A 66–year-old woman showed profound neuropsychiatric disturbance after withdrawal from prolonged corticosteroid treatment. Reintroduction of an alternative corticosteroid, at low dose, produced a return to premorbid mental state.

A total of 2605 old long-stay patients, defined as those admitted to hospital before the age of 65 years and in hospital more than six years, were identified in psychiatric hospitals serving 83% of the Scottish population. The bed occupancy was 59 per 100 000 of the general population, with a range among hospitals of 19–123 per 100 000. Of all patients, 64% were schizophrenic and 15% had organic brain disease; most patients were male, single and over 60 years of age; 41 % had been in hospital more than 30 years; 61 % had either florid psychotic symptoms or symptoms of a deficit state in marked or severe degree, and the rehabilitation potential for 70% was low. An increasing prevalence of deficit symptoms in schizophrenics was associated with increasing length of stay in hospital; the difference was most marked between those admitted before and after 1953.

It is now universally recognized that there is nothing specific in the form of psychoses associated with childbearing. There is, however, still a tendency to attribute to the puerperium itself or to pregnancy or lactation a significance quite out of proportion to that of other precipitating factors; thus such terms as “puerperal depression”, or “puerperal schizophrenia” are still in use, as if the precipitating factor were something special as opposed to the innumerable other causes assigned to the appearance of an attack of mental disorder. Nor is this surprising when one reflects on the enormous significance of the sexual life. One is quite willing on a priori grounds to grant to the puerperium this all-important rôle.

In another paper, Jenner, Kerry and Parkin (1961) confirmed the views of earlier workers, Harris (1960) and Voelkel (1960) and others that methaminodiazepoxide is an effective agent in relieving anxiety in neurotic patients. That study was a blind controlled comparison of methaminodiazepoxide against lactose, but gave no indication of its value as compared with other drugs. The present paper is a comparison of methaminodiazepoxide (Librium, Roche) and amylobarbitone. The latter drug was felt to be one of the best known and most reliable drugs used in psychiatry for the treatment of anxiety. Raymond, Lucas, Beesley, O'Connell and Fraser-Roberts (1957) compared it very favourably with benactyzine, chlorpromazine, meprobamate, sedaltine and lactose. In that trial amylobarbitone was the only drug significantly better than lactose.

Twenty Asian psychiatric patients suffering from neurotic illness completed the Urdu version of the HAD Scale. The results were compared with the Clinical Interview Schedule. Somatic symptoms were significantly related to various measures of anxiety but not to those of depression. This finding contradicts the previously held view of linking somatic symptoms with the presentation of depression.

Eighty chronic schizophrenic and 16 manic-depressive psychotic patients conforming to Research Diagnostic Criteria were examined in terms of their mental state, cognitive functioning, current behaviour, and neurological status. They comprised out-patients, day-care patients, and long-stay in-patients belonging to two mental hospitals with different social conditions. Assessed deficits were not significantly related to record variables such as age, duration of Illness, duration of hospitalisation, or treatment received. Analysis of the different groups of patients reveals that long-term hospital care has had little effect on the deficits of chronic schizophrenia, and suggests that these are integral features of the disease process.

Two patients with moderately severe AD, when asked directly, could identify their own images in a mirror, but also consistently misidentified their own reflections as that of another person. Both patients were paranoid and mildy depressed at times, but had no evidence of other concurrent psychotic symptoms. It appeared that mood substantially modified the nature of the symptom and the patients' reaction to it over time. These cases illustrate the ability of an organic symptom to be modified by a concurrent affective state, indicating the importance of the interaction between biological and psychological factors in the expression of such symptoms.

An out-patient alcohol detoxification service based in a psychiatric emergency clinic is described. Of 173 patients referred during the first year, 76 (44%) were accepted for the programme; 60 (79%) of these successfully completed detoxification with no medical complications. Compared with previous years, during the year of operation of the service there was a 50% fall in the number of in-patient admissions for detoxification to the local hospital. We conclude that a structured out-patient detoxification programme is safe and effective, and may obviate the need for many patients to be admitted, freeing psychiatric beds for other uses.

