“To isolate and quantify possible determinants of any increased prevalence of depressive disorders in women we studied a select group of men and women, initially similar in terms of a number of putative social determinants of depression, and reviewed the sample five years later when social role diversity was anticipated. We used the Diagnostic Interview Schedule (DIS) to generate DSM–III and RDC diagnoses to estimate lifetime depressive disorders, and established (via corroborative reports) the likely accuracy of those data. Despite lifetime depression being a relatively common experience, no significant sex differences in depressive episodes were demonstrated, suggesting the possible irrelevance of biological factors in determining any sex difference. As there was not major social role divergence over the five year study, we interpret the lack of a sex difference as a consequence, and suggest that findings support the view that social factors are of key relevance in determining any female preponderance in depression described in general population studies.”

There is growing evidence for yoga's neurobiological effects in people with psychiatric disorders. Postulated mechanisms of action include: (a) modulation of the hypothalamic–pituitary–adrenal (HPA) axis; (b) enhancement of GABAergic neurotransmission; (c) autonomic modulation; and (d) neuroendocrinological effects. Yoga as a therapeutic intervention in psychiatric disorders appears promising and merits further attention in clinical practice and research.

Borderline intellectual functioning (BIF) is associated with several neuropsychological deficits. We used national data to establish the prevalence of psychosis and psychotic symptoms, and the role of potential mediators. The BIF group were more than twice as likely to have probable psychosis (adjusted odds ratio (OR) = 2.3, 95% CI 14−4.0) and to report hallucinations (adjusted OR = 2.9, 95% CI 1.9−44) but not persecutory ideation. Salient mediators were depressive symptoms and the cumulative total of life events. Our findings suggest mechanisms other than drug use that are contributing to the strong relationship between BIF and severe mental illness and that may be amenable to treatment.

Not everyone thinks that psychiatrists have much to offer in a discussion of dangerousness. The first point made by the advocates of this position is that psychiatrists get it wrong much of the time when they predict violence. The second point is that they do not use clinical information to predict. Exactly how much of the time they get it wrong is the subject of some debate. Those hostile to the idea of medical involvement in risk assessment argue that psychiatrists and psychologists are wrong 95% of the time when they predict violent behaviour (Ennis, 1972). Even sometime supporters of clinical intervention contend that psychiatrists and psychologists are wrong at least twice as often as they are right when they predict violence (Monahan, 1984).

The Mental Treatment Act of 1930 has brought within the purview of the mental hospital that large class of psychoneurotic and “early psychotic” patients who formerly drifted despairingly in the wilderness between orthodox medicine and the quack. The purpose of this paper is to show how an attempt is being made in this hospital to deal with this heterogeneous class of patients by means of psychotherapy, carried out by the ordinary medical staff of the hospital, without interference with their routine duties.

Trimble (1986) has pointed out a shortcoming of the current wave of literature on negative symptoms: there is no overall consensus within psychiatry as to which symptoms and signs are to be considered positive and which negative (Kayton, 1973; Carpenter et al, 1976; Sheldrich et al, 1977; WHO, 1979; Andreasen, 1979; Jablensky, 1981; Crow, 1982, this volume; Rosen et al, 1984; Zubin, 1985; Kulhara et al, 1986).

The formation of a therapeutic relationship involves the negotiation of a treatment contract which conforms to the general principles of any contractual agreement. Attempts have been made to formalize the therapeutic alliance, and this paper reports the development of a written contract for psychiatric in-patients.

Although chronic depressive illness has not attracted a great deal of attention, it is a source of considerable psychiatric morbidity in the community and occurs in a proportion of the new long-stay patients. Prior to the introduction of specific antidepressant treatments, figures for continued affective illness were high. Lundquist (1945) observed an overall recovery rate of 80 per cent for a first attack. Perhaps the best researched study is that of Winokur who followed up for between two and 20 years 225 depressive patients. He showed that 25–30 per cent of female depressives developed a chronic state, compared with 10 per cent of male patients (Winokur and Morrison, 1973).

Four children presented to child psychiatric clinics with a variety of symptoms. They were all later recognised as having Crohn's disease. There was a significant delay between the onset of symptoms and diagnosis, compared with a control group of patients with Crohn's disease whose presentation was with predominantly gastrointestinal symptoms, which was associated with evidence of increased morbidity. Children with abdominal and psychiatric symptoms occurring in combination need serial assessments of physical status, including height and weight, and measurements of inflammatory and nutritional status.

