Five mentally handicapped patients are described in whom a bipolar manic depressive psychosis was associated with flexion deformities, involving principally the fingers. The effect of increasing degrees of retardation on the clinical presentation of the affective psychosis is discussed. Surgical treatment of the flexion deformity brought about considerable improvement in one patient. These five patients were further investigated cytogenetically using high resolution banding techniques. The results obtained were interesting but inconclusive. There would seem to be a definite place for further cytogenetic investigations of some of the more distinctive psychotic disorders using this technique.

A sample of 1070 elderly persons aged over 65 living in the Liverpool community was interviewed using the community version of the Geriatric Mental State (GMS) and the findings processed to provide a computerised diagnosis by AGECAT. Levels of organic disorder, probably dementia, reached 5.2%, intermediate between those of London and New York derived from previous studies. Levels for depressive illness overall were below those of other studies at 11.3% while levels for neurotic disorder were much the same at 2.4%. The rise in the prevalence of dementia with age was further confirmed. The GMS AGECAT Package provides a method for standardising both the collection of data and the diagnostic process for comparative epidemiological studies and other research.

A Classification of suicidal behaviour was derived by cluster analysis from descriptive data on parasuicide patients. The grouping was meaningful in terms of clinical interpretation and had both therapeutic and prognostic implications. The sample was broken down into three groups, identified as repeated, serious and non-serious attempts. The repeated attempters had the worst prognosis at 1 -year follow-up. When the sample was classified into five groups according to seriousness of the attempts, the repeater and non-serious groups were retained, while the serious attempts were split into three subtypes, which differed on nosological characteristics, treatment disposal and outcome. An excessively high successful suicide rate was found in a small group of elderly attempters.

Drugs can sometimes be helpful within the overall treatment and management of anorexia nervosa. In this study we have examined the impact of clomipramine on food and activity in anorectics engaged in a treatment programme enabling them to regain normal body weight. Consumption of the drug was associated with increased appetite, hunger and calorie consumption during the early stages of treatment. There was no impact on ultimate outcome. In this study it was evident that the drug was unnecessary for weight gain, but it may be helpful in other programmes, both short and long term, where the patient has sufficient trust (to tolerate the enhanced hunger experience) but is not involved in the same behavioural constraints. However, its possible value in such programmes has not been proven here. Meanwhile, we take our findings as further evidence that clomipramine increases drive behaviour and appetite in humans and may be beneficial in the treatment of affective disorders because of this effect.

When the length of stay of restricted patients admitted to Broadmoor under the legal category of psychopathic disorder was examined, the factor found to be of primary importance was the gravity of the admission offence. If the men's offences did not cause personal injury, they had a good chance of early release. Patients convicted of violent or sexual offences, and particularly those who attacked strangers, made up the great majority of the long-term group. For the mentally ill there was no relationship between length of stay and admission offence: instead the data suggested that severity and chronicity of illness were the main relevant factors.

Depressed, schizophrenic and normal subjects were tested for incidental recall and recognition of lists of positive and negative personal attributes. It was hypothesised that depressives would show a deficit in recall and recognition of words of which they had been asked a self-referential encoding question, but would show equivalent performance to controls on words of which they had been asked an other-referential, semantic or structural encoding question. The experiment was designed to enable a decision to be made between two possible explanations of the expected deficit: Davis's (1979) suggestion that it is due to disorganisation of the self-schema in depression, and the hypothesis of Beck at al (1979) that depression is characterised by the predominance of a negative self-schema. The expected deficit was observed on the recall but not on the recognition task. However, the precise pattern of the results raises problems for both of the above interpretations, and alternative explanations are considered.

Basal plasma luteinising hormone concentrations and the LH responses to LH-releasing hormone injection were higher in 11 young men after recovery from mania than in 15 control subjects. Since plasma concentrations of testosterone and sex hormone binding globulin were similar in the recovered manic compared with the control subjects, the increased LH response to LHRH is likely to have been due to the priming effect of LHRH consequent on an increased release of LHRH into hypophysial portal vessel blood. Abnormal control of LHRH, and thereby LH release, is a state-independent feature in male patients with mania and may be a useful trait marker for this disorder.

We completed the Newcastle Diagnostic Scale on 152 unipolar depressed in-patients: its validity was supported by the findings that endogenous depressives were, in contrast to neurotic depressives, older, more severely depressed, with better social support, fewer life events, less personality disorder, and a lower morbid risk of alcoholism and antisocial personality in their first-degree relatives. The relationship between Newcastle scores and the morbid risk for alcoholism was non-linear, such that a cut-off score of 4, rather than 5, maximised the difference between the endogenous and neurotic groups with respect to familial alcoholism rates as well as other validating variables.

We studied 27 patients who complained of pain, for which no organic basis could be found, and 11 patients without pain. All patients were depressed according to clinical diagnosis and Beck Depression Inventory (BDI) scores. Plasma β-endorphin levels were found not to differ between the two groups or across other variables. The patients who complained of pain had significantly higher scores on the BDI.

Memory impairment is a salient and early feature of developing dementia, but in practice is often not recognised until it has reached an advanced stage. The operation described is of a Memory Clinic opened on an experimental basis at the Geriatric Research Unit, University College London, in 1983, with the aim of identifying the causes of memory impairment in the elderly, with particular reference to the early detection of dementia. It proved possible to identify a group of people with early dementia who had previously been undiagnosed, and also to reveal deficiencies in the utilisation of existing services. Memory clinics would be a valuable addition to geriatric and psychogeriatric services.

