The relationships between symptoms in 40 schizophrenic patients, selected for persistence of symptoms, were examined. The symptoms segregated into three syndromes: psychomotor poverty (poverty of speech, lack of spontaneous movement and various aspects of blunting of affect): disorganisation (inappropriate affect, poverty of content of speech, and disturbances of the form of thought): and reality distortion (particular types of delusions and hallucinations). Both the psychomotor poverty and disorganisation syndromes were associated with social and occupational impairment; in particular, the psychomotor poverty syndrome was associated with impairment of personal relationships, and the disorganisation syndrome with poor self-care and impersistence at work.

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months.

A bilingual rater was trained in English in a technique of assessing relatives emotional attitudes to patients, and was then required to rate material in Hindi without any further experience. This strategy revealed that the rating of critical comments, hostility and positive remarks could be transferred from English to Hindi without distortion. There were problems with the remaining two scales, over-involvement and warmth, but these were due to technical issues connected with rating and not to cross-cultural distortion.

We measured the components of expressed emotion among two samples of relatives of first-contact patients from Aarhus (Denmark) and Chandigarh (India). The Danes were very similar in most respects to samples of British relatives, whereas the Indian relatives expressed significantly fewer critical comments, fewer positive remarks, and less over-involvement. Within the Chandigarh sample, city-dwellers were significantly more expressive than villagers of all EE components except over-involvement.

We conducted a one-year follow-up of patients who had made a first contact with psychiatric services in Chandigarh, North India, and had been assigned a diagnosis of schizophrenia. The expressed emotion (EE) of the patients' relatives was assessed early on. We found the same associations between the individual components of EE and relapse of schizophrenia as in previous Anglo-American studies, but only the association between hostility and relapse was statistically significant. Applying the same criteria as in the Anglo American studies for ‘high EE’, we found a significant relationship between high EE and relapse. This relationship was not explained by other factors often associated with higher relapse rates. We conclude that the significantly better outcome of Chandigarh first-contact patients compared with a London sample is largely due to the significantly lower proportion of high-EE relatives in the North Indian sample.

Expressed emotion ratings were performed, in two separate settings, on the parents of 20 children suffering from anorexia nervosa. Ratings were made on conventional individual interviews and on videotapes of a family interview. Comparison of ratings in the two settings showed a very high correlation for ‘critical comments'. Findings on the other scales were harder to interpret, but significant correlations as well as differences were noted. Expressed emotion rated in family interviews provides new possibilities for the study of families.

The timing and number of recent stressful life events occurring in the year before onset of emotional or behavioural disorder was examined in a consecutive sample of children. Overall, events increase the relative risk of psychiatric disorder by 3–6 times. Events occur throughout the 12 months, but tend to cluster in the 16 weeks nearest onset of symptoms. The number of events influences the onset of disorder: cases with multiple events are more likely to have an event within 16 weeks of onset; cases with single events are more likely to have the event 36–52 weeks before onset. Cases whose onset occurs within 4 weeks of an event may have experienced single or multiple events. The results support the concept of additivity of recent stressful events in some cases of emotional and behavioural disorders in childhood.

Thirty out-patients with severe anorexia nervosa were randomly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy. At one-year follow-up both groups showed significant overall improvement, and the dietary advice group showed significant weight gain. A similar mean weight gain for the psychotherapy patients did not reach statistical significance, but this group made significant improvements in sexual and social adjustment.

Concurrent behaviour therapy and psychotherapy in the treatment of anorexia nervosa creates significant problems in the development of a therapeutic alliance and in the multiple roles staff are required to assume. Our protocol was developed to keep treatment personnel in their usual roles so that their various treatment skills could be fully utilised. A physician treated the anorexia with naso-gastric feeding, freeing the psychotherapist to act in the usual manner. This avoided role confusion, and the split of ‘bad’ and ‘good’ treatment personnel was appropriate and therapeutic, rather than pathological. Four successful cases are described.

We present 11 pedigrees in which a propositus with Gilles de la Tourette's syndrome had first or second-degree relatives with obsessive-compulsive behaviour or agoraphobia with panic attacks, but only partially expressed the TS gene (i.e. had only motor tics or vocal tics, or neither). Of 90 females over the age of 18 presenting with TS, or with motor or vocal tics alone, nine had severe agoraphobia with panic attacks. There may be genetic subtypes of both obsessive-compulsive disorder and agoraphobia with panic attacks that are due to partial expression of the TS gene.

