A case report is presented of the genital retraction syndrome, koro, associated with alcoholic hepatitis, avitaminosis and urinary tract infection, occurring in a Zulu male. Treatment of the physical conditions resulted in resolution of the koro symptomatology.

The nosological status of koro is discussed and it is proposed that the condition be regarded as a symptom-complex reaction to a variety of psychological or physical stressors rather than as a purely culture-bound syndrome.

In a recent article in the British Medical Journal Maurice-Williams & Dunwoody (1988) reported two patients with frontal meningiomas who presented initially to psychiatrists. The correct diagnosis was made in one of them after prolonged, perhaps unnecessary, psychiatric treatment. In the other the diagnosis was made at autopsy. In this case psychiatrists were only briefly involved and neurosurgical referral had been made promptly. The authors, who treat these reports as a cautionary tale, conclude by warning psychiatrists to pay special attention to a number of features in the history and examination of psychiatric patients. In particular we are told that suspicion should arise in the presence of gradual non-remitting symptoms such as irritability, memory loss, self-neglect, dysphasia or incontinence in patients without a previous history of psychiatric disease or clear precipitating factors. They also suggest that we pay attention to the views of relatives when they feel the patient suffers from a physical rather than a psychiatric illness, and emphasise that early diagnosis leads to easier surgical removal and better outcome.

An elderly patient with bipolar manic-depressive psychosis, stabilised satisfactorily on lithium carbonate, developed acute symptoms of lithium toxicity shortly after commencing mefenamic acid. Vulnerability factors for the interaction may have included age, history of cardiac failure, and impaired glomerular function. It is hypothesised that the interaction may have been mediated by inhibition of prostaglandin activity.

Family size, sex of siblings and birth order were examined in 225 bulimic patients of normal weight, all stemming from the same circumscribed catchment area. Although bulimia can occur in any size family, all-female sibships were significantly over-represented. In small families at least, the bulimic patient was highly likely to be the only or eldest daughter. In small sibships, a bulimic who was first-born was significantly more likely to have a younger sister; if second-born she was more likely to have an elder brother. Despite the very large sample size, no final conclusion can be made on birth order.

Auditory evoked potentials were recorded in a choice reaction-time task. This test paradigm elicited the attention-related P300 component and was used to study cognitive processing. Compared with age-matched controls, 17 patients with dementia of the Alzheimer type were shown to have significantly longer reaction times as well as delayed latencies of several components of the auditory evoked potentials. The fractional increase in the reaction times was much greater than that of the P300 peak latency. The latter is commonly accepted as an index of stimulus-evaluation time. These findings suggest a delay in both response selection and stimulus evaluation.

The coronavirus disease 2019 pandemic has led to unprecedented disruption to the normal way of life for people around the globe. Social distancing, self-isolation or shielding have been strongly advised or mandated in most countries. We suggest evidence-based ways that people can maintain or even strengthen their mental health during this crisis.

Five children aged 8–10 years presenting to child psychiatric clinics with hyperkinetic syndrome and severe disruptive early experiences are described. At referral all had been living in stable families for a minimum of four years. Biological risk factors were absent. It is proposed that the disruption of early attachments resulted in ill-regulated search and exploratory behaviour and that this had a continuing effect on the children's ability to focus and control attention skills and motor behaviour.

The material for this paper was obtained by using the Rorschach test. Purely as an introduction to this paper it may be said that the test differentiates individuals according to their preference for perceptions of form, colour and movement. This separation into categories is obtained by the exhibition to the patients of ink-blots of different colours and shapes. For details of the technique the best source of reference is Rorschach's Psychodiagnostik, though no English translation of the original German is available in print. For those unfamiliar with the test the articles of P. E. Vernon, McCalman, and the present author may be found useful.

The distribution of the plasma cholinesterase variants found in 1,374 mentally ill patients differs from that of a random control sample. The patients are more likely to have a rare phenotype than an individual from the normal population. None of the diagnostic groups have been shown to differ in the distribution of the E1a gene, but there is strong statistical evidence that Group IV (psychosis) patients have a higher frequency of the E1f gene than the other groups. The overall frequency of the electrophoretic variant C5 + did not differ significantly from that observed in a Caucasian population, with the exception of the increase observed in Group IV c2.

Twenty-eight unrelated patients with Huntington's chorea were found to have a significantly altered incidence of the C5+ variant and six patients from this group were found to have the rare E1f gene. Our results indicate that the plasma cholinesterase variants may provide some insight into the inheritance of Huntington's chorea.

The skin is by far the largest organ of the body and it performs a variety of important functions. In both a concrete and symbolic sense the skin serves as a boundary separating the inner person from the outer world, self from non-self. It is evident therefore that cutaneous awareness is a central part of overall body image. It should be no surprise to learn how frequently real, imaginary or factitious dermal-pathology may occur in association with psychiatric disorder. The false idea that something is alive and moving in the skin has been presented to dermatologists and, to a lesser extent, psychiatrists for many years. It has attracted a ready psychodynamic explanation based on the concept of somatisation of emotional experience, and taking into account the symbolic function of the target organ.

