The author fundamentally questions the traditional concept of the disease-entity (or several disease entities) of ‘schizophrenia’ and discusses an alternative concept, based on vulnerability and information-processing. According to this, schizophrenia-like psychotic phenomena develop in three phases. In the first, premorbid phase, combined biological (genetic and possibly other organic) and psycho-social influences lead to a premorbid ‘vulnerability’, characterised by a low tolerance of cognitive and emotional stress, corresponding to an insufficient capacity for the adequate processing of complex information. In the second phase, stressful life-events can lead to unique or repeated acute productive psychotic episodes. The third phase, that of long-term evolution, depends more on psycho-social influences than on biological factors. Under unfavourable conditions, it may lead to predominantly unproductive residual states of various degrees, which can largely be understood as regulatory mechanisms to restrict stressful over-stimulation. There is no clearly delimitable disease entity of schizophrenia with constant causes, psychopathological picture, or course, but rather a multi-conditioned life-process, occuring in people with a particular vulnerability, interacting with complex life-events and circumstances. This new concept has important consequences for therapy and prevention.

The authors investigated the dexamethasone suppression test (DST) in 93 female patients with primary (endogenous) major depression; in 20 female paranoid schizophrenics, and in 17 healthy females. Depressed patients had a significantly higher rate of abnormal DST response and significantly higher post-dexamethasone serum cortisol levels than schizophrenics and normal controls. The unipolar and bipolar depressives showed a similar profile of DST abnormalities. Depressed patients with psychotic features had a significantly higher rate of positive DST results than non-psychotic patients.

Previous research has shown that nominal dysphasia occurs commonly as a language disorder in senile dementia (Alzheimers' type). This study provides evidence that the degree of nominal dysphasia shown by a patient may be a reliable index of the severity of dementia, as measured by both behavioural and cognitive rating scales.

The occasional abuse of anticholinergic drugs for their psychotropic and specifically hallucinogenic properties has been known for over a century, but benzhexol (trihexyphenidyl) abuse has only recently attracted attention in the literature, mainly in case reports. This paper reports on a study of 21 benzhexol abusers. They were a young, single, and disadvantaged group of poyldrug abusers with poor employment, educational, and social skills, who abused benzhexol mainly for its euphorogenic properties. The two major diagnostic categories were antisocial personality disorder and schizophrenia. An unexpected finding was cognitive impairment persisting after acute intoxication.

A review of reported cases of attempted suicide in Benin City indicates that the incidence has not increased over the four-year period 1978 to 1981, during which the average crude suicide attempt rate was 7 per 100, 000. Eighty seven per cent of the attempters were under the age of 30, but the commonest age-group was 15–19 years (39.4 per cent). The female/male ratio was 1:1.2. The majority of the attempters (64 per cent) were students, housewives, and the unemployed. Ingestion of drugs (68 per cent) or of chemicals (20 per cent) was the predominant method. The major predisposing factors were mental illness (32 per cent) and conflicts with parents (24 per cent).

In a collaborative study between St George's and the Maudsley Hospitals, 34 pairs of twins and one set of triplets were identified in which the proband had anorexia nervosa. The diagnosis was based on standard criteria and zygosity was established by blood group analysis or by use of the physical resemblance questionnaire. In the 30 female twin pairs, 9/16 of the monozygotic (MZ) and 1/14 of the dizygotic (DZ) pairs were concordant for anorexia nervosa. Three of the non-anorexia co-twins had other psychiatric illnesses, and two had minor eating disorders. None of the male co-twins had anorexia nervosa.

In a double-blind, placebo-controlled study, ten chronic schizophrenic patients with pronounced symptoms of tardive dyskinesia (TD) were withdrawn from anticholinergic medication. All patients had previously been under long-term treatment with neuroleptics and anticholinergics for at least two years. The rating-scales used were the AIMS, our own TD Scale, and the Simpson-Angus scale for extra-pyramidal side-effects. The severity of TD decreased significantly in nine patients within two weeks; this improvement, most pronounced in the oral region (P <.001), persisted during a six-week placebo period. There was a slight increase in parkinsonian symptoms (P <.05), which was not a prerequisite for improvement in TD. Hence, discontinuation of anticholinergic medication is a possible therapeutic approach in patients with TD.

In a retrospective study, 20 psychotic children and adolescents with hallucinations were compared with 15 psychotic controls without hallucinations. In the former, auditory hallucinations predominated, which tended to be localised in the internal space of the child. Subjects with hallucinations had significantly more symptoms of depression and anxiety, more precipitants of illness and problems in reading ability. There was a trend for increased laconic speech in them. The findings suggest a link between hallucinations and mood and cognitive changes in children and adolescents with psychoses of late onset.

Three samples of supporters of elderly infirm dependents who were either attending or about to attend day hospitals were given the 30-item General Health Questionnaire (GHQ) to complete. Prevalence levels of disturbance varied from 57% to 73%; female supporters (the majority) reported higher levels of distress. High scores were related to a diagnosable psychiatric condition, and were significantly associated with a combination of poor self-health ratings in the supporters, more frequent behaviour problems in the dependents, and a more negative view of the premorbid relationship between supporter and dependent. Reported amount of contact time and levels of formal and informal outside support were not related to GHQ scores.

