This report of about 150 children is based on recent experience gained in the Maudsley Hospital Children's Department, in which epileptic children are investigated at special sessions. Most of the patients were examined in the usual way on their first visit to the Department. A full psychiatric history was taken from the mother or other relation. Intelligence tests, electroencephalogram (E.E.G.) and physical examinations were carried out. Later, as indicated, further special tests, such as air encephalograms, were done.

It is important to note the type of patients discussed in this report, in view of the notorious difficulty of obtaining reliable statistics in such a subject as epilepsy, whose manifestations are so varied that any one hospital or clinic cannot expect to see a truly unbiased sample. Children referred to the Maudsley Hospital nearly always show some behaviour disorder, but lack gross neurological signs and symptoms. Even in the case of epileptics a behaviour problem is frequently the presenting complaint, the actual seizures being a secondary problem. As the facilities for investigation are better than in many other clinics, cases are frequently referred from other hospitals for special investigation. This material, therefore, is undoubtedly heavily weighted by epileptics with behaviour problems. There are, on the one hand, disproportionately too few mentally normal children with epilepsy, and on the other, too few with epilepsy in association with grosser neurological disorders. No attempt is made, therefore, to give any statistics on the incidence of a particular symptom or sign within this group, as it is meaningless in relation to the whole body of epilepsy in children. The recent outstanding book by Bridge (1950) gives a very fair picture of epilepsy in childhood.

The aetiological factors may be divided into two groups: those within the social situation and those within the child.

The activities of the A and B forms of the enzyme monoamine oxidase (MAO, E.C. 1.4.3.4) have been assessed with the substrates 5-hydroxytryptamine and benzylamine respectively in seven areas of the brains of 39 patients with schizophrenia and 44 control subjects. Whereas previous studies have found the enzyme unchanged in brain in schizophrenia, in this study there was a modest but significant decrease in the activity of MAO-B in frontal and temporal cortices and in amygdala. This decrease could not be accounted for by neuroleptic medication, age, sex or post-mortem variables. In a series of 22 patients who had been assessed in life, the reduction in MAO-B activity was found to be associated specifically with the presence of negative symptoms (flattening of affect and paucity of speech). The findings are therefore consistent with other evidence for structural and neurochemical change in the temporal lobe that have been associated with the type II (defect state) syndrome of schizophrenia. The change in enzyme activity is unlikely to be related to a change in monoamine metabolism but may reflect a disturbance in glial function. The change in MAO-B activity in brain in this study is confined to particular areas of brain and a subgroup of patients; it is thought to be entirely unrelated to earlier reports of reductions of enzyme activity in platelets, which are probably attributable to prolonged neuroleptic medication.

Those who were labelled as depressives in a rural survey were randomly divided into a Medicine group (who received antidepressive drug treatment), a Placebo group (who received placebo) and a Natural Process group (who received no treatment). The depth of their depression was assessed by Hamilton's Depressive Rating Scale before the beginning of the trial, on the 14th day and on the 28th day of trial. They were compared with a matched group of healthy controls and again with a matched group of depressives who attended an urban clinic for treatment.

The results indicate that the rural depressives who never sought treatment voluntarily were not different from those who sought treatment in clinics, so far as their response to treatment is concerned.

Three cases of self-inflicted eye injuries are described and discussed. A review of the literature shows that several psychiatric diagnoses have been assigned to those who mutilate their eyes, and various unconscious mechanisms proposed to explain this unusual phenomenon.

Re-examination of the various problems arising from psychoses following childbirth is of interest for various reasons. Firstly, their place in the system of psychiatry is far from clear; their original description under the term “puerperal insanity” (Kraepelin) had given rise to the idea that they represented a clinical entity. According to Kraepelin the great majority of these psychoses take the form of catatonic states and only a few are of the manic-depressive group. More recent investigators, however, have shown that there is no psychotic reaction peculiar to childbirth (Clarke, Kilpatrick and Tiebout, Zilboorg, Saunders, James, Strecker and Ebaugh, Harris, Karnosh and Hope, and Piker). In these contributions the importance of the accompanying environmental and sociological factors has also received consideration.

“This paper discusses the advantages and disadvantages of case management systems for the co-ordination of care of people with long-term mental illness living in the community. Many of the principles are equally applicable to other client groups with long-term needs, e.g. elderly people or people with learning difficulties. Some of the historical background to the emergence of case management concepts is discussed, culminating in the recent White Paper on Community Care. The underlying concept of case management is examined, together with a number of fundamental questions concerning who should act as case managers, what kinds of training they will require, problems of inter- and intra-agency co-operation, and the empirical evidence regarding its effectiveness. It is concluded that case management could be an important element in a comprehensive range of mental health services, but it is not a substitute for basic community provisions.”

