We compared children aged 7–12 years referred to child psychiatrists by general practitioners (GPs) with community control children matched for the presence of psychiatric disorder. Referral status in psychiatrically disturbed children was linked to male sex, severity of the disorder, mental problems in the mothers, high levels of psychosocial stress in the family, and less support from extended families. For the whole group of referred children, the referral was associated with high antisocial scores on parental questionnaires, with parental reports of problems in controlling the children, and of high levels of stress felt in relation to them. In addition, parents of referred children were in disadvantaged socioeconomic groups.

Data deriving from the Mental Health Enquiry were obtained from the Department of Health and Social Security (DHSS) for all 186 000 admissions in England in 1981 to test the ‘ethnic density hypothesis'. This hypothesis has been used to explain variations in rates of mental illness between ethnic groups in other countries, and suggests that there is an inverse relationship between the size of ethnic groups and their admission rates. The data analysed in the present paper for the main foreign-born immigrant groups to England not only failed to support the ethnic-density hypothesis, but in some cases, showed a significant positive relationship between group size and admission rates. Some possible reasons for these findings are explored.

Families were identified, in north-east Wiltshire (UK), (population 200 000), in which there was a pattern of two or more generations of child maltreatment and where there were also two or more children maltreated in the current generation (born between 1960 and 1980). These children had high rates of mental handicap, backwardness, and antisocial behaviour, and there were also characteristic patterns of emotional disturbance. The post-neonatal death rate for the 294 index children was very high, but higher still for their brothers and sisters. Some of the deaths, and at least 11 cases of violence-induced mental handicap (VIMH), were caused by characteristic types of child abuse – particularly violent shaking and throwing of infants, and secret suffocatory practices. There were very strong indications that larger numbers of children than the 11 proven VIMH cases had also suffered blunting of the intellect, physical complications such as epilepsy, and educational problems, as well as emotional and social maladjustment as the consequence of ill-treatment and neglect. Within the families, for children remaining at home, forms of ill-treatment and poor quality care persisted and ultimately affected most, or all, of the children in each family unit. Many families were chaotic, and within each family unit there were children frequently in care who suffered multiple placements, and who needed sustained specialist support throughout their childhood, encompassing a huge range of professional and other social support services. Such detail was generally underplayed or not accessible, and its full significance for children in each family could only be assessed by combining direct personal clinical involvement with record linkage methods, depending in turn on good co-operation from all agencies concerned wholly or partly with child protection.

One hundred and seven accidentally injured adults were studied while in hospital and assessed prospectively twice more in a mean period of 28 months. The patients were studied by means of taped clinical interviews, including the Comprehensive Psycho-pathological Rating Scale (which includes the Montgomery-åsberg Depression Rating Scale), and several self-report measures of distress (Schedule of Recent Life Events, General Health Questionnaire, Impact of Event Scale and State Anxiety Inventory) at the three assessments. The total incidence of psychiatric disorders considered to be caused by the accident during the follow-up period was 22.4%. The incidence of non-organic psychiatric disorders caused by the accident was 16.8% at the first follow-up and 9.3% at the final follow-up. Depressive disorders of different severity were most often seen. Only one patient suffered from a posttraumatic stress disorder during the follow-up, and none at the final follow-up (DSM-III). Organic mental disorders were diagnosed in 9.3% of the patients. In 5.6% of the patients this was the only disorder.

A hundred and ten women admitted to a psychiatric hospital within 90 days of childbirth were individually matched for age, psychiatric syndrome, and year of admission with women admitted to the same hospital with illnesses unrelated to childbirth. Both groups were followed up after a mean interval of nine years, and 72 matched pairs of patients for whom adequate information was obtained were then compared. The previous and subsequent psychiatric morbidity of these two groups, their subsequent obstetric careers, and the psychiatric morbidity of their first-degree relatives were all very similar. However, the puerperal women had significantly fewer relapses in the follow-up period, fewer committed suicide, and the psychiatric morbidity of their relatives tended to be lower. This better outcome was most marked in puerperal subjects with major depressions; those with manic disorders fared no better than controls. These results suggest that puerperal psychoses are basically the same as affective illnesses occurring at other times but, because childbirth is a uniquely potent precipitant of affective illness, some of those who develop puerperal episodes have a lesser genetic predisposition to affective illness than the generality of women with affective disorders.

