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.

A new treatment using a saccadic eye-movement desensitisation (EMD) procedure has recently been introduced to treat post-traumatic stress disorder, a disorder that has been difficult to treat in the past. The treatment is claimed to be very rapid and successful. This paper reports the treatment of a woman with post-traumatic stress disorder following a horrific road traffic accident using the EMD procedure.

British Journal of Psychiatry (1993), 163, 106–108

I. Problem and Method.

Recent work on the psychology of intelligence and thinking suggests that perceptual types of intelligence tests are inadequate for dealing with psychiatric cases, young children, old people, mental defectives, and primitive peoples. The argument is that, in these groups, intellectual processes have either deteriorated from or failed to develop to that level with which most perceptual intelligence tests are concerned. The methods of scoring also assume that the correct answers are always reached in the same way, but this is by no means always the case, as Goldstein and Scheerer (1941, p. 14) have pointed out. The studies of Werner (1948), Piaget (1951), Goldstein (1940), Hanfmann and Kasanin (1942), Rapaport (1951), Moursy (1952) et al. show convincing evidence that cognition can take place at different “levels.” The exact determination of the number, nature, and scope of the different levels remains a task for the future, since the present situation is confused, to say the least.

Corpora amylacea (C.A.) or amyloid bodies found in the brain and the product of amyloid degeneration in other organs derive their name from the starch-like reaction which they give with iodine (Virchow); otherwise these substances have few points in common, and while amyloid disease has become fairly rare nowadays, the presence of C.A. constitutes one of the regular changes in senile and senescent brains. This is perhaps why it has attracted much less attention than amyloid degeneration. For instance in 18 out of 25 papers, containing detailed accounts of the histo-pathological pictures, I found no references to C.A., yet one could hardly assume that amyloid bodies were overlooked. Most text-books pay scanty attention to the subject, while Buzzard and Greenfield (1921) consider it of no pathological significance. Since, however, C.A. are encountered under a variety of conditions (not merely senility), in greatly varying amounts and at different sites in the central nervous system, it may be worth while to investigate their nature, origin and occurrence in the light of recent observation.

Although homicidal tendencies are well recognized in the depressive psychoses, this medico-legal aspect of the illness receives only cursory mention in text-books, e.g. Henderson and Gillespie and Noyes, if it is referred to at all. Inasmuch as it is on this most serious complication that the psychiatrist is most liable to be asked to give evidence in court, there would seem to be good reason for examining the factors leading to such behaviour, and comparing them with similar data from non-depressive homicides. It is hoped that these notes will show a behaviour complex peculiar to the melancholic subjects.

Adults attending general health facilities in Guiné-Bissau were screened for the presence of mental disorder; minimum estimate of definite mentally ill cases was found to be 12%. The proportion correctly identified by general health workers was low: only one of every three patients with a mental disorder was recognised and of every 100 non-cases 12 patients were wrongly diagnosed by the health worker as suffering from psychiatric illness. On the basis of these results health workers are now being taught how to detect mental illness.

The mid-life period is regarded as a period of profound physical and psychosocial change for women. Psychological disturbance at this time has been associated with discrete life events. The influence of other psychosocial variables on psychological disturbance is examined in a general population sample. Five psychosocial variables are shown to have a relationship with psychological disturbance, either in conjunction with or independently of life events. The implications of these findings for the understanding of psychological disturbance at this time are discussed.

Sarcoidosis is defined by Scadding (1967) as “a disease which is characterized by the presence in all of several affected organs or tissues of epithelioid cell tubercles … proceeding either to resolution or to … (the formation of) fibrous tissue”. The organs which are most commonly involved are the lungs, skin, eyes, liver, spleen and joints. Clinical evidence of involvement of the central nervous system may be found in 5 per cent of all cases (Silverstein et al, 1965; Wiederholt and Siekert, 1965; Delaney, 1977). Typical lesions are cranial nerve palsies, intracranial space-occupying lesions, pituitary or hypothalamic lesions and, less frequently, lesions of the brainstem or spinal cord (Waldenstrom, 1937; Matthews, 1965; Wiederholt and Siekert, 1965; Scadding, 1967; Delaney, 1977).

In a study of male addicts attending a London drug dependence unit, it was found that convicted addicts tended to score more highly on measures of hostility than non-convicted subjects. The differences in hostility between the convicted and non-convicted groups were most clearly seen on the violent crimes variable, although addicts convicted of drug-possession and of non-drug crimes were also more hostile than non-convicted subjects. It is suggested that hostility acts as a personality factor which predisposes the individual towards criminal behaviour, and that the more hostile subjects may also be more likely to be apprehended and convicted.

The concept of reactive or psychogenic psychoses has had a peculiar fate. Especially at the beginning of the century, under the influence of the writings of Jaspers (Jaspers, 1913) which included definitions of ‘psychogenic’ and ‘psychoses’, the term ‘psychogenic psychoses’ came into common use in European psychiatry. In Scandinavia, this trend was greatly reinforced by August Wimmer's monograph in 1916 on the subject. In the later editions of Kraepelin's standard textbook, the concept appeared quite frequently, and the same was the case in other leading textbooks, for instance in the Soviet Union and Japan.

To test the hypothesis that schizophrenia can be differentiated on the basis of family history, the authors compared two matched samples of 20 patients each, distinguished by the presence or absence of family history of schizophrenia. Family history was not associated with either onset characteristics, symptom picture, phenomenological subtypes of schizophrenia, prognostic indicators or global assessment score for psychosocial functioning.

The problem of the long-stay patient in the Mental Hospital has been discussed for a long time. The prediction that there would be a steady decline in the number of these patients made by Tooth and Brooke (1951) has not been borne out by the evidence of Baldwin and Hall (1967), and more recently by Hailey (1971). They have shown that although there has been a fall in numbers the rate has been far from steady.

The last 20 years have seen a rapidly growing interest in disorder of brain function in psychiatric illness but this is only the latest phase in a steady development of ideas over the last three centuries. Throughout this time, biological and psychological formulations of psychiatric disorder have co-existed and, at different periods, one or other has been the focus of attention. Thomas Willis, who coined the word ‘neurology’ 300 years ago, felt that psychiatric disorder represented brain disorder, but it was only during the nineteenth century, as understanding of brain function made its first real progress, that this opinion became more explicit and accepted. By the second half of the century, it was axiomatic that psychiatric disorder was synonymous with brain disorder (Griesinger, 1845; Maudsley, 1873; Ferrier, 1878); all that was lacking was the actual neurophysiological basis of mental disorder.

It is possible that genes contributing to the development of schizophrenia may be identified within the next decade. Genetic methods are improving rapidly, and are surrounded by great public interest. Requests for genetic counselling are keeping pace with this increased attention, but the problems faced by psychiatric genetic counsellors are complex, and the experience of offering such counselling and the issues involved are rarely discussed. In this context the paper describes a year's work counselling for schizophrenia in the Maudsley Hospital Genetic Clinic.

The effects of two experimental interview styles, designed to differ in the extent of their use of active feeling-oriented techniques but similar in their use of active fact-oriented techniques, were compared in initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. The style that employed a higher level of actively responsive feeling-oriented techniques elicited more emotional expression and more often obtained certain feelings of potential diagnostic significance. The actively responsive style was more effective in increasing the amount of feeling expressed if mothers' spontaneous rate of expression was relatively low.