A double-blind placebo-controlled trial of L-tryptophan, with pyridoxine and ascorbic acid, was carried out in 10 female patients suffering from mania.

In contrast to earlier studies led by Prange and Murphy, L-tryptophan was found to be no better than placebo.

A case-control study was undertaken to evaluate the effects, if any, of sibship size, birth order and parents' age at birth on the risk of a person's developing schizophrenia. Information was obtained, during an 18-month period, from 221 schizophrenic patients in the only mental-health hospital of the region of Peloponese, Greece, and from an equal number of matched patients. The data were analysed by modelling through logistic regression. No relationship was found between the occurrence of schizophrenia in a patient and either father's or mother's age at patient's birth, or sibship size, or birth order, when demographic and socio-economic variables were accounted for in the analysis. Although patients with schizophrenia were of similar socio-economic status to the comparison patients, they came from families with higher original socio-economic status, a fact which appears to reflect the decline of both schizophrenic and pre-schizophrenic people in the social ladder.

Lipopigment, identifiable in the fluorescence microscope, is thought to be cellular debris partly derived from free-radical-induced peroxidation of cellular constituents. The volume of neuronal lipopigment has been positively correlated with advancing age, Alzheimer dementia, and the neuronal ceroidoses, while various changes in neuronal lipopigment have been reported in association with the chronic administration of dihydroergotoxine, ethanol, phenytoin, centrophenoxine, and chlorpromazine. An increase in the volume of neuronal lipopigment may indicate increased functional activity of the cell, impaired removal of pigment or anoxia. Chronic administration of agents which can be correlated with decreased neuronal lipopigment in animal models might protect neuronal function against any adverse effects associated with (but not necessarily resulting from) lipopigment accumulation in normal ageing, anoxia, or certain degenerative diseases. Long-term studies of the prophylactic use of such agents, or of drugs which neutralise free radicals, may be indicated. Other clinical applications of such drugs may include protection against the effects of free radicals formed during periods of oxygen deprivation.

Trifluoperazine, which is 2-trifluoromethyl-10-(3′-[1″-methylpiperazinyl-4″]-propyl)-phenothiazine dihydrochloride—a preparation manufactured by Smith, Kline and French Laboratories Limited under the description SKF5019—is the most recent phenothiazine derivative reported to have a beneficial effect on certain types of mental illness. On the basis of animal tests trifluoperazine is described as having nine times the potency of chlorpromazine in blocking the conditioned response, and its specificity is greater than that of chlorpromazine.

In a recent paper (1, 2) Abse elaborates at some length the psychological aspect of cardiazol therapy, and suggests, among other things, that “asa result of repeated danger-situations and perceptual stimulation repression and organization (synthesis) follow as a psycho-biological necessity. The convulsion gives rise to objective anxiety and repression results, so that the ego, whose function it is, may deal with the situation. There may be factors (e.g. quantitative) which make this desirable conclusion impossible to establish… . The physician can exploit his relationship to the patient to the latter's benefit… . and he (the physician) can increase his knowledge of the operative conditions in the patient's life by observation of the pre- and post-convulsive episodes.”

During the last decade prolonged narcosis has been accepted as a most valuable form of treatment in mental disorder, but many psychiatrists refuse to use it because of its dangers. The present paper presents clinical and laboratory evidence that a method has been devised whereby most of the toxic symptoms can be obviated. It is claimed that a large proportion of these symptoms are due to upset of carbohydrate metabolism of the liver and heart by the narcotic, and that in the administration of insulin and glucose as an integral part of the treatment a rational method of prevention has been evolved. No attempt is made to record the results of treatment, as it is proposed to publish this separately, the aim of the present paper being to show the elimination of toxic symptoms by the suggested modification of treatment.

The following account is based on the writer's experience of convulsion treatment at centres abroad, on a review of the literature up to the present date, and on three cases recently treated at West Park Hospital, Epsom. It is published at this early stage in order to make a knowledge of the technique and literature of a method which has already proved itself worthy of extensive trial, available to a larger number of workers in this country.

Culture in its anthropological sense has been described as “a configuration of learned behaviour and results of behaviour whose component elements are shared and transmitted by members of a particular society” (Linton, 1936); in other words, a way of life. It has long been understood that more than one type of culture may be found in any one society. All societies are stratified and in an industrial society people of different levels have different ways of life. These are subcultures.