the community) non-epileptic mentally handicapped people. Behaviour was studied using the Profile of Abilities and Adjustment Schedule. Of the total population, 55.3% showed some type of severe behaviour problem. Although the epileptics showed slightly more severe behaviour problems than the non-epileptic group, there was no statistically significant difference between the two groups. Some differences emerged between the groups when subgroups of epileptics were studied.

The prevalence of psychiatric illness was studied in 150 epileptic mentally handicapped people (both hospital in-patients and living in the community) and a matched group of 150 non-epileptic controls. The Profile of Abilities and Adjustment (PAA) scale was used for the initial screening of psychiatric illness. Mildly to moderately handicapped individuals who had good communication skills and scored positively on the PAA schedule for psychiatric illness were interviewed using the PSE interview schedule. Severely mentally handicapped individuals who scored positively on the PAA's psychiatric illness subscale were observed and information was gathered from their medical notes and carers. A psychiatric diagnosis was made using DSM–III–R criteria. The non-epileptic group showed significantly more psychiatric illness than the epileptic group. Psychiatric illness was diagnosed in 25% of the cohort.