Are viruses the cause of mental illness, or does stress or mental disorder produce impaired immunity, with increased susceptibility to infection? These two separate but not unrelated questions have been debated periodically and there has been much renewed interest recently, with increased sophistication in immunology and widespread topical concern about immunodeficiency. The neuropsychiatry of the acquired immunodeficiency syndrome (AIDS) (Snider et al, 1983; Carne & Adler, 1986; Wortis, 1986; Burton, 1987; Fenton, 1987) and the validity of a ‘post-viral fatigue syndrome’ as a clinical entity (Behan, 1983; Southern & Oldstone, 1986; Dawson, 1987; David et al, 1988) are not discussed here, but have been dealt with in the editorials and reviews cited.

Any reader of the handbooks of medical history will know that among the ancient Greeks, the womb was on occasion held to cause various complaints by moving about the body. A particularly graphic account is to be found in the Timaeus (91b–c), where, in likening sexual desire to an actual animal, Plato first mentions “… in men the organ of generation becoming rebellious and masterful like an animal disobedient to reason”, and then alludes to:

For a long time, monoamine oxidase inhibitors (MAOIs) have been the Cinderella drugs of psycho-pharmacy. Although they were introduced just before the tricyclic antidepressants (TCAs), they rapidly became second-line treatments. Several factors contributed to this, in particular the dietary restrictions, the scattered reports of death from overdose and/or toxic interactions, and the unfavourable reports on the efficacy of phenelzine in depression from, among others, the Medical Research Council trial (1965). For a number of years afterwards, prescription of these drugs was limited to a few enthusiasts. More recently, however, their popularity has increased owing firstly to a re-evaluation of their effectiveness in tricyclic-resistant depression and in anxiety disorders, and secondly to growing awareness of the exaggerated claims made about their dangerousness (Pare, 1985).

There can be few more impressive sights in contemporary neuroscience and biological psychiatry than the imaging of neurotransmitter receptors in the brains of living human subjects by positron emission tomography (PET; Sedvall et al, 1986). How has such technology advanced our understanding of the pathophysiology and/or treatment of major psychiatric disorders?

Studies demonstrating the linkage to separate chromosomal locations of Alzheimer's disease, manic depression, and schizophrenia require re-evaluation of our ideas of their genetic aetiology. This article reviews the findings, and explores the increasing contribution of the ‘new genetics' to our understanding of the organic and functional psychoses.

The Gilles de la Tourette Syndrome is a movement disorder characterised by both motor and vocal (phonic) tics. It was once thought to be rare, and the literature until the 1970s consisted predominantly of case reports, both highlighting the fascinating clinical manifestations and speculating as to their aetiology. Many areas of GTS are under investigation, including the neurology, psychopathology, neurophysiology, biochemistry, and genetics. This review briefly considers early descriptions of GTS as well as current research, highlighting the areas of agreement and controversy.

Brain damage can induce anomalous neuronal connections in experimental animals, which can sometimes result in maladaptive behaviour, particularly when damage occurs early in development. Anomalous patterns of neuronal connection can also arise from genetic disorders. In humans, neuronal misconnections could be involved in a variety of psychiatric disorders. For example, they may account for the link between hyperkinesis and childhood hemiplegia, and for the link between schizophrenia and ‘alien tissue’ lesions of the temporal lobes. Predictions from misconnection hypotheses can potentially be tested in neuropathological, neurophysiological, and clinical studies.

Empirical studies have recently demonstrated that major and minor depressive disorders occur in 30–50% of stroke patients, and last more than one year without treatment, although they do respond to tricyclic antidepressants. These mood disorders are not strongly associated with severity of impairment, demographic characteristics, social supports or prior personal history, but major depression is often strongly associated with left frontal or left basal ganglia lesions and pre-existing subcortical atrophy. While the aetiology of these mood disorders remains unknown, serotonergic or noradrenergic dysfunction may play a role. Mania is a rare complication of stroke: the clinical presentation and response to treatment are usually the same as mania without brain injury. Post-stroke mania is strongly associated with both a right hemisphere lesion in a limbic-connected area and a second predisposing factor, such as genetic loading for affective disorder, pre-existing subcortical atrophy or seizure disorder. This disorder may be mediated through frontal lobe dysfunction. The lesion method represents a potentially fruitful technique for investigating the mechanisms of affective disorder.

