There has been attention drawn recently to those parents who deliberately harm their children in relatively unusual ways such as poisoning (Rogers et al, 1976; Lorber et al, 1980; Kempe and Heifer, 1980). Prognosis has been poor, with a high mortality rate for the children unless removed, and parental denial precluding any form of family rehabilitation.

In good health care systems, the planning and purchasing of services for individual people should be based on individual needs assessments and outcome expectations. No two patients or users of a given service or programme are likely to present exactly the same symptoms or needs, or to experience exactly the same outcomes. They will have different personal and family circumstances, resources and preferences. Consequently, service responses should rarely be exactly identical.

The effect of long-term lithium treatment on the kidneys has generated concern among psychiatrists, and proposals have been made that routine determinations of serum lithium and serum TSH should be supplemented with control of the kidney function through regular determinations of serum creatinine, glomerular filtration rate, and renal concentrating ability, as well as through kidney biopsy in certain circumstances.

In a recent review (Dewhurst, El Kabir, Harris and Mandelbrote, 1968) the evidence relating the effect of stress to thyroid function has been surveyed. In that account the comment was made that although it is impossible to assess or quantify the psychological trauma that any mentally ill patient is undergoing, it would seem reasonable to assume that if emotional stress is associated with abnormal thyroid activity, then a study of thyroid function in mentally ill patients would reveal such abnormal activity. In the present work a study has been made of the function of the pituitary–thyroid axis in control subjects and in patients suffering from schizophrenia and affective illnesses. Since there is strong evidence that emotional stress in many cases affects endocrine function through the mediation of the hypothalamus and anterior pituitary gland, measurement of the blood concentration of thyrotrophic hormone (T.S.H.) has been used in the present investigation. A further reason for assaying the blood concentration of T.S.H. is that measurement of many of the more direct parameters of thyroid function are subject to variables which are difficult to control. Studies of the blood level of T.S.H. in psychiatric patients have not, so far as we know, been carried out previously.

Obesity, one of the major threats to health and longevity in Western society, is usually treated with some form of weight-reducing regime. However, in recent years several authors have cautioned against the widespread prescription of reducing diets for obese patients because of the danger of inducing severe depression. The present investigation was undertaken to determine the actual risk of such severe depressive illness occurring among a group of obese dieters attempting weight reduction under the supervision of their general practitioner.

There have been many studies (3,15,4) on the effects of oral contraceptive hormonal agents, though relatively few have concerned themselves with the possible adverse emotional reactions accompanying their use. To date, seven women (8, 6, 5, 13) have had psychotic episodes in temporal association with drug use, one patient having reported two such episodes. Four of these seven women had a history of severe postpartum disturbance in the past, and two others had previous psychiatric illness. There have been reports of varying incidence of depression, anxiety, increased or decreased sexual desire and relief of premenstrual tension. We wish to present data from a pilot double blind study of one combination oral contraceptive.

Current planning in the field of the community mental health services places considerable emphasis on the after-care of patients discharged from hospital. This is partly in response to the high re-admission rates experienced as a result of the “revolving door” policy, partly to a scepticism about the present state of knowledge regarding factors amenable to primary prevention techniques, and partly to a belief that keeping the patient in the community is in itself beneficial both to the patient and to the community. The benefits of such a policy are felt to lie in avoidance of institutionalization and furthering of rehabilitation, and in preventing a re-distribution of roles within the family to exclude the patient. The primary purpose of the policy is not necessarily to cut short the illness of the patient, at least as measured by time under treatment, and evidence will be given below to suggest that in fact time in treatment is prolonged. This study focusses on one issue. Can aftercare in fact prevent re-admission to hospital to any significant extent? In view of the complex nature of the decision to select which patients are to receive after-care and which not, a factor in itself likely to prejudice any results, successive discharges from a psychiatric hospital falling within selected categories were randomly allocated to psychiatric after-care and to their general practitioner, and followed for a six-month period. A null hypothesis was set up that the re-admission rate during the follow-up period would not significantly differ in the two groups.

Most people with schizophrenia live in low- and middle-income countries in which clinicians/policy makers are not the first targets of marketing. Because it is years after a drug is first launched that the full effects become known with confidence, the evidence upon which to base practice in low- and middle-income countries may be less biased than that in richer nations.

Factors from the social history of male psychopaths were examined in relation to their success or failure as measured by re-convictions or psychiatric hospital re-admissions 2–3 years after treatment at Henderson Hospital. From these data a weighted prediction formula was calculated and was tested out on a further cohort of patients. As a prediction instrument it was found to be reliable to a degree of significance just above the 1 per cent level. Other aspects of the subsequent career of treated patients are noted, in particular a tendency to early but often short-lived relapse and then longer standing success.

The current wisdom in psychiatric rehabilitation suggests that social and instrumental skills training combined with judicious neuroleptic therapy, prosthetic environments, and assertive case management confers the greatest degree of protection from relapse while promoting an optimal quality of life for patients suffering serious and long-term mental illness.

A cross-sectional study of 3426 referred children and adolescents showed that the presence of both migration history and family dysfunction was associated with a fourfold (95% CI 2–9) higher risk of psychotic symptoms compared with the absence of these factors. The relative risk was 2 (95% CI 1–4) for migration history only. Interaction between migration history and family dysfunction accounted for 58% (95% CI 5–91%) of those with psychotic symptoms. These results suggest a relationship between family dysfunction and migration in the development of psychosis.

Adults with neurodevelopmental disorders frequently present to, but fit uneasily into, adult mental health services. We offer definitions of important terms related to neurodevelopmental disorders through unifying research data, medical and other viewpoints. This may improve understanding, clinical practice and development of neurodevelopmental disorder pathways within adult mental health services.

When 20 female anorexic in-patients were investigated with weekly DSTs, 10 had an abnormal result at initial testing. There was no identifiable relationship between severity of weight loss and DST status; % ideal body weight was no different between suppressors and non-suppressors. There was no consistent relationship between normalisation of the DST response and weight gain. Depressive symptoms were common, with half the patients scoring 20 or more on the HRSD. Plasma ACTH concentrations before and after the DST were normal. There was a significant negative correlation between plasma dexamethasone concentrations and pre- and post-dexamethasone plasma Cortisol concentrations.

A clinical relationship between obsessional illness and epilepsy is unusual, but the few electroencephalographic (EEG) investigations of obsessional patients which have been published claim a high incidence of abnormal electrical activity. Records of twenty-six neurotic and five schizophrenic patients, all with obsessional symptoms, were examined by Pacella et al. (13), who found twenty-two of the thirty-one EEGs to be abnormal. Fourteen showed definite convulsive patterns with frequent 2–4 c.p.s. activity and increased high voltage waves after overbreathing. Rockwell and Simons (14) found only two abnormal records in eleven uncomplicated obsessional neurotics, using Gibb's criteria of normality, but of ten patients classified as psychopathic personalities with obsessional symptoms, all had abnormal EEGs although two were borderline. Their definition of psychopathic personality is not made explicit and the clinical distinction between their two groups is unclear. Jarvie (4) reports a case in which slow activity on hyperventilation in the EEG was associated with phobias and obsessional impulses preceded by a two-year history of episodes of rage.