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.

In the last twenty years many workers have applied multivariate statistical techniques to problems of classification in psychiatry. To what extent have the techniques resolved the problems? This personal view will attempt to appraise the current situation.

This is the first attempt to study the socio-demographic aspects of anxiety disorders in Egypt and to apply the Arabic version of the PSE in evaluating the profiles of clusters and symptoms of anxiety in a sample of 120 patients with anxiety. There were significant differences in some presentations between males and females, between illiterate and educated groups, and between those exposed to mild and severe crowding. Structured interviews like PSE will help in transcultural comparisons of clinical psychiatric disorders.

Pseudocyesis is rare in childhood and adolescence. Moreover, in all age groups, there has been little written on its therapeutic handling. We describe a case of pseudocyesis in a fifteen-year-old girl and discuss the therapy in some detail.

All choices are personal but some more personal than others. The task of selecting from the vast literature of psychoanalysis has felt like the task of the castaway on Desert Island Discs; should I include old faithfuls of long ago or replace them with the shining prizes of today? My selection will not be the same as that of any other psychoanalyst and reflects my position as a therapist who works with individuals, groups and institutions, and who tries both to clarify the different frames of reference appropriate to these areas, and to seek unifying common factors.

Although behavioural psychotherapy is a potent therapeutic technology which is now the approach of choice in perhaps 25 per cent of neurotic patients (12 per cent of adult psychiatric outpatients), many psychiatrists are still reluctant to use it as part of their armamentarium in the clinical management required in everyday practice. At least four factors contribute to this resistance.

A survey of the practice of electroconvulsive treatment, ECT, in Great Britain was made during 1980–81 for the Royal College of Psychiatrists, supported by grants from the Department of Health and Social Security and the Scottish Home and Health Department. This paper is a summary of the main findings together with suggestions from the authors.

An educational history, corroborated by records where available, was obtained on 54 of the 58 adult offspring of 17 bipolar manic-depressives. The offspring were also interviewed and psychiatric status was ascertained.

Primary and other affective disorder in the offspring was not associated with a lower IQ or lower ultimate educational attainment than that of the remaining offspring. There was a trend towards increased educational failure in the offspring with primary affective disorder, but they were as likely as other offspring who had failed to have resumed their education at a later date. Ill offspring with any form of school failure had a significantly earlier onset to their psychiatric illness, although school failure could not be shown to be a part of an early symptom complex.

Despite the high prevalence of unipolar depression in the general population, few genetic studies are available on subtypes of unipolar illness. We evaluated morbid risks for depression, alcoholism and/or sociopathy in the relatives of early onset (before age 40) and late onset (after age 40) unipolar patients in a sample of 106 probands consecutively admitted to the New York State Psychiatric Institute. Unipolar patients with an early onset disease have a greater familial morbidity for depression, alcoholism and sociopathy than unipolar patients with a late onset disease. There is an excess of unipolar depression in female relatives of early onset unipolars when compared to late onset probands, regardless of the proband's sex. Alcoholism and sociopathy are also more prevalent in the relatives of early onset unipolars versus late onset probands. Our morbidity risk data show familial genetic differences between early and late onset forms of unipolar illness and partially confirm Winokur's concept of two subtypes of unipolar depression.

Presumably one function of an hypothesis is to provoke further thought and observation. Therefore, I welcome the critical comments of Ashcroft and colleagues (Journal, March 1981, 138, 268–9) on my suggestion concerning the relationship between dopaminergic disturbances and the positive and negative symptoms of schizophrenia (Crow, 1980a, b). However, I think they have misunderstood the proposal and have underestimated some of the relevant evidence. I believe the evidence for two processes is more compelling than they have conceded and I note that in their own hypothesis they have introduced two factors to account for phenomena that both Mackay (1980) and I regard as a problem for the simple dopamine theory.

This paper analyses the pattern of use of and the response to electroconvulsive therapy (ECT) in an Indian rural teaching general hospital between 1977 and 1980. ECT was used in 503 cases (14.3 per cent of 3,517). Three-quarters of the patients to whom it was given were schizophrenic, one-fifth depressed and 6 per cent suffering from post-partum psychosis. Though the treatment gave the best results in depression it was also effective in many schizophrenics and post-partum psychotics. The commonest side effect was memory impairment. Following unmodified ECT severe confusion and excitement were frequent while thrombophlebitis, bronchospasm, prolonged apnoea and peripheral circulatory collapse occurred only with the modified technique. The usefulness of ECT in developing countries like India is highlighted.

There is only a small literature on the psychiatric complications of acromegaly. Manfred Bleuler (1954) reported an acromegalic man who had blunted affect and apathy and suggested that this clinical picture represented a special variation of the endocrine psychosyndrome. Avery (1973) reported a further case of depression and anxiety in association with the illness. There are relevant reviews by Michael and Gibbons (1963), Beumont (1972), Labhart (1974) and Lishman (1978).