Classification of child (including adolescent) disorders is reviewed within six areas: requirements for a good taxonomy, current systems of classification for children, data-capture methods, reliability and validity, the link between child and adult disorders, and directions for future developments. While substantial progress has been made, there is a continuing need for comparisons of different systems, more systematic yet practicable data capture, proper psychometric analyses of criteria and categories, intensive studies of clinical validity, closer attention to the similarity of, and links between, child and adult categories, and better definition and targeting of those disorders with a serious outcome.

Subtypes of the features of chronic schizophrenia were investigated. As in previous research, three discrete syndromes were found. These were then related to demographic, psychological, and movement-disorder variables. Possible pathophysiological mechanisms are discussed in terms of known neostriatal functions.

Psychodynamic concepts about borderline personality disorder are reviewed and the literature concerning psychotherapeutic treatment of this group is examined. The treatment contexts considered include: psychoanalysis and intensive (expressive) psychoanalytic psychotherapy, supportive psychotherapy, group psychotherapy, family therapy, in-patient treatment, the therapeutic community, cognitive–behavioural approaches, and combinations of drugs and psychotherapy. The practical implications of recent follow-up studies for intervention strategies are considered.

This review focuses on ‘aches and pains' and conversion syndromes as a basis for the description of psychological factors and mechanisms of relevance for the somatisation of distress in childhood and which may contribute to medical help-seeking for children. The characteristic pattern of associated psychological factors includes child personality features; academic concerns; family health problems; and styles of family interaction. Further research is required to explore in more depth the nature of these factors, the mechanisms that mediate the development of severe handicapping problems, and effective interventions.

The information available on the illness of Anna 0. is reviewed together with follow-up data from the literature. It is concluded that the diagnosis of a severe depressive illness with depressive delusions is well justified. Hysterical symptoms which appeared can be understood as part of the depressive state modified by the expectations of the period and by the intervention of physicians. The illness was a very protracted one, with fluctuations or exacerbations lasting from 1880 to 1887, and was complicated by dependence upon morphine and chloral hydrate. However, by 1888, the patient appears to have made a considerable recovery, and she went on to lead an effective and fruitful life, demonstrating high intelligence and the resilience of the cyclothymic temperament.

Studies which have examined the perception of emotion by schizophrenic patients have produced conflicting results, an outcome which may, in part, be due to difficulties in presenting a realistic portrayal of emotion. This study exposed 32 schizophrenic patients in remission and ten controls to five videotaped scenes of emotional situations played by actors. The schizophrenic patients were divided into three groups, namely those living with high-EE relatives, those living with low-EE relatives and those living alone, in order to test the hypothesis that patients in a high-EE environment are less able to identify emotionally charged situations. Measures of electrodermal activity and self-ratings of tension were recorded concomitantly. The schizophrenic patients in all groups were as adept at identifying emotions as were the controls. There was no difference between the groups in electrodermal activity and subjective tension for all video scenes, except for the one which portrayed the only pleasant interaction; the high-EE group was significantly more aroused on both measures, which were independent of each other.

Chromosomal aberrations associated with schizophrenic disorders may suggest regions in which to focus a search for genes predisposing to schizophrenia by a linkage strategy. As for other genetic illnesses, chromosomal abnormalities may also provide useful tools for subsequent physical mapping, fine localisation, and isolation of important susceptibility genes. Identification of several chromosomal aberrations may be especially important, given the unknown pathophysiology, the paucity of known brain genes, and the probable genetic heterogeneity of schizophrenia and manic-depression. However, because psychiatric disorders are common and inherited in a complex manner, researchers must use caution when drawing inferences about associations with chromosomal aberrations. Reported abnormalities involving autosomes (chromosomes 1–22) associated with psychotic disorders are reviewed. Their relevance to linkage studies localising genes for schizophrenia was estimated by standardised criteria for specificity, diagnosis, family history, and overall weight of evidence. Four ‘possibly relevant’ chromosomal regions were identified: 5q, 11q, 18q, and 19p. This paper outlines strategies for future studies to detect new chromosomal aberrations associated with major psychotic disorders that may be relevant to isolating the genes for schizophrenia.

Between 1987 and 1990 a large series of at-risk individuals has been referred to our Huntington's disease (HD) presymptomatic testing programme. A detailed protocol for assessment and counselling has been followed. Out of 238 serious inquiries, 36% were potentially suitable for the testing programme, but 19% chose not to continue. Reasons for exclusion included the presence of clinical features of HD and being under the age of 18 years. Out of 40 final results given to 38 individuals, 23 indicated a lowered risk, 11 an increased risk, while five results were uninformative, two of these becoming informative on repeat testing. This series contained more women than men, and was disproportionately from the higher socio-economic groups. Motives for requesting a test principally related to child-bearing, informing existing children, and planning for the future. No significant psychiatric symptoms have been reported in the short term, but difficult counselling problems were presented by the high proportion of applicants who already showed clinical signs of HD. It is concluded that a detailed counselling protocol is essential in testing for HD, as many applicants are ill-prepared; this will assume even greater importance when the HD gene is identified and a test for specific mutations is available. The experience of presymptomatic testing for HD provides important general lessons which are likely to be applicable to other inherited neurological and psychiatric disorders.

