Combat reaction is a clinical entity which is classified under one of the most complex diagnostic formulations in modern psychiatry-post-traumatic stress disorder (PTSD). Of all the life experiences which may create trauma, war-related stress seems the most complicated and difficult to understand. Despite an abundance of clinical observation, this has been considered from such differing theoretical perspectives that a comprehensive therapeutic conceptualisation has proved elusive.

Patients referred over 28 months from nine medical centres for a trial of prophylactic neuroleptic medication following first episodes of schizophrenic illness (462) were assessed with the Present State Examination, WHO scales for disability, past history, and socio-demographic factors, and a rating of disturbed behaviour; 253 fulfilled the study criteria; of the 209 who did not, 54 did not meet the diagnostic criteria, 65 had a history of a previous episode, and in 15 the psychotic illness was found to have an organic basis. The interval between onset of illness and admission varied widely, but was often more than one year and associated with severe behavioural disturbance and family difficulty e.g. in arranging appropriate care. Current arrangements for initiating management of first schizophrenic illnesses are frequently unsatisfactory.

Interest in the different diagnostic groups of the mentally retarded started in the 19th century, but this made little contribution toward better treatment and care. Medical interest was mainly focused on the prevention of mental retardation. It was not until the 1950's and 60's that interest in research in the care and treatment of these persons intensified. The next step, study of the interaction between handicapped persons and the environment is the key to a better understanding of how to plan for work with the handicapped. New members of the therapeutic team (e. g., psychologists, and sociologists) will take over (Edgerton, 1984) if medical groups, especially psychiatrists, do not become more aware of the importance of the interaction between the handicapped and the environment.

Much current research in psychiatry proceeds in the absence of an integrated model of brain function. It is based instead on the effort to relate clinical syndromes to single, localised abnormalities in the brain. Such an approach is inconsistent with existing data, inadequate for linking research findings with clinical practice, and, probably, fundamentally misdirected. A model of brain function is presented that is based on Luria's notion of cerebral functional systems and on the proposition that the neural substrates of emotion are those processes that integrate different brain regions. Some of the implications of this model for research are discussed.

This paper describes the standard version of the MRC Social Performance Schedule, which covers 21 behaviour areas such as hygiene, initiating conversations, etc. and was designed to be used with long-stay populations, within a hospital or the community. Data on the schedule's consistency over raters, informants, time, and situation showed that the reliability was reasonable over all four areas. The schedule is recommended as a standard instrument to describe the behavioural difficulties of patients likely to be dependent on psychiatric services for some time. Recent data are provided on the levels of problem behaviours found within both long-stay hospitals and community settings, together with references for more detailed behaviour profiles of such groups.

For a social group to develop, two opposing adaptive processes must be reconciled—mechanisms for developing cohesion and mechanisms for establishing a dominance hierarchy. The formation of stable groups provides significant evolutionary advantages: a source of protection, increased reproductive opportunities, and a larger store of survival strategies than any one individual could encompass. A recent theory of human evolution (Reynolds, 1981) stresses that social behaviour would seem to be the most likely single cause of the origin of human intelligence, if one origin must be isolated. Current interest in the biological basis of behaviour has been focused particularly on specific diagnostic categories and biochemical mechanisms. This paper reviews a different research tradition, based on ethological principles, and applies the findings to an understanding of human group behaviour.

In the spring of 1985, a party of psychiatrists from Great Britain and Ireland visited four major Chinese cities—Beijing (Peking), Shanghai, Nanjing (Nanking) and Guangzhou (Canton), as a study tour of the Royal College of Psychiatrists, under the auspices of the Chinese Medical Association. A number of psychiatric hospitals were visited and there was opportunity for many discussions with psychiatrists and other professional staff. This paper records some impressions of the psychiatric services and practices that were observed, together with material obtained in discussions. It is hoped that it will update and complement previous reports by Western visitors to China, and thus increase understanding of mental health in China.

The possibility that chronic abuse of volatile substances can cause permanent neurological, psychiatric, and intellectual sequelae is critically reviewed. Toluene, present in the commonly used adhesives, is most often implicated in ‘glue sniffing’; this review focuses on its potential long-term effects. Many criticisms—particularly poor matching of control samples and inability to distinguish between acute and chronic effects—can be levelled at the available studies, while no adequate follow-up studies have been performed. In the light of present knowledge, the possibility that permanent structural brain damage, with accompanying psychiatric manifestations, results from solvent abuse remains inconclusive.

Out of 253 patients fulfilling criteria for a first episode of schizophrenic illness, 120 entered a randomised placebo-controlled trial of maintenance neuroleptic medication on discharge; they were followed to relapse or loss to follow-up, for two years or to the end of the study. Of those on active medication, 46% relapsed, as did 62% of those on placebo; the most important determinant of relapse was duration of illness prior to starting neuroleptic medication. This finding might be because extended duration of symptoms before admission is more likely to be present in illnesses which in any case will have poor prognosis, or because susceptibility to relapse is reduced by early institution of treatment. The study provides no data on which a decision between these alternative explanations can be based.

Using an Arabic version of the PSE, supplemented by CATEGO, we selected 48 patients with acute schizophrenia from the population of the Najd region of Saudi Arabia. Their life-event histories for the six months before onset or relapse were compared with those of 62 control subjects. A postive association between events and onset was established only for married women, although there was a parallel trend for men and single women suffering their first schizophrenic episode. The observed impact of life events was limited to the three weeks before onset. These findings are discussed in the light of Saudi culture.

