When Kraepelin originally defined and described dementia praecox, he assumed that it was due to some type of neural mechanism. He hypothesised that abnormalities could occur in a variety of brain regions, including the prefrontal, auditory, and language regions of the cortex. Many members of his department, including Alzheimer and Nissl, were actively involved in the search for the neuropathological lesions that would characterise schizophrenia. Although Kraepelin did not use the term ‘negative symptoms', he describes them comprehensively and states explicitly that he believes the symptoms of schizophrenia can be explained in terms of brain dysfunction:

A case of doll phobia in a 14-year-old boy is presented and discussed.

Our current study compares intermittent medication with maintenance medication in the treatment of stable schizophrenic out-patients. According to the intermittent approach, known active medication is given only when the patient develops prodromal signs of relapse and until the patient restabilises. After restabilisation, medication is discontinued. The impetus for this work came as the result of our interest in finding ways to diminish the incidence of tardive dyskinesia. Many investigators believe that tardive dyskinesia is generally related to the amount of neuroleptic medication a patient has taken during his lifetime. Since it is routine for many aftercare clinics to maintain these patients indefinitely on antipsychotic medication, ways must be found to reduce the amount of medication taken by chronic schizophrenic patients. This paper will present the background ideas and preliminary studies which led to the present study and preliminary results of the present study.

A 35-year-old Arab lady and her mother, both with bipolar manic-depressive illness and 46,XX,21p-(pcenåpter), are reported. The clinical significance of this association is considered.

Status epilepticus is a rare complication of ECT. We describe a patient who suffered a prolonged seizure which required termination with intravenous diazepam. The status epilepticus was not accompanied by motor movements, and the diagnosis was made only because of simultaneous EEG monitoring. The incidence of status epilepticus after ECT may be underestimated.

The existence of a definable and distinct negative syndrome within schizophrenia remains to be established (Barnes & Liddle, 1989). Addressing this issue, Sommers (1985) discusses three stages required to demonstrate validity for a syndrome. These are first, that the signs and symptoms must be shown to occur together. Second, operational definitions must be developed which will reliably identify and rate and features, and third, the relationships between the syndrome and other variables must be shown to be predictable. With respect to the second and third stages, this paper reports briefly on two recent studies which explored the relationship between negative features and other clinical features, specifically depressive symptoms and drug-induced movement disorder. The results of such studies (see also McKenna et al; and Lindenmayer & Kay, this volume) allow some assessment of the ability of the rating methods used to discriminate between negative symptoms and features such as drug-related bradykinesia and depressive features.

A case of a 21-year-old woman with subacute sclerosing panencephalitis presenting with paranoid schizophreniform symptoms is presented. The relationship between viral encephalitis and psychiatric symptoms is briefly considered.

The treatment of two chlorpromazine-medicated chronic schizophrenics with cimetidine resulted in excessive sedation, which necessitated a reduction in chlorpromazine dosage. Eventual discontinuation of cimetidine therapy led to a return of schizophrenic symptoms, which responded to an increase in chlorpromazine dosage to previous levels.

Psychosis is reported following abrupt withdrawal of oestrogen and surgery for male-to-female sex reassignment. The resemblance of the patient's mental state to puerperal psychosis suggested a hormonal aetiology.

It has repeatedly been demonstrated that both acutely psychotic and remitted schizophrenics, as well as some relatives of schizophrenics, show experimentally assessable cognitive dysfunctions, i.e. attentional or information-processing deficits. It is therefore assumed that these are at least potential vulnerability indicators for schizophrenia (Nuechterlein & Dawson, 1984; Nuechterlein, 1987).

A 59-year-old woman with Turner's syndrome developed epilepsy, diabetes mellitus, chronic psychosis, and subsequently pre-senile dementia. This would endorse the view that psychosis in Turner's syndrome arises through brain damage.

Restless legs syndrome was observed in three patients receiving mianserin. The symptoms resolved when the treatment was discontinued or reduced.

The treponemal serological status of 800 patients above the age of 65 was reviewed. Twenty-one were found to be positive and the venereologists advised against treatment in all referred cases. The question is posed whether syphilis serology screening in the elderly mentally ill should be confined to those patients with obvious clinical manifestation of syphilis or with obscure psychiatric presentations.

The authors present two patients with neurosyphilis who presented with psychiatric disorders and who both benefited from penicillin therapy. Increases in such cases may be expected.

An important basis for this work is the vulnerability model proposed by Zubin & Spring (1977). They integrated findings on schizophrenia in a second-order model showing the relationship between vulnerability to schizophrenia and stress, adaptation to stress, and especially coping breakdown, i.e. the incapacity to adapt in the shorter or longer term. Thus, given a certain degree of vulnerability, stress, and how the affected individual copes with it are the critical factors for the occurrence of a schizophrenic episode. The work presented here describes an empirical investigation of these two components.

If negative symptoms represent a distinct class of schizophrenic symptoms, they should, to paraphrase Bleuler (1911), be more closely related to each other than they are to other schizophrenic symptoms. The first part of this statement, that negative symptoms are intrinsically related to each other, has received considerable experimental support (Andreasen, this volume; Mortimer et al, this volume). The second, that negative symptoms are unrelated to other schizophrenic symptoms, has been somewhat more unevenly investigated.