Fifty-five adult Down's syndrome subjects resident at Northgate Hospital were screened for the presence of thyroid dysfunction. Approximately 50% of the subjects had clinical features suggestive of hypothyroidism, sufficient to require thyroid-function tests. Twenty-two per cent of the total suffered from some degree of hypothyroidism, and 16% had positive antibodies to thyroid tissue.

A case of childhood affective disorder with episodes of depressive stupor in a 13-year-old pre-pubertal boy is described. Changes in the patient's clinical state were accompanied by changes in the dexamethasone suppression test. A family history of affective illness on the maternal side, with phenomenological similarities, is noted.

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20–24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.

Fluoxetine, a selective serotonin-uptake inhibitor, has been shown to be effective in the treatment of depression. A series of studies found fluoxetine to be more effective than placebo and to be associated with equivalent efficacy to standard reference tricyclic antidepressants (Stark & Hardison, 1985; Feighner & Cohn, 1985).

The selection of a dosage regime for fluoxetine in these studies was based on the information gathered from open dose-ranging investigations. In these studies, treatment starts with one dose level, which is then increased as indicated in the protocol or until increased doses are not tolerated due to side-effects. One of the weaknesses in this method of choosing the likely standard dose of a new antidepressant lies in the inherent bias towards the selection of the higher dose levels. This is particularly true for drugs which are well tolerated.

Two young adolescents are reported in whom fears of contracting AIDS were a prominent part of their clinical presentation. Public anxiety, specific developmental vulnerability, and exposure to the media information campaign about HIV infection and AIDS are discussed as factors in the genesis and precipitation of emotional disorder in these youngsters.

The prospective, successful, use of ECT in a patient with a frontal meningioma is described. The authors review the literature on ECT in patients with brain tumours, and suggest factors predictive of a favourable outcome.

A case of autoscopy in a 43-year-old epileptic and mentally handicapped woman is described. The possible significance of this phenomenon to the patient is discussed.

A case of weight loss from food avoidance and vomiting in a young Ethiopian torture victim is described, and possible aetiological factors discussed.

A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.

A patient who resumed sleep-walking as an adult is described. The failure to diagnose his disturbed nocturnal behaviour as sleep-walking kept him from his work for over 8 months, and led to a treatment which exacerbated the behaviour. The diagnosis was made when the patient attempted to strangle his wife.

A double-blind, cross-over, placebo-controlled study of dydrogesterone (10 mg b.d.) in the treatment of premenstrual syndrome is described. Two groups of women were studied: secondarily referred hospital clinic patients, and self-referred patients. Only one-third of patients screened completed the study. All patients showed significant improvements in symptom scores during the course of the study, the only significant difference between placebo- and dydrogesterone-treated patients being an increase in frequency of breast tenderness and a decrease in pain with menstrual bleeding in the latter.

Adult hexosaminidase A deficiency is a form of GM2 gangliosidosis with autosomal recessive inheritance. Only 35 cases (mostly among Ashkenazic Jews) have been reported worldwide. Symptoms include, in a third of the cases, psychosis. A 27–year-old sufferer with no prior psychiatric history, developed a post-partum psychosis, with affective and hebephrenic components, 3 days following her first delivery. She responded to lithium within 10 days of initiating treatment; the full episode lasted 1 month. We conclude that lithium is the preferred treatment for psychosis in such adult patients, especially in light of possible long-term neurological deterioration caused by phenothiazines. Ashkenazic Jews with atypical neurological syndromes presenting with psychosis should be tested for hexosaminadase A deficiency.

A case of mania subsequent to the addition of lithium in unsuccessful treatment by antidepressants is presented. It is suggested that lithium might potentiate some properties of antidepressants which affect their capacity to induce mania.

The Capgras delusion has long been held to be specific for close personal relationships. This paper presents evidence that this is not the case and the implications of this for accepting psychodynamic explanations of the phenomenon are discussed. Parallels are drawn with the condition prosopagnosia and a hypothesis presented that any specificity is apparent rather than real. It is proposed that both prosopagnosia and the Capgras symptom represent abnormalities of visual perception occurring at different stages of this neurophysiological process.

Although neuroleptic malignant syndrome (NMS) was initially thought to be a rare, idiosyncratic complication, the incidence estimates have been rising over the years. A part of this increase can be explained on the basis of an over-inclusive definition of NMS. The unitary concept of NMS has been challenged recently and a spectrum concept has been enunciated on the basis of findings of retrospective chart-reviews which have used too broad a definition of NMS. The authors describe three cases of neuroleptic-related toxicity with different clinical presentations which appeared in a manner apparently supporting the spectrum concept. They discuss this controversial concept critically, however, and caution against its overzealous use in routine clinical practice owing to its far-reaching clinical implications.