Social medicine seeks to discover and tries to remedy pathogenic influences arising from poor housing, poverty, and occupational hazards. Similarly, social psychiatry has shown much concern with the prevalence and incidence of mental disorders in different socio-economic classes, in urban as against rural surroundings, and especially in conditions of relative social isolation or integration, which have often been found to be linked with certain areas of towns and cities. The limitations of this ecological approach have been summarized by Clausen and Kohn (1954). They were highly critical of many of the assumptions made by ecological workers, and they felt that their approach was too coarsegrained. The units studied were too big, and they suggested that a study of family relations and of more intimate interpersonal interactions would be more rewarding and more likely to shed some light on the social aspects of mental ill-health. They might have added that it would also be much more difficult.

Two cases of psychotic illness in association with the karyotype triple X showed specific diagnostic and management problems as well as obstetric complications, EEG abnormalities, and lack of a family history of psychiatric disorder. Routine karyotyping during the investigation of psychosis is becoming relevant to psychiatric practice as research reports increasingly feature genetic and chromosome anomalies in association with schizophrenic psychoses.

British Journal of Psychiatry (1992), 160, 554–557

The treatment of phobic states by desensitization is tedious and not always completely successful (Marks, 1969). Recently newer methods claiming improvement in speed and efficacy have been introduced, such as flooding or implosion (for example, Boulougouris et al., 1971) and prolonged exposure (Watson et al., 1971). An approach based on respiratory control which seems to be as effective as other methods and even more rapid in action is described in this short paper.

Twenty-two schizophrenic patients (DSM-III-R criteria) with clinically significant akathisia were matched with 22 schizophrenic patients without akathisia on the following variables: age, sex, diagnosis, duration of illness, and current treatment. Both groups were assessed using a variety of clinical rating scales and several parameters of serum iron status. The akathisic patients showed greater severity of clinical psychopathology, particularly positive symptoms, and an excess of extrapyramidal side-effects. We were unable to confirm any association between low serum iron and neuroleptic-induced akathisia in our sample of community-based patients.

One current classification of depression divides the syndrome into psychotic and non-psychotic varieties. It is interesting that a similar classification developed over a thousand years ago out of some words of St. Paul. In his Second Epistle to the Corinthians, Ch. 7, v. 10, Paul wrote: “For godly sorrow worketh repentance to salvation not to be repented of, but the sorrow of the world worketh death.” The word sorrow used in English translations of the Bible stood for the tristitia of Latin versions (Greek λνπη); connoting sadness, sorrow, despondency, depression. Paul's distinction between the two kinds of tristitia, the one “from God” and the other “of the world”, led mediaeval theologians to enlarge on differences between the two kinds of depression.

IQ, appears to play a major role in the development and course of schizophrenia. Patients with low IQ tend to have an earlier onset (Pollack, 1960; Belmont, Birch, Klein and Pollack, 1964; Offord and Cross, 1971), to stay in hospital longer (Offord and Cross, 1971) and improve less while there (Pollack, 1960), to remit less often (Stotsky, 1952) and to make a poorer post-hospital adjustment (Pollack, Levenstein and Klein, 1968) than patients with normal or high IQ. In addition, schizophrenics, particularly the men, tend to have lower childhood IQs than their siblings (Lane and Albee, 1965; Offord, 1974).

Within the past 15 years, it has become clear that the continuing administration of neuroleptics can produce several long term side effects, the two most important being tardive dyskinesia (TD) and skin pigmentation. In mental hospital surveys, the proportion of patients with TD has been described as about 30 to 40 per cent. At this point, there is no recognized treatment although some cases improve if the drug is discontinued (Jeste et al, 1979). In addition, TD may increase mortality (Mehta et al, 1978).

A case of senile dementia that initially presented with complex visual hallucinations in the absence of clinical cognitive impairment or other psychopathology is described. Dementia must be added to the differential diagnosis of isolated visual hallucinations in the elderly.

Respiratory relief (R.R.) appeared to be a simple and rapid treatment for specific phobias and for the phobic components of more complex neurotic conditions (Orwin, 1971). The basic hypothesis was that the R.R., satisfying an intense need to breathe, if simultaneous with the presentation of a phobic stimulus, would inhibit the degree of anxiety previously provoked and that this inhibition would persist. The need to breathe was induced by voluntary restriction up to maximum voluntary respiratory arrest (M.V.R.A.). As in conventional desensitization (Wolpe, 1958), a hierarchy was drawn up and the patients were desensitized using R.R. instead of relaxation. Carbon dioxide-oxygen mixtures were introduced because CO2 is known to stimulate respiration, and it was expected that by intensifying the need to breathe the speed and effectiveness of treatment would be increased by the augmented respiratory relief (A.R.R.).

A group of 156 psychiatric patients from an urban community psychiatric unit for chronic psychiatric patients was routinely medically screened and reported on. Re-evaluation of the medical diseases found in those patients was carried out three years later. Those who were still being treated – 73 patients (47%) – were interviewed, as were their psychiatrist and, where necessary, their general practitioner (GP). The implementation of medical recommendations given following the physical screening by the specialist in internal medicine was also assessed. Re-evaluation of the diagnoses confirmed that 36% of this population had one or more physical diseases, rather than the 53% found earlier. The results show that the majority of physical complaints and diseases as well as functional illnesses were as persistent as the psychiatric diagnoses in this patient group. The patients' GP seems to be the person best suited as the primary physician responsible for the patient's physical health.

There is a growing body of evidence which points to a high prevalence of psychiatric disorder in students and to the contribution of such disturbance to wastage and under-achievement. The relationship between psychiatric illness and academic difficulty is, however, a complex one, for severely ill individuals may be capable of high achievement while apparently mildly disturbed students may fail academically through the operation of emotional factors. The ability to predict or detect at an early stage the psychiatrically or academically vulnerable student would clearly be of great value.

Psychiatric Day Hospitals are likely to play an important role in the development of community psychiatry. Although they have existed in Britain for approximately 25 years, there is much that remains unknown about them. The present is a report of the functioning of a Day Hospital over a period of ten years. Stress is laid on (a) the source of patient referrals; (b) the diagnostic categories of the patient, and (c) the follow-up of patients after discharge.

The challenges presented by the Present State Examination (PSE) in a multi-cultural context are explored. The general approach to the use of this instrument, difficulties with rating items relevant to cultural or subcultural conditions, and particularly the assessment of psychosis are considered, as well as the possibility of additions to and modifications of the PSE-CATEGO system. Though disagreement exists as to whether the research model which the PSE represents is adequate to deal exhaustively with cultural factors, the instrument is useful in cross-cultural research and also in stimulating debate and crystallising issues.

The need for a long-acting phenothiazine has been long recognized, especially since it has been shown (Parkes et al., 1962; Renton et al., 1963; Kline, 1964; Willcox et al., 1965; Wilson and Enoch, 1967) that a high proportion of schizophrenic patients do not take their prescribed medicines.

Three schizophrenic patients who had transient recurrence of auditory hallucinations during acute dystonia precipitated by neuroleptic medication are reported. If it is accepted that psychotic symptoms result from dopaminergic overactivity, such phenomena suggest that acute dystonia might also have been caused by increased dopaminergic neurotransmission in these cases.

Against the background of impressive advances in the neurosciences, which are opening new perspectives on the mechanisms of mind, and the development of increasingly powerful instruments and methods with a potential to revolutionise clinical research in psychiatry, clinicians continue to disagree on the definition and taxonomy of the elementary units of observation in their universe of discourse: the individual mental disorders.