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.

The Koro syndrome, a “special cultural psychiatric syndrome’, is encountered in South China, Malaysia and Indonesia, especially among people of Chinese origin. There are only eight case reports of Koro from the Western hemisphere. We present a typical primary Koro patient from Israel. Jewish cultural mores are a possible contributory factor.

The internal consistency and factorial composition of the eight-item Life Satisfaction Index-Well-being, adapted for use with elderly British samples, were examined. Crossvalidation was carried out with a randomly drawn community sample of 155 rural people aged 65–89 years. The scale was found to have acceptable internal reliability, but may require modification.

Schizophrenies who completed suicide were compared with those who made suicide attempts, on the basis of blind ratings of previous hospital records and follow-up interviews with treating clinicians. Results indicated that the two groups were relatively distinct. Suicides tended to live alone and to feel depressed, hopeless, worthless, and suicidal. Attempters, on the other hand, lived with their families or others and were less likely to manifest several features of depression during a period in hospital. In evaluating suicide potential among schizophrenics, living situation and mental state changes indicating depression, suicidal intent, worthlessness, and hopeiessness are more important than a history of suicidal behaviour.

A 28 year-old woman, blind since the age of two, had become anorexic at 21. She had eating problems as a child, and weight preoccupation from her teens onwards. Psychiatric admission with other anorexic patients preceded the illness. Inability to see oneself does not pretect against anorexia nervosa.

The late prognosis of childhood encopresis is unclear: our literature reviews have failed to reveal any studies of it. Halpern (1977), discussing the effectiveness of treatment, states that this is difficult to evaluate “since encopresis is a self-limiting symptom”. Bellman (1966) followed up 186 children with encopresis seen at two Stockholm clinics; their age range at follow-up was 6–19 years. She found a steady decline in encopresis from the age of six in boys and eight in girls. It disappeared by the age of 16, although there were two relapses—one at 17 and one at 19.

Patients suffering from obsessional neurosis without other psychiatric diagnosis were examined with reference to the association of the mood disorders of depression, anxiety, and outwardly and inwardly directed irritability. All mood disorders were common, and many occurred together in individual patients, but anxiety was the most prevelant. Inwardly directed irritability was significantly related to the overall severity of obsessions, and to the degree of handicap or interference in everyday life experienced by the patient.

Clinical experience suggests that treatment with electroconvulsive therapy (ECT) produces an early improvement in psychomotor retardation. Warnings have been given of the increased risk of suicide when ECT-treated patients recover motor activity before their depressed mood is alleviated (Slater & Roth, 1977).

A case of severe lactic acidosis following paraldehyde administration is described, and the adverse effects of paraldehyde reviewed.

In genetically proven identical female twins, discordant for presenile dementia of the Alzheimer type, the affected twin began to dement at the age of 49, and died 15 years later; the diagnosis was confirmed at post-mortem. The surviving twin remains clinically unaffected 20 years after the onset of dementia in her sister. Environmental aetiological factors are postulated to account for this discordance.

Two bipolar depressed patients and one unipolar depressed patient developed manic Symptoms after receiving trazodone. The Symptoms resolved when the treatment was discontinued or reduced. We believe the two bipolar patients are the first cases of this reaction reported in the literature.

We asked 24 patients with anorexia nervosa and 30 normal controls to estimate their body-size several times, each time using different instructions. The degree of over-estimation was found to vary predictably with the wording of the instructions. Informing the subject that she had made an error without specifying the direction of the error resulted in reduced over-estimation on a subsequent trial, for both anorexics and controls. ‘Internally directed’ instructions were associated with a greater degree of over-estimation than ‘external’ instructions in both groups, but particularly in anorexic subjects. Our results indicate the necessity of controlling the ‘demand characteristics' of such experiments.

In an era when it is generally believed that the acute Symptoms of schizophrenia can be controlled pharmacologically, the case of a young man who has remained almost continuously floridly psychotic for 13 years, despite treatment, is disquieting. Conventional psychiatrie treatment appears to be rendered impotent. It is in this context that it may be of interest to report a summary of the proceedings of a Special Problems Conference held at the Institute of Psychiatry on 18 February 1985 to discuss such a case.

A man with Munchausen's syndrome was treated for drug dependence, which allowed him to establish and sustain a bond with a hospital, but eventually brought about an ethical dilemma.

The management of aggressive and disruptive behaviour in mentally handicapped patients is a severe problem, and it is widely accepted that drug therapy is only one component in the range of measures required for a comprehensive regime, although the use of depot phenothiazines is widespread (Craft & Schiff, 1980). The evidence for their therapeutic effectiveness in the mentally handicapped is usually empirical, and sometimes based on anecdotal evidence. Clopenthixol decanoate is widely used in the management of aggressive and disruptive behaviour in such patients, probably as a result of experience of the use of this drug in schizophrenic patients. Carney & Rutherford (1981) reported a marked improvement in both aggressive and non-aggressive behaviour disorders in 20 chronic schizophrenic patients treated for 11 months with clopenthixol decanoate, while Visiwanathan & Rajhkowa (1982) stated that it was of undoubted value in the management of chronic in-patients, especially those with ‘positive affective’ symptoms such as hostility, aggression, suspiciousness, and irritability.

The use of art in the context of a therapy group in a day hospital setting is described, and the literature on art and factors influencing such groups discussed.