Some of the clinical factors contributing to the currently unsatisfactory state of therapy for tardive dyskinesia are reviewed. Problems such as lack of clear syndrome delineation and phenomenological description, the lack of standardization in rating scales and the lack of attention to trial design have all probably contributed to a rather confusing picture. Controlled trials suggest that several pharmacological agents may be of therapeutic value but that clinical prediction of an individual's response is impossible. The strategy of acute drug challenge has emerged as perhaps the most promising approach to the definition of pharmacological subtypes and therefore the choice of optimal treatment.

Seventeen schizophrenic patients with tardive dyskinesia (TD) and 33 schizophrenics without tardive dyskinesia were examined by psychological tests of intellectual function and EMI scans were performed. The group as a whole were found to be demented and 31 out of 45 had abnormalities on the scan. On a learning test the tardive dyskinesia group did significantly worse and using a measured parameter of the scan (the Ventricular Index) the tardive dyskinesia group had more abnormality. It is suggested that the higher incidence of pathology in the tardive dyskinesia group may be related to chronic neuroleptic toxicity.

The effect of single intravenous doses of metoclopramide (10 mg, 20 mg and 40 mg) and haloperidol (5 mg and 10 mg) have been compared to placebo (saline) in a double blind randomised study in 8 patients with tardive dyskinesia secondary to neuroleptic therapy. Tardive dyskinesia rating scores were improved significantly (P <0.01) 6 hours after dosing by metoclopramide 40 mg, and haloperidol 5 mg and 10 mg, when compared to placebo. Single doses of dopamine receptor blocking agents improve tardive dyskinesia. The dose of metoclopramide required to show a beneficial effect was high, and this therefore suggests that it is unlikely to be of therapeutic value as the incidence of adverse reactions would be greatly increased. By monitoring the effects of single doses of dopamine receptor blocking drugs in patients with tardive dyskinesia it is possible to compare the relative potencies of these drugs on dopaminergic systems in vivo in man.

The point prevalence of tardive dyskinesia (TD) as assessed by means of the Simpson rating scale was determined for 14 psychiatric wards with 347 patients (213 and 134 female) at the time of the study. TD was found to occur in 17.3 per cent of the patients, the prevalence being significantly higher in female than in male patients. The frequency of TD increases with age.

A random group of TD patients was matched with a group of patients without TD and the total medication for both groups was calculated. No differences were found as concerns total amount of high or low dosage neuroleptics, or anticholinergic drugs, for the two groups. However, significantly more TD patients than controls had received dosage neuroleptics, or anticholinergic drugs for the two groups. However significantly more TD patients than controls had received anticholinergic drugs.

There was no significant relationship between severity of TD: age, duration of treatment, total amount of high or low dosage neuroleptics. On the other hand a significant relationship was found between severity of TD and amount of anticholinergic drugs. Significantly more patients in the TD-group than in the control group had a past history which might suggest possible brain damage prior to the neuroleptic medication.

Fifty-seven patients with a diagnosis of schizophrenia were started on either fluphenazine decanoate or flupenthixol decanoate injections in a double-blind trial just prior to discharge into the community. During the six month follow-up 30 per cent dropped out of the treatment. Of those observed for six months, 7 per cent relapsed, 54 per cent experienced depressive symptoms and 88 per cent extrapyramidal side-effects. Analysis of both clinical data and the ratings failed to discriminate between the two drugs.

Two patient samples, with different criteria for selection, have been surveyed following maintenance therapy discontinuation. The patients had previously remained in a steady mental state on depot injections for periods varying between one and four years. Both the rates of relapse and pattern of relapse suggest that patients responding to medication need to remain on maintenance therapy for a minimum of four years. The results further suggest that in chronic schizophrenia the drugs only suppress symptoms and that the prognosis following discontinuation is substantially unchanged by increased duration of medication, even after four years. The possibility of using short-term ‘drug holidays’ to reduce the risk of unwanted effects was explored; after only three months without drugs, the risks of relapse were significantly increased.