What is known about the biology of AIDS is reviewed, and the social factors which influence disease transmission and public attitudes are considered. After an evaluation of the methods available to control the epidemic, the reasons for the limited success of public health measures thus far undertaken are considered. The ethical debate on public health policy is analysed, and the need for a nationwide educational programme on AIDS is emphasised – one which is responsive to the rights and obligations of citizens in a democratic society.

Recent research into the dementia of Parkinson's disease has exposed a complex area in which it has not always been possible to match clinical and pathological observations. Certain neuropsychological deficits result from a disruption of basal ganglia and frontal lobe interactions. These are unrelated to a global dementia, the prevalence of which exceeds twice that in the normal population. The associated pathological lesions comprise cortical pathology, either Alzheimer's disease or Lewy bodies, in combination with moderate degeneration of the subcortical, cholinergic, basal nucleus of Meynert.

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Seclusion is a commonly used management technique in some areas of psychiatric practice. However, its theoretical and empirical underpinnings are greatly wanting in many respects. This paper reviews the present state of our knowledge and ignorance about seclusion, and suggests some strategies for much-needed research.

The authors review the development of liaison psychotherapy in general practice, and argue that a 'skill-sharing’ approach, where the general practitioner retains the treatment role, is a more efficient model than a ‘consultation’ approach. Skill-sharing models are reviewed, and the need for psychiatrists and psychotherapists to be more directly involved in teaching basic psychotherapeutic skills to general practitioners is emphasised.

The efficacy of implementing a clinically feasible psychosocial intervention which addresses the needs of carers of the long-term mentally ill is reported. All the relatives of patients in continuous high contact with one clinical team in a local day-care facility were offered the intervention. An interactive education session at home was followed by a monthly relatives group which aimed to reduce components of expressed emotion and to alleviate burden. Patients and relatives were assessed. The controls were the patients in contact with the other teams in the day-care facility, and their relatives. The intervention was effective at reducing EE and improving family relationships. Offering this kind of support to people who are providing long-term care for the severely mentally ill can contribute significantly to the quality of life of both supporters and patients.

It is generally recognised that much cardiovascular disease is the result of voluntary behaviour such as smoking cigarettes, and the pursuit of stress-prone lifestyles. Since these risks are primarily behavioural, it is appropriate to attempt to alter them, and hence reduce the risk of cardiovascular disease, using psychological methods, and such methods can reduce both biological and psychological stress-related factors. Studies of healthy populations, of those at increased risk, and of patients with clear cardiovascular disease have all shown that risk-related behaviour can be altered and, in some cases, the incidence of cardiovascular disease reduced. Future research will have to extend these findings, which were often on atypical populations, and confirm reduction of cardiovascular disease.

Findings on the efficacy of day-hospital and community treatment for acutely ill psychiatric patients have been contradictory. This review confirms the methodological problems previously noted, but highlights the variation in feasibility of day care: staffing levels and the attitudes of staff appear to have been responsible, along with the severity and chronicity of illness. The comparison of day and in-patient care to see which is 'superior’ has been unrewarding, and further research is needed. Day-hospital treatment is unlikely to be more widely used for acutely ill patients until: (a) there is clear evidence that certain patients are best treated in this way; (b) the social and clinical characteristics of such patients are defined; (c) adequate staffing is achieved (i.e. day care is not regarded as a cheap option); and (d) day centres are available for chronic patients.

Research which tries to understand human experience within the time dimension is entering difficult and uncomfortable territory. Long before the first prospecting research worker arrived on this scene with his questionnaires and statistical methods, creative writers had been exploring the same terrain. Take poetry, for instance. When poets write about the passage of time the visions which they conjure seem nearly always to carry menace. An image offered by Yeats exactly captures the sense of helplessness and haplessness which we may all sometimes experience under the pressure of passing time: