The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with Impairment of family relationships and adverse social factors. It was concluded that a dimension of Inattentive, restless activity should be separated from one of antisocial, defiant conduct In children with psychiatric disorder.

Sixty boys, aged from 6 to 10 years, were studied after their referral to psychiatric clinics for antisocial or disruptive behaviour. Their scores on reliable measures of hyperactivity, defiant behaviour, emotional disorder and attention deficit were taken for the home, school and clinic settings; and subjected to two techniques of cluster analysis. Both gave a similar set of clusters, one of which had high scores on all measures of hyperactivity and attention deficit. Membership of this cluster was associated with a lower IQ, a younger age of problem onset and referral, an abnormal neurological examination, a history of developmental delay, smaller family size, poor peer relationships and a high rate of accidental injuries; and It predicted a good response to stimulant medication In a controlled trial. Other research on the classification of hyperactivity is discussed, and proposals are made for the criteria of a rather narrow definition of ‘hyperkinetic conduct disorder’.

The Newcastle diagnostic index was completed on 159 depressedin-patients, who received the dexamethasone suppression test during their first week in hospital. Patients suffering from endogenous depression had a significantly higher rate of DST non-suppression, were older, were more frequently psychotic, and more frequently lost weight; even after con trolling for these variables, DST non-suppression was significantly more frequent in the endogenous group. The relationship between Newcastle scores and the frequency of DST non-suppression was non-linear.

The total population of children under 10 years in one Swedish urban area and one rural area was screened for infantile autism (IA) and autistic-like conditions (AC). A total prevalence of 6.6 per 10 000 was found, which is somewhat higher than in previous similar studies of the same region. Infantile autism accounted for two-thirds of the cases. Boys far outnumbered girls, but this was entirely accounted for by the IA group. The preponderance of autistic boys was less pronounced among the severely mentally retarded children. Mental retardation was seen in almost 90% of cases and only one child had an IQ exceeding 100; clinical and laboratory signs of brain dysfunction were also found in a majority of cases. Distribution by social class was no different in either patient group from the general population.

Anxiety attacks were included in the first descriptions of the syndrome of anxiety neurosis. Recently it has been suggested that such attacks (now usually called panic attacks) characterize a distinct form of anxiety disorder—panic disorder, it has also been proposed that panic attacks result from a biochemical disorder and require pharmacological treatment. Some of the evidence for these ideas is presented, and two other explanations for panic attacks are reviewed: that they are caused by hyperventilation, and that they result from a cognitive disorder. It is concluded that although it is not possible on the present evidence to choose between the three theories, there is strong indirect support for the cognitive theory and good reason to investigate cognitive factors more thoroughly. Future work on biochemical causes of, and pharmacological treatments for panic attacks should take account of such factors.

Hypochondriasis was assessed in 60 patients with panic disorder and agoraphobia using the Illness Behavior Questionnaire. Before treatment, IBQ hypochondriasis scores were similar to those of a group of hypochondriacal psychiatric patients. In patients who improved with treatment, significant reductions in somatic preoccupation, disease phobia, and disease conviction occurred. Hypochondriasis appears to be a prominent feature of panic disorder and agoraphobia, and responds to treatment of the primary conditions. Our findings underscore the importance of providing adequate treatment and thereby avoiding wasteful use of medical resources and alienation of patients from doctors.

Four case reports are presented of psychotic patients seen in clinical practice in Nairobi over a period of one year, who inflicted serious bodily harm to themselves during that period. Possible psychopathological basis for this self-damage is briefly considered. A review of the literature reveals paucity of similar reports from Africa and the third world. Reasons for this paucity are hard to come by.

By comparison with the PSE-ID system, we showed that the GHQ-60 could be used with good results as a screening instrument in the first of a two stage community survey. Unlike the sensitivity and negative predictive values, the specificity and positive predictive rates reach low figures in this study. The global efficiency and positive and negative predictive values of the test are significantly improved by raising its cut-off score, but at the expense of great reduction in sensitivity. The revised scoring system failed to provide better prediction of caseness' than conventional scoring. The GHQ does not distinguish fully between persons in the community afflicted by ‘transient states of distress' and those whose symptoms would classify them as cases' by the PSE.

Psychological and drug-related variables and their effect on the severity of withdrawal symptoms were examined in a group of addicts being withdrawn from opiates on an in-patient drug dependence unit. Two psychological factors—neuroticism and the degree of distress expected by the patient—were related to subsequent severity of symptoms. Both are anxiety-related, and may serve to amplify withdrawal symptoms. Surprisingly, drug dose was unrelated to symptom severity.

