A young man aged 23 made contact and asked to talk about an adverse drug reaction. He had been puzzled and frightened by what had happened to him and although he was a very experienced drug-user he had not fully realized that a drug could cause such consequences—he had feared that he was going mad. He came along not as ‘a patient’ but because he believed that he had something to tell which might add to medical insights.

A questionnaire was sent to 274 doctors and nurses. The first section was to see if certain symptoms and signs elicited the description of patients as ‘confused’, and the second to discover the respondents' definitions. The results showed a marked discordance in health workers' understanding of this word ‘confused’ in reference to patients, and it is suggested that it should only be used if it is clearly defined.

It has become customary to classify the typical abnormalities of the mental state of schizophrenic patients into positive and negative features, with reference to behavioural excesses and deficits. Positive features are pathological by their presence and negative features represent the loss of some normal function. Positive features are generally considered to include delusions, hallucinations and positive formal thought disorder (Fish, 1962). Some studies (e.g. Johnstone et al, 1978) have also included incongruity of affect under this heading. Negative features include affective flattening, poverty of speech, retardation, apathy, lack of sociability. There is some evidence that the clinical correlates of positive and negative features may not be the same (Owens & Johnstone, 1980). Some workers (Andreasen & Olsen, 1982) but not others (Pogue-Geile & Harrow, 1984) have found that among schizophrenic patients positive and negative symptoms were negatively correlated. Although the nature of the relationship between positive and negative features is not entirely established and may not be simple (Wing, 1978) certain generalisations may be applied:

1. (a) Positive features are characteristic of earlier and negative of later phases of the illness (Pfohl & Winokur, 1982).

2. (b) The effects of drugs upon positive features are greater than those upon negative features. Thus neuroleptics produce more marked improvement (Johnstone et al, 1978; Angrist et al, 1980) and amphetamine more marked exacerbation (Angrist et al, 1980) of positive than of negative features.

3. (c) Positive features have been said to be relatively variable and negative features relatively stable (Ovchinnikov, 1968; Snezhnevsky, 1968).

To test the hypothesis that suicidal and self-destructive behaviour correlate with subjective and objective measures of hostility and violence, these behaviours in hospitalized schizophrenics were correlated to self-report (Buss-Durkee) and observer-rated (Lion Scale) measures. Self-destructive acts were significantly correlated with six of the seven of the Buss-Durkee self-report hostility subscales. The observed measures of hostility and violence correlated with seclusion and with restraint as a self-protective measure. Neither the Lion nor the Buss-Durkee measures correlated with depression measures. Thus, our data indicate that self-destructive acts in hospitalized schizophrenics may be better predicted by feelings of anger and hostility than by depression, a finding with relevance for clinicians who treat schizophrenic patients.

The conviction rates for the first 61 admissions to a therapeutic community for drug dependence were obtained for a period two years prior to admission and two years after discharge, by searching in the Criminal Records Office at Scotland Yard.

A long-stay group (n = 20) which had remained in residence more than six months was compared with a medium-stay group (n = 20) which had remained from one to six months and a short stay group (n = 21) which had remained less than one month.

The long-stay group had a pre-admission conviction rate of 60 per cent, which was significantly reduced to 10 per cent during the follow-up period. The conviction rate of the medium-stay group was reduced from 70 per cent before treatment to 45 per cent after treatment; that of the short stay group remained constant at 57 per cent before and after treatment. It is suggested that periods of more than six months treatment in the community are effective in reducing subsequent criminality.

90 patients with a primary depressive illness, admitted consecutively to one psychiatric ward were studied. All patients had the dexamethasone suppression test (DST) done before initial treatment. First treatment response was correlated with the DST results. The non-suppressors, as a group, improved with treatment better than the suppressors. However, unlike in previous studies, no relationship was found between non-suppression and poor response to antidepressant medication.

Findings are presented on 42 children of school age, the offspring of 26 adult psychiatric patients. Psychiatric disorder was found in 19 (45 per cent) of the children, compared with 12 (26 per cent) of 47 children from a control group of families.