A community study on stroke registered 976 patients. Over 60% of survivors at three weeks, six months and 12 months after the stroke were assessed for depressed mood, using the Wakefield self-assessment depression inventory, and on other functional and social activities. At each point, 25–30% of those assessed were depressed; over 50% of patients depressed at three weeks remained so at one year. Factors associated with depression included loss of functional independence, a low level of other activities, a low reasoning ability, and being female and living with someone; path analysis showed that most depression was not explained by these factors. Few depressed patients at six months were on antidepressant medication.

Groups of organically and functionally mentally ill psychogeriatric day patients were assessed by the 37-item Roth-Hopkins test and the abbreviated ten-item Roth-Hopkins test. The scores correlated highly, correlation being equally good for both diagnostic groups. Among the functionally ill and the mild organically ill, scores improved between first and second test. The quicker, better tolerated ten-item test is a useful test of mental impairment for psychogeriatric patients in the community, as well as in institutional care.

There has been a recent renewal of interest in the use of monoamine oxidase inhibitors, but the concurrent administration of narcotic analgesics is often a cause for concern. This review clarifies the different types of MAOi/narcotic interactions and offers guidelines for the use of narcotic analgesics in the presence of MAOIs. The MAOI/pethidine interaction has two distinct forms: an excitatory and a depressive form. Pethidine must never be used in the presence of MAOIs because of the risk of a fatal excitatory interaction. Morphine does not cause this excitatory interaction, and is the drug of choice provided an allowance is made for possible potentiation of the depressive narcotic effect. It is inevitable that strong analgesia will occasionally be required as an emergency measure in patients on MAOIs, and insufficient attention is paid in psychiatric textbooks to the two different types of interactions and their therapeutic implications.

Seven patients suffering from severe endogenous depression who had proven resistant to lengthy trials of treatment with tricyclic and other antidepressants are described. Their successful treatment with a combination of clomipramine, L-tryptophan and lithium is discussed in the context of other strategies for the treatment of resistant depression.

A consecutive series of prison suicides in Scotland between 1970 and 1982 was examined. The initial phase of imprisonment was found to be the most vulnerable stage of confinement, with almost two-thirds of the deaths having taken place within the first month. A disproportionately high number were found to be on remand. A history of some form of psychiatric involvement was common, and a third of the group had received previous psychiatric inpatient treatment. In contrast to results from general population studies, there was little evidence to link suicide with a history of depressive illness. A record of problems with either alcohol or drug dependence was found in almost half the cases. The importance of general measures designed to reduce stress and promote coping mechanisms is emphasised.

We compared reality orientation with reminiscence therapy for elderly people in a large residential home, using a controlled cross-over design. Both kinds of therapy group were enjoyed by both staff and residents, and enabled staff to get to know moderately and severely confused residents. The group that received reality orientation followed by reminiscence therapy showed improvement in cognitive and behavioural measures which was not found in the other two groups. It may be important to use reality orientation techniques with confused residents before involving them in a reminiscence group.

Descriptive studies of a crisis intervention service replicated previous findings of relationships between staff members' attitudes towards treatment and their ‘personal styles'. The attitudes and personal styles of crisis team members and non-members differed, largely because of differences in the professions making up these groups. While all staff groups shared the same concept of crisis, they differed in their discrimination of crisis cases from ‘furores'. Initial crisis intervention interviews exhibited more confrontation and less exploration by therapists than did initial psychiatric out-patient clinic interviews. Patients referred to the crisis team differed from significant other people in their lives, and from control patients referred to the ordinary out-patient clinic, in aspects of their perception of problems.

The social and demographic characteristics, drug history and current levels of drug taking, drug-related illnesses, and criminal records of a one year cohort of attenders at the Southern General Hospital are described. The findings are compared with those of previous studies at the same clinic; made when methadone was prescribed for a limited period in reducing dosage and when this policy was being replaced by one of the use opiate-free drugs to cover withdrawal.

Electrical measurements were made during treatment of two groups of patients, one group receiving treatment from a constant current ECT machine and the other from a constant voltage machine. The electrical impedance and energy were calculated and compared for the two groups. More energy was delivered by the constant voltage than by the constant current machine, but the spread of energy delivered was comparable. With a consistent technique for applying the electrodes there is little to choose between these machines, but the constant current machine may be preferred where consistency cannot be achieved.

The use of an immunological metaphor allows the incorporation of established theoretical ideas about trauma and stress in an integrative way which enables delineation and illustration of several varieties of combat stress reaction, including subtle forms of that condition which do not often appear in post-traumatic stress disorder literature.