The cerebral vascular transit time of 17 patients with presenile dementia of the Alzheimer type (ATD), nine abstinent patients with alcoholic Korsakoff's psychosis (KOR), and ten age-matched controls was determined by the bolus intravenous injection of pertechnetate. A gamma camera was used to estimate the median transit time (MTT) of the radioactive bolus in a planar (non-tomographic) projection normal to the vertex. The spread of the bolus arriving at the aortic arch was measured independently by a single external detector over the chest, and correction made for the transit time of this input function in calculating the net MTT for the head. Both ATD and KOR groups showed lengthened net MTTs, compatible with reduced cerebral blood flow, and which were correlated with reduced cognitive function. It is concluded that the method employed gives a simple, inexpensive estimate of function-related blood flow to the brain in presenile dementia.

Ninety-five schizophrenic patients were assessed using the Present State Examination, the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Negative and depressive symptoms were frequent, and significant relationships among negative symptom complexes and depressive syndromes were noted. Retardation, lack of energy, slowness, and other symptoms of depression were significantly associated with the negative symptoms of schizophrenia. Depressed affect per se did not have a significant correlation with negative symptoms.

Nicotine in patients with dementia of the Alzheimer type (DAT) producted a significant and marked improvement in discriminative sensitivity and reaction times on a computerised test of attention and information processing. Nicotine also improved the ability of DAT patients to detect a flickering light in a critical flicker fusion test. These results suggest that nicotine may be acting on cortical mechanisms involved in visual perception and attention, and support the hypothesis that acetylcholine transmission modulates vigilance and discrimination. Nicotine may therefore be of some value in treating deficits in attention and information processing in DAT patients.

During open trials of intravenous and oral S-adenosyl methionine (SAM) and a placebo-controlled trial of intravenous SAM in 29 patients, 25 patients had SAM and four had placebo (27 courses of SAM, two of the patients receiving two trials apiece). Nine of 11 bipolar patients (all SAM-treated) switched into elevated mood state (hypomania, mania and euphoria) and two did not respond. Six endogenous unipolar patients improved and five did not. No non-endogenous patient or placebo patient responded for more than 14 days. No unipolar patient switched into elated mood. In eleven (38%) trials and nine (33%) patients there was a switch from depression to elation. Biochemical data from the cerebrospinal fluid of eight patients suggested that the role of the dopaminergic system should be further explored.

Severity of psychiatric illness was assessed using standardised clinical and social measures in 69 in-patients and 41 day patients admitted consecutively from the community. Day and in-patients differed little in terms of psychiatric symptoms and social disability, especially if compulsory admissions were excluded. Protection of self or others was a common reason for in-patient admission given by clinicians, who were otherwise prepared to treat seriously ill patients in the day hospital. Very few of the day patients had to be transferred to the in-patient facility, and at three months and one year the two groups showed similar improvements. It is concluded that day treatment is feasible for some seriously ill psychiatric patients, but a random-allocation study is required to assess more completely the efficacy of day treatment, and define the characteristics of those who require in-patient admission.

Seventeen patients with schizophrenic symptoms were assessed before and after ECT to elicit possible factors predictive of outcome. The strongest associations with good outcome were shown by short duration of illness and paucity of premorbid schizoid personality traits; significant associations were also shown by short duration of current episode, paucity of paranoid premorbid personality traits, and the presence of perplexity. The diagnosis of schizoaffective disorder was not related to outcome. Questionnaires completed by 16 patients after ECT showed their attitudes to be generally favourable to the procedure.

This paper gives a brief outline of the present state of development of the psychiatric chapter of the tenth revision of the International Classification of Diseases (ICD-10). It is written from the point of view of one of the many consultants to the Division of Mental Health, World Health Organization (WHO), Geneva, and thus is not an authoritative or official statement on behalf of WHO. The responsibility for decisions about ICD-10 Chapter V (F) rests with Dr Norman Sartorius, Director of the Division of Mental Health, though many psychiatrists in many countries have contributed to ICD-10 Chapter V (F), and will continue to do so, since much work is still to be done before the final form is officially agreed and published in about 1990. Before he left WHO, Geneva in September, 1986, Dr Assen Jablensky also carried a great deal of responsibility for the arrangements necessary for the production of the drafts of ICD-10 Chapter V (F) that are now being developed.

The relationships between duration of schizophrenic illness before first hospital admission, expressed emotion in key relatives, and illness course have yielded conflicting reports. This study examined the issue from a methodological perspective in a sample of first-episode schizophrenic patients. A ‘best estimate’ of illness onset, based on a compilation of all sources, was compared with an estimate based on parental report. Parental estimates suggested that the children of high-EE parents had been ill for significantly longer, but this difference was not confirmed by the best estimate. In most cases, the ill children of high-EE parents were living at home before hospital admission and their parents' estimates of duration were quite accurate. In the few cases in which the child was living away from home, high-EE parents strikingly overestimated duration. Children of low-EE families were more likely to be living away from home, but this factor did not explain the consistent underestimates of duration made by their parents. Although duration of illness did not relate to EE, successful engagement in out-patient before in-patient treatment was more common among children from low-EE families.

