Compulsory detention rates of white, West Indian and Asian males under Part IV and Part V (offenders) of the 1959 Mental Health Act were compared: British-born West Indians and Asians were differentiated from migrants. Rates for Asians were similar to those for whites, but West Indians were significantly over-represented amongst compulsory detentions, especially as offender patients. A high total number of admissions and diagnostic differences accounted for the excess of West Indians admitted under Part IV, but not Part V.

Fifty cases of attempted suicide were compared with 50 cases of completed suicide on variables reported to measure suicide risk: the seriousness of the attempt, and the circumstances in which the act occurred discriminated best. Depressive symptoms were more frequent in the suicide group and in the serious attempters' group than in the nonserious attempters' group.

Cognitive performance in 46 first episode schizophrenics was assessed within 1 week of admission to hospital by Progressive Matrices, Mill Hill Vocabulary Scale, Block Design and Similarities subtests of the Wechsler Adult Intelligence Scale, and Digit Copying Test. Patients' intellectual performance was at a dull normal level, just within one standard deviation from the mean. There was an association between the presence of anxiety and depression and lower scores on psychological tests. Patients assessed by the Present State Examination as belonging to the ‘uncertain psychosis' category performed more poorly.

The development and use of a new psychiatric symptom change scale based on the Present State Examination (PSE) - the PSE Change Rating Scale - is described. The advantages of the PSE are retained (the extensive glossary, the diagnostic facility and the standardised interview technique) while improving its sensitivity to change and decreasing its administration time. The scale has been designed to prevent feedback of results and ‘halo’ effects: it has proved highly reliable in use across raters with different backgrounds and experience. The scale has been used to monitor drug effects on clinical state across a variety of diagnoses and examples of its use are given.

Cross-cultural investigation in psychiatry is revealing the need for standardised instruments in diagnosing and assessing depression. Recently, a new instrument was developed to evaluate depressed patients, namely the Montgomery-åsberg Depression Rating Scale (MADRS). The present study introduced the MADRS in Brazil, comparing it to the Hamilton Depression Rating Scale, the Visual Analogue Mood Scale (a self-rating scale), and with the global clinical assessment of independent Brazilian psychiatrists. The results show correlation between MADRS and the three other assessments, indicating that it is a useful and operational instrument to evaluate depressed patients. They also support the application of the MADRS in cross-cultural studies of depression in Brazil and other countries. These results are critically discussed.

This clinical trial of a new antidepressant, fluoxetine, shows it to be as effective as a standard tricyclic drug, imipramine. It is effective as a single daily dose and is free of any significant side-effects. It is less sedative and appears to cause fewer problems of weight increase. The three scales used to assess efficacy showed a very positive correlation.

An assessment of 31 main care-giving relatives living with schizophrenics was carried out using the General Health Questionnaire and the Social Adjustment Scale by Self Report. More than 75% of relatives had a high probability of themselves being a psychiatric case. Relatives also showed social role dysfunction and impairment especially marked in social and leisure activities. Relatives' distress was related to the level of symptoms in patients, as assessed by the Present State Examination.

A retrospective study of psychiatric referrals from a general hospital inpatient population was carried out for three separate years, 1973, 1976 and 1979. Reorganisation of the liaison service to the responsibility of one consultant team was associated with changes in referral rate and disposal. In particular, there was a significant increase in the referral rate of patients from medical and surgical wards who were not involved in acts of deliberate self-harm.

The prescription sheets for all patients in a mental handicap hospital on one day in 1972 and on the same date in 1982 were examined to identify trends in anticonvulsant medication over a 10-year period. There was a reduction in size of the hospital population associated with fewer very young and milder handicapped persons. Prescription of anticonvulsants fell slightly during the decade under study with a dramatic fall in the use of phenobarbitone, and a parallel increase in the prescription of carbamazepine. Other changes included the use of sodium valproate in a significant minority of patients and the occasional use of clonazepam in 1982, while phenytoin remained a first-rank anticonvulsant throughout the period under review. The proportions of patients on polytherapy did not change over the 10-year period, though the contribution of phenobarbitone to the combined drug regimes was significantly reduced.

Using four brief assessment scales, profiles of mental health and psychological well-being were obtained from 507 old (aged 65–74 years) and 535 very old (aged 75 +) individuals randomly sampled from the community. Assessments of dementia and depression were subsequently validated against diagnostic ratings made by experienced psycho-geriatricians. Levels of agreement between psychometric and clinical ratings of dementia x = 0.83) and depression (x = 0.66) were satisfactory. The old and very old groups reported similar levels of anxiety and personal disturbance, and showed a similar prevalence of depression. However, those aged 75+ showed higher levels of dementia and significantly lower levels of social involvement and morale.

Levels of vasopressin, somatostatin, neurotensin, vasoactive intestinal peptide, corticotrophin-releasing factor and adrenocorticotrophin in CSF were determined in lithium-treated and unmedicated euthymic bipolar patients and controls, in a search for a trait marker in affective disorder. No group differences in levels of these peptides were found. Highly significant positive correlations were found among these peptides (with the exception of neurotensin), suggesting that their presence in CSF is functionally significant, as opposed to the result of random diffusion from the interstitial space of the brain.

Three studies are reported. In study 1, vanadium concentration was estimated by neutron activation analysis in hair, whole blood, serum and urine from 13 patients suffering from depressive psychosis and then when on recovery- Vanadium concentration of hair, whole blood and serum decreased significantly with recovery, but there was no significant change in 24-h urinary excretion or in renal clearance of vanadium. In study 2, vanadium concentration was estimated by neutron activation analysis in serum and urine of 31 patients with depressive psychosis and of 27 normal controls. Mean renal clearance of vanadium was significantly lower and mean serum vanadium concentration significantly higher in depressed patients than in controls. Mean 24-h excretion of vanadium did not differ between the two groups. Vanadium excretion did not correlate with urine volume, with serum concentration or with age. In study 3, erythrocyte Na-K ATPase activity and serum vanadium concentrations were estimated in 58 patients. There was a strong negative correlation between the two, supporting the suggestion that changes in tissue vanadium concentration may explain the changes in sodium transport which occur in depressive psychosis.

This study follows the psychological profile of a group of Antarctic explorers on a remote base in British Antarctica. Each month for 1 year the 60-item General Health Questionnaire (GHQ) was administered to the 12-man complement and the results compared to those of a control group. Three men resigned and left, 4 months later, at the end of winter. Their scoring showed marked differences from the others, including the highest scores in the severe depression factor scale. The GHQ was accepted by the men despite the intrusive threat it offered in such a small community; there was also a seasonal variation in scoring, with higher scores in the winter, and no evidence of long-term psychological sequelae in those who stayed.

Asphyxia as a means of heightening sexual pleasure unfortunately comes to notice more often in the coroner's court than in the psychiatrist's consulting room. The victims are usually adolescent men who strangle or hang themselves while masturbating; transvestism is frequently associated with this behaviour (Simpson, 1979; Friedmann & Faguet, 1982; Mason, 1983). Few such people ask for help, and behavioural treatment in such a case has not been previously described.

A sample of 100 schizophrenic patients admitted to London area psychiatric hospitals were examined as part of the International Pilot Study of Schizophrenia. Clinical and social outcome were variable. At 5-year follow-up, 49% had good symptomatic outcome and 42%, good social outcome. Poor social functioning at inclusion was predictive of poor symptomatic outcome. Illness history (IH), occupational functioning (OF), social relationship functioning (SRF), negative and non-specific symptoms (NNS) at initial evaluation, and their interaction with sex and race accounted for 32% of the 5-year symptomatic outcome variance (n = 84; F=3.48; P<0.001). OF, SRF, housing status, NNS and their interaction with sex, race and age accounted for 47% of the social outcome variance (n = 62; F=2.62; P<0.007).

We followed up 181 elderly living at home over 2 years. The changes shown on a brief dementia rating scale (the Abbreviated Mental Test Score (AMTS)) were monitored. At follow-up, subjects were classified as organic or non-organic by three potential screening tools-a screening questionnaire (the Psychogeriatric Assessment Schedule), a psychometric test (the Inglis' Paired Associate Learning Test) and a dementia scale (the AMTS). The value of these as screening tools for community samples was considered as a function of their sensitivity to cognitive decline. The classifications made by each were significantly related to previous cognitive change, but all were conservative, missing many subjects who had declined. Of the three, the AMTS appeared the most useful as a predictor of previous change on the AMTS. It remains to be seen whether it is equally useful with different samples and with different measures of outcome.

Computer linkage of an obstetric register and a psychiatric case register made it possible to investigate the temporal relationship between childbirth and psychiatric contact in a population of 470 000 people over a 12-year period resulted in 54 087 births: 120 psychiatric admissions within 90 days of parturition. The ‘relative risk’ of admission to a psychiatric hospital with a psychotic illness was extremely high in the first 30 days after childbirth, particularly in primiparae, suggesting that metabolic factors are involved in the genesis of puerperal psychoses. However, being unmarried, having a first baby, Caesarian section and perinatal death were all associated with an increased risk of psychiatric admission or contact, or both, suggesting that psychological stresses also contribute to this high psychiatric morbidity. Women with a history of manic depressive illness, manic or depressive, had a much higher risk of psychiatric admission in the puerperium than those with a history of schizophrenia or depressive neuroses, and the majority of puerperal admissions met Research Diagnostic Criteria for manic or depressive disorder. Probably, therefore, puerperal psychoses are manic depressive illnesses and unrelated to schizophrenia.

This study describes a survey of prescribing to psychiatric patients on iong-stay wards, together with a follow-up survey carried out after a 2-year period. Our findings show that there had been no significant improvement in polypharmacy and overprescribing of psychotropic drugs over that period, 1983–1985. Guidelines for improvement are suggested.

A systematic endocrine investigation in dementia, depression and control subjects showed that plasma growth hormone (GH) was higher in the morning and plasma TSH concentrations were higher throughout the day in Alzheimer-type dementia (ATD) than in age-matched depressed patients (MDD), and plasma TSH concentrations were also higher throughout the day in female ATD compared with age-matched female control subjects. The increased plasma TSH concentrations could not be due to reduced negative feedback because plasma T3, T4 and rT3 were in the normal range. Plasma concentrations of oestrogen-stimulated neurophysin (ESN) were lower throughout the day in ATD compared with MDD and controls and lower in the morning compared with other dementias. The high plasma GH and TSH concentrations in ATD may reflect the reduced hypothalamic content of somatostatin in ATD, and the reduced concentrations of ESN may reflect reduced cholinergic activity in ATD prain. These selective hormonal changes provide a useful diagnostic test for Alzheimer's disease.

From a sample of consecutive referrals for psychogeriatric day care, the influence of the supporters' emotional distress and self-reported strain, together with the number of problems presented by the patient, was examined in relation to outcome, 6–7 months after initial attendance. A higher level of problems and the failure to achieve any reduction in reported distress were both found to contribute to the breakdown of community care and to the subsequent institutionalisation of the patient. Day hospital care was associated with a significant reduction in emotional distress for the majority of relatives, although for relatives whose distress was not alleviated by their dependents' attendance, admission to long-term care did produce such a reduction.