We describe the case of a 33-year-old man with Down's syndrome and severe eating disorders. The clinical symptoms, and their difference from those of anorexia nervosa, are discussed. The patient responded well to a strict behavioural programme after long, in-patient treatment and was still well at a 2-year follow-up examination.

A man with Nelson's syndrome developed severe associated behavioural and psychiatric problems, which completely resolved following selective resection of his pituitary tumour. It is postulated that ACTH, β-endorphin, or related peptides may have caused these problems.

With mentally handicapped people now being moved into the community, information on mentally handicapped criminal offenders is valuable. A group of such offenders was examined by reviewing the case-notes of 92 patients referred on hospital order to two mental-handicap hospitals over 10 years. Compared with the general criminal population, these offenders' ages were higher, the ratio of male to female offenders was similar, and the proportion of married people was lower. The offences committed were for the most part serious, with a greater number of offences against property and public order in the subgroup whose intelligences were in the mentally handicapped range. Their tested intelligences fell almost entirely into the normal and mild mental-handicap range, suggesting that factors other than intelligence testing, such as social skills, were considered in their admission to the hospitals.

A paper referred to me for statistical review has drawn my attention to the issue of appropriate evaluation of the effectiveness of treatments used in psychiatry. It has been suggested that the classical randomised controlled trial (RCT) is inappropriate to many aspects of psychiatry. I feel it is important that this issue should be looked into closely. I believe that the principle that treatment evaluation should be by RCT wherever this is feasible is certainly no less important in psychiatry than in other medical specialties. Discussion of this issue is needed, so that guidelines can be set out which will both be acceptable to researchers in psychiatry and meet scientific standards accepted in other areas of medicine.

Marker loci in 113 members of nine unrelated multiplex families identified by a bipolar proband were tested for linkages with primary affective disorder. Linkage was excluded between the disease locus (assuming that it was a single autosomal dominant gene) and the HLA loci at a recombination fraction of 0.2, the ABO, Rh, and Lu loci at almost 0.05 and the Fy and P loci at 0.001.

The onset of post-traumatic stress disorders in a group of firefighters who had an intense exposure to a bushfire disaster was investigated using a longitudinal research design. Contrary to expectation, the intensity of exposure, the perceived threat, and the losses sustained in the disaster, when considered independently, were not predictors of post traumatic stress disorder. By contrast, introversion, neuroticism, and a past history and family history of psychiatric disorder were premorbid factors significantly associated with the development of chronic post-traumatic stress disorders.

My title points to the basic paradox: if it is psychotherapy, can it be supportive? If it is supportive, can it be psychotherapy?

Pseudocyesis is an uncommon condition in which the psychological and somatic phenomena are usually thought to arise with neurotic rather than psychotic illness. We report a patient whose pseudocyesis took a course not previously described, culminating in an acute schizophrenic episode. Despite this she demonstrated many similarities with neurotic patients previously described in the literature. A phenomenological explanation, the belief of pregnancy as an overvalued idea, is discussed.

Urinary output of homovanillic acid and 4-hydroxy-3-methoxymandelic acid was decreased both in patients with panic attacks and in normal controls during lactate infusion, whereas that of tribulin (an endogenous monoamine oxidase inhibitor and benzodiazepine receptor binding inhibitor) was increased. There was no change in urinary excretion of any of these compounds during saline infusion. These findings provide further evidence of a link between tribulin output and stress and anxiety in man and point to its possible in vivo action as a monoamine oxidase inhibitor.

An unusual case of writer's cramp in a 12-year-old deaf girl is reported. Possible aetiological and contributing factors in her environment are discussed, with particular relevance to a hysterical conversion reaction.

The prevalence of psychiatric disorder (by DSM–III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.

A case of a patient with monosymptomatic hypochondriasis exhibiting koro-like symptoms is reported. The patient did not respond to pimozide, but improved with a tricyclic antidepressant and has remained symptom-free for 1.5 years.

A case is described of a patient with Turner's mosaic (XO/XX) associated with anorexia nervosa. The cases described in the literature point towards the multifactorial aetiology of anorexia nervosa, emphasising factors other than the suppression of sexuality.

Attempts to repeat in human subjects animal studies in which naloxone stopped withdrawal symptoms after prolonged use of heroin failed. Nevertheless, suggestions for further studies are made, as the subjects' subsequent desire for opiates did seem attenuated.

The mental health of 523 medical students was examined one month after enrolment and two years later. The point prevalence rates of all mental disorders were 16.1% and 17.5% respectively. The incidence rate was 5.3% per year, with neuroses being the most frequent diagnoses (3.5%).

The treatment of patients with dysmorphophobia remains a confused matter, probably because of clinical heterogeneity. Our experience with the case reported in this paper suggests that psychodynamic psychotherapy is indicated for certain carefully selected patients.

The premenstrual and menstrual periods are associated with increased psychiatric disturbances, both of a psychotic and neurotic nature. Pre-existing psychosis can worsen in the premenstrual period, or, as we describe in the following case report, a psychosis can occur in the premenstrual period with complete remission once the bleeding has ceased. The role of menstruation in the timing and pathogenesis of the major psychoses is largely ignored in present-day psychiatry. In the nineteenth century, however, psychosis coincident with menstruation was thought to merit its own special term (Menstruationpsychose), and Kraepelin himself described the importance of the association (Kraepelin, 1909). In contrast, premenstrual tension has been the subject of continuous interest since the term was first used by Frank (1931), and there have been cases described of premenstrual tension in association with psychosis. Williams & Weeks (1952), for example, reported on 16 cases where the psychosis was characteristic of mania or catatonic schizophrenia, and more recently, Price & DiMarzio (1986) found that 60% of a group of rapidly cycling manic-depressive psychotics suffered from severe premenstrual tension. Psychosis associated with the menstrual cycle without concomitant symptoms of premenstrual tension has also been described. Lingjaerde & Bredland (1954) presented a case of a 24-year-old woman who developed a manic–depressive (manic-type) psychosis synchronous with her menstrual cycle, after childbirth. A Japanese cohort of patients diagnosed as suffering from “periodic psychosis” (Wakoh et al, 1960) showed significant correlation between acute psychosis and the luteal phase of the menstrual cycle. The premenstrual period is also known to exacerbate pre-existing psychosis; Ota et al (1954) and Gregory (1957) have shown a significant increase in psychotic behaviour in the last 10 days of the menstrual cycle. We present a patient with a schizophreniform psychosis occurring irregularly but concomitant with her menstrual cycle, with total remission during the interval stage.

A case report of a 37-year-old woman with Munchausen syndrome which differs in many respects from the classical picture is described. Attempts are made to examine the motives behind the syndrome and to make a link with the common pattern of deliberate self-harm.

This report describes a young patient with acute overdose lithium toxicity, who developed severe memory impairment in spite of treatment with haemodialysis. His memory showed gradual recovery, but definite impairment could still be detected 2 months after the overdose.

Dependence on mephentermine, a widely used sympathomimetic pressor agent, is so far unreported, although misuse of inhalers is recognised. A case of mephentermine dependence associated with chronic psychosis is reported here. Psychosis initially surfaced with chronic dexamphetamine abuse, but was sustained for 3 years by mephentermine. After a period of remission lasting for 4 years, the patient again developed psychosis on restarting abuse of mephentermine, which lasted for 5 years.