An episode of postpartum psychosis can be devastating for a woman and her family, and it is vital we understand the factors involved in the aetiology of this condition. Sleep and circadian rhythm disruption is a plausible candidate but further research is needed that builds on the latest advances in chronobiology and neuroscience.

Although the high rate of suicide in elderly people is conventionally explained as being due to greater intent to die, we have noted elderly Sri Lankans dying after relatively mild poisoning. Using data from cases of yellow oleander poisoning, we investigated the effect of age on outcome in 1697 patients, controlling for gender and amount ingested. In fully adjusted models, people over 64 years old were 13.8 (95% CI 3.6–53.0) times more likely to die than those less than 25 years old. The high number of suicides in elderly people globally is likely to be due, in part, to the difficulty they face in surviving the effects of both the poisoning and its treatment.

“41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 μg/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness.”

Prisons in England and Wales have reached a low point in service delivery. Despite initial improvements after National Health Service transfer in 2006, it has deteriorated since 2010, with numerous reports giving cause for concern. Improvements are now urgently required, and political courage and a revised national programme of expenditure are necessary.

The lives of Children and Adolescents with PaRental mental Illness (CAPRI) represent a public health priority. Identifying those at most risk within the risk subset is crucial to promote resilience for this group. The ability to develop child-centred interventions will underpin the success of evidence-based services and CAPRI themselves are key to unlocking current service barriers.

Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.

Delirium tremens and toxi-infective delirium are not now common diseases, but are still encountered often enough for their treatment to present problems. Delirium tremens is a medical emergency and intercurrent pneumonia is a serious complication, more likely to occur if the patient's over-activity persists. Toxi-infective delirium is less frequently accompanied by crude over-activity, but this may be a source of significant added strain in the severely ill patient, in whom it is more likely to occur. The standard treatment for delirium tremens is by sedation, and the giving of fluids and glucose. Paraldehyde seems to be the drug of choice. Opinion is divided on whether it is advisable to continue to give moderate amounts of alcohol. Sedation is the standard treatment in toxi-infective delirium, and here barbiturates tend to be used.

Addison (1855) in his classical description wrote of the patient's mind “as occasionally wandering” during the final stages of pernicious anaemia. The relative frequency with which different psychiatric syndromes present differs from that recorded by previous writers and is probably due to earlier psychiatric consultation in the present group, though mode of referral may also play a part. Bowman (1935) found organic confusion in 48 per cent., a death rate of 35 per cent. and a red blood cell count of below 4 0 million in 65 per cent. of his 23 cases. Herman, Most and Joliffe (1937) found organic confusion in 35 per cent. compared with the present writer's 5 per cent., a death rate of 22 · 5 per cent. compared with 10 per cent. and a red blood cell count of under 3 · 0 million in 75 per cent. of his 40 cases, compared with 25 per cent. of the present group.

I have endeavoured to prepare tables on Irish Lunacy corresponding to those which I have given in my paper∗ on the “Alleged Increase of Insanity in England and Wales.”

The term “schizophrenia” was first introduced by Bleuler (1) as descriptive of the dissociation and fragmentation of mental processes which he regarded as the chief characteristic of the condition. There is “a detachment from the world without, and a breaking up of normal psychological connections within. The personality is not integrated as in normal people; thinking emotion, and conduct are discrepant and morbid, yet there is no impairment of formal intelligence such as is found, for example, in organic dementia” (Mapother and Lewis (2)). To quote Bleuler (1), “even though we cannot as yet formulate a natural division within the disease, nevertheless schizophrenia does not appear to us as a disease in the narrower sense but as a disease group, about analogous with the group of the organic dementias, which are divided into paresis, senile forms, etc. One should therefore speak of schizophrenias in the plural. The disease at times runs a chronic course, at times in shifts; it may become stationary at any stage or may regress a certain distance, but probably does not permit of a complete restitutio ad integrum. It is characterized by a specific kind of alteration of thinking and feeling, and of the relations with the outer world that occur nowhere else”.

In a previous paper in this series (Sandier, Holder and Dare, 1970a) aspects of the doctor-patient relationship were discussed under the general heading of treatment alliance. It was pointed out that the concept included features which have been at times referred to as ‘transference’, and the purpose of the present paper is to consider some of the further meanings of the latter term.

Disorientation is not a uniform phenomenon and does not always follow the same pattern. Its pattern varies with its causes. Three varieties may be recognized. (1) The disorientation of toxic delirium. This is the best known variety. (2) The disorientation seen in some cases of schizophrenia. (3) That seen in some cases of brain tumour and other organic brain disease. The three varieties are all different, and the object of this paper is to consider why.

In 1897 Ganser (1) gave a lecture entitled “Ueber einen eigenartigen hysterischen Dämmerzustand.” This has been translated literally as on “A specific hysterical twilight state,” which we consider unfortunate, as in keeping the words it loses the sense of the original, for the notion of a twilight state remains foreign to us, and is better rendered as a “dimming of consciousness” or “clouding of consciousness.” Further, the concept of hysteria has changed considerably since then and his cases would now be regarded as psychotic.

This paper analyses the pattern of use of and the response to electroconvulsive therapy (ECT) in an Indian rural teaching general hospital between 1977 and 1980. ECT was used in 503 cases (14.3 per cent of 3,517). Three-quarters of the patients to whom it was given were schizophrenic, one-fifth depressed and 6 per cent suffering from post-partum psychosis. Though the treatment gave the best results in depression it was also effective in many schizophrenics and post-partum psychotics. The commonest side effect was memory impairment. Following unmodified ECT severe confusion and excitement were frequent while thrombophlebitis, bronchospasm, prolonged apnoea and peripheral circulatory collapse occurred only with the modified technique. The usefulness of ECT in developing countries like India is highlighted.

A prospective evaluation of Schneider's first-rank symptoms in 56 Nigerians with RDC schizophrenia gave a prevalence of 73%. The presence of first-rank symptoms was unrelated to schizophrenic subtypes, duration or severity of illness. While some of the symptoms correlate with age of patients, the pattern of inter-correlations among them supports previous views about their empirical heterogeneity.

This paper describes a double blind controlled trial of the compound trimipramine ('Surmontil’), which does not appear hitherto to have been reported upon by the English-speaking investigators, though there have been many clinical studies reported by French, and some by Italian authors.