Basal serum cortisol and dexamethasone suppression test (DST) results were studied in 21 pathological gamblers who varied on the Beck Depression Inventory and selected scales of the Minnesota Multiphasic Personality Inventory, which had previously been shown to be related to depression in gamblers. All subjects were suppressors on the DST. There was a significant relationship between fluctuation in 08.00 h and 16.00 h basal cortisol levels and the psychological measures, suggesting a subtype of pathological gambler with potential clinical significance.

The measurement of the effects of an antidepressant on psychomotor ability and cognitive processing tests is important for three reasons. Firstly, because a change in psychomotor and cognitive function is one of the truly objective assessments of psychotropic activity of a drug. Secondly, since batteries of psychological tests are often analogues of the essential aspects of real-life behaviour, performance changes can reflect the potential impairment of the activities of everyday living such as car driving, operating industrial machinery, and domestic tasks. Thirdly, since Widlocher (1983a,b) has proposed that mental and psychomotor retardation are a primary expression of depressive illness, psychomotor and cognitive tests can be used to measure the extent to which a putative antidepressant affects these psychological functions. Psychopharmacological testing can thus indicate the ‘safety’ of the drug in clinical usage by establishing an index of the behavioural ‘toxicity’ of the substance. It can also objectively determine the magnitude of the drug's psychoactive properties, and the extent to which a particular compound affects information processing and cognitive function. Substances which have a negative action on these aspects of psychological integrity could be regarded as counter-therapeutic, as they are making psychomotor and mental functions worse.

The case records of 499 victims of civil and terrorist violence were examined, and the presence or absence of post-traumatic stress disorder (PTSD) and associated features recorded. The results support the face, and predictive, validities of PTSD. ‘Acting as if the event were reoccurring’ and 'survivor guilt’ seemed not to be characteristic symptoms, and the homogeneity of the emotional state in PTSD was questionable. Only marital disharmony and suicidal behaviour were associated complications. PTSD seemed to be found in a wide range of stressors, but the danger in over-reliance on results from combat veterans is emphasised.

Forty-two first-episode RDC schizophrenic patients were matched on sociodemographic variables with an equal number of control subjects. The life-event histories of both groups for 6 months before onset or interview were compared. Onset of illness was not preceded by an increase in life events. The only significant observation was that control subjects had experienced more events in the month previous to interview. These were reported mainly by male control subjects, involved the family, and were possibly related to the period when the control subjects were interviewed. The observations are discussed within the context of the Nigerian culture.

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

In the last paragraph of his paper ‘A defect in training’, Yorke (1988) has a sentence which serves as an excellent link to the opening of this paper – “For all their importance, empathy and awareness of patients' anxieties do not in themselves amount to psychological understanding”. In his paper, he had made a plea for more psychoanalytical psychology to be included in a general postgraduate psychiatric training, and I am in complete agreement with his cogently-argued case.

A straightforward test for detecting clustering in patterns of parasuicide in individual patients is described and applied to data from the Edinburgh Regional Poisoning Treatment Centre.

The Self Reporting Questionnaire (SRQ), a psychiatric-case-finding instrument designed by the WHO for developing countries, was tested in Ethiopia. It was submitted to 40 patients attending a psychiatric clinic, 30 at a somatic clinic, and 40 subjects not attending a clinic. Forty per cent of the yes-answers were rated as invalid. The concept-invalidity contributed mainly to the rather poor criterion-validity of the SRQ. In addition, clinic patients seemed to heighten the number of yes-answers to express their need for help. The SRQ measured not only psychiatric complaints but also illness behaviour, even without the presence of any illness. This is a substantial disadvantage if the SRQ is applied to detect the psychiatric cases in the primary-care facilities.

During the past 75 years, the proportion of elderly individuals in the USA has grown twice as fast as the general population. Depression in this age-group occurs four times more frequently than in the general population (Butler, 1975), and the suicide rate for people over 65 years of age is 15 times greater than that of the general population (Lehman, 1980).

The elderly may be more susceptible to depression due to biological and/or psychosocial variables. Elderly people experience significant losses associated with increasing age, including death of spouse and friends, loss of work, social status, and physical and mental abilities (Lehman, 1980). The biogenic amine hypothesis suggests that the aging brain may experience a decrease in the functional availability of neurotransmitters (Lehman, 1980); this decrease may also play a role in the aetiology of depression.

Due to age-related changes in the body, the elderly can be more sensitive to drug therapy. Older patients may require careful dosage adjustments and may also be more prone to experiencing drug-related adverse events. The elderly often receive medication for various indications, and drug interactions are a concern (Thompson et al, 1983). Therefore, efficacy and safety studies of new antidepressants in elderly patients are particularly important. We pooled data from both double-blind and open-label studies to evaluate the efficacy and safety of fluoxetine in geriatric outpatients with DSM-III major depression. Positive results of fluoxetine in the treatment of geriatric depression were reported in one of these studies (Feighner & Cohn, 1985). The favourable safety and side-effect profile of fluoxetine in the general population has been discussed elsewhere (Wernicke, 1985). Plasma concentrations of fluoxetine in elderly subjects are similar to those in younger individuals (I.emberger et al, 1985). These findings, combined with a lack of cardiovascular effects (Fisch, 1985), and low lethality with overdose, indicated promise for fluoxetine as a geriatric antidepressant.

Ambulant, transcutaneous PCO2 monitoring has been used to show that hyperventilation precedes exacerbation of asthma in a patient. Brief treatment was shown to give him greater control of his breathing and enable him to avoid attacks of asthma.

The demography, psychiatric morbidity, and motor consequences of long-term neuroleptic treatment in the 14 children born to a father with a family history of chronic psychiatric illness and a mother with a late-onset affective disorder resulting in suicide are documented. Twelve siblings lived to adulthood, nine of whom were admitted to a psychiatric hospital in their second or third decade, and required continuous in-patient care; five remaining in hospital, with long-term exposure to neuroleptics, had chroniC., deteriorating, schizophrenic illness and emergence of movement disorder. Two siblings showed no evidence of psychosis but developed a late-onset affective disorder. The implications for the issues of homotypia, vulnerability to involuntary movements, and interaction with affective disorder are discussed.

A woman with persistent obsessive-compulsive rituals showed limited improvement with exposure therapy, because of her refusal to comply fully with treatment and a lack of homework practice. She was negativistic towards therapists. Following a relapse, she was asked to try anti-exposure and to increase rituals. Paradoxically, this led to marked self exposure to the feared situation, and self-imposed response prevention, with resultant improvement, whereas anti-exposure instructions are generally anti-therapeutic in obsessive-compulsive disorder.

The enigmatic title is taken from my first professorial lecture given on 21 December 1980 at the Royal Manchester Children's Hospital. It linked psychiatry, mythology, and Christmas, bringing together three incredibles, in trying to bridge the credibility gap that makes paediatric/psychiatric liaison so tricky. The hospital psychiatrist is, like Tiresias in Sophocles' play, a bisexual (equally as available as repellent). Blinded when he once saw truth (mythically he peeped at Athena bathing), he was given the gift of prophecy by way of consolation. Tiresias, like the psychiatrist, although blind, knows all but, tiresomely, will not speak what he knows. “How does he know?” whisper the non-psychiatrists. “He is blind, he knows nothing”, they muse.

Depot neuroleptics are now commonly used for maintenance therapy of schizophrenia. Their physicochemical composition makes them ideal for such use because they are long-acting and show stable blood levels for prolonged periods. Their absorption from the site of injection may, however, be affected by local muscle factors. This paper describes three such factors in relation to fluphenazine decanoate: varying the site of injection; massage of the injection site; and effects of muscular exercise. Our results suggest that fluphenazine pharmacokinetics are not significantly affected by any of these factors.