Good scientific hypotheses rarely succumb to a lack of confirmatory evidence; they may sometimes even be resistant to apparent outright refutation (Kuhn, 1970; Lakatos, 1970). Considering this, Kuhn (1970) suggested that the dominant hypotheses in a field are often replaced not on grounds of greater theoretical coherence but rather on grounds of strategic necessity.

Ninety patients with severe anorexia nervosa fulfilling DSM–III–R criteria were assessed in depth in terms of their family developmental psychopathology and then randomly allocated to either one of three treatment groups or to no treatment. In three treatment regimes, a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems. All three treatment regimes were highly significantly effective at one year in terms of weight gain, return of menstruation, and aspects of social and sexual adjustment. Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group.

The admission pattern of under-65s during the first seven years of Kidderminster's District General Hospital Psychiatric Department was compared with the last seven years of the mental hospital (Powick Hospital) which it superseded in July 1978, and with its nearest mental hospital (Barnsley Hall Hospital). In Kidderminster the average length of patient's hospital stay was half that at Barnsley Hall. There were more admissions per head of population, more which lasted less than a week, and more patients with over six admissions to Kidderminster than Barnsley Hall. The retrospective comparison with Powick Hospital showed that these differences were not due to the superior community facilities in Kidderminster since there was no real change in hospital bed use with the development of community services; this supports the view that there is a bed-rock of illness which will always need in-patient care however comprehensive the community resources.

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.

All referrals made to the liaison psychiatric service for HIV and AIDS patients over one year were reviewed. ICD–9 and CDC diagnoses were applied to each case at presentation. Sixty HIV-positive patients were assessed, of whom 35 had affective disorder, which was significantly associated with CDC group IV disease (AIDS). Adjustment reaction was seen in nine patients, paranoid states in six, dementia in four, personality changes in four and paranoid schizophrenia in two. CT scans of the brain were performed on 23 of the patients: 17 of these showed abnormalities. The proportion of registered AIDS patients who were referred was five times the proportion of HIV patients.

The WHO launched a multicentre study to explore the nature and prevalence of HIV-1-associated neurological, psychiatric, and neuropsychological abnormalities in persons living in different geographical and sociocultural contexts. The study is being conducted in Brazil, Germany, Kenya, Thailand, the United States of America, and Zaire. A comprehensive instrument for the collection of neuropsychiatric data (including a battery of neuropsychological tests suitable for cross-cultural use) has been developed, and the feasibility of the recruitment and assessment procedure designed for the main phase has now been demonstrated.

The place of family therapy in adult clinical psychiatry remains unclear, despite considerable theoretical developments in the subject. In order to delineate the potential role of a family therapeutic approach, a study was conducted of the first 50 families treated in a newly established family-therapy clinic located in an adult psychiatric hospital.

Seventy consecutive patients admitted to an alcohol unit were given a modified version of Yalom's therapeutic factor questionnaire at various points during the therapeutic programme. This programme consists of a two-week introductory programme, followed by a treatment programme, which includes psychodynamic groups, life-history reviews and intensive cognitive-therapy sessions. Internal agreement of ranking order of therapeutic factors was high among all patients and was independent of time spent in group therapy. Patients valued most an existential factor (which embraces concepts of personal responsibility and isolation), self-understanding and cohesiveness; they least valued guidance and identification. Therapists also completed the questionnaire: their ranking of therapeutic factors correlated highly with that of patients, but they ranked an existential factor much lower.

Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10–56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; ‘fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.

Fifteen children who developed anorexia nervosa aged 13 years or less were followed up at least three years later (mean 5.3 years). Outcome measures included the Morgan & Russell Outcome Schedule and the PSE. The general outcome was good in seven, intermediate in four, and poor in four, one of whom had died. A high incidence of psychiatric symptoms at follow-up, which has been suggested in other studies, was not confirmed in the 11 subjects who completed the PSE. Where onset was very early (11 years and under) and where hospital stay was prolonged, outcome tended to be poor.