Case notes of all patients admitted from two adjacent catchment areas with a diagnosis of schizophrenia, schizoaffective disorder, or psychosis were examined for information concerning the patient's family. On average, case notes contained only 9–25% of the basic information looked for. Family trees were rarely drawn. A record was made of contact with families of only half the sample. It is suggested that information concerning families is not considered of major importance in the management of such cases.

‘Hypochondria’, ‘hypochondriasis’, and ‘somatisation’ are terms long used to characterise individuals who display unrelenting somatic symptoms that cannot be medically explained. A psychiatric aetiology for such phenomena is often assumed on the basis of potential psychological gain, the presence of ‘stressors’, the co-existence of unexplained somatic symptom and symptoms of depression or anxiety, or merely the absence of a medical explanation.

The eating habits of 33 patients with dementia were studied. They were assessed by semistructured interview with a relative who was able to act as an informant for the whole period of the dementia. Changes in eating were found to be common and included both increased and decreased food intake, altered food choice, the consumption of inedible substances and disturbances in the process of eating. The clinical significance of these changes and some likely underlying mechanisms are discussed.

Poverty of speech, a prominent feature of the negative symptom construct in schizophrenia, was assessed longitudinally in 12 schizophrenic and 13 depressed subjects at hospital admission and about seven months after discharge in order to evaluate hypotheses concerning course and diagnostic specificity. Multiple measures of the poverty of speech construct were employed, including both clinical and quantitative indices. During the inpatient period, poverty of speech was more pronounced among depressed than schizophrenic subjects. Examination of this specific negative symptom across inpatient and followup evaluations indicated that poverty of speech increased among schizophrenic subjects, but remained relatively stable or declined among depressed subjects. These results suggest that the processes underlying poverty of speech may differ in schizophrenia and depression.

A family study was carried out in two groups of patients fulfilling RDC for schizoaffective disorder: in one, a full affective and a full schizophrenic syndrome were simultaneously present; in the other, affective and schizophrenic features appeared within a polymorphic and rapidly changing clinical picture, with depersonalisation/derealisation and/or confusion. In the first-degree relatives of patients of the former group, the risk of major psychiatric disorders was not significantly different from that of relatives of schizophrenics, whereas in the first-degree relatives of patients of the latter group a low risk for both schizophrenia and major affective disorders, and a relatively high risk for schizoaffective disorders, were observed.

We describe the patterns of illness attributed to sorcery among 209 patients who attended a special clinic in south India. Somatisation and conversion disorders accounted for the majority of patients, although several other psychiatric and medical disorders were also seen. Aspects of treatment of such patients in the sociocultural context are discussed.

This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging.

One hundred and fifty middle-aged and elderly adults with a diagnosis of major depression were assessed initially as inpatients, and were reinterviewed 6–32 months later. Both size of social network and subjective social support were significant predictors of depressive symptoms at follow-up, with baseline depression scores and other predictors of outcome status statistically controlled. Subjective social support was most strongly associated with major depression; this effect was significantly stronger for middle-aged than older adults, and for men than women. Differences in the effects of marital status, size of social network, and subjective social support also suggest the importance of distinguishing between involvement in and quality of interpersonal relationships.

The prescribing of psychotropic medication to 96 attenders at a lithium clinic was compared with their prescriptions while inpatients. As outpatients, they received fewer psychotropic drugs fewer times a day. This suggests that psychiatrists do not adopt intransigent stances in favour of polypharmacy and irrational psychotropic prescribing, as previous studies have implied. Caution is advised before attributing apparently irrational prescribing to bad clinical practice, or advocating remedial action aimed at changing the habits of prescribers.

The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The α coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.

A group of 469 firefighters were studied 4, 11 and 29 months after having an extreme exposure to a bushfire disaster. The relative importance of the impact of the disaster, personality and ways of coping were investigated as determinants of post-traumatic morbidity. Neuroticism and a past history of treatment for a psychological disorder were better predictors of post-traumatic morbidity than the degree of exposure to the disaster or the losses sustained. These results raise doubts about the postulated central aetiological role a traumatic event plays in the onset of morbidity.

The classification of anxiety disorders is a controversial subject, and this controversy is reflected in the differences between the systems adopted in DSM-III-R and in the draft of ICD-10. The scheme in ICD-10 is the simpler: anxiety disorders are divided into phobic disorders and other anxiety disorders, and each is divided further into three subgroups. The three phobic disorders are: agoraphobia, social phobia, and specific phobia. The three subgroups of ‘other anxiety disorders’ are panic disorder, generalised anxiety disorder, and mixed anxiety and depressive disorder. The subdivisions of phobic disorder are those now generally adopted in most countries, and are uncontroversial. The subdivisions of generalised anxiety disorder, and mixed anxiety depressive disorder are also widely accepted, the latter group being particularly frequent among patients seen in general practice and not referred on to psychiatrists. Only the category of panic disorder is controversial. In addition to these categories which are specifically allocated to anxiety disorders, two others are relevant: ‘reactions to severe stress and adjustment disorders’, and anxious personality disorder.