A 30-year-old man with a 3-year history of tardive dyskinesia developed a neuroleptic malignant syndrome while having reserpine and lithium; his symptoms worsened following three doses of neuroleptic medication and improved with bromocriptine. The pre-existing dyskinesia made the presentation confused, and delayed proper diagnosis.

Goodchild & Duncan-Jones (1985) have proposed a new scoring method for Goldberg's General Health Questionnaire (GHQ) in which increased weight is given to item responses considered to indicate current (but chronic) affective disorders. This report examines both their revised and the conventional scoring of the GHQ in the context of a longitudinal general population study of psychiatric disorder among women. Sensitivity estimates based upon advised cut-points were found to be higher for the revised than for the conventional scoring scheme, and this difference remained when allowance was made for the duration for which disorders had been present prior to assessment with the GHQ. However, Relative Operating Characteristic (ROC) analysis revealed that while both forms of scoring the GHQ discriminated affective conditions (with or without allowance for their duration) there was no significant difference in their ability to do so. The justification therefore for the post-hoc interpretation of certain item responses as indicators of enduring affective states remains controversial and an issue for future research.

The physical examination on admission, as recorded in the psychiatric case notes, was assessed for 100 consecutive admissions under the age of 65. Assessment was made on the presence or absence of reference to 43 items of examination and the recording of the examinations was found to be uniformly poor. One of the authors re-examined 50 patients within 48 h of admission and the findings were then compared with the initial recorded examination. Significant unrecorded positive findings were most frequent in the neurological and locomotor systems.

Bilateral palmar skin conductance and heart rate were measured throughout a series of psychological tests and during both sitting and ambulant social interactions in 14 right-handed men with chronic schizophrenic disorder and 12 healthy volunteers matched for age and handedness. Miniature radio telemetry equipment was used to collect the physiological data. The schizophrenic group was effectively unresponsive to 70-dB auditory stimuli, while all but one of the control group responded and habituated to a nil response by the tenth tone in sequence. The schizophrenic group showed some evidence of increased skin conductance activity at rest, and in socially demanding conditions skin conductance level and variability were increased in the right hand. The present group of electrodermal ‘non-responders' was not in general autonomically underactive. Asymmetry of skin conductance activity during social interaction may be a characteristic of chronic schizophrenic disorder.

Three psychosocial variables were rated independently by two clinicians for 140 adolescent referrals to a psychiatric unit. Overall, intraclass correlations for DSM-III Axis IV, Axis V and a psychosocial adversity index (PSAI) were respectively 0.44, 0.58 and 0.68. The main source of unreliability is probably the operational definitions, rather than their application by clinicians; indices similar to the PSAI may be preferable.

In a double-blind trial lasting 4 months in 42 mentally handicapped patients, the effect of lithium on aggression was assessed in comparison with placebo. In the lithium-treated group, 73% of patients showed a reduction in aggression during treatment. There were significant differences in mean weekly aggression scores and in the frequency of aggressive episodes between the lithium and placebo groups. Side-effects were noted in 36% of the lithium group (and 20% of the placebo group), but were mainly transitory. There were no episodes of toxicity, and no patients had to be withdrawn from the trial. Lithium appears to be worth a 2-month trial in such patients, where repeated aggression has not been relieved by more appropriate placement, occupation or company.

Fifty patients in their first manic episode were compared retrospectively with groups of (a) manic patients in other than first admissions and (b) acute surgical cases. They were then followed up for 3–8 years. First manic admissions were linked to life events far more frequently – 66% vs 20% and 8% respectively for the other groups. Within-group comparisons showed patients with life events were much younger. The link between life events and manic episodes appeared immediate and selective, a view further supported by the findings of the follow-up. Later episodes precipitated by life events seem to require smaller amounts of stress. The possible role of life events in relation to mania is discussed.

A case of Koro is described in an elderly person with associated inguinal hernia and schizophrenia. Its aetiology and origin are traced in Chinese culture, to the Chin Dynasty. A nosology for the classification of Koro Syndrome is proposed.

Significantly more of 300 patients with non-endogenous depression compared with 300 matched controls were unemployed and had a poor marriage before the onset of depression, had a first-degree relative who had been treated for depression, had experienced separation for one year or more from a parent before 17 years of age and had three or more children under 14 years of age at home. However, significantly more of 44 patients with endogenous depression, than their 46 controls, also had a poor marriage before the onset of depression and 43% of them had a first-degree relative who had been treated for depression. Thus a family history of depression and a poor marriage before the onset of depression are associated with both non-endogenous and endogenous depression but unemployment, separation for one year or more from a parent before 17 years of age, and having three or more young children at home may be risk factors for non-endogenous depression.

Reaction time, set index, critical flicker frequency, two-flash threshold, a sustained performance task and psychophysiological parameters from people with chronic schizophrenic disorder (n = 14) and a control group (n = 12) were analysed to assess the association between arousal, attentional dysfunction and social dysfunction in schizophrenia. Shorter reaction time, rated ability to mime and, in the schizophrenic group, scores on Venable's ward activity scale correlated with each other. In the schizophrenic group, prolonged reaction time latency correlated positively with skin conductance level in the right hand and negatively with skin conductance variability in the left hand, the latter being in the opposite direction to that for the control group. The results may provide support for the hypothesis that lateralised cerebral dysfunction is associated with performance deficits in people with chronic schizophrenic symptoms.