The presentation of inappropriate penile erections calls for great caution in making a diagnosis. Two patients who had unwanted erections also had obsessive-compulsive disorder – a previously unreported association. Obsessive-compulsive disorder is not inconsistent with unwanted erections and should be considered in assessment.

Insight, psychopathology and functioning are related in schizophrenia, but it is unclear whether insight relates independently to functioning after controlling for psychopathology. Equally, any such relationship may vary culturally. We investigated the relationship between insight, psychopathology and functioning in 60 patients with schizophrenia in Mzuzu, a town in Malawi. After controlling for psychopathology, functioning was associated with the ‘symptom relabelling’ dimension of insight (P=0.01). This preliminary finding suggests that symptom-focused psychoeducation might be appropriate for African patients with schizophrenia.

Camptocormia is a rare conversion syndrome found mainly in soldiers from World War I and II. No case has been reported since, but this paper reports the syndrome in a former soldier of the Nicaraguan army. It is characterised by severe frontal flexion of the spinal cord and knees, with passive dropping of both arms, and sometimes behavioural abnormalities.

In making a diagnosis between psychotic and neurotic depression, characteristic signs and symptoms are usually looked for. Although there is much controversy in the literature in respect to this difference, particularly since Lewis's work in 1934, nevertheless one commonly observes that when people are sad they cry. We would expect, therefore, that this would apply also in depressions. Yet, in our survey of the journal literature and such major textbooks as Mayer-Gross, Slater and Roth's Clinical Psychiatry, Arieti's American Handbook of Psychiatry, and Freedman & Kaplan's Comprehensive Textbook of Psychiatry, the authors fail to include crying as a symptom of depression.

Two depressive patients with systemic lupus erythematosus (SLE) and cerebral infarction, while being treated with corticosteroid, are described. In both cases, lithium was remarkably effective and no severe side-effects occurred. These findings suggest that lithium can be a useful antidepressant agent in the treatment of depressive SLE patients.

The politics of shortening hospital stays for people with psychosis has been questioned by a number of studies. Hospital practice in the meantime remains highly variable and the research evidence increasingly difficult to interpret given different conceptualisations of what constitutes effective treatment. In the absence of clearer guidelines from researchers in this area, decisions about duration of hospitalisation risk being driven by economic rather than clinical considerations.

A new drug, trimipramine (Surmontil, 7162 R.P.), has been found to have a specific antidepressant effect (Lambert et al., 1961), and has been used in France for two years; hitherto no controlled trial of trimipramine has been published. This paper reports a three weeks' comparative trial between this drug and imipramine (Tofranil), in the treatment of psychotic depression, using the statistical method of sequential analysis, the actual design used was that at the 5 per cent. chance level (Armitage, 1960).

Existing approaches to psychosis prediction capture only a small minority of future cases. Recent research shows that specialist child and adolescent mental health services (CAMHS) offer a (previously unrecognised) high-risk and high-capacity approach for psychosis early identification, prediction and, ultimately, prevention.

Delirium is now the preferred term to describe acute confusional states and related organic mental disorders associated with acute impairment of consciousness (Gill & Mayou, 2000). No longer is delirium reserved for those states in which overactive behaviour, often with visual hallucinations, is dominant. To accommodate the broader usage, hypoactive states of delirium have been emphasised (Lipowski, 1990), particularly as these are the states most easily missed.

It is common knowledge that the French school of psychiatry began with Pinel (1745–1826) at the end of the 18th century. Pinel is credited with having delivered the insane from their chains in the two hospitals of Paris where they were detained, Bicêtre and la Salpêtrière: his near contemporaries in the humanization of the treatment of the insane were Tuke in England, Chiarugi in Tuscany and Daquin in Savoy. Pinel's essential achievement was the creation of the 19th-century French tradition in psychiatry, encompassing the medical, clinical, descriptive and nosological fields. Pinel's breadth of outlook was shared by his pupil Esquirol (1772–1840), who dominated the so-called ‘classical’ school of the ‘Alienists of the Salpêtrière’ via his numerous disciples and his treatise, published in 1838, Des Maladies Mentales Considérées sous le Rapports Médical, Hygiénique et Médicol-légal.

It is widely recognized that judgment of time may be grossly disturbed in amnesic states of organic origin. Korsakoff (1890), in his classic exposition of the syndrome which has come to bear his name, pointed out that memory for time is often more severely affected than memory for events, and that temporal reference may remain markedly defective, even after remission of the psychosis. Thus one of his patients was able to recall recent events with fair accuracy, but was unable to state whether a given event had occurred yesterday or three years before. After recovery, moreover, this patient presented disturbances in the temporal sphere as the most outspoken residual symptom. Korsakoff further observed that defects of temporal localization might appear as the most prominent manifestation in mild cases of the amnesic syndrome. It would seem, then, that disorders of time judgment form an integral part of this syndrome and may well reflect a disturbance of memory at its highest levels of psychological organization.

This analysis identifies the significant problem of ambiguity, variation and vagueness in relation to the intervention described as ‘psychotherapy’. Its purpose is to raise international awareness of this problem and alternative solutions.