Patients who discontinued lithium after a mean of 29 ± 21 months prophylaxis were compared with a similar group who were not taking the drug; all had only been in hospital once, and satisfied DSM-III criteria for mania. During the first three months following withdrawal of lithium, significantly more patients relapsed than in the control group; after this period, the rate was identical. These findings suggest that lithium withdrawal exists as a clinical phenomenon and that a period of lithium treatment does not improve the long-term prognosis, once the drug has been stopped.

Gamma glutamyl transpeptidase and mean corpuscular volume are shown to be of little value in the assessment of patients admitted to psychiatric beds for problem drinking.

In three years of clinical practice, the authors saw 35 cases of dermatological disorders of strictly psychological origin-8 patients with dermatitis artefacta, 8 with delusional parasitosis, and 19 who presented with skin complaints but showed no dermatological pathology (‘dermatological non-disease’). All but two initially presented for dermatological opinion rather than psychiatric assessment, and 12 refused psychiatric referral. Demographic and clinical details of all 35 cases are given, including possible related factors, course, treatment, and outcome, and the cases are discussed in the context of the existing literature. Liaison between dermatologists and psychiatrists is strongly advocated.

Body size estimation was studied in 22 patients with bulimia and 20 normal controls. Two methods of body size estimation were used, a distorting television image method (DTIM) and the image marking method (IMM). The subjects estimated body size of a dummy as well as their own body on the DTIM. When estimating body size on the DTIM the bulimics overestimated and the controls underestimated, there being a significant difference between the two groups. There was no difference between the groups when estimating the size of the dummy. On the IMM a significant difference was found between the bulimic and control groups, the bulimics overestimating body size and the controls being more accurate. Marked directional effects were found with the DTIM. The two methods of body size estimation are compared.

Practising psychiatrists' views about the treatment of schizophrenia were investigated as part of a Quality Assurance Project. A questionnaire which asked for treatment recommendations for each of four case descriptions of patients with schizophrenia was mailed to a one-in-six random sample of Australian psychiatrists; 90% responded. Psychiatrists almost uniformly advocated the use of antipsychotic drugs and usually recommended concurrent supportive psychotherapy or family/social intervention procedures. The recommendations varied systematically, according to the initial history obtained and to the initial response to treatment.

The clinical and biochemical disturbances of a patient with seasonal hypomania and cold urticaria are described and discussed with reference to histamine metabolism in mental disorder.

Anorexia nervosa is frequently associated with neurotic traits and symptoms. The symptomatology and history of a housebound 20-year-old woman with anorexia nervosa and dysmorphophobia are described. The role of the family In maintaining the problems, use of external cues to control behaviour, overvalued somatic ideas and the definition of dysmorphophobia are discussed.

Sodium bicarbonate abuse is unusual, and rarely reported. A patient was extensively investigated at several hospitals for a recurrent hypokalaemic metabolic alkalosis; it transpired that she had been abusing sodium bicarbonate for 8 years and had gained hospital admission at will by taking large amounts. She also showed features of the Munchausen syndrome.

Priapism is a rare but serious adverse effect of psychotropic drugs resulting from their peripheral alpha-adrenoreceptor blocking action. Two patients developed this during treatment with oral phenothiazines: one was treated surgically with a venous shunt, and the second case resolved after intracavernosal injection of an alpha-adrenoreceptor stimulating drug.

A schizophrenic patient whose severe level of auditory hallucinations had proved refractory to neuroleptic medication was given two treatment techniques derived from Green's theory that hallucinations represent verbal activity in the non-dominant hemisphere. Voice activity was markedly reduced in frequency and severity over a six-month period, and led to general improvements in interpersonal functioning. There was evidence for independent and additive effects of the two techniques.

Clinical data on 30 Korean patients of the authors with Gilles de la Tourettes's syndrome are described, as well as data on seven other Korean cases from the literature. The overall characteristics and EEG findings were similar to those of Western patients, but there were fewer obsessive-compulsive behaviour problems, and family histories were less often positive.

Post-traumatic stress disorder may follow combat stress or civilian psychological traumata. In 25 retrospectively studied patients, symptoms were severe in terms of number of DSM–III items fulfilled, chronicity, and severity of psychosocial disability. Antidepressants had good or moderate results in 67% of cases treated, but major tranquilisers were much less effective; response to drug treatment was not clearly related to somatisation symptoms, significant depression, or panic attacks. Pharmacotherapy appeared to have had a positive impact on psychotherapy in 70% of cases.