Recent research shows that the demands of the caregiving role are experienced differently by men and women. Both the subjective and the objective strain and burden appear to be greater in female carers of dementia sufferers, and factors that influence this include differences in role expectations and coping strategies. These findings have implications for the provision of services for dementia sufferers and their carers.

A survey of 204 south-Asian and 355 Caucasian schoolgirls was conducted in Bradford using the EAT-26 and the BSQ. At interview, seven Asian girls and two Caucasian girls met DSM–III—R criteria for bulimia nervosa, yielding a prevalence of 3.4% and 0.6% respectively. One Asian girl met DSM–III–R criteria for anorexia nervosa. Factor analyses of the EAT and BSQ supported their cross-cultural conceptual equivalence in this south-Asian population. Among the Asians, high EAT and BSQ scores were associated with a more traditional cultural orientation and not with greater Westernisation. It is probable that these findings reflect the cultural and familial difficulties faced by these Asian girls growing up in Britain.

Meta-analysis was used to establish the efficacy of lithium in acute treatment and prophylaxis of depressive illness from existing published clinical trials. Effect sizes were measured by the odds ratio using the Mantel–Haenszel method and the Pearson product-moment correlation coefficient. Some benefit from lithium, compared with other treatments, emerged from trials of acute treatment. Lithium was clearly superior to placebo in the acute treatment of bipolar depressed patients. In controlled studies of lithium prophylaxis over five months to three years, an impressive effect was found for lithium when compared with placebo. For uncontrolled studies there was a similar-sized effect, corresponding to an improvement in the rate of favourable outcome from 35% for placebo to 70% with lithium treatment. The comparison of lithium with other antidepressants in prophylaxis showed no conclusive advantage for lithium in unipolar illness. There is no reason to doubt the efficacy of lithium in the prophylaxis of unipolar depressive illness.

Between 1982 and 1987, 42 patients were selected who had been admitted three times in one week to the Regional Poisoning Treatment Centre in Edinburgh for the treatment of deliberate self-harm. Most (87%) of these admissions related to drug overdose. Most of the patients were young, unemployed, lacking a partner and from the low social classes. Three-quarters of the sample had at least one known conviction and more than a third were known to have served a prison sentence. There was only one patient in whom mental illness was thought to be relevant to the episode of self-harm, although five patients were mildly mentally handicapped. Case notes were reviewed to assess the outcome one year after the index admission. None of the patients had committed suicide, although 36 repeated self-harm during the follow-up year.

Seven units providing psychiatric day care to residents of an inner-city area were surveyed. The extent to which the clinical and special problems of attenders were adequately managed by the services was measured using a ‘needs-assessment’ technique. Units differed in the proportion of clinical and social problems that were rated as ‘unmet needs', although the extent of ‘unmet need’ was not clearly related to the morbidity of attenders at a unit or the available staffing.

In a follow-up study of 49 children and adolescents with anxious or depressive disorders up to 50% had not recovered. In the 12 months preceding onset there were no social factors which predicted recovery at follow-up. Between onset and follow-up the children were less likely to be exposed to undesirable life events, and significant improvements in maternal confiding relationships were reported. Neither of these improvements predicted the level of recovery at follow-up. Poor recovery is best predicted by moderate to poor friendships after the onset of disorder, particularly for those with a diagnosis of depression. Further confirmation is provided that direct interviewing of children by trained personnel using semistructured schedules is a valid method for determining mental symptoms and perception of recent friendships.

Twenty-four patients who developed their first psychotic episode after the age of 45 were studied with MRI and comprehensive neuropsychological testing and compared with 72 healthy elderly subjects. The patients demonstrated more clinical abnormalities on MRI, were more likely to have large white-matter lesions or metabolic illness, and did more poorly on many neuropsychological tests, particularly those testing frontal-lobe and memory abilities. We conclude that structural brain injury is commonly associated with the late onset of psychosis. Neuroimaging investigations are a valuable component in the evaluation of this patient group.

In the development and evaluation of a multi-ethnic inventory (the BSI) of somatic symptoms associated with anxiety and depression, symptoms were derived from psychiatric case notes of Pakistani and indigenous British patients with a clinical diagnosis of anxiety, depression, hysteria or hypochondriasis. The inventory was constructed simultaneously in Urdu and English. A pilot version of the BSI was checked against psychiatric case notes in north and south India, and Nepal. The revised BSI achieved over 90% coverage of all somatic symptoms recorded in each centre. The linguistic equivalence of the Urdu and the English versions was established in a bilingual student population in Pakistan. Conceptual equivalence of the BSI was explored using factor analysis of responses by functional patients presenting to medical clinics in Britain and Pakistan. Four principal factors (head, chest, abdomen, fatigue) were similar in both populations.

Four cases of anorexia nervosa occurring in Asian children are described. These case histories are set against the recent increase in eating disorders in patients of different racial origin. The role of sociocultural conflict in immigrant Asian families to Western countries is raised as a possible contributor to the emergence of eating disorders and the need to be aware of anorexia nervosa in such childhood populations is stressed.

There is a paucity of research concerning service usage and needs of female long-term psychiatric patients. A series of studies comparing the provisions for chronically mentally ill men and women in a south London community-focused rehabilitation and continuing care service indicate marked differences in the services received by men and women, and raise questions concerning whether the needs of female patients are adequately served. As a group the women had been in contact with services for longer, had received less intensive input from services, and it appeared that the services had been less responsive to their changing needs. Among those in high contact with the services, the functioning of men and women did not differ, yet women were over-represented in workshops designed for those functioning at a lower level. Women over 45 years of age seemed to be particularly badly served by the organised activities offered.

Brain ERPs were recorded in ten unmedicated schizophrenic patients and age- and sex-matched healthy controls during a multidimensional listening task. Patients showed a marked reduction in a long-duration attention-related negative ERP component, termed ‘processing negativity’ (PN), which was elicited by attended stimuli. The amplitude of PN was significantly correlated with SANS and SAPS scores of schizophrenic symptoms. The P300 component was also reduced in amplitude in patients, and was significantly correlated with SANS ratings of negative thought disorder. These findings provide neurophysiological evidence of impairment in the maintenance of selective attention and the cognitive processes associated with target detection among schizophrenic patients. The reduced PN in schizophrenics implicates frontostriatal pathways in the aetiology of attentional deficits in schizophrenia.

The closure of large psychiatric institutions has led to alternative accommodation being developed for people with long-term psychiatric disabilities, with an emphasis on group living. Despite this, very little is known about where these people live, about the accommodation needs of this group, or whether men and women have differing needs. This paper examines the accommodation of all people with long-term and severe psychiatric disabilities in one South London borough who were in contact with a specialist service. It was found that the majority of people either live with their families – although the family member differed for men and women – or live alone. Men were more likely than women to live in hostels or alone, while women were more likely than men to live with their families.

An unselected community sample of 128 patients were studied over the 12 months after their first stroke, and compared with a control sample of subjects from the general population. Psychiatric status was assessed using the PSE and BDI. Symptoms of mood disorder were commoner in the stroke patients than the controls, but the differences were not substantial and had largely disappeared by 12 months. Psychiatric problems encountered included agoraphobia, social withdrawal, apathy and self-neglect, irritability and pathological emotionalism. While there was a high cumulative incidence of psychiatric disorder, little of it persisted: only two cases of major depression were present for the whole 12 months. We believe undue emphasis has been placed in the recent literature on major depression as a specific syndrome following stroke.

‘Prescription-event monitoring’ (PEM) is one of two national systems of post-marketing surveillance in operation in Britain. It identified 22 065 patients who had received NHS prescriptions for alprazolam, and data available on 10 895 of these were analysed. The main reasons for treatment with alprazolam were anxiety and depression. The patients provided 3360 patient-years of treatment and 7540 patient-years of follow-up. No serious events clearly associated with treatment were recorded. The main events reported during treatment, albeit infrequently, were drowsiness and depression, although depression is more likely to be due to the disorder being treated than to the drug. Some of the other alleged unwanted effects of alprazolam in published reports were not encountered. Since PEM is unable to determine the dependence potential of alprazolam, further evaluation of this problem is called for.

Long-stay psychiatric in-patients in South Glamorgan were reviewed using the MRC Needs for Care assessment. The majority were middle aged or elderly and were severely disabled, with problems encompassing symptoms/behavioural difficulties, social skills, and physical health. In most, long-standing psychiatric illness was compounded by physical illness and cognitive deficits as age advanced, producing care needs that were greater than existing community services could meet.

The Home Office files of all 295 cases of defendants being found unfit to plead between 1976 and 1988 were evaluated. The majority were male and either schizophrenic or mentally impaired. Median age was 32 years. Two-thirds had past criminal convictions, and nearly 90% had past contact with psychiatric or social services, but only 28% were receiving psychiatric care at the time of their alleged offence; 14% were hospital in-patients. Offences of theft and violence predominated, but in most cases they were not of a serious nature: 34% were rated as mild or nuisance, 40% moderate, and 26% severe. In more than 80% of cases, evidence linking the accused with the offence seemed good. Less than one-third were admitted to special hospitals. Forty-six per cent of the population (135 patients) eventually regained their capacity to plead (within a median of four months), with 76 (26%) returning for trial. Of the remainder, 68 (23%) are still in hospital, 39 of whom have been there for more than five years. Time to discharge without trial reflected the severity of the alleged offence.

Ninety-nine neurotic patients from a controlled trial of CPN v. psychiatric out-patient aftercare were followed up seven years later. Of the 92 survivors, 76 were successfully interviewed. Few differences were found between the groups. Chronic mild symptoms and moderate social disability persisted, and tended to worsen a little. Treatment patterns persisted for one to two years beyond the original study; the CPN group had more CPN contacts, fewer psychiatric out-patient contacts and less psychiatric care. Thereafter, more out-patients were discharged from psychiatric care and care patterns for the two groups became similar. Out-patients attended more non-psychiatric out-patient clinics than the CPN group, but it is possible that this reflected pre-existing differences. About a third of patients remained in contact with the psychiatric service during follow-up.

Twenty-seven families, 14 with a history of child physical abuse and 13 with no such history, were studied over the course of intensive in-patient treatment. The families in the former group differed significantly from those in the latter group in terms of current circumstances and background histories. Families where abuse was admitted benefited significantly more from treatment than families where abuse was suspected but not admitted. The ability of mothers to remember good relationships from childhood and to establish good relationships during treatment was an important prognostic factor for successful treatment.

At three centres, 21 women at high risk for puerperal psychosis were given prophylactic lithium carbonate late in the third trimester of pregnancy or immediately after delivery. Only two of the women had a recurrence of their psychotic illness while on prophylactic lithium. One woman given lithium during third trimester had an unexplained stillbirth. Although a larger sample in a carefully controlled study is still required, there now seems to be grounds for the use of prophylactic lithium immediately after delivery in women not breastfeeding who have previously suffered from either puerperal psychosis or bipolar disorder.

Aspects of the normal psychology and psychopathology of women are discussed in relation to adolescence, young womanhood and motherhood. Perversions of motherhood exist, although they are largely denied by a society which idealises being a mother. This denial may be caused by society's inability to see a woman as a complete human being. The aetiology of perversions in women is both psychobiological and social and it is bound up with the politics of power. Perverse motherhood can be seen as the product of the emotional instability and inadequate individuation brought about by a process involving at least three generations.