Abnormality of subjective time experience is well recognised in psychiatric illness. Earlier authors suggested that slowed time experience in depression is an aspect of psychomotor retardation, while more recently it has been argued that this disturbance is non-specifically linked to the global severity of the depressive syndrome. This study offers evidence that both views can be justified: slowed time awareness is a common symptom of depression, related particularly to retardation, and to the severity of the mood disturbance. Some of the experimental difficulties in this kind of research are illustrated.

Analysis of 33 instances of recovery or improvement among 92 women with anxiety, and 49 instances of recovery and improvement among 67 episodes of depression, showed that recovery and improvement, when compared with conditions not changing, were associated with a prior positive event. Such events were characterised by one or more of three dimensions: the ‘anchoring’ dimension involved increased security; ‘fresh-start’, increased hope arising from a lessening of a difficulty or deprivation; and ‘relief’, the amelioration of a difficulty not involving any sense of a fresh start. Events characterised by anchoring were more often associated with recovery or improvement in anxiety, and those characterised as fresh-start were associated with recovery or improvement in depression. Recovery or improvement in both disorders was more likely to be associated with both anchoring and fresh-start events. The study involved the reworking of some social and clinical material, and although done blind should be seen as exploratory.

This study aimed to establish the prevalence of psychosocial problems in gay men with HIV infection, and to identify factors associated with psychological morbidity. The study was a cross-sectional controlled investigation, which included 24 HIV seropositive and 25 seronegative gay men. Outcome measures included current psychological status and psychiatric history; coping and health beliefs; and social and sexual functioning. Seropositive subjects had worse scores on the PSE total score, and greater sexual difficulties. There were also differences in health beliefs and coping. Psychological morbidity was associated with hopelessness, previous psychiatric illness, symptomatic HIV disease, and low self-esteem.

The authors assessed the relevance of clinical symptoms to genetic research in schizophrenia in the nuclear families of 65 chronic schizophrenic probands. The morbidity risk for schizophrenia and schizotypal personality (a ‘spectrum’ disorder) was markedly reduced in first-degree relatives of probands with predominant negative symptoms, as compared with relatives of probands with other symptom patterns. The data support the notion that negative-symptom schizophrenia has an attenuated genetic component.

A sample of 115 DSM–III–R schizophrenics was studied by means of the SANS and SAPS. A factor analysis from the nine subscales and two symptoms (inappropriate affect and poverty of content) and a review of the previous factor analyses suggest that schizophrenic symptoms cannot be appropriately classified into positive and negative syndromes. The low internal consistency of the SAPS suggests that the positive symptoms are not a homogeneous syndrome. Our results fit better with Liddle's model of three syndromes (negative, delusion-hallucination and disorganisation syndromes). It is argued that we are far from a valid classification of schizophrenic symptoms and the positive-negative dichotomy appears to be an oversimplification.

This study investigated lay subjects' theories of schizophrenia. A questionnaire examining the five identified main academic theories of schizophrenia (medical, moral–behavioural, social, psychoanalytic, and conspiratorial) along various dimensions (aetiology, behaviour, treatment, function of the hospital, and the rights and duties of both patients and society) was constructed for use in the study. The results from 106 lay respondents showed that no single model was favoured exclusively but seemed to point to a synthesis of several academic theories. The lay subjects stressed the importance of patient environment in the aetiology of schizophrenia rather than a physiological malfunction, but tended to stress the personal rights of the schizophrenic. The differences between lay and the currently dominant psychiatric models are discussed in terms of the function these models serve for each group.

The burden of schizophrenia on rural and urban Nigerian families was studied using a standardised questionnaire. Rural families experienced more burden; however, the difference was significant only in respect of financial burden. Rural families of schizophrenics were shown to be more prone to minor psychiatric morbidity than urban families. Policies should be instigated to reduce such burden.

Derived simply from the Greek work chronos, meaning time, the label ‘chronic’ denotes an illness of long duration or one of frequent recurrence. However, when chronic is paired with schizophrenia, as in ‘this person is a chronic schizophrenic’, the connotation becomes an expectation of deterioration, defect, or deficit states (Cutting, 1983). These perceptions about schizophrenia have pervaded and guided clinical judgements (Feighner et al, 1972; American Psychiatric Association, 1980, 1987), treatment programming (Bachrach, 1979; Lamb, 1981; Strauss & Glazer, 1982), policy formulation (Greenblatt, 1978; Talbott, 1979), and decisions about priority for funding (Kraft, 1981). These perceptions have also stripped hopes of recovery from patients and their families (Chamberlin, 1979; Lovejoy, 1984). Further, the use of phrases such as ‘deinstitutionalisation of chronic mental patients’ glosses over the large heterogeneity of patient types, courses of illness and recovery, and the actual shifts in composition and migrations of groups of patients within society (Lamb, 1979; Leighton, 1982; Harding & Ashikaga, 1982).

Research with schizophrenic out-patients has shown that antipsychotic medication reduces relapse rates. This protective factor may operate partially by raising the threshold for relapse in the face of environmental stressors such as life events and high levels of familial expressed emotion. A prospective, longitudinal design was employed in the monthly collection of life-events data with 23 recent-onset schizophrenic out-patients. In a between-subjects ANOVA, a significantly higher frequency of independent life events was found in the month prior to a relapse for ten patients on medication, as compared with the analogous month for 13 drug-free patients. These findings suggest that neuroleptic medication may produce a prophylactic effect by raising a patient's threshold of vulnerability to relapse.