This paper reviews literature on the mental health effects of involuntary job loss among women. In addition, a prospective study of the effects of job loss on psychological distress in a cohort of blue-collar women is described. A total of 141 women, of whom 73 were laid off during the 12-month study period, were examined. The occurrence and duration of lay-off was significantly associated with increased depressive symptoms, but not anxiety-related symptoms, even after effects of pre-lay-off psychological symptoms, social supports and occupational stress were considered. There was no evidence that these effects of lay-off were moderated by other characteristics measured prior to lay-off. Among women who were laid off, those who reported poor levels of support from their husband or partner in the immediate aftermath of lay-off and those experiencing more financial difficulties during the lay-off had higher depression levels at follow-up. The nature of the lay-off as a chronic psychosocial stressor is discussed.

A survey over 2 years of all Police Referrals (Section 136 of the Mental Health Act 1983) in an inner-city health district identified 163 cases, with a core group of repeat referrals. Previous psychiatric admissions, a diagnosis of schizophrenia, social deprivation, and a bias towards young men of Afro-Caribbean ethnicity were key features. The difficulty of obtaining clear data and uncertainties within the law rebound unfairly on patients, police and psychiatrists. Section 136, while not inappropriate diagnostically, can be seen as highlighting unmet social and medical needs in the context of community care. The requirement for coordinated resources, including acute in-patient services sufficient for deprived populations and legal provision for treatment beyond a hospital's boundaries, seems paramount.

The principal aim of this study was to assess the validity and usefulness of the Ways of Coping (Revised) questionnaire (Folkman & Lazarus, 1985) with a British sample of parents of children with Down's syndrome. Factor analysis yielded five subscales which were compared with those reported elsewhere. Other properties of the instrument were investigated. It was concluded that the instrument was potentially valuable to those investigating coping in families with special problems.

The study is a prospective investigation of the factors associated with treatment compliance in 61 patients discharged from hospital with a ward diagnosis of schizophrenia. All cases were classified using reliable diagnostic criteria and all were followed up for two years. Compliance was assessed by inspection of records and by analysis of urine. Sociodemographic factors and illness variables were unrelated to compliance. Some aspects of a patient's insight and attitude, namely, a belief that medication had helped during the admission, a stated willingness to take treatment after discharge and a generally optimistic outlook, were associated with improved compliance. Other variables which showed such an association were the absence of the drug side-effect akinesia, good previous compliance and voluntary, as opposed to compulsory, admission to hospital.

A right-handed young man with contusions affecting temporo-parietal areas of the right cerebral hemisphere and some bilateral frontal lobe damage became convinced that he was dead (the Cotard delusion), and experienced difficulties in recognizing familiar faces, buildings and places, as well as feelings of derealization. Neuropsychological investigation while these symptoms were resolving revealed impairment on face processing tests. We suggest that these impairments contributed to his Cotard delusion by heightening feelings of unreality, and that the underlying pathophysiology and neuropsychology of the Cotard delusion may be related to other problems involving delusional misidentification.

To understand anything, it is helpful to know its history. All psychiatrists are confronted by clinical problems that have developed over a large part of their patients' life span. This applies most obviously to the disorders of personality, but it is also true of many disorders arising in adult life. The roots of depression can sometimes be traced back to suffering and loss in childhood. Schizophrenia is often preceded by long periods of cumulative problems in personal relationships; and recent theory has drawn attention to very early signs of abnormality in the perinatal period. Many child psychiatric disorders present as enduring traits. The model of ‘psychiatric illness’ tends to emphasize the change and discontinuity from previous life, but it is also necessary to understand the extent to which an individual's plight can be seen as the product of character and stress.