It has been routine psychiatric practice in recent years to prescribe vitamins in alcoholism and confusional states and sometimes in other organic psychoses. The doses given are massive, varying from about ten to twenty times those strictly necessary in deficiency states. This empirical therapy is supported neither by controlled trials nor by direct evidence of vitamin deficiency.

The basic controversy in criminology at present is that between the psychiatric school and the sociological school. Members of the latter school recognize that psychogenic factors must be taken into account in the explanation of criminal behaviour, and members of the psychiatric school have recognized the importance of social and cultural conditions. But there is disagreement on the extent to which ‘Personality’ and ‘Culture’ should be emphasized in criminological theories.

I am particularly grateful for the privilege of delivering the first Mapother Lecture. I believe it will be appropriate to devote it to a review of Professor Mapother's life and his work in shaping the Maudsley Hospital, with which he is inseparably connected. It is nearly thirty years since his death. The course of events since then has shown on what sure foundations he built. Those like myself who had daily contact with him during the later years of his life felt great respect and admiration, as well as warm affection, for him; but it is only in the perspective of recent history that the full measure of his achievement can be seen: perhaps not even yet. In preparing this Address I have been mindful of what Sir James Crichton-Browne said when delivering the first Maudsley Lecture in 1920—‘the last thing the donor of this Lectureship, retiring and shy of publicity as he was, would have wished would be that its inaugural discourse should be devoted to any elaborate eulogy of himself.’ It is an éloge rather than a Eulogy that I would wish to put before you this evening; Condorcet, a master of the art of obituary appraisal, said that an academic éloge should not be a panegyric but an effort to report the truth about a scholar and to do him full justice.

Cognitive performance in 46 first episode schizophrenics was assessed within 1 week of admission to hospital by Progressive Matrices, Mill Hill Vocabulary Scale, Block Design and Similarities subtests of the Wechsler Adult Intelligence Scale, and Digit Copying Test. Patients' intellectual performance was at a dull normal level, just within one standard deviation from the mean. There was an association between the presence of anxiety and depression and lower scores on psychological tests. Patients assessed by the Present State Examination as belonging to the ‘uncertain psychosis' category performed more poorly.

Should personality disordered individuals receive treatment within today's mental health services? The debate often follows episodes of aggression towards staff or patients by personality disordered individuals receiving treatment in hospital, and more recently where the general public have been affected. The subjects of personality disorder and psychopathy in particular have long evoked strong emotions which make clarity of thought difficult and psychiatry unclear of its position.

The Newcastle scores of a group of 64 and subsample of 52 severely depressed inpatients were not normally distributed. Evidence for discontinuity in these distributions was adduced from the contrast in outcome between the endogenous and neurotic patients thus defined, the endogenous consistently doing better than the neurotic group. The unipolar/bipolar system failed to predict different results for endogenous and neurotic patients unless unipolar was subdivided into endogenous and neurotic subgroups. The DSM-III criteria for major depression and melancholia failed to identify subgroups of differing prognoses.

The hypothesis that schizophrenia and some non-psychotic abnormalities occurring in the close relatives are both manifestations of a unitary ‘schizoid state’ due to a major dominant gene is further examined. Comparisons are made (1) of the observed and expected frequencies of the different types of parent mating; and (2) of the observed and expected risks among sibs in families with neither, or with one or both, of the parents abnormal. It is concluded that the results do not fit well with the model of inheritance of the schizoid state through a major dominant gene.

Since some hereditary contribution in schizophrenia can be regarded as established, the excess of personality disorders and heavy drinking in the families is thought to be due to a combination of polygenic inheritance and environmental influences. The findings are regarded only as tentative, but suggest several hypotheses which could be tested.

Acute non-anaphylactic reactions to procaine penicillin include fear of death, sensations of disintegration, perceived changes of body shape, and visual and auditory hallucinations. Fragments of the original reaction experience, or elaborations of it, feature prominently in a chronic syndrome which persists if the initial reaction is not supported emotionally or professionally. The cultural acceptance of the reality of ‘mysterious' forces played a role in the syndrome. Compatible diagnostic labels were panic disorder, post-traumatic disorder, mixed phobic disorder, and depressive illness. The observed period prevalence rate is 5.9 per 1000.

Most reports on the treatment of drug addiction describe only some form of aversion therapy, either by electrical (Lesser, 1967) or chemical means (Raymond, 1964). There seem few reports in which any attempt has been made to correct the underlying disorder which was responsible for the patient's addiction (Seelye, 1967). The argument is put forward that the basic disturbance in drug addiction is frequently one of social anxiety, and that when this has been corrected the patient no longer requires drugs for his support.