Schizophrenia research is affected by the current change of scientific paradigms of thinking and investigation. The 1960s and 1970s were mainly characterised by a theoretical shift from a unifactorial towards a multifactorial view of the aetiology of schizophrenia, while in the 1980s, traditional linear models of pathogenesis have been more and more given up in favour of systems models.

The novel antidepressant, moclobemide, is a reversible inhibitor of monoamine oxidase (MAO) preferentially of monoamine oxidise-A (MAO-A); it emerged for study out of a series of lipid-lowering agents. In spite of its weak MAO-A inhibition in vitro, moclobemide is a potent inhibitor of MAO-A, in vivo; its in vivo activity is of short duration, in contrast to the extremely long-lasting inhibition, e.g. by tranylcypromine. Moclobemide only slightly potentiates the pressor effect of oral tyramine in freely moving rats, again in contrast to tranylcypromine; it is not anti-cholinergic and is free of hepatotoxicity. Published evidence on the preclinical pharmacology is reviewed.

“The first 50 referrals to a newly established liaison psychiatry service for the breast cancer unit at Guy's Hospital, London, have been examined. The majority of referrals were for psychological reactions to malignant disease; most of these were mood disturbances. Patients with sustained psychological reactions to their malignant disease were more likely to have had treatment for previous psychiatric illness and to lack a confiding relationship compared with those whose psychological reactions were transient. Teaching doctors and nurses to deal effectively with the transient psychological reactions of patients to their malignant disease is an important task of liaison psychiatry.”

Within a group of hospitals for the mentally handicapped serving the Leicestershire district, a cohort of 215 epileptic patients was identified, who were followed up for four years. The anticonvulsant medication of each patient was reviewed regularly until an optimal balance between seizure control, absence of medication side-effects, and reduction of polypharmacy was attained. After four years 172 patients remained in the study. A significant reduction in polypharmacy was attained overall. Some groups of patients showed a significant reduction in the frequency of seizures, while a small group of patients with frequent seizures remained difficult to control.

A survey was conducted of 47 suicides, 16 failed suicides, and 24 attempted suicides that occurred from Brisbane river bridges over 15 years. Compared with findings from other suicide surveys, subjects of bridge suicides and failed suicides had a much higher rate of schizophrenia (46%), with hallucinations often precipitating the jump. They also had extensive histories of previous self-harm. Those who attempted suicide by jumping had a higher rate of personality disorder (58%) compared with findings from other attempted suicide surveys, and had very extensive histories of previous self-harm which tended to continue beyond the bridge incident. Both groups had histories of extensive previous psychiatric care.

Platelet MAO activity and platelet serotonin uptake were determined in 20 agoraphobic and 16 neurotic depressive out-patients, and 19 healthy volunteers. Agoraphobic patients were characterised by significantly higher mean values of platelet MAO activity compared with the other two groups, while neurotic depressive patients exhibited significantly higher maximum platelet serotonin uptake velocity. These findings are compatible with an abnormality in the uptake and metabolism of serotonin.

The perceived parental rearing practices and attitudes of agoraphobics, social phobics and non-patient normal controls were investigated, employing the EMBU, an inventory for assessing memories of upbringing. Findings obtained previously with out-patients were replicated with in-patients as subjects. Compared with the controls, agoraphobics rated both their parents as having been less emotionally warm but only their mothers as having been rejective. Socially phobic in-patients rated both their parents as having been rejective, as having lacked emotional warmth, and as having been over-protective. Comparisons between agoraphobics and social phobics showed differences in certain aspects of parental rearing, with the socially phobic in-patients assigning ratings more negatively than the agoraphobic group.

A follow-up study of 17 old long-stay psychiatric patients resettled in private facilities for the elderly is reported. Resident satisfaction with the placement and functioning (using the CAPE Behaviour Rating Scale) was assessed, together with the quality of the physical and social environment, and the regime characteristics in the establishments. All residents were satisfied with life and their functioning had improved significantly. The private facilities were more resident-orientated, and had a generally superior social environment to their local authority ‘old people's home’ counterparts. The physical amenities, safety features, and architectural choice available were of a similar standard to those in local authority old people's homes, but there were fewer prosthetic and orientational aids and on-site recreational amenities.

In a general population survey by Gallup in Great Britain of 4148 subjects, 7.7% had taken benzodiazepines within the last year (male:female ratio 106:212). Younger subjects tended to take anxiolytics for shorter periods compared with older subjects, who often took hypnotics chronically. This pattern was most marked among females. Dosage escalation, tolerance, high daily dose usage, and hoarding were not common. A substantial proportion of current users had experienced difficulty in stopping their medication. Withdrawal problems were associated with being older than 45 years and consuming benzodiazepines for over 12 months. This lends support to the idea of benzodiazepine dependency. However, the appropriateness of long-term therapy for chronic symptoms cannot be ruled out.

