A strong emphasis on individual psychopathology has informed much discussion on female crime, although more recent research has stressed its social setting and influences. Women commit all types of crime, although to a much lesser extent than men, particularly with regard to violent crime. Social and economic marginalisation is a significant factor in female crime. Criminal convictions seem to be more stigmatising for women. In court, women are treated as doubly deviant and their actions are explained in psychopathological terms. Because of the small numbers of women offenders, non-custodial and custodial provisions for them are inadequate. Although men are more likely to be victims of, for example, street crime, women express more fear of crime. One reason for this may be the prevalence of domestic crime committed by men against women (and children) that is underestimated in some surveys.

As highlighted in the recent systematic review by Stimpson et al (2002), we know little about the relative efficacies of the treatment interventions that are routinely deployed for those with depressive disorders that have not responded to standard, first-line treatment approaches. Accepted practice is, at best, systematic ‘trial and error’, with sequential antidepressant monotherapy and/or combinations of antidepressant drugs with ‘augmenting agents'. This haphazard medicinal approach to managing the patient with poorly responsive depressive disorder is compounded by the lack of available information on the effectiveness and optimal role for psychological treatment methods. Given the high prevalence of depressive disorders and their frequent presentation to both primary and secondary care health services, it is a source of embarrassment that we remain so ignorant. Nevertheless, it is against this backdrop of uncertainty that we must now evaluate the relative merits of a novel intervention that has captured considerable media and lay interest: vagus nerve stimulation (VNS™).

Recently many new anti-depressive drugs have flooded the market, the objective being initially to assist and finally to replace E.C.T. as the treatment of choice for depressive states. One such preparation is Tofranil (N-(γ-Dimethyl-aminopropyl)-iminodibenzyl hydrochloride or imipramine). It was first favourably reported on by Azima (1) and Kuhn (2).

In a previous paper on general and focal symptoms localization in the brain was discussed as to its principles and limitations. In the subsequent investigations a method of examination has been worked out and is here presented. It is meant to serve a threefold purpose, which should be kept in mind when the scheme is applied.

There is a general consensus that 5–25% of schizophrenic patients are partially or totally unresponsive to antipsychotic drug therapy (Brenner et al, 1990). Agreement is needed on how to define the varying degrees of response and resistance in individual patients on conventional antipsychotic medication. Apparent “treatment resistance” may be due to noncompliance; excessive protein binding with inadequate bio-availability of the neuroleptic; an inadequate or excessive dose resulting in poor efficacy or side-effects outweighing therapeutic effects (Osser, 1989); or incorrect diagnosis.

Kraepelin (10) in 1908 first defined a group within his classification of schizophrenia which he described as periodic catatonia. The clinical features of this type may be briefly summarized. The onset, usually between 14 and 20 years, is frequently characterized by a period of erratic conduct followed by an interval of stupor, confusion or excitement, which thereafter undergoes periodic remissions and relapses. The periodicity is remarkable in the rapidity with which all changes occur. In the periods of remission the patient is free of catatonia and associated symptom-complex (sympatheticotonia), but is still dull, apathetic and withdrawn; he often recalls events from the reactive phase, but without insight. The patient is still schizophrenic, with emotional flattening and poverty of ideation, and remains so throughout. In the reactive phase the picture is one of catatonic stupor or excitement, with clinical evidence of sympathetic over-activity.

The insulin treatment of schizophrenia has been practised at Hatton since June, 1937. The Vienna technique has been employed, with certain modifications described in a recent paper in this journal by Gillman and Parfitt.

It is perhaps not too fanciful an analogy to compare the expanse of psychiatric symptomatology to an expanse of sea scattered with a small and determinate number of islands.

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

In the spring of 1985, a party of psychiatrists from Great Britain and Ireland visited four major Chinese cities—Beijing (Peking), Shanghai, Nanjing (Nanking) and Guangzhou (Canton), as a study tour of the Royal College of Psychiatrists, under the auspices of the Chinese Medical Association. A number of psychiatric hospitals were visited and there was opportunity for many discussions with psychiatrists and other professional staff. This paper records some impressions of the psychiatric services and practices that were observed, together with material obtained in discussions. It is hoped that it will update and complement previous reports by Western visitors to China, and thus increase understanding of mental health in China.

Among those who present to the emergency department for self-harm, many will repeat. Self-harm repetition is an outcome of interest in both observational and intervention studies. However, few such studies analyse the number of repeat self-harm presentations. Here, hurdle models are introduced as a potentially useful statistical method for these analyses. Emergency department data from the Province of Ontario, Canada, are used to illustrate an example of implementing hurdle models and interpreting their results.

Response to dextromethorphan (15 mg b.i.d.), an antitussive agent not usually considered to have psychotropic properties, was seen in a 25–year-old man with severe developmental disabilities, congenital rubella, and an organic mental disorder. Dextromethorphan affects CNS serotonergic systems, and this was the probable therapeutic mechanism. This and other published cases suggest the existence of a distinct organic mental syndrome in developmentally disabled persons which responds to drugs that increase indoleaminergic activity.

Symptom rating sheets completed by psychiatrists over a 9-year period on 2602 intellectually normal child and adolescent clinic attenders were subjected to factor analysis (principal components). Two types of factor sets were derived, one for younger subjects (3–11 years) and another for older subjects (12–18). Both had three factors in common: conduct disturbance, relationship problems and emotionality, but differed on the fourth – developmental immaturity for the younger group, depression for the older. A factor solution was also derived for the whole clinic sample with three scales: conduct, emotionality and immaturity. Both types of factor solutions were subjected to MANOVA for age and sex effects, both of which proved to be of significant influence. Good correspondence was found between the symptom factors identified and conceptually similar clinical diagnoses.

In a structured sample of 100 male and 100 female minimally impaired patients, aged 60 years and over, females were more depressed. Varimax factor analysis demonstrated four factor groupings which have clinical relevance - Depression, Anxiety, Cognitive impairment, and Psychosomatic disorder; their relative importance is different in males and females. Analysis of variance of the scores of clusters generated by cluster analysis demonstrated four groups of subjects - normal, mildly depressed, moderately depressed with borderline dementia and disability, and severely depressed with moderate dementia and frank disability. In the mildly and moderately depressed, symptoms of anxiety predominated.

A 42-year-old mentally handicapped woman presented with symptoms of affective disorder which resolved completely on excision of a colloid cyst of the third ventricle.

We report a patient with an anteriorly palced tumour of the corpus callosum presenting with primarily depressive symptoms, without any associated neurological abnormality. It is important to be alert to the possibility of an organic cause to depression.

The Maudsley Personality Inventory and the Beck Depression Inventory, with additional items to assess depressive functional shift features and outlook on life values, were administered to 100 patients diagnosed as suffering from depressive illness. Patients’ scores for questions eliciting information about symptoms assumed to be dependent on personality correlated at substantial and significant levels with N scale scores of the Maudsley Personality Inventory. Similar levels of correlation were found for the added items for assessing life values. Items believed to assess changes in functions independent of personality, such as the features of the Depressive Functional Shift, showed no correlation with either N or E scales of the Maudsley Personality Inventory, while demonstrating a substantial level of correlation with the depression scale. It is concluded that whereas changes in innate biological functions independent of environment are direct indications of the depressive illness process, psychological symptoms of the illness may reflect changes in personality dependent on upbringing, education and cultural background, thereby producing greater variation in this group of psychological symptoms.