A limited study into the accuracy of information for the Mental Health Enquiry was undertaken at two major mental illness hospitals in Leicestershire. The results indicate that certain items of data are of questionable value. The current arrangements for processing the data may also need review.

Recent studies have suggested that psychosocial factors play an important part in the prediction of the course of minor psychiatric disorders. Fifty-nine new psychiatric out-patients suffering from minor disorders were assessed, using standardized clinical and social interviews, and 52 were followed up after one year and the clinical assessment repeated. Social and clinical factors were equally important predictors of the number of months ill in the survey year, but social and constitutional variables were superior in the prediction of percentage change in symptoms over the year.

The results of correlation, factor and multiple regression analyses suggest that the course of minor psychiatric disorder is best predicted by three sets of variables which are, in order of importance, the patient's material social circumstances, his clinical symptoms and his ‘genetic risk’ scores.

A study was carried out to compare the antecedent factors, phenomenology, treatment required and prognosis in 30 cases of Reactive Psychosis and 30 cases of Acute Psychosis without antecedent stress, matched on age and sex. Both groups were followed up for 7 months.

It was found that the two groups differed markedly on several dimensions: The Reactive Psychotics had more hysterical and affective features, more vulnerable personality, higher stress experience in their life prior to illness and relatively better prognosis compared to the Acute Psychotics. The difference still remained when those in either of the groups who at the end of the follow-up turned out to be schizophrenics or suffering from affective disorder were excluded from analysis.

Twenty-one patients with bipolar affective disorder (20 manic episodes, one depressive episode) during the postpartum period were evaluated. They were compared to an unselected group of women with bipolar histories, as well as to a matched control group. The postpartum group had significantly more Schneiderian symptoms and fewer recurrences of illness within the three-year period after the index admission. There was a notable trend toward postpartum patients having fewer affectively ill relatives than the controls. The practical significance of these findings with regards to lithium therapy is discussed, as is the theoretical significance in terms of heterogeneity of the bipolar syndrome.

The clinical impression that phobic patients perceive their parents as being uncaring and overprotective was investigated in a controlled study of eighty-one phobic patients. Those assigned to a social phobic group scored both parents as less caring and as overprotective, while those assigned to an agoraphobic group differed from controls only in reporting less maternal care. Intensity of phobic symptoms in the pooled sample was examined in a separate analysis. Higher agoraphobic scores were associated with less maternal care and less maternal overprotection, while higher social phobic scores were associated with greater maternal care and greater maternal overprotection.

Seventy-one school phobic children seen at a child guidance clinic were followed up after they had passed school leaving age. Their record in work and further education was compared with the length of time they were off school, whether or not they returned to school, and the occurrence of further psychiatric treatment after discharge from the clinic. It was found that whether or not the child returned to school and the length of time he was off school had no relationship to future performance at work or in further education. A significantly larger number of children receiving further psychiatric treatment after discharge from the clinic failed to reach their potential in work or further education. Adequate treatment of the underlying conditions appears to be more important than returning the child to school.

Of 102 alcoholics admitted to an alcoholism treatment unit one third (33) were clinically rated as having disabling agoraphobia and/or social phobia, and a further third (37) as having less disabling phobic symptoms of either or both kinds. Questionnaires and self-report symptom scales were used to validate the clinical ratings. Alcohol problem screening tests and consumption levels confirmed the severity of alcohol dependence. In a group of 44 phobic alcoholics who reported physical dependence, the onset of phobic symptoms preceded the onset of alcohol-telated problems and physical dependence significantly more frequently than the converse.

The prevalence of agoraphobia and social phobia in alcoholics is discussed in relation to prevalence data in affective and normal populations, together with their implications for the aetiology of phobias and alcohol dependence, and for screening and assessment of phobic alcoholics, preventative counselling, treatment approaches and prognosis.

Epileptic automatism is now believed to be a rare disorder, and only a very small number of cases have been described (Knox, 1968; Gunn and Fenton, 1971; and Gunn, 1978) in which aggressive behaviour has occurred during automatism. There are important legal issues involved if a serious crime is committed and insane automatism is given as the defence.