Psychiatric assessment strategies that integrate research findings with daily practice are necessary and clinically useful. This paper uses the example of an attention deficit disordered adolescent to illustrate how double-blind placebo controlled and multi-dose adjustment designs can be successfully implemented in routine clinical practice. These designs are especially valuable In evaluating the therapeutic effect of methylphenidate because of biases that may lead to clinical misuse of this stimulant medication.

Wrist motor activity was continuously recorded by a solid-state monitor in 12 patients with major depression throughout their stay in hospital; their clinical state was evaluated using three scales. During the day, activity troughs and immobility peaks occurred before noon and around 1500 hrs. Activity level progressively increased, while the duration of immobility decreased, with clinical improvement. The immobility measurement appeared to be a valuable index of depression and is more sensitive than the activity level, mainly for agitated depressed patients. Immobility episodes during the day could suggest the release of an ultradian sleep-wake rhythm in depression.

The families of Down's Syndrome children and another group with a similar degree of retardation were compared using data collected at interview. Differences in social class distribution were explained by the maternal age effect in the Down's group. Divorce was more common in the control group but the quality of marriage in those parents still together and the health of parents were similar. No close associations were found between behaviour disorders in the children and family factors, except that behaviour disorders were likely to be associated with similar disturbance in siblings next in age and to be more common in the less happy marriages.

Hysteria has been a topic of interest throughout the history of medicine; those who have been concerned with it include Galen, Paré, Sydenham, Charcot and Freud. Anyone who chooses to proclaim its importance, therefore, might be asked to provide some reason for gilding the lily. Controversies have always attended the subject, and different disciplines still disagree over it. The diagnosis, which occurs in the International Classification of Diseases (ICD-9, 1978) has been deprecated on both sides of the Atlantic (Slater, 1965; DSM-III, 1980) and also advocated with varying degrees of fervour (Walshe, 1965; Lewis, 1975; Merskey, 1979). It is a subject of historical study (Veith, 1965; Walker, 1981; Shorter, 1984); there have been at least nine monographs on it since 1977 (Horowitz, 1977; Krohn, 1978; Jakubik, 1979; Merskey, 1979; Roy, 1982; Riley & Roy, 1982; Colligan et al. 1982; Weintraub, 1983; Ford, 1983), and there is a steady flow of paper on the topic of hysteria or its major subdivisions (eg, hysterical personality, conversion symptoms) or pseudonyms and partial pseudonyms (eg, somatisation disorders, borderline personality, and operant pain).

Cranial computed tomography (CT) scans of 48 patients with senile dementia of the Alzheimer type (SDAT) and 40 normal elderly volunteers were compared. The demented group were found to have significantly larger lateral ventricles assessed planimetrically and by using a linear measure of the ratio of the maximum width of the frontal horns of the lateral ventricles to the maximum intracranial diameter. Attenuation density was computed for 1 5 brain regions. The demented group did not differ significantly from the normal controls with respect to attenuation density In any of the regions studied.

Severe degrees of inattentive and restless behaviour in childhood are a risk factor for later psychological disorders. They have many causes, but a pattern of severe and pervasive hyperactivity with poor concentration in the absence of affective or psychotic disorders should be recognised as a hyperkinetic syndrome. The syndrome is often associated with developmental delays in abilities such as language and motor control. Powerful short-term treatments are available, but long-term ways of promoting normal personality development need more research.

Charcot's term ‘hysteroepilepsy’ implies brain mechanisms in common between epilepsy and hysteria. No such direct link between these two conditions exists. Nevertheless, there are a number of indirect associations between epilepsy and hysteria that can lead to confusion in the differential diagnosis and management of the patient with seizures.

Of 81 patients receiving ECT during a period of 24 months, 21 ate or drank something, against medical advice, shortly before ECT was due. Compared with controls, the fast-breakers were less often married; were more likely to be detained under a section of the Mental Health Act; had an unfavourable view of ECT; and had often not given consent for ECT. Fast-breaking was more likely to occur after four or more ECTs. Amongst the fast-breakers there was a significant correlation between age and (a) number of previous ECTs; (b) treatment at which the fast-break occurred. The more drugs the patient was taking the more likely it was that the fast would be broken early in the course of ECT.

There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.

Positive and negative syndromes were studied in relation to demographic, historical, genealogical, clinical, psychometric, extrapyramidal, and follow-up measures of 101 chronic schizophrenic patients. The criterion scales proved to be reliable, normally distributed, and strongly correlated with general psychopathology, but otherwise inversely related to one another. Multiple regression analysis identified sets of 4–6 independent variables that explained 74%-81 % of the scales' variance. A positive syndrome was associated chiefly with productive features, family history of sociopathy, more previous hospital admissions, and longer in-patient stay during the 30-month follow-up period. A negative syndrome correlated with deficits in cognitive, affective, social, and motor spheres, higher incidence of major psychiatric illness but less affective disorder among relatives, lower education, and greater cognitive developmental impairment. The results underscore the importance of genetic and biodevelopmental variables for understanding schizophrenic syndromes.

