In anorexia nervosa, amenorrhoea and endocrine disturbance make pregnancy unlikely while the patient's weight is low. Bulimics may conceive at quite a low weight, and anorexics who have regained weight may become pregnant but typically relapse following delivery (Crisp, 1980). Anorexia has also been reported following termination of pregnancy (Thomas & Harris, 1982). Cases of onset of anorexia nervosa with weight loss during pregnancy are rare in the literature, although there are isolated reports (e.g. Weinfeld et al, 1977; Strimling, 1984). Strimling described a treated anorexic who restarted dieting during pregnancy in response to weight gain before she realised that she was pregnant. We report on a schoolgirl who became pregnant at 14 years, whose anorexia began when she was 5 months pregnant and whose pregnancy was not discovered until she was in labour.

A case of tuberous sclerosis presenting with autistic behaviour is described. Although tuberous sclerosis is a rare cause of the autistic syndrome, it should be more strongly suspected when autistic behaviour is associated with seizures in a young child.

Sovner et al (1985) proposed that the presence of Down's Syndrome (DS) precludes the possibility of concomitant mama, and this is not a new claim, since Earl (1961) had stated that neither cyclothymia nor manic-depressive psychosis occurred in the mentally retarded. While Sovner et al conceded that cases of mania in individuals with DS may simply have gone unrecognised or unpublished, they felt this to be unlikely. However, lest this suggestion enter the canon, we present a previously unreported case of a young adult with both DS and recurrent mania.

Two samples of patients suffering from senile dementia were administered the Kew tests for parietal lobe function and aphasia. No evidence emerged of any clinical heterogeneity; parietal lobe test performance was found to be more a function of degree of impairment rather than of age.

Abnormal intestinal absorption has been suggested as an aetiological factor in schizophrenia. A procedure for investigating intestinal permeability was carried out in a group of chronic psychiatric in-patients. A proportion of the subjects studied showed abnormal intestinal permeability which could not be attributed to established bowel disease. Patients who were receiving neuroleptic but not anticholinergic drugs were those most often showing abnormal intestinal permeability. This work is at an early stage of development but preliminary findings suggest that further investigations should be carried out to establish the circumstances in which changes in intestinal permeability may be associated with mental illness.

The case of a 63-year-old severely mentally handicapped man is reported with chromosomal mosaicism. His karyotype was established as mosaic 46XY/47XXY with the fragile site present in a proportion of cells of both cell-lines. He showed phenotypic features which could be related both to the fragile-X and Klinefelter's syndromes.

The Capgras syndrome was first described as an ‘illusionf doubles' in 1923 by two French psychiatrists, Capgras and Reboul-Lachaux. Since then, a number of cases have been reported of this syndrome co-existing with functional as well as organic disorders. Enoch & Trethowen (1979) regarded the syndrome as purely functional – a manifestation of schizophrenia. Recently, there have been case reports describing the occurrence of Capgras syndrome with diabetes (MacCallum, 1973), hypothyroidism (Madakursira & Hall, 1981), hepatic encaphalopathy (Pies, 1982; Cummings, 1985), pseudo-hypoparathyroidism (Hay et al, 1974), temporal lobe epilepsy (Chawla & Virmani, 1977) and vitamin B12 deficiency (Zucker et al, 1981).

The following report discusses the presence of Capgras syndrome in a patient with dementia.

A patient developed Capgras' syndrome as part of an interictal psychosis of epilepsy; magnetic resonance imaging revealed bilateral subcortical lesions in occipitotemporal and frontal regions. These findings have implications for the postulated association between Capgras' syndrome and neuropsychological deficits, in particular prosopagnosia.

A population-based study of infantile autism from western Sweden has been completed. Urban children with autism more often than age-matched children in the general population had immigrant parents from ‘exotic’ countries. No such trend was seen in rural children with infantile autism.

An 18-year-old male, originally diagnosed as suffering from infantile autism but with a developmental history and clinical picture in keeping with Asperger's syndrome, and showing current signs of impairment of higher cerebral functioning, is presented. The subject and several males of his family present behavioural disturbances of an enduring type. An aminoaciduria was discovered in the subject and his father. A possible relationship between the metabolic disturbance and the neurological and behavioural disturbance is raised. Mechanisms for this relationship are discussed, including sporadic hyperlysinaemia.

