Temporal arteritis, also called giant cell arteritis, or cranial arteritis, was first described in 1932 by Horton and Magath. This syndrome is caused by a reversible inflammation of the cranial arteries, especially the temporal arteries (which are visibly inflamed), causing headache, mental and neurological disturbances as well as general toxic signs, and almost always occurring after the age of fifty-five years.

Pathology.—In the arteries involved there is a subacute inflammation of the adventitia and media with focal necrosis of the media, fragmentation and destruction of the internal elastic lamina with gross hypertrophy of the intima, often leading to occlusion of the vessel. In many cases giant cells are found in the media. Besides the cranial arteries other vessels are sometimes involved, e.g., the carotids (Scott and Maxwell 1941; Gilmour 1941), subclavian, coronary and femoral arteries (Cooke et al., 1946), post-auricular (Dick and Freeman 1940).

Aetiology is unknown. There is no evidence of tuberculosis or syphilis. A low-grade bacterial or virus infection of the arteries has been postulated, but repeated bacteriological examinations of the biopsied arteries have failed to isolate any organisms. The predilection which the condition shows for the temporal and cranial arteries is unexplained.

Background. Cost containment mechanisms, such as prepayment, are being considered or implemented in the US and elsewhere, but there have been few studies of the effects of such mechanisms on quality or outcomes of care for individuals with serious psychiatric disorders.

Method. Key results from US studies on cost containment and their implications are reviewed.

Results. Cost savings in out-patient mental health care can be achieved through increasing the share of costs paid by the covered individual or through prepayment, but individuals with the greatest psychological distress or poor people may achieve worse outcomes under greater cost containment. Quality of care may be poorer under some forms of prepayment than under fee-for-service care, yet a national prospective payment mechanism for depressed elderly in-patients was not associated with a marked drop in quality or outcomes of care among those admitted.

Conclusions. Prepayment, relative to fee-for-service is not always associated with lower outcomes or quality of care for affective disorders. Under cost containment, quality and outcomes of care, especially for the sick poor, should be monitored to identify adverse consequences.

The socio-demographic and clinical characteristics of patients attending psychiatric day care in an inner-urban catchment area were assessed using structured techniques. The overall prevalence of the use of day care was high (164 per 100 000 total population), and 86% of attenders were in prolonged psychiatric contact. Of those in prolonged contact, the clinical and social morbidity of 68 attenders at National Health Service day hospitals was strikingly similar to that of 42 attenders at other units. Users of a ‘community mental health centre’ and two work centres were less disabled than attenders at other day units. Implications of these results for the organisation of day services and training of staff are discussed.

Since the inception of the use of artificially induced convulsions as a therapeutic agent in 1935 by Meduna and the modification of this method of treatment by the use of electric currents by Cerletti and Bini in 1938, a vast literature has accumulated on this form of psychiatric treatment. Yet, despite this vast literature and the passage of over 30 years of experimental opportunity, no predominant or convincing rationale for the use of electroconvulsive therapy (E.C.T.) has emerged; Meduna's (53) original theory of the incompatibility of schizophrenia and epilepsy having been long discredited. E.C.T. remains, therefore, an empirical form of treatment.

Background. Most mental illness is treated in primary and not secondary care settings, with depression and anxiety the commonest conditions encountered.

Method. The paper describes on-going Department of Health initiatives to optimise the primary care of common mental illnesses such as depression.

Discussion. Primary care attenders with depression are often higher consumers of general health care than non-depressed attenders. Further data will become available soon from these ongoing studies to inform the debate on the optimal use of available resources in primary care. There is a particular need to evaluate non-pharmacological interventions in primary care.

Several cases of increases in frequency of mood cycling have recently been reported in women as a result of tricyclic antidepressant treatment (Siris et al, 1979; Wehr and Goodwin, 1979). We report here the occurrence of 48-hour rapid cycling in a man with recurrent unipolar depression after treatment with dibenzepin (Noveril), an atypical tricyclic antidepressant. Alterations in urinary cyclic adenosine monophosphate (AMP) have been reported with mood changes and were therefore evaluated at the same time.

When Kraepelin formulated the concept of dementia praecox, he lumped together a number of diagnostic categories. One of his reasons for doing so was that he had seen many patients who ended up in the same kind of demented state, even though their initial symptoms might have been quite different. He noted that even some cases presenting with mania, or melancholia, took the same downhill course as did the more classic cases of dementia praecox. Kraepelin, aware of the striking paradigm of general paresis, stated that “a single morbid process” explained the downhill course (Kraepelin, 1983, p. 68).

Clozapine has been endorsed by national clinical guidelines for 10 years and yet underutilisation and delay to initiation remain rife. Although there will be good clinical reasons for clozapine not being initiated for some patients, it is hypothesised here that for others, clinicians' attitudes and preferences are the most likely predictive factors.