Of 120 pathological gamblers randomly allocated to imaginal desensitisation (ID) or to other behavioural procedures (60 to each group, all procedures administered over one week) 63 subjects were contacted two to nine years later. Twenty-six of the 33 who received ID reported control or cessation of gambling compared with 16 of 30 who received other behavioural procedures. This difference was significant, indicating ID had a specific effect additional to that of the other behavioural procedures. It is suggested the other procedures could be regarded as placebos. As the response at a mean of over five years to one week of ID is comparable with that reported to more intensive therapies, after briefer follow-up, it is suggested ID is a cost-effective therapy for pathological gambling, and is worth considering when resources are limited.

To compare the safety and antidepressant efficacy of paroxetine, imipramine, and placebo, data from six centres using the same protocol were pooled. A double-blind parallel-group design was used, with therapy lasting six weeks. From week 2 onwards, both the 240 paroxetine-treated and the 237 imipramine-treated patients were significantly different from the 240 placebo-treated patients, but no different from each other. Side-effects with paroxetine were less likely to lead to drop-out than with imipramine. Paroxetine had a possible earlier antidepressant effect than imipramine, and a possible earlier beneficial effect on anxiety symptoms associated with depression.

The effect of drug-induced Parkinsonism and of the topography of the dyskinetic movements on the psychological consequences of tardive dyskinesia was assessed in 20 schizophrenic subjects and 20 non-dyskinetic schizophrenic controls matched for age, sex, the presence of anticholinergic medication, and the presence and severity of drug-induced Parkinsonism. Limb–truncal subscale scores but not orofacial scores had a significant correlation with cognitive impairment and with negative symptoms. Drug-induced Parkinsonism was found to be a powerful confounding variable.

The DASH scale was used to assess 506 profoundly and severely mentally retarded persons (247 females and 259 males). The scale, covering 13 major psychiatric disorders, consists of 83 items derived from DSM–III–R as well as previously published studies of this population. Data were collected on symptom frequency, duration and severity in individual interviews with direct-care staff. Elimination and pervasive developmental disorders were most frequent, self-injurious behaviour disorders most severe. Most symptoms had been evident for at least a year. Inter-rater reliability was generally good.

Auditory evoked potentials were recorded in a choice reaction-time task. This test paradigm elicited the attention-related P300 component and was used to study cognitive processing. Compared with age-matched controls, 17 patients with dementia of the Alzheimer type were shown to have significantly longer reaction times as well as delayed latencies of several components of the auditory evoked potentials. The fractional increase in the reaction times was much greater than that of the P300 peak latency. The latter is commonly accepted as an index of stimulus-evaluation time. These findings suggest a delay in both response selection and stimulus evaluation.

Two hypotheses were tested concerning the nature of the cognitive dysfunction in schizophrenia: (a) that there is a broadening of selective attention; and (b) that there is an impairment in associational learning. RDC-diagnosed acute and chronic schizophrenics and normal controls carried out a choice reaction time (RT) task in which conflict between the correct response to a target (a letter in the centre of a computer screen) and that cued by simultaneously presented flankers (two letters either side of the target) increased RT. For 80 (‘valid’) trials, flankers and targets were consistent in the response cued (pressing a button with either left or right hand); on 8 (‘invalid’) trials they conflicted. On invalid trials there was a slowing of RT, and an increase of errors for left-hand responses. Chronic schizophrenics showed the same reactions to cue validity as normal controls, both groups differing significantly from acute schizophrenics. For the latter, the RT data supported hypothesis (b), but the error rates appeared to support hypothesis (a).

Seven cases are described in which the central symptoms were fear of contracting AIDS, avoidance of related cues, rituals and reassurance-seeking, Associated features include previous illness phobias and obsessive-compulsive disorder. Treatment with exposure and response prevention (plus a cognitive session in one case), led to improvement sustained up to three months after discharge, although one patient stopped treatment prematurely. Controlled trials of behavioural treatment in hypochondriasis are required.

When 42 cases of primary dissociative states from India were classified according to DSM–III–R and ICD–10 criteria, DSM–III–R was found to be unsatisfactory, with 40 (95.2%) cases receiving a diagnosis of dissociative disorder not otherwise specified. The majority fit well into simple dissociative and possession disorders. ICD–10 was found to be more satisfactory, with 36 (85.5%) patients fitting into specific subcategories, which, however, need to be defined and described more explicitly.

Although a large growing literature indicates that monosymptomatic hypochondriacal psychosis is more common than previously thought, little contribution has been made from psychiatrists working in developing countries. Fifteen patients are described who presented with the delusion of emitting a foul smell.