The theme of this address—that brain and mind are as warp and woof in the fabric of psychiatry—may seem so much a truism as to be a banal choice. I think not. Despite the lip service paid to brain-mind integration, its implications are daily contravened in both theory and practice. At least, this is so in the country where I reside. If the problem is more extreme in the States, as most everything seems to be, recall the words Sir Aubrey Lewis (1953) wrote in commenting on Anglo-American contrasts, some 30 years ago: “the chief differences between your psychiatric scene and ours are differences only of quantity and tempo.” Think of me, then, as an anthropologist describing an exotic foreign culture and reporting on the strange customs of the natives, in hope of shedding light on your own.

Eighty chronic schizophrenic and 16 manic-depressive psychotic patients conforming to Research Diagnostic Criteria were examined in terms of their mental state, cognitive functioning, current behaviour, and neurological status. They comprised out-patients, day-care patients, and long-stay in-patients belonging to two mental hospitals with different social conditions. Assessed deficits were not significantly related to record variables such as age, duration of Illness, duration of hospitalisation, or treatment received. Analysis of the different groups of patients reveals that long-term hospital care has had little effect on the deficits of chronic schizophrenia, and suggests that these are integral features of the disease process.

The concept of ‘sluggish schizophrenia’ is virtually limited to the USSR and some other East European countries, and may contribute to the mis-diagnosis of democrats as psychiatric patients. Recently, a number of articles have appeared in the Soviet literature relating the diagnosis of ‘sluggish schizophrenia’ or ‘slowly progressive schizophrenia’ to affective disorders, especially hypomania. Soviet publications on this theme from 1980 to 1984 are discussed, together with their relationship to questions on the abuse of psychiatry.

Of 253 patients from nine medical centres identified with first episodes of schizophrenic illness, 17 did not achieve discharge during the period of trial recruitment. 120 entered a randomised controlled trial of neuroleptic medication and were followed-up, as were 116 who were eligible for the trial but did not enter it. Overall, 60% of the sample had relapsed within two years of discharge; age, sex, ethnic origin, duration of admission, social withdrawal before admission, and type of onset of illness were not significantly related to relapse. Relapse rates were lower on active trial or standard medication than placebo, but however assessed, outcome at this early stage was poor for many patients.

A validity study of the Self-Report Questionnaire (20 item version, Harding et al, 1980) against the criterion of a standardised psychiatric interview (Goldberg et al, 1970) was carried out at three primary care clinics in Sao Paulo; 875 patients filled in the SRQ-20 questionnaires and a subsample of 260 was interviewed by the psychiatrist. The SRQ-20 was shown to be a feasible screening instrument for psycho-emotional disturbance in these settings. Sensitivity was 83% and specificity 80%, and the questionnaire was a good indicator of morbidity. A correlation was found between questionnaire total scores and independent clinical judgment (r= +0.70). A sex difference in the validity coefficients is described.

One hypothesis concerning the nature of the link between negative self-appraisal and certain psychological disorders is that low self-esteem may be a consequence of both early and current experiences, and may predispose to breakdown. An alternative view is that the negative self-concept is only to be found in the presence of illness, which is the primary cause. Results are reported from a community survey, confirming the influence of certain biographical factors on self-esteem in the absence of illness, whereas other factors appear to operate only after the onset of illness. Anxiety as well as depression, has effects on self-esteem.

The relationship between spouses' levels of expressed emotion (EE) and relapse was examined in a sample of 39 depressed psychiatric hospital patients. Over a nine-month follow-up, 59% of patients with high-EE spouses relapsed, although no patients living with low-EE spouses did so. The results replicate the association found by Vaughn & Left between EE and depression, and suggest that the EE construct has predictive validity in both schizophrenic and depressed populations.

The relatives of 82 patients in a study of first episodes of schizophrenia were interviewed within six weeks of the index admission; 77 patients were subsequently discharged, and were followed to relapse or readmission. Analysis of relapse-free survival time was used to examine whether the components of ‘expressed emotion’ predicted relapse or response to neuroleptic medication: ‘critical comments' by relatives was the only component present often enough to be used and was inversely related to ‘social contact’. When preadmission duration of illness, and neuroleptic medication following discharge (identified previously as significant predictors of outcome) were taken into account, neither ‘critical comments' nor ‘social contact’ were related to outcome nor to response to medication. The constellation of factors suggested as pathogenic was present only in a minority of cases: many patients lived alone and of those that were with families, most were not in high face-to-face contact with other members. The failure of the components of ‘expressed emotion’ to predict outcome or response to neuroleptic medication suggests that at best, such factors are weak predictors of liability to relapse. Their influence is unlikely to be comparable in magnitude to that of neuroleptic medication.

The internal construct validity of the endogenous sub-type of major depression was investigated by statistically modelling the RDC endogenous and DSM-III melancholia diagnostic criteria. Data consisted of symptom ratings on 788 patients with major depression from NIMH Collaborative Depression Study. Results indicated that the symptoms in the criteria do not specify a dichotomous classification, melancholic-non-melancholic or endogenous-nonendogenous. Results did support the existence of two sub-typings, one related to anhedonia, and one related to vegetative symptoms. The vegetative sub-type rarely occurred in non-anhedonic patients. Previous studies may have found support for a simple endogenous sub-type because of this hierarchical relationship and as a result of methodological differences.