Alterations in the visual system may underlie visual hallucinations in dementia with Lewy bodies (DLB). However, cortical excitability as measured by transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) activation of lower visual areas (V1–3) to visual stimuli appear normal in DLB. We explored the relationship between TMS-determined phosphene threshold and fMRI-related visual activation and found a positive relationship between the two in controls but a negative one in DLB. This double dissociation suggests a loss of inhibition in the visual system in DLB, which may predispose individuals to visual dysfunction and visual hallucinations.

There is an increasing appetite for a change in the law to allow assisted suicide. This editorial suggests that psychiatrists should engage in the debate because the issues at stake will affect us, and we are likely to have a significant part to play were the law to be changed. We suggest that there are three main areas where psychiatrists' expertise may be informative: (a) the extent to which safeguards to limit the availability of assisted dying to target groups can be applied safely and fairly, including to individuals with psychiatric disorders; (b) the complexities inherent in assessing mental capacity; and (c) the degree to which individuals adapt or change their desires, particularly in relation to suicidal behaviours.

Antarctica is the southern end of Earth, a continent surrounded by oceans. It is a land of extreme cold and it has been estimated that it contains over 85 per cent. of all the world's ice. It is larger than the United States and Europe combined but contains practically no vegetation or wildlife except along its coasts. The coldest temperature ever recorded anywhere in the world was noted here (minus 109 · 6 degrees Fahrenheit) and temperatures rarely go above freezing. The wind blows almost constantly, including 200 m.p.h. blizzards. In appearance, it is like a great white desert and it includes a cap of ice that in some places is 100,000 feet think.

Since the treatment of juveniles as in-patients in a special unit is somewhat unusual in mental hospital practice, a brief introduction may not be out of place. These units might be considered as another development in a trend which has been progressing for the past 25 years. Until 1930 certification of all admissions to mental hospitals and a mainly custodial régime ensured the majority of patients being largely the end-results of psychiatric illness. Since 1930 the steadily increasing use of the voluntary system has brought many patients to hospital at a stage when their illness can be favourably influenced by modern therapeutic methods. An associated development was the increased provision of wards or units separate from the chronically disturbed cases, or even, as at this hospital, a complete villa system of detached and semi-detached wards for mainly voluntary adult patients.

Previous studies from this laboratory have shown that loading with large doses of certain amino-acids and Marsilid produced marked behavioural change in some chronic schizophrenic patients (Pollin, Cardon and Kety, 1961). Methionine and tryptophane produced qualitatively different effects and there was no overlap between marked methionine and tryptophane reactors. The changes with tryptophane were characterized by mood elevation and increased involvement with the environment and extra-version, in several instances to a dramatic degree.

This investigation began as an attempt to measure the anxiety shown by patients while awaiting electro-convulsive therapy. One measure used was an assessment of the degree of palmar digital sweating, using the plastic paint technique described by MacKinnon (1963). This is a method by which the number of active sweat glands in a given area at a given time can be counted. In a preliminary trial, the effect on sweating of waiting for E.C.T. was equivocal, but there seemed to be an increase in sweating in depressed patients as their clinical condition improved. In the main trial, therefore, the emphasis was placed on differences in sweating of depressed patients when ill and recovered, though the reading in the E.C.T. waiting-room was retained.

The association of physical illness and psychiatric illness has been found by Doust (1952), Downes and Simon (1953), Hinkle and Woolf (1957) and others.

The present investigation was conducted in a general practice; the aim was to assess whether a physical illness could precipitate psychiatric ill health. The conditions in general practice appeared to be suitable for this investigation because patients can be observed before and after a physical illness.

Previous studies suggest that chronic schizophrenics differ from normal subjects in their reactions and responses to experimental “sensory deprivation” conditions, not only in that they tolerate these with no difficulty or upset for weeks at a time, but also in that they display what may be an alleviation, albeit temporary, of the degree of severity of some signs of their disorder (Smith and Lewty, 1959; Smith, Thakurdas and Lawes, 1961).

Studies using objective tests have found that two relatively independent types of thought disorder occur in patients diagnosed as “schizophrenic”. In several studies (Payne, 1961) approximately half the acute schizophrenic patients showed an extreme degree of intellectual and motor retardation, more severe than that found even among retarded depressed patients, while half suffered from overinclusive thinking, as measured by the tests used. There was a significant tendency in one study (Payne and Hewlett, 1960) for these two types of thought disorder not to occur in the same acute schizophrenic patients.

“The author discusses the sociopsychiatric consequences of the 1978 Italian mental health law. He also reviews the international scientific ideas that led up to it. The sociopolitical psychiatric views of the late Franco Basaglia, pioneer of the change in the mental health system of the Italian Republic, are described. Statistical reports and critical analyses are reported. Objective data, based on the author's personal experience as a practising psychiatrist in Rome, Italy, from 1969 to 1987, are given.”

All animal species have a high potential rate of increase, which must imply a high potential rate of death. Professor Holliday (1) has said: “Something must die, either the sperm, or the egg, or the embyro, or the infant or the adult … Most animals maintain a population at a fairly constant level—there are fluctuations of numbers, but they are fluctuations round a mean. There is a strong element of stability in nature. How is the population fixed at this relatively stable level? Two schools of thought exist. One says that the rules of Malthus apply strictly to the animal world—starvation, disease and predators are the stabilizers and do an immediate and effective job. The other, developed by Professor Wynne-Edwards in Aberdeen, says that animals limit their numbers before starvation does it for them. It is part of the animal's social organization and it is based on instinctive patterns of behaviour. Only a proportion of the population is allowed to breed and those who lose this right in competition become outcasts.”

In some quarters schizophrenia has gained the reputation of a graveyard of research. Few findings stand the test of time, most of the pieces of this particular jigsaw seem to be missing, and it is not easy to make sense of those that are available. Even ‘hard’ scientific findings fail to be replicated, an example being the status of D2 receptors in drug-naive schizophrenics (Wong et al, 1986; Farde et al, 1987).

Twelve patients with obsessive compulsive disorder were studied with psychophysiological measures during a randomised, double-blind placebo-controlled drug trial. Significant clinical improvement followed six weeks of treatment with the tricyclic antidepressant clomipramine, but was not evident after an equal period of treatment with the monoamine oxidase inhibitor (MAOI) clorgyline. Compared to placebo, both drugs reduced skin conductance indices of baseline arousal, but only clomipramine reduced skin conductance and heart rate responses to loud tones and tonic and phasic skin conductance responses in a two-flash discrimination task. This suggests that reductions in autonomic responses to important and/or aversive stimuli may be critical to clinical improvement in obsessive compulsive disorder.