The influence of beta-adrenoceptor antagonism on the effects of a simple experimental stress was investigated in 12 healthy volunteers, using a double-blind protocol. A single oral dose of 80 mg propranolol reduced the stress-induced increase in heart rate and systolic blood pressure to 49.9 per cent and 8.3 per cent respectively compared to 61.0 per cent and 17.4 per cent with placebo. The rise in diastolic blood pressure was small and unaffected by beta-adrenoceptor blockade. The rise in temperature of the skin of the trunk was significantly reduced by propranolol. The self-rating of anxiety, alertness and concentration by the subjects was unaffected by propranolol.

Theories on the classification and aetiology of male homosexuality are reviewed, particularly recent hypotheses on the role of prenatal hormonal influences on brain sexual differentiation and subsequent sexual object choice in the male. Female as well as male brain sexual differentiation may be hormonally determined, and so primary homosexuality in both sexes may be due to abnormalities in foetal exposure to hormones, leading first to physical mis-differentiation and later to homosexual behaviour in genetically and phenotypically normal men and women.

Twenty-three patients taking lithium carbonate alone in therapeutic dosage for a mean period of 43 months (range 6–108 months) and 23 control subjects matched for age and sex had the frequency and amplitude of postural tremor measured and extrapyramidal symptoms assessed by standard techniques. Patients on lithium had a significantly lower peak frequency of tremor than control subjects (P <0.05) and significantly greater extrapyramidal symptoms (P <0.01), indicating that tremor appearing after chronic lithium therapy is likely to be an extrapyramidal symptom. Such symptoms are common long-term adverse effects of lithium carbonate.

Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between ‘dieters' and ‘vomiters' were less pronounced than those reported elsewhere. However, the ‘vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown–Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.

Erythrocyte transketolase activity and the effect of adding thiamine pyrophosphate (% TPP effect) were measured in subjects suffering from Wernicke-Korsakoff syndrome both before and during treatment with thiamine and/or thiamine tetrahydrofurfuryldisulphide (TTFD). Transketolase activity was significantly lower in untreated patients than in healthy volunteers. Treatment with either thiamine or with TTFD restored enzyme levels to control values but TTFD produced a greater increase than thiamine in enzyme activity. In a group of seven patients there was no correlation between duration of TTFD therapy and either increase in erythrocyte transketolase activity or % decrease in the TPP effect. However, when three patients were followed at intervals during treatment with TTFD, their erythrocyte transketolase increased progressively. Neither thiamine nor TTFD produced clinical improvement in the mental symptoms of Wernicke-Korsakoff psychosis unless administered early in the course of the disease.

A comparison was made between ‘offender’ (part V) and ‘non-offender’ (part IV) male patients admitted to the State Hospital, Carstairs, over a ten year period. More than a third of the ‘non-offender’ group had at some time in the past been in penal institutions. During their stay in the State Hospital, the ‘non-offender’ patients were more disturbed in behaviour than their ‘offender’ counterparts, and relatively fewer of them were discharged during the period of study.

The outcome in clinical and social terms of a psychiatric illness arising within 1 year of confinement or termination of pregnancy and requiring on-going care was studied after a period of 1–6 years in 47 women. The outcome was related to the earlier features of the illness and to personal and historical features. Social impairment and continuing psychopathology occurred in many cases. The only factor which significantly related to poor outcome was an initial diagnosis of schizophrenia.

There are considerable practical and ethical difficulties that confront a psychiatrist preparing a report for the defence when the case against the accused rests upon his confession of guilt. Until recently there has been widespread belief that a false confession is not made to a serious crime except in highly unusual or irregular circumstances. Indeed, Sir Henry Fisher, a former high court judge, who had been requested by the Home Secretary to examine the cases of three youths who had confessed to the murder of Maxwell Confait, a transvestite prostitute, concluded that their confessions could not have been made unless at least one had been involved in the killing. His belief has now been considered ill-founded, yet it was an opinion made after the three boys had been given their absolute discharges at appeal.

The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.

Previous speculation based on a mail survey of psychiatrists suggested that exhibitionism is rare in Latin American countries. This survey of potential victims conducted in Guatemala and using a comparable United States facility as a control, shows the incidence in the two countries to be essentially the same. This suggests that the psychopathology of the exhibitionist has more to do with the act than does the culture in which it occurs.

A pair of monozygotic twins, one suffering from the Wernicke-Korsakoff syndrome, verified at autopsy, and the other healthy, was studied biochemically. The erythrocyte transketolase of each twin showed abnormalities, though these differed in the two individuals. In the healthy twin, the basal transketolase was low, but responded normally to thiamine pyrophosphate (TPP) added in vitro. In the twin with the Wernicke-Korsakoff syndrome the basal level of the enzyme and its response in vitro were normal, but a period of treatment with thiamine tetrahydrofurfuryldisulphide, led to loss of the in vitro response. It is suggested that, initially, an inborn error of metabolism may have been common to both twins.