Forty-three neurologically and psychiatrically assessed patients with idiopathic Parkinson's disease (PD) underwent detailed cognitive assessment. Cognitive deficits typical of senile dementia of Alzheimer's type (SDAT) were found in 7% but the majority showed definite impairments not typical of SDAT. Cognitive impairment was significantly more likely in those with more severe PD symptoms. There was substantial agreement between psychiatric diagnosis and psychological picture of SDAT and some links were found between other diagnostic categories and nature of cognitive functioning. However, cognitive deficits were also found In two-thirds of patients with no psychiatric diagnosis.

Few biological theories of manic-depressive illness have focused on the longitudinal course of affective dysfunction and the mechanisms underlying its often recurrent and progressive course. The authors discuss two models for the development of progressive behavioural dysfunction—behavioural sensitisation and electrophysiological kindling—as they provide clues to important clinical and biological variables relevant to sensitisation in affective illness. The role of environmental context and conditioning in mediating behavioural and biochemical aspects of this sensitisation is emphasised. The sensitisation models provide a conceptual approach to previously inexplicable clinical phenomena in the longitudinal course of affective illness and may provide a bridge between psychoanalytic/psychosocial and neurobiological formulations of manic-depressive illness.

Levi-Strauss (1977) describes what happened to a child, in a primitive tribe, accused of sorcery–a crime punishable by death. The child invented more and more complex stories by way of self-justification. In the end his accusers believed his outlandish explanation because “the choice is not between this system and another but between this system and no system at all-chaos.” The child's plight can represent the close affinity between magic and hysteria; his accusers might represent those contemporary psychiatrists who would prefer any system of classification of hysteria, however absurd, to no system at all (Sheehan & Sheehan, 1982a, b; DSM-III, 1980).

Twenty-three consecutive married and sexually active Chinese women treated for breast cancer were compared with a randomly selected group of 34 female patients suffering from different kinds of malignancies. A structured interview was used to study both groups. The breast cancer group were found to be less depressed and more emotionally stable than those suffering from other malignancies, suggesting that the diagnosis of malignancy was the more important factor in the psychosocial morbidity of these patients.

The priorities accorded severely disabled or disturbed long-stay patients in Regional and District planning strategies vary enormously. A scheme to cater for the needs of this group is described. The scheme includes: non-stigmatising housing; a domestic regime, daytime occupation and leisure activities offering forms of enabling and caring that foster the highest possible levels of functioning; a secure home; private and peaceful outdoor space; and graduated steps towards independence that allow for the possibility of relapse. The central concept is the establishment of a Community for people with severe difficulties in making social contacts. The importance of integrating the scheme into a comprehensive District psychiatric service is emphasised.

The initial features and progress of depressive symptomatology over 42 to 104 months are presented for 100 elderly patients admitted with severe, non-neurotic depressive states; none had experienced a previous hypomanie episode. Sixty per cent either remained well throughout or had further episodes followed by full recovery; only 7% suffered continuous depressive symptoms. Of potential prognostic factors, only male sex and poor physical health, both at presentation and developing subsequently, were associated with poorer outcomes. The view is supported that treatment with well established methods achieves worthwhile and sustained improvement for most patients.

There has recently been an increased interest in providing relatives of schizophrenic patients with information about the illness and how to manage the patient at home, due partly to the development of psychosocial intervention programmes (which frequently include an educational component) and a consumer demand for such information in an era of community care. Studies which describe the effects of such educational programmes are reviewed, and two different models of information acquisition are contrasted. These models have different implications, in terms of outcome measures, on how educational programmes should be evaluated. Guidelines are offered for practitioners wishing to give information to relatives.

Secondary school pupils and their parents were investigated using the scaled version of the General Health Questionnaire (GHQ–28) and by a questionnaire designed to study attitudes involved in inter-generational conflict in psychiatric patients. Parent-pupil and interparental conflict in answers to the attitude questionnaires were taken as measures of inter-generational and intra-generational conflicts respectively. The former significantly exceeded the latter. Parent-student conflict was higher when the students involved were females, Kuwaiti, or had less educated fathers. The tendency of the number of reported GHQ symptoms to be higher in members of families with higher inter-generational conflict did not reach statistical significance. There is an apparent discrepancy between this finding and the prominence of inter-generational conflict in clinical material.

Twelve patients with neuroleptic-induced akathisia were treated in a randomised, double-blind, cross-over design with propranolol and matching placebo. Propranolol caused significant decrements in both subjective and objective ratings of akathisia, but not in anxiety scores. This confirms prior findings of the efficacy of propranolol in akathisia induced by neuroleptic treatment.

A new dichotic listening test (fused rhymed words) was used to monitor changes in perceptual asymmetry (PA) in patients recovering from acute psychotic episodes; some were also given a dichotic nonsense syllables test, a dichotic tone test, and a single visual field dot localisation test. Contrary to expectation, PA on the word test decreased with recovery, while asymmetry on the tone and dot tests did not change; results cut across diagnosis, could not be related to medication, and were independent of changes in overall performance. More specific hypotheses are needed than those of generalised single hemisphere dysfunction in major psychiatric illness, but existing models and concepts are inadequate to explain the findings.