Families with disturbed children differed from the remaining families in the following ways: presence of frank marital discord, the diagnosis of personality disorder in the parents, the inability of the father to tolerate angry situations, and the presence of siblings of under 9 years of age. Six months later, 9 of the 19 children had improved considerably. In almost every family this was associated with improvement in the condition of the parents.

It is suggested that the psychiatric disorder of these children is reactive to the presence of emotional turmoil in the families.

A case of colloid cyst of the third ventricle in a patient presenting with delusional depressive syndrome, in clear consciousness and with minimal cognitive impairment, is reported. The possible pathogenesis of the syndrome is discussed in the light of the reported association between aqueduct stenosis, diencephalic dysfunction, hydrocephalus, and psychotic symptoms.

This study compares the diagnostic terminology used for 592 consecutive discharges from a psychiatric unit before and after teaching psychiatric trainees the use of the ICD-9 classificatory system. The results show a marked increase in specificity of diagnostic labels, with a decrease of diagnoses with the term ‘not otherwise specified’, and an increase in the diagnoses of organic psychoses, paranoid and hebephrenic schizophrenia and depressive neurosis. The implications of this for training about diagnosis, clinical practice and recording of data for national statistics are discussed.

It is a paradox that during the years of psychosocial development each man has to achieve an identity, a role in which he can feel secure, and yet poets and philosophers tell us that man is forever seeking to diminish the isolation which a personal identity imposes. Without the development of a personal identity and a role in life the individual remains a social isolate, a dependent parasite or a social deviant. Yet, once achieved, identity brings a new awareness of separateness from others and a need to merge the self with others, to identify with someone or something else. This would seem to be a main objective of love. It has been said that human love is the supreme act of communication with another, a merging of identity, and poets speak of communicating with nature or with God in like terms. Romantic and sacred literature abound in metaphors and images describing the bliss which such activity offers. If it is true that while we have a need to develop a sense of personal selfhood, an identity and a role, we have a further need to diminish the separateness such awareness imposes, how do we go about it? The contemporary answer is, of course, by communication, by relating to others. The better the communication we have with others, the greater our sense of belongingness, the less the pain of individual isolation. It is not necessary to emphasize that a cardinal feature of all severe mental illness is either a loss or a distortion of the individual's communicative capacity. But I would like to emphasize that the debate as to whether failure of communication is either a cause, or an association, or a consequence of mental illness is not my theme.

Epileptic automatism and violence are seldom found among temporal lobe epileptics. The case of a 19-year-old girl who killed a 20-month-old child during an epileptic attack is described, and the literature and medico-legal issues are briefly reviewed.

Neuropsychoanalysis is a new school of thought attempting to bridge neuroscience and psychoanalysis. Yet few neuroscientists and psychiatrists would have heard of it if it had not recently received public support from notable neuroscientists. The present paper discusses whether such support is warranted.

Buspirone is a newer anxiolytic which differs chemically and pharmacologically from the benzodiazepines. The question as to whether buspirone can induce rebound, dependence, or abuse can be examined through a variety of clinical and control studies, as well as animal studies, together with meticulous follow-up of adverse reports. It is concluded that, on present evidence, the short-term use of buspirone is unlikely to be followed by rebound or long-term use through dependence; nor is abuse likely to be a problem.

Smoking contributes to health inequalities for people with severe mental illness (SMI). Although smoking cessation interventions are effective in the short term, there are few long-term trial-based estimates of abstinence. The SCIMITAR trials programme includes the largest trial to date of a smoking cessation intervention for people with SMI, but this was underpowered to detect anticipated long-term quit rates. By pooling pilot and full-trial data we found that quit rates were maintained at 12 months (OR = 1.67, 95% CI 1.02–2.73, P = 0.04). Policymakers can now be confident that bespoke smoking cessation interventions produce successful short- and long-term quitting.