Of a random sample of new attenders at a dermatology out-patient clinic, 40% were classified as suffering from a psychiatric disorder. There was no correlation between psychiatric morbidity and the severity or site of skin disease. Self-report measures of the behavioural impact of skin disease and attitudes to appearance were related to psychological morbidity. Except in subjects without visible skin pathology (5%) there was no evidence that psychiatric illness was an aetiological factor in the development of skin disease. Self-report measures were used to distinguish between those patients in whom psychiatric morbidity was closely related to skin disease (75%), and those in whom it may be coincidental (20%). Psychological care for the former group is most appropriately provided by physicians, who should be encouraged to improve their detection and management of psychiatric morbidity.

The general view that relationships between factors within the patient and those in the environment are important in understanding schizophrenia has been widely accepted and is the basis for vulnerability/stress models of this disorder. However, the specifics of the patient-environment relationships that may be critical for schizophrenia continue to be largely a mystery. At the UCLA Clinical Research Center for the Study of Schizophrenia, we have developed a tentative working model of schizophrenic episodes that emphasises the mediating role of information-processing and autonomic abnormalities in the patient in interaction with stressful circumstances and protective factors in the patient's environment (Nuechterlein & Dawson, 1984a; Liberman, 1986; Dawson & Nuechterlein, 1987; Nuechterlein, 1987). Here we examine two examples of patient-environment relationships that may increase our understanding of such processes in schizophrenia.

An elderly lady, of superior verbal intelligence and with no severe psychiatric condition, severely neglected herself, and required prolonged day patient care. Brain scans showed selective frontal atrophy, and both traditional and new computerised neuropsychological testing demonstrated severe frontal dysfunction.

Based on the experience with the International Pilot Study on Schizophrenia (IPSS) (WHO 1973, 1979), the WHO Division of Mental Health and Centres in Sofia, Groningen and Mannheim, joined by expertise from Nottingham and Zurich, conceived a prospective study to assess the ‘natural history’ (Ciompi, 1980a, b; Watt et al, 1983; Biehl, 1987) of psychological impairments and social disabilities in patients with functional psychosis in different socio-cultural environments (Jablensky et al 1980).

“We cannot command nature except by obeying her” (Bacon)

Our confidence in being able to offer successful treatment of paedophilia remains low. A multifaceted cognitive/behavioural treatment approach is described in the hitherto successful treatment of a man with a 13-year history of sexually interfering with young children of both sexes.

Trimble (1986) has pointed out a shortcoming of the current wave of literature on negative symptoms: there is no overall consensus within psychiatry as to which symptoms and signs are to be considered positive and which negative (Kayton, 1973; Carpenter et al, 1976; Sheldrich et al, 1977; WHO, 1979; Andreasen, 1979; Jablensky, 1981; Crow, 1982, this volume; Rosen et al, 1984; Zubin, 1985; Kulhara et al, 1986).

Attention was first drawn to the importance of this topic by Schneider (1957) when he proposed that some of his first-rank symptoms could be grouped together under the concept of ‘permeability’ of the barrier between the individual and his/her environment — the ‘loss of ego boundaries’. Similarly, in a recent series of papers (Strauss et al, 1987), the essence of schizophrenia was conceptualised in the processes of interaction between biology, behaviour, and environment. The two main syndromes — acute and chronic — can each be precipitated or made worse by environmental factors, and although most patients with the negative syndrome appear to show some irreducible impairment, poverty of the social environment has been found to worsen their condition, while on the other hand, a moderate degree of social stimulation promotes relative improvement (Wing, 1987).

Minaprine is an amino-phenylpyridazine antidepressant reported to be relatively free of anticholinergic effects, cardiotoxicity, drowsiness, and weight gain. Minaprine (100mg t.d.s. and 100mg b.d.) was compared with mianserin (20 mg t.d.s.) in 117 depressed patients, and all three regimes produced significant reductions in scores on the HRSD at the end of six weeks' treatment. There were no anticholinergic effects, but there was a significantly greater incidence of drowsiness with mianserin than with minaprine.

In a study of the effects of the teaching of the ‘Grammar of Psychotherapy’ Course, 26 subjects were matched with 27 controls. The students were found to have significantly better interviews than the controls as rated by their patients and by independent blind assessment of their audiotapes six months later. There are some trends which were of interest, although not statistically significant.