The Scale for the Assessment of Negative Symptoms (SANS) was developed in order to facilitate evaluation of five important symptoms frequently observed in ‘core schizophrenia’ (process schizophrenia, the schizophrenic defect state, negative schizophrenia). These symptoms include affective flattening, alogia (poverty of speech and thought), avolition, anhedonia, and attentional impairment.

A case is described of anorexia nervosa arising in a mentally-handicapped 35-year old person with Down's syndrome. The late onset is accounted for on the grounds that adolescent challenges had only recently arisen in this instance. Removal of the patient from the provocative situation, coupled with some effective psychotherapeutic ‘grief work’ with the family, was associated with restoration of normal body weight and menstrual function, following the patient's acceptance of the usual re-feeding treatment programme.

My involvement with the psychiatry of learning disability began in 1968 when Professor Batchelor, then Professor of Psychiatry at the University of Dundee, suggested that mental illness in people with learning disability was a clinically interesting and under-researched topic which merited further investigation. At that time, mental illness was not usually considered even a part of the medical specialty of learning disability – or at least, not in Scotland. People in mental handicap hospitals who developed signs of mental illness were normally passed on to colleagues in general psychiatry who were considered to have the investigative and treatment expertise. If admission to in-patient care was considered necessary, it was usually to the local general psychiatry service.

The mental health of 523 medical students was examined one month after enrolment and two years later. The point prevalence rates of all mental disorders were 16.1% and 17.5% respectively. The incidence rate was 5.3% per year, with neuroses being the most frequent diagnoses (3.5%).

A family study was carried out in two groups of patients fulfilling RDC for schizoaffective disorder: in one, a full affective and a full schizophrenic syndrome were simultaneously present; in the other, affective and schizophrenic features appeared within a polymorphic and rapidly changing clinical picture, with depersonalisation/derealisation and/or confusion. In the first-degree relatives of patients of the former group, the risk of major psychiatric disorders was not significantly different from that of relatives of schizophrenics, whereas in the first-degree relatives of patients of the latter group a low risk for both schizophrenia and major affective disorders, and a relatively high risk for schizoaffective disorders, were observed.

We compared the psychiatric manifestations of 56 CATEGO S schizophrenic in-patients from three ethnic groups (white, coloured and black). A marked similarity among the groups on both schizophrenic and non-schizophrenic symptoms was found, as well as a high prevalence of depressive and anxiety symptoms. Differences occurred on the syndromes of (1) olfactory hallucinations and (2) subcultural delusions and hallucinations. Black patients had both syndromes more frequently than either white or coloured patients.

Since the Second World War the number of Italians working in Switzerland has greatly increased. In 1962 there were officially 454,000 Italian workers in that country and this is almost certainly an underestimate. In 1960 and 1961 one of the authors (Risso) investigated the social, cultural, genetic and other factors in the mental illnesses of 709 Italian patients in psychiatric clinics and mental hospitals in German-speaking Switzerland. These patients had rather unusual symptoms in that there was a mixture of normal ideas, which appeared to be derived from their cultural background, and psychotic or psychotic-like symptoms. It was therefore often difficult to allot these patients' illnesses to one of the usual diagnostic categories, so that it was not easy to decide if the patient had a schizophrenic episode, a schizophrenic reaction or a non-psychotic psychogenic reaction.

Family-genetic studies of child and adult psychiatric disorders have become increasingly fashionable over the past decade. The development of structured diagnostic interview schedules, the emergence of uniform diagnostic criteria such as DSM-III, and the use of refined design and analytic techniques from the field of chronic disease epidemiology have made substantial contributions to the methodology of such studies. Advances in molecular genetics, particularly our emerging capacity to perform chromosomal linkage studies throughout the human genome, have renewed hope that the constitutional underpinnings of some psychiatric disorders can be identified and that the pathophysiology of these disorders can be elucidated. Family-genetic techniques in child and adult psychiatry are discussed with a particular focus on their potential value in validating diagnostic categories spanning developmental epochs.

The term ‘conversion’ implies a correlation between conversion symptoms, hysteria, and hysterical personality. A clinical case of conversion related to chronic post-traumatic disorder, with paranoid features, was successfully treated by anti-psychotic drugs; it illustrates the non-specific nature of conversion symptoms. Mechanic's concept of ‘illness behaviour’ is a frame-work that meets the need for a broader understanding of conversion symptoms.

