It has long been recognised that the neuroglia presents difficulties of a very special kind in the way of its histological study. These difficulties are due mainly to the remarkable lack of affinity shown by its extra-nuclear part for the usual staining reagents. No histological method that has yet been described serves in a satisfactory manner for the complete investigation of this tissue in its normal and pathological states. The most generally serviceable at present in use is, I think, beyond all question the fresh method of Bevan Lewis. It at least furnishes us with a reliable test for the presence or absence of hypertrophy and sclerosis; but it does not give a complete or clear view of the normal tissue, the fibres remaining for the most part invisible (except in tissues from some of the lower animals), and the nuclear structure being quite obscured. Golgi's method gives us only a silhouette of a small proportion of the neuroglia-cells and fibres. It does not aid us in the solution of questions regarding nuclear and protoplasmic structure. Weigert's new method gives us a very clear view of the fibres and nuclei, but it leaves the protoplasm invisible in the normal state. Its chief deficiency, however, consists in the fact that its use is restricted to the fresh human brain. It is of little value for ordinary postmortem-room tissues, or for those of the lower animals. Other methods that might be mentioned are likewise imperfect in their results, or extremely limited in their utility. In these circumstances it is scarcely surprising that there is still the widest difference of opinion among the recognised authorities regarding the normal structure of the neuroglia. Yet until this question is carried beyond the stage of controversy it is obvious that all our views of the pathological changes occurring in the supporting tissue of the central nervous system must remain vague and unscientific.

A national survey in 1997 found that Australia had a high prevalence of mental disorders with low rates of treatment. Since then, treatment availability has increased greatly and unmet need has reduced. However, there is little evidence that the nation's mental health has improved.

Mentally handicapped people are increasingly being subjected to the stresses of everyday life, and bereavement represents a particularly potent stress. This report considers the case of a mentally handicapped woman whose difficulty in mourning and expressing and sharing grief had a profound effect on her recovery from bereavement and led to her developing an affective psychosis.

The relationship between neurotransmitter metabolite concentrations and measurements of ventricular size on CAT scans and pneumoencephalographs was investigated in 15 patients with severe affective disorder. An association was identified between reduced levels of plasma free tryptophan and ventricular enlargement and also between raised ventricular CSF levels of 5 HIAA and ventricular enlargement.

A mother and her son shared delusional beliefs that doubles of themselves existed and that they were being harassed by the police and social and educational services. The nature of these ‘double double’ symptoms is discussed.

The association of attentional, neuropsychological, and behavioural abnormalities with Tourette's syndrome (TS) suggests that the abnormal function of the disorder extends beyond the motor circuits of the basal ganglia. To explore this possibility we studied, with conventional 18-channel electroencephalography, monozygotic twins ranging from 8 to 26 years of age, where at least one member of the twin pair suffered from TS. In nine out of the 11 twin pairs that differed in clinical severity of the tic disorder, the twin with the more severe course of illness had a significantly more abnormal electroencephalogram (EEG) by qualitative visual analysis. Most of the differences were due to excessive frontocentral theta activity, suggesting dysfunction outside the basal ganglia. There was also a significant relationship between a lower global neuropsychological testing score and a worse overall EEG. In eight of nine twin sets with different global neuropsychological testing scores, the twin with the lower score had a worse EEG. A similar relationship was found between birth weight and overall EEG quality. In the nine sets that differed in birth weight, the twin with a lower birth weight had a worse EEG in seven of the sets. The EEG findings are unlikely to be a medication effect because the same result was seen in the six twin pairs who had been medication-free for at least six months before entry into the study. The origin of this slowing may relate to the interaction between environmental insults to the central nervous system and the genetic component of TS, an interaction producing damage to the cortex, thalamus, or both.

A patient with chronic depression responded to treatment for her major depressive episodes, but was left with a dysthymia which was eventually relieved by anticonvulsants. Sodium valproate may be of use in a range of affective disorders.

Two repertory grids relating to body image and interpersonal relationships were administered to dysmorphophobic, psoriatic and control subjects. Both dysmorphophobics and psoriatics expressed dissatisfaction with their body image and, in addition, dysmorphophobics were dissatisfied with their interpersonal relationships. The dysmorphophobic group were also less happy with their self-concept than the other two groups.

A group of normal women and a group of women in hospital for treatment of a neurosis but without a disorder of eating were compared with a group of anorexic patients in terms of their attitudes to weight. All subjects completed a rank order form of repertory grid. Differences in construct patterning between the anorexic patients and the other female groups could not be accounted for by social class, age or neurotic disorder. The most psychologically significant finding was a positive correlation between the constructs self at normal weight and ideal weight instead of a negative correlation which clinical experience would lead one to expect. Four explanations are proposed to account for this finding.