A case of folie à deux affecting two women friends who presented as a suicide pact is described. The shared delusion was based on their life situation and experiences. Social intervention and obtaining employment led to marked attenuation of the delusion in both partners simultaneously and while in close contact. Review of the relevant literature revealed striking theoretical similarities between folie à deux and suicidal pacts suggesting the ease with which the former could become the foundation for the latter.

Sarcoidosis is defined by Scadding (1967) as “a disease which is characterized by the presence in all of several affected organs or tissues of epithelioid cell tubercles … proceeding either to resolution or to … (the formation of) fibrous tissue”. The organs which are most commonly involved are the lungs, skin, eyes, liver, spleen and joints. Clinical evidence of involvement of the central nervous system may be found in 5 per cent of all cases (Silverstein et al, 1965; Wiederholt and Siekert, 1965; Delaney, 1977). Typical lesions are cranial nerve palsies, intracranial space-occupying lesions, pituitary or hypothalamic lesions and, less frequently, lesions of the brainstem or spinal cord (Waldenstrom, 1937; Matthews, 1965; Wiederholt and Siekert, 1965; Scadding, 1967; Delaney, 1977).

The familial incidence of affective illness is well documented. Many studies have shown identical twins to be highly concordant for affective illness (e.g. Price, 1968; Tsuang, 1977). Suicide is strongly linked with affective disorder. However, few cases of both twins committing suicide have been described, and the family reported here, in which several other members also committed suicide by violent means, is thought to be of considerable interest.

I live in a basement flat in Central London. Three years ago I opened my front door and found a woman asleep outside. She seemed about 55-years-old. I had never seen her before. Since then she has used this area for sleeping purposes and has slowly acquired prescriptive rights over my doorstep and over the disused coke cellar adjacent to it (where she stores her possessions). Before she turned up on my doorstep she had tried sleeping in several other doorways in the vicinity, but my neighbours are all, to varying degrees, afraid of her. She is only a small woman, weighing perhaps 8 stone and rather frail, so clearly she represents no physical danger, but her strangeness may put people in mind of a witch.

This paper describes a patient who has had two episodes of mania, both of which occurred immediately after weaning. Although no recent reference to weaning as an aetiological factor in psychiatric disturbances could be found, it is suggested that weaning was an aetiological factor in this case.

The corpus callosum, a cerebral commissure of 200,000,000 fibres, is thickened in chronic schizophrenia and several neuropsychological and neurophysiological techniques have suggested poor links between the two cerebral hemispheres. The interhemispheric conduction time across the corpus callosum, measured in 12 schizophrenics, using the ipsilateral/contralateral latency differences of the early somatosensory evoked response, was found to be effectively zero. It is suggested that schizophrenia is a split-brain condition akin to agenesis of the corpus callosum, unrecognized through the use of compensatory ipsilateral sensory pathways.

Delirium remained a stable psychiatric category until the early 19th century when it underwent aetiological and phenomenological redefinition, precipitating the transformation of the functional insanities into psychoses.

Confusion, introduced by French workers during the second half of the century, referred to a syndrome wider than (but including) delirium. It emphasized chaotic thinking and cognitive failure. The notion of clouding of consciousness (and temporo-spatial disorientation) established a common denominator for the two concepts, while Chaslin and Bonhoeffer redefined confusion and delirium as the stereotyped manifestations of acute brain failure.

The status of enuresis as a symptom of psychiatric disturbance is still uncertain despite a considerable amount of research, which has been well reviewed by Shaffer (1973, 1977, 1980). The problem is that although general population surveys, such as the Isle of Wight investigation (Rutter et al, 1973) and the National Child Development Study (Essen and Peckham, 1976) have indicated a definite association between enuresis and psychiatric disorders, particularly the common neurotic and conduct disturbances, they have also made it abundantly clear that the majority of children who wet are actually well-adjusted and free from other problems affecting their behaviour. Enuretic children referred to clinics for treatment are more likely to be psychiatrically disturbed (Hallgren, 1957), but even then the majority of them are free from other behaviour difficulties.

Opportunities exist for psychiatrists to spend a short term, from two weeks to four months, in underdeveloped countries under the auspices of the Inter University Council, (IUC, 1978). This is accepted as a desirable part of training and experience, as outlined in the Royal College of Psychiatrists Handbook for Inceptors and Trainees in Psychiatry (1980), and allows first-hand experience of symptom patterns and features peculiar to another culture. The present case showed a number of features characteristic of African psychiatry, including ‘brain fag’ syndrome (the syndrome which owes its name to the patient's explanation of his illness as being due to tiredness of the brain), a bizarre colourful presentation of the condition at the onset, and at one point a concern with witchcraft. Behind the illness lay family problems and significant life events which could be grasped by the outsider.