A case of delusional parasitosis is presented in which a patient with classic symptoms of six years' duration responded to pimozide. Similarly chronic cases may be responsive to pimozide.

In 2018, India's Mental Healthcare Act 2017 granted a legally binding right to mental healthcare to 1.3 billion people, in compliance with the Convention on the Rights of Persons with Disabilities. Many countries, including the UK, ratified the Convention but only India has stepped up to the mark so dramatically.

The prevalence of Klinefelter's Syndrome in new-born males in large surveys throughout the world has shown a scatter of 1.4 to 1.9 per thousand. Forssman (1970) accepted by pooling results a figure of 0.17 per cent as the average proportion of males born with at least one too many X chromosomes in some or all cell lines. Studies of mental hospital populations have consistently shown a higher prevalence of extra X chromosomes in males, averaging 0.54 per cent. The two largest studies, in Great Britain (Maclean et al, 1968) and in Sweden (Hambert, 1966) made no differentiation in the psychiatric diagnosis of the patients, although Hambert stated that the high prevalence did not stem from the mentally retarded population.

The general aim of the experiment was to discover whether, during an interview directed at discussing the patient's life, there was any significant alteration of blood-pressure, heart rate or brain waves in association with emotional content; as it turned out, changes in blood-pressure proved to be the most rewarding field for study and in consequence this aspect was accorded more attention.

Progress in developing personalised care for mental disorders is supported by numerous proof-of-concept machine learning studies in the area of risk assessment, diagnostics and precision prescribing. Most of these studies primarily use clinical data, but models might benefit from additional neuroimaging, blood and genetic data to improve accuracy. Combined, multimodal models might offer potential for stratification of patients for treatment. Clinical implementation of machine learning is impeded by a lack of wider generalisability, with efforts primarily focused on psychosis and dementia. Studies across all diagnostic groups should work to test the robustness of machine learning models, which is an essential first step to clinical implementation, and then move to prospective clinical validation. Models need to exceed clinicians’ heuristics to be useful, and safe, in routine decision-making. Engagement of clinicians, researchers and patients in digitalisation and ‘big data’ approaches are vital to allow the generation and accessibility of large, longitudinal, prospective data needed for precision psychiatry to be applied into real-world psychiatric care.

Theoretical models ranging from neurological to analytical have been introduced in the hope of providing new insights into psychopathology. The flesh and blood model is of more recent origin in this field. The experimental or model psychosis results from giving “normals” drugs which bring about a psychotic-like experience for a few hours. As is the case with theoretical models, the flesh and blood models are not accurate representations of the naturally occurring psychosis. In fact, the variability manifest in most naturally occurring psychoses makes the existence of an accurate model impossible. A model, whether carefully planned and developed or accidentally discovered, is useful to the extent that it assists us in better understanding the naturally occurring process it approximates. It is useful if it enables us to set up and test hypotheses which contribute additional knowledge about disease aetiology, mechanisms, or treatment. The model psychosis to be studied in this paper is that produced by lysergic acid diethylamide (LSD).

The Uffculme Day Hospital was opened some two and a half years ago as part of an experimental scheme to treat psychiatric patients outside the confines of a mental hospital. The plan was to admit a small number of patients and gradually to develop and organize a group therapeutic technique in the light of experience. It was hoped that a Day Hospital conveniently situated within a large industrial city would help to meet an increasing need for diagnostic and therapeutic facilities. It might find a solution for those patients who could not be adequately treated as out-patients and yet were not likely to benefit from admission to already hard-pressed and overcrowded mental hospitals. While the present Day Hospital scheme is too small to have a significant influence on the total psychiatric problems of some one million and a half people living in the vicinity, it has so far shown signs of being a welcome addition to the mental health services of the region.

In the earlier papers of this series Stephenson has already reported an experiment in psychiatry, in which patients at Horton Mental Hospital have been tested by psychologists of the Spearman School of Factors.∗ The p-factor has been introduced and its contact with psychiatric material developed. The present paper serves to introduce the general factor in cognition (“g”), and to indicate the significance of measures of the g-factor for psychiatric research.

The autosomal dominant mode of inheritance of Huntington's Chorea (HC) has been established for over 100 years. Strong psychological defences against the acceptance of this knowledge are commonly found both in professionals and in Huntington families and relatives who are at risk. One consequence of maintaining these defences is the continuing transmission of the gene, and therefore the disease, to succeeding generations. The defences of professional persons protect them from the difficult and unsettling task of providing genetic counselling to healthy relatives at risk. An increase in awareness of the psychodynamics involved may lead to constructive thinking about the current deficiencies in care and counselling services provided for these families.