Anyone acquainted with Dr Thomas Szasz's previous writings about mental disorder, the nature of its relationship to the Law and to the problems of drug dependance (Szasz, 1961, 1963, 1970, 1972, 1975) has learned to look in the first instance for the dualism, the poles of which are to be demonstrated as irreconcilable. For, as Glazer (1965) has pointed out, one of Dr Szasz's main conceptual devices is ‘the dichotomy game‘. A phenomenon may belong to category (x) or another category (y) but not to both. As a first step it is as well to examine the definitions of the categories in question. They are liable to prove inconsistent or idiosyncratic or just to be omitted. In other cases, as Professor Stone (1973) has shown in his detailed and telling dissection of the tortuous and confused logic pursued by Dr Szasz in The Myth of Mental Illness, the definitions are incomplete or erroneous and the implied anti-thesis dubious or false. Beginning with the equation that a lie is to a mistake as malingering is to hysteria, Szasz manages, following a maze of tortuous and self-contradictory arguments, to emerge at the conclusion that it would be ‘… more accurate to regard hysteria as a lie than as a mistake‘.

Currently available antipsychotic drugs target dopaminergic neurotransmission. Many patients do not respond fully to these treatments, and there has been considerable effort to investigate alternative targets. Here we summarise the rationale and recent evidence supporting efforts to develop glutamatergic antipsychotic drugs.

It has been suggested that a dimensional model of personality pathology should be adopted for the development and refinement of personality disorder classification. In this article, the advantages and challenges of moving toward a dimensional model are briefly reviewed. However, it is suggested that although categories and dimensions are valuable frameworks for personality pathology diagnosis, an expansion beyond categories and dimensions is needed to improve the shortcoming seen in current diagnostic systems. Ideas and examples are offered for how this might occur.

Two series of patients with epilepsy and with febrile convulsions were analysed on Slater's computational model for evidence on the mode of inheritance. The study demonstrated that in both series a polygenic inheritance may be more likely than an autosomal dominant or recessive inheritance.

1. 1. The clinical functioning of the Young People's Unit, Edinburgh is described. This involves a relatively permissive, democratic ‘milieu‘. Psychotherapeutic efforts are devoted to the resolution of family psychopathology and the achievement of maturational progress for the adolescent.

2. 2. Data on the first seventy admittions to the Unit were examined. Two-thirds of the patients were diagnosed ‘developmental crisis’; the majority of these also had a personality disorder.

3. 3. Assessments of family functioning showed high levels of disturbance and psychiatric morbidity among the parents. The adolescents had mutually good, positive relationships with their opposite-sexed parents, but markedly negative ones with the same-sexed parents. This was not in accordance with the usual findings in ‘normal’ families. Delinquent and impulsive patients showed uniformly negative family attitudes.

4. 4. A simple estimation of treatment outcome at discharge gave results comparable to those of other units, with 70 per cent of patients rated as improved. Neurotic and psychotic patients had a relatively better outcome. Tension-discharge personality disorder and a history of very disruptive or antisocial behaviour were associated with poor outcome.

5. 5. The poor response of very disturbed, impulsive adolescents to this type of therapeutic regime is discussed. These individuals do not appear to have sufficient personality resources and organization to benefit from this type of treatment. Emerging from this is a suggestion for an increased provision of specialized units offering containment and intensive care to the very disturbed adolescent.

Before discussing the relationship of the temporal lobes to the body image, it is necessary to consider briefly some other aspects of the neurology of body image and its disturbances. Further, some clarification of the term body image is required.

Thirty-nine patients with DSM–III diagnoses of schizophrenia were examined for age disorientation, an inability to produce one's correct chronological age upon request. Six patients were age-disoriented and demented (as defined by Mini-Mental State evaluation), while two patients had delusions concerning their age, but were not demented. Age-disoriented, demented patients had very large cerebral ventricles and very low Mini-Mental State scores. This group differed on the cognitive and neuroanatomic variables from other demented, but not age-disoriented, patients, as well as from non-demented patients who were age-oriented. The age-disoriented patients appeared to be at an extreme end of the dementia spectrum in schizophrenia.

Amitriptyline (Tryptizol) is an antidepressant drug which is related structurally to imipramine (Fig. 1). Its full name chemically is 5-(d-dimethylaminopropylidene)-dibenzo (a,d) (1,4) cycloheptadiene hydrochloride. Numerous uncontrolled trials to date (Ayd, Bennett) have reported success with this drug in the treatment of both endogenous and reactive depressions. Several reports (Ayd, Dorfman, Dunlop) have stressed the fact that agitation as a manifestation of depressive illness is frequently relieved. The purpose of this study was to assess the effect of the drug on depression in a controlled trial.