In 1969 Barton & Whithead described the Gaslight Phenomenon. In this condition a presentation of mental illness is found, on further enquiry, to a hospital. Previous reports have highlighted the malicious intent of the exploiter (Barton & Whitehead, 1969; Smith & Sinanan, 1972; Tyndal, 1973; Lund & Gardiner, 1977).

Psychotic episodes and epilepsy can occur without mental retardation in tuberous sclerosis. The diagnosis may depend on elucidating the family history since physical signs may not be obvious. Establishing the diagnosis makes genetic counselling possible.

In recent years, there has been renewed appreciation of the morbidity which can result from unusual or overwhelming stress and while many situations can give rise to post-traumatic disorder, the most frequently studied of these is probably military combat. Psychiatric disorder pursuant to combat experience can not only become chronic, but may intensify with advancing age, decades after the original trauma (Archibald & Tuddenbaum, 1965; Wilmer, 1982). Moreover, a high percentage of combat veterans are believed ultimately to develop chronic psychiatric morbidity (Walker & Cavenar, 1982). The drug treatment of such post-traumatic states remains an important question, largely over looked until the last 2 years but recent case reports suggest that doxepin and imipramine (White, 1983; Burstein, 1984) are beneficial in treating post traumatic stress disorder (PTSD), which may be either combat or non-combat related. Hogben & Cornfield (1981) described five veterans whose PTSD improved when treated with phenelzine, while Van der Kolk (1983) has described beneficial results with antidepressants, lithium, benzodiazepines, beta blockers, and neuroleptics in uncontrolled studies of PTSD.

Fifty cases attending a walk-in psychiatric emergency clinic with alcohol-related problems were studied retrospectively. Results confirm that this group represents a sizeable load on the clinic – about 15% of all assessments. Other psychiatric problems were common, and many patients had recently attempted or threatened suicide.

A case of cerebellar haemangioblastoma in described in a middle-aged woman with a history of multiple psychiatric admissions for depressive and psychosomatic symptomatology. The diagnosis was not made until a late stage, largely because of the knowledge of her psychiatric history and its particular slant. Similar psychiatric symptoms were present at the outset, colouring the emerging neurological picture. The clinical manifestations and management of cerebellar haemangioblastoma are described.

Three patients attempted suicide by burning in one ward of a psychiatric hospital in a period of less than 1 month. No such attempts had occurred there in the previous 9 years. The three patients were schizophrenics with depressive features who occupied the same room in the ward. It seems reasonable to suggest that at least the choice of method and the timing of these suicide attempts were influenced by imitation. Hospital staff should be especially aware of the influence of imitation in suicide in order to avert such undesired epidemics.

The birth of a mentally handicapped child to a couple is a traumatic event. It has even been compared with a bereavement. In the crisis of family handicap, however, there is also anxiety, fright, guilt and shame. Some of these reactions have been denied by families but it has to be borne in mind that mothers of abnormal babies, although they are not aware of it consciously, may be protective and dominant (Prechtl, 1963). The reactions of parents of mentally handicapped may swing from extremes of over-protection to complete rejection. On the other hand, there is stress both emotional and physical in looking after the handicapped day in, day out. The amount of the emotional stress has not been quantified, but of the many forms of interactions between parent and offspring, over-involvement, criticism, hostility, and warmth can be evaluated using the Expressed Emotional scales.

A case of schizophreniform episode following measles infection in a 27-year-old woman is presented. The possibility that the clinical picture is a first description in the literature of an association between a schizophreniform episode and possible measles-induced allergic encephalitis is discussed. Other possible connections between measles infection and schizophreniform episode are also mentioned.

The case of an 82-year-old woman with delusional infestation and senile dementia of the Alzheimer type is reported. Her symptoms of infestation ceased dramatically with pimozide given for 5 weeks, and did not recur during follow-up over 9 months. The importance of organic factors in patients with this disorder is emphasised.