Pure erotomania was first described in 1920 by the French psychiatrist de Clérembault. It is a delusional condition, usually in a woman who believes that a man, unattainable because of his much higher social class or married state, is very much in love with her. The belief has a precise onset and occurs suddenly in a state of clear consciousness. Enoch and his colleagues (1967) claim that ‘some instances of this syndrome may be distinct from ordinary paranoid psychoses and deserve a separate place in psychiatric nosology’, while Arieti thinks that it is not a clinical entity but a symptom of paranoia or paranoid schizophrenia (Arieti and Meth, 1959).

In a double blind trial, 50 male chronic alcoholic patients were treated with either fenfluramine in a dose of 60 mg or 120 mg daily, or with identically prepared placebo tablets. Patients were interviewed on admission to the trial and then at four-weekly intervals for a period of one year and blood levels of delta-aminolaevulinic acid dehydratase (ALAD) and gamma-glutamyl transpeptidase (γGT) and fenfluramine were determined. The efficacy of fenfluramine at the two dose levels was compared with placebo on the basis of the number of lapses indicated by the clinical history and also by alterations in the biochemical indices.

Twenty-seven patients completed the period of observation, there being 9 in each of the three groups. Those receiving 120 mg fenfluramine daily showed significantly fewer lapses than either of the other two groups (p < 0.01) on biochemical but not on clinical criteria. Overall assessment revealed that 3 of the 9 patients receiving the high dose of fenfluramine had a good result during the period of the trial, but there were none in the 60 mg group or in those receiving placebo. More extensive trials of fenfluramine in the treatment of chronic alcoholism are indicated.

Experiences arising from the work of a multi-disciplinary psychotherapy liaison team in the primary care setting are described. Special emphasis is given to the difficulties encountered in working relationships. Attention is drawn to the complexity of the inter-professional relationship, its unconscious roots, and its influence on the quality of patient care.

On the border-land of Lunacy lie the criminal populations. It is a debateable region; and no more vexed problem comes before the Medical Psychologist than this—viz: where badness ends and madness begins in criminals. The inmates of Asylums and of Prisons are so nearly allied that “thin partitions do their bounds divide.” From large experience among criminals I have come to the conclusion, that the principal business of Prison Surgeons must always be with mental diseases; that the number of physical diseases are less than the psychical; that the diseases and causes of death among prisoners are chiefly of the nervous system; and in fine that the treatment of crime is a branch of psychology.

Forty depressives and 40 matched controls were compared in terms of a number of self-report variables and in terms of their descriptions and evaluations of both real-life and hypothetical social relationships. Clear differences between the two groups reveal poorer self-ratings in the depressive sample, together with a tendency to describe and to evaluate both real and imaginary relationships more negatively. A retest of the depressed patients at the time of discharge from hospital showed improvement only in the two depression measures and not in any of the other self-rating and perceptual measures used. The possibility is discussed that the perceptual variables are predisposing to depression rather than concomitant with it.

The methods of Roth's 1948–49 Graylingwell study, previously applied to a Crichton cohort of elderly patients of the years 1974–76, were repeated in 1984–86. The results support the continuing validity of Roth's classification of mental illness in the elderly, but changes in the diagnostic distribution of the cohort, previously observed in the 1970s study, are further in evidence in the 1980s one. Admissions of dementia cases continued to increase both relatively and absolutely, while the trend of increasing survival in dementia also continued.

The purpose of this study was to examine the validity of assessing pictures produced by acute schizophrenic subjects as a technique in differential diagnosis. It was hypothesized that art productions by schizophrenics differ from those both by other acute psychiatric patients and by ‘normals'. Coloured slides were made from pictures produced in standardized conditions by three samples each of thirty subjects. It was found that repetition of abstract forms was the only factor studied to be associated specifically with schizophrenia; whereas the presence of pictorial imbalance, overelaboration, childlike features, uncovered space, detail and colour variety were found to be associated with psychiatric admission irregardless of diagnosis. Doubt is cast on the use of art as a technique in differential psychiatric diagnosis.

Disorders of the thyroid gland are associated with disorders of mood (Thomas et al, 1970; Van Uitert & Russakoff, 1979; Folks, 1984; Young, 1984; Jadresic, 1990). Both hypothyroid and hyperthyroid states can be associated with depression, which is sometimes accompanied by psychotic features such as delusions and hallucinations (Wilson & Jefferson, 1986). Similarly, primary affective disorders can be accompanied by changes in thyroid function, with low thyroid-stimulating hormone (TSH) levels and elevated thyroxine (T4) (Kirkegaard & Faber, 1980), and in major depressive illness there is often a blunted TSH response to thyrotrophin releasing hormone (TRH) (Prange et al, 1972; Loosen, 1987).