The internal consistency and factorial composition of the eight-item Life Satisfaction Index-Well-being, adapted for use with elderly British samples, were examined. Crossvalidation was carried out with a randomly drawn community sample of 155 rural people aged 65–89 years. The scale was found to have acceptable internal reliability, but may require modification.

It is recognized that the differential diagnosis between psychosis and mental defect is apt to present difficulties; and the presence of aments in mental hospitals and of psychotics in homes for the mentally defective, though often due to lack of appropriate accommodation, suggests that the diagnostic problem is not always successfully solved. Hitherto, when a certified defective has been found to be psychotic, it has generally been assumed that psychosis has supervened on amentia, defectives being regarded as more prone to psychotic upset than are persons of normal intelligence. The alternative proposition—that mental defect may on occasions be due to psychosis in youth—has received comparatively little attention. This study is an attempt to find out whether psychotic illness beginning in childhood is an important cause of mental defect.

This brief report draws attention to some recent results showing that questionnaire measures of rigidity and extreme response set, which are regarded as closely related variables, are likely to possess a much higher degree of generality than usually accepted and that they play an important part in the measurement of normal and abnormal personality.

My purpose in this article is to draw attention to certain statistical features of manic depressive psychosis and to inquire into their possible aetiological significance.

I shall show that some of these statistical characteristics are very similar to comparable aspects of diseases that are widely considered to be autoimmune. Although it does not follow than manic depressive psychosis is an auto immune disorder, the parallels and coincidences are perhaps sufficiently striking to warrant further investigation.

One hundred medical and surgical patients admitted to an accident and emergency ward were screened for psychiatric disorder. A psychiatric diagnosis was made in 37 patients, 32 of whom were correctly identified by the GHQ. Psychiatric morbidity was associated with being single, lower social class, unemployment, homelessness and living in Bloomsbury Health District or north-east London. It was also associated with not being registered with a GP. The 14 overdose patients were no more likely to receive a psychiatric diagnosis than other patients, yet constituted most of the psychiatric referrals. Few patients were asked by medical staff about emotional worries or problems. A desire to be asked such questions and a past psychiatric history were associated with a psychiatric diagnosis. Routine screening of psychiatric morbidity in both medical and surgical patients and appropriate psychiatric referral of identified patients is recommended. A system of facilitating GP registration is necessary, as much of the morbidity identified could be contained within primary care.

The most relevant psychological and neuropsychophysiological effects induced by lithium in healthy volunteers or in patients during the free interval are changes of vigilance and possible changes in patients' personality. In EEG terms lithium acts as a “chopper” and induces left-hemispheric asymmetry. Interesting concepts for description of personality changes are the typus melancholicus of Tellenbach and the psychoanalytical view of depression. Effects in an individual patient are heterogeneous and cannot be predicted. Primary and secondary psychological effects may influence compliance, and a detailed analysis of compliance seems necessary.

In 2008 it became policy that all those on the care programme approach were assessed for sexual violence/abuse. The implementation of this policy was assessed 8 years on. The findings of a survey and data request to Health and Social Care Information Centre are disappointing. We argue that this important initiative needs to be reinvigorated.

It is now respectable to read about personality disorder. It was not always so. Despite the impossibility of practising psychiatry without being aware of the term and the subject matter it describes, it was not appropriate in good psychiatric circles to mention the subject unless presaged by a pause and pronounced with a mocking inflexion that indicated that the words were in parentheses: signposts to somewhere undesirable, usually somewhere in the jungle of forensic psychiatry (a subject about which I write very little in this piece, in an attempt ot redres the balance). I think the reason for this was that personality disorder had such a strong flavour of criticism that, even in a discipline in which stigma confronts us on every corner, its words were the ultimate derogatory label that, once attached, became virtually indelible. Or, as my Landcashire grandmother would say about all unsavoury topics, it was “not very nice and no one really wants to know.”. So research and writing on the subject became almost a samizdat topic, written about in code, discussed in quiet corners between professionals when they could not be overheard, or in proxy phrases such as ‘relationship difficulties’ or ‘patients who are difficult to place’ (Coid, 1991).

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.