The point-prevalence of tardive dyskinesia in schizophrenics from a discrete geographical area (Nithsdale, in Dumfries and Galloway Region) in 1981, 1982, and 1984 was 31%, 27%, and 30% respectively. This suggests that the prevalence of tardive dyskinesia in a community of schizophrenics has reached a plateau. In 12% of patients there was persistent dyskinesia, i.e. abnormal involuntary movements were present at all three assessments. Persistent dyskinesia was more common in older patients. The severity of tardive dyskinesia fluctuated between assessments in 41 % of patients, indicating that it is only a transient feature in some cases.

Mental handicap includes specific behavioural phenotypes apparently caused by single enzyme errors or deletions, for example, compulsive self-mutilation and hypoxanthine-guanine phosphoribosyl transferase deficiency in the Lesch-Nyham syndrome. In Down's syndrome, the possession of additional genetic material is found to be linked to various physical abnormalities (premature cataract formation and hypothyroidism). These close associations between types of behaviour, illnesses, and known genetic abnormalities offer promising avenues for research. In this article we concentrate on the well known link between Down's syndrome and presenile dementia.

The case of a young, unmarried boy, who had moderate mental retardation, epilepsy, and post-ictal psychosis, is described here. During the psychosis, he believed he was pregnant, and had related behavioural disturbances. The review of other such cases reveals that organic brain damage was evident in all cases. Brain damage seems to be the more likely causative factor than psychodynamic factors.

One of the problems with the administration of unilateral ECT is to select the correct side for giving the treatment. If it is given routinely to the right side of the head, a proportion of patients will receive ECT to the dominant hemisphere, which is more unpleasant for the patient and more disruptive of memory than even bilateral ECT (Halliday et al., 1968; Fleminger, Horne and Nott, 1970).

First rank symptoms have assumed an important role in the assessment of schizophrenia. Only recently, however, have there been empirical studies of their reliability and validity. In this study, we examined the relationship between first rank and other psychiatric symptoms in 100 schizophrenic patients. The results are consistent with other research reports suggesting that first rank symptoms do not represent a homogeneous group of symptoms within an individual patient.

A case of rabbit syndrome, a complication of long-term neuroleptic medication, is reported. It is important to differentiate it from tardive dyskinesia and continuous therapy with an antiparkinsonian agent may be required for control of symptoms of rabbit syndrome.

Darwin's On the Origin of Species was published 150 years ago, but evolution is just now being recognised as the missing half of a truly biological psychiatry. The general framework offered by an evolutionary perspective may be as valuable as its specific applications.

When does a therapeutic intervention become an accepted part of standard clinical practice? Is it when there is sufficient research evidence? But what constitutes ‘sufficient’? What about available resources and acceptability to patients? Do we have to wait until the National Institute for Clinical Excellence pronounces? A convincing evidence base for family work in schizophrenia (Kuipers, 2000) has existed for many years but has been poorly implemented (Anderson & Adams, 1996). Will cognitive-behavioural therapy (CBT) for psychosis suffer the same fate? Which professional group will champion such an implementation? The evidence for other psychological treatments is less robust. Psychoeducation may prolong time to relapse and improve insight but at the cost of increasing suicidal ideation (Carroll et al, 1998). Personal therapy (Hogarty et al, 1997) may be of value but is contra-indicated for patients who are living alone in the community. Psychodynamic approaches are advocated (Mace & Margison, 1997) but most psychiatrists do not support their use in practice, owing to lack of evidence of efficacy.

Charcot was the first to notice the occurrence of amnesia in some of his patients suffering from alcohol-neuritis. Korsakow studied this peculiar kind of amnesia more elaborately. He regarded this condition as a disease sui generis, which could arise also from other causes besides abuse of alcohol, and used the name “polyneuritic psychosis.” It was later recognised that the same mental picture could exist without accompanying neuritis. Jolly proposed the name “amnestic” or “Korsakow's” syndrome, regarding it as a modus of reaction of the nervous system to various harmful agents, viz., head-trauma, senium, infections, poisons—alcohol being the most frequent cause of this reaction. Most later writers agree with this view. I shall deal in this paper with the cases of thirty patients, who, at some time during their illness, presented this syndrome; I have not included any cases in which alcohol could not be regarded as the principal factor.

Recognising confusion as an antecedent to NMS may help abort the full-blown syndrome. Two such cases are reported, along with a third.