Recent research has suggested that the absence of an intimate, confiding relationship may be a vulnerability factor in the development of depression in women living under adverse circumstances. This study demonstrates a significant association between severity of depression and deficiencies of marital intimacy; depressed patients with the lowest levels of marital intimacy failed to improve at one month follow-up, while 36% of the spouses of the depressed patients had symptoms of non-psychotic emotional illness. The depressed patients and their spouses' perception of their marital intimacy differ, but these differences appear not to be solely related to the spouse's depression.

Daily measurement of mood, and the occurrence of specific eating behaviours, were assessed concurrently over an eight-week period in a sample of 50 patients meeting diagnostic criteria for bulimia nervosa. Results of observer-rated scales of mood showed a significant reduction of scores, whereas self-assessment of mood showed no change over the study period. Negative mood states, although not severe, were more marked when the specific behavioural symptoms of binge-eating, vomiting, or purging occurred, and they increased as abnormal eating behaviours accumulated. It is suggested that the accompanying dysphoric mood states of bulimia nervosa are likely to be a secondary manifestation related to the presence of abnormal eating symptoms, and that they do no constitute a primary depressive illness.

In a sample of 130 consecutive patients with a lifetime diagnosis of anorexia nervosa and/or bulimia, 17 displayed psychotic symptoms. In 16 patients, these symptoms appeared attributable to major affective disorder or schizo–affective disorder, while in one, they appeared to represent factitious psychosis. No cases of schizophrenia or organic psychosis were identified.

The paper compares the prevalence of psychiatric morbidity amongst sentenced prisoners and in the general population. Major psychosis was no more common in the majority of studies of criminal populations. Although prisoners have a higher level of neurotic symptomatology, this was mainly found to be secondary to imprisonment itself. Long term imprisonment was not found to be a precipitant of severe psychiatric morbidity or intellectual deterioration, and prisoners adopt elaborate coping mechanisms which may themselves be protective. However, there is a higher prevalence of mentally handicapped and epileptic prisoners, and doctors in the Prison Medical Service have to cope with frequent, serious behavioural problems. Prisons appear to be a particularly important area for future psychiatric research.

With the aid of the Texas Inventory of Grief, 130 first-degree relatives were studied eight years after bereavement. It was found that relatives of persons who had died suddenly and unexpectedly had more pronounced grief reactions than those of persons whose deaths were more expected. The same was observed concerning parents as a group, compared with widows and widowers. The inventory was found to be of value for assessing whether the outcome was good or poor, but it was not possible to identify risk groups with this method.

The recognition of rehabilitation as a special interest in psychiatry, and its practice by professional teams, raises the need for some uniformity in examining patient outcome. The features required in a scale designed for this purpose are considered and the Morningside Rehabilitation Status Scales, which have been prepared specifically for psychiatric rehabilitation, have their development and use described. They measure the dimensions of dependency, inactivity in occupation and leisure, social integration/isolation, and current symptoms and deviant behaviour. The measures can be expressed as a profile of the dimensions, with the total a measure of overall level of functioning; reliability has been established, and validity assessed. The soales are not difficult to apply when the patients are known to the staff using them. They should be useful to rehabilitation teams for defining the current status of patients, measuring changes produced by rehabilitation programmes, deciding areas where treatment or service deficits may exist which the team should be attempting to remedy, as well as for teaching purposes.

Over a six month period, 142 consecutive referrals of patients over 65 to a community-orientated psycho-geriatric service in North London were studied. The psycho-social factors determining referral were quantified and their relationship to diagnosis analysed. Therapeutic strategies are described, devised to deal with the presenting psycho-social problems. It is suggested that a family-centred approach is of some value in the management of the elderly mentally ill.

Changes in appetite and weight were recorded in mild to moderately depressed out-patients during the course of clinical trials of various antidepressant drugs. After six weeks, differences due to treatment regimes were minimal. Patients who on becoming depressed experienced severe changes in appetite and weight in either direction, tended to return to normal. The significant associations of appetite and weight change during treatment were with weight, appetite, and carbohydrate preference at presentation, and also with the ‘appetite history’ and ‘weight history’. The associations with the degree of depression were relatively minor.

A census was taken of all patients in psychiatric hostels and homes, psychiatric day care, and short-term in-patient care who also had at least one year's history of contact with services. During the following two years, 61% of the patients stayed continuously in day or residential care, while 17% were discharged from care within the first year and made no further use of day or residential services. Two main patterns of contact were evident–repeated short-term in-patient care or longer-term care in services outside hospital. Their most important determinant was whether a viable marriage still existed for the patient.

Subjects in Botswana were asked to state their preference between modern (doctor or nurse) or indigenous (traditional or religious healer) care for three case vignettes of epilepsy, psychosis, and tuberculosis. Nurses, medical patients, and a general village population were studied. Many subjects preferred modern care for all disorders, whilst a small number favoured indigenous treatment only. A significant percentage discriminated between disorders, choosing indigenous care for some and modern for others. Indigenous care was most favoured for epilepsy, and least for tuberculosis. Psychosis took an intermediate position. The size of the discriminating group varied between populations, but the overall pattern of attitudes remained the same. Neither demographic factors nor aetiological beliefs consistently identified those who choose indigenous care.

It is known that the development of maternal feelings for a newborn baby is often delayed or may not occur at all (Robson & Moss, 1970); something is also known about the psychopathology of the mother-baby relationship (Margison, 1982) but little has been written about the natural history and treatment of child rejection. The case reported here demonstrates that long-lasting rejection can be successfully treated.