This study examines a series of elderly admissions to a psychiatric hospital and a geriatric hospital serving the same catchment area in order to evaluate the success of the two hospital services in separating their patients into two groups, and to study the effect, if any, on the prognosis of those patients who were ‘incorrectly labelled’.

There have been few cases of this syndrome published since the original papers by Kleine in 1925 and Levin in 1929. Critchley (1962) described 26 cases in his paper, in which he reviewed the condition fully. Earles (1965) mentioned 44 cases in the literature: a female case was recently discussed by Duffy and Davison (1968). According to Critchley the characteristic symptoms of this syndrome are ‘recurring episodes of undue sleepiness lasting some days, associated with an inordinate intake of food and often with abnormal behaviour’. Invariably male adolescents are affected; they are normal in between attacks and the condition tends to disappear in later life.

Memory impairments are handicapping to those who suffer them, and a number of ways of trying to help those afflicted have been devised. Effective psychological approaches are likely to be based on methods designed either to make the most efficient use of remaining memory capacity, or to alter the environment so as to reduce the demands placed on memory. At present the success of such approaches is limited.

Of 40 depressed and anxious patients who received treatment during the Sheffield Psychotherapy Project, 31 completed the BDI and SCL-90 at two-year follow-up. At both group and individual levels, outcomes were very similar to those obtained at the completion of treatment. Substantial minorities of patients reported major life events and seeking further help for psychological problems during the two years, but these reports were not reliably associated with symptoms at follow-up. Patients recalled very different elements in prescriptive and exploratory therapies as helpful, with a notable emphasis upon prescriptive therapy's relaxation and anxiety management as a source of problem solution.

Ten years ago, specific high-affinity binding sites for benzodiazepines (BDZs) were found in the brain (Mohler & Okada, 1977; Squires & Braestrup, 1977). These binding sites are believed to be the primary site of action of BDZs and are found on the same protein as GABA receptors. GABA is the main inhibitory neurotransmitter in the brain.

The Reform Law 180, approved in Italy in 1978, had – and still has – great national and international significance for its dramatic consequences on both clinical and health organisational aspects of psychiatry: the law, in short, had the great effect of bringing psychiatry back to medicine, to the community and to the general hospital. This was the starting point of other relevant events, one of which was the establishment of the specialty of consultation-liaison psychiatry in Italy (Cazzullo et al, 1984). Since then, consultation-liaison psychiatry has gradually developed worldwide and in Italy as a super-specialised branch of psychiatry, able to put into practice – to operationalise – the great psychosomatic tradition in its three interrelated strands of clinical, teaching and research activities. The report that follows is strongly influenced by this historical background.

There is a growing research interest in childhood hallucinations as predictors of psychotic states. This work appears to have limited direct relevance for clinical child psychiatric practice, but it highlights the continuing relevance of research into precursors of psychotic states and into the determinants of clinically relevant hallucinations in children.

Bright young schizophrenics, like bright young people generally, are interested in reading about their condition. From the vast and varied selection of literature available to them, they appear to show a marked preference for R. D. Laing's The Politics of Experience (1967). The present authors, like other members of the 'square’ older generation, are of the opinion that they know what is best, and that this book is not good for these patients. It is an appealing book, and emotionally there is not a false note in it. This alone makes it important. But it contains treacherous confusions, and while we do not presume to make choices for our young friends we do feel that it is our duty to clarify the alternatives as presented in this book.

Clinical and empirical reports suggest that individuals use non-suicidal self-injury (NSSI) not only to ameliorate dysphoria, but to curb suicidal ideation or avoid suicidal behaviour. To date, however, no study has quantitatively assessed whether NSSI leads to short-term reductions in suicidal ideation. Using real-time monitoring over 7 days in a sample with borderline personality disorder, we found evidence that NSSI is followed by reductions in suicidal ideation in the subsequent hours. This suggests that NSSI may serve as an effective, albeit maladaptive, coping strategy for suicidal states. These findings have important implications for the management of suicide risk and self-harm.

We administered an extensive battery of primarