Three men presented to a single regional secure psychiatric unit over a twelve-month period, after taking their youngest child hostage in their own homes because of a threatened separation from the family. In each case the episode had escalated because of hostility to police involvement in what for them was a typical domestic upheaval. All cases ended without injury. In each man, substance abuse, a family history of domestic violence and fears of rejection were prominent, and the recent birth of a child may have been an added precipitant. There may be a common family structure which predisposes to such situations. Psychiatric intervention was deemed appropriate, with some evidence of benefit for the two men who engaged in treatment.

A multiplex kindred ascertained through a single proband with GTS has been systematically investigated with standardised diagnostic instruments for other cases of GTS and related disorders. Complex segregation analysis supported the hypothesis that a single major gene inherited in autosomal dominant fashion but with incomplete penetrance contributed most of the variance in the liability to develop GTS and related disorders. This result is consistent with previous segregation analyses which have employed different methods of ascertainment, and tends to confirm that a proportion of GTS is due to a dominant gene and is suitable for investigation with genetic markers for linkage analysis.

Psychiatric research over the past three decades has now acquired the esteem it clearly deserves. Since empirical research presupposes definition of the object one studies and availability of instruments to measure it, operationalisation of diagnosis and development of psychometric instruments have become major concerns for psychiatry. This progress was promoted to a large degree by biological psychiatry. The search for biological underpinnings of abnormal human behaviour and the study of the efficacy and mechanism of action of biological treatments are both contingent on the use of standardised diagnoses and objective measurement. Biological psychiatry moved in recent years from a minority position into the mainstream, and its methods became the standard approach, especially in research.

Of 113 patients in long-stay wards of a psychiatric hospital, 43 had TD. Twenty-six of the 39 patients who consented to take part in the study were unaware of abnormal involuntary movements. These patients scored significantly lower on a short test of cognitive function than patients who were aware of such movements. The diagnosis of schizophrenia, perticularly the ‘defect’ state with cognitive deficit and negative symptoms, was found to be associated with lack of awareness of TD.

“This paper reviews the recent empirical studies on psychosocial family intervention in schizophrenia. Six family educational intervention studies and five more intensive family work studies with 2-year follow-up have been included. A series of questions is asked relating to the effects of such interventions, the efficacy of the different educational models, the active ingredients of these multi-component treatment packages, and the contribution of this new generation of studies to our understanding of the mechanisms through which these interventions work. Suggestions for further research are made. Finally, from the published manuals, the common components of these diverse, multi-component treatment packages of different family-intervention studies are identified.”

An 18-year-old woman presented with SMAS: an additional diagnosis of anorexia nervosa was later made. Both conditions should be considered when an adolescent presents with weight loss and vomiting.

British Journal of Psychiatry (1992), 160, 552–554

Three cases of stress-induced hallucinations in young soldiers are described. The hallucinatory experience was not accompanied by gross psychopathology. The phenomenology and psychopathological implications of hallucinations following exposure to environmental stress are discussed.

Insight can be defined not only in terms of people's understanding of their illness, but also in terms of understanding how the illness affects individuals' interactions with the world. The term ‘insight’ encompasses a complex concept which should not be considered as an isolated symptom which is present or absent. Instead, it may be more appropriate to think of insight as a continuum of thinking and feeling, affected by numerous internal and external variables. Different psychiatric disorders involve different mechanisms in the process of impairment of insight; this may influence the ways in which insight should be assessed in clinical practice.

Three males with factor-IX deficiency (Christmas disease) in one pedigree all had severe affective disorder. This apparent cosegregation, if true, would support the hypothesis that in some pedigrees, a gene for major affective disorder is located on the X chromosome.

This is the first report of a case of anorexia nervosa in a woman with XY gonadal dysgenesis. Anorexia nervosa is a potential complication of gonadal dysgenesis, stemming not only from the disorder itself but from its investigation and treatment.

The misidentification of a familiar person or of oneself may occur as a complication of dementia. Seven patients experienced alterations of the sense of familiarity for a familiar object or place, for the misidentified person in a novel role, for personal characteristics, or for unfamiliar events as familiar. Five of these had persecutory delusions. These cases suggest that person misidentification in dementia begins with an altered sense of familiarity for a familiar person from a mismatch of new perceptions with past memories. They are sustained by paranoid elaboration or confabulatory rationalisation of a double.

Two cases of psychotic illness in association with the karyotype triple X showed specific diagnostic and management problems as well as obstetric complications, EEG abnormalities, and lack of a family history of psychiatric disorder. Routine karyotyping during the investigation of psychosis is becoming relevant to psychiatric practice as research reports increasingly feature genetic and chromosome anomalies in association with schizophrenic psychoses.

British Journal of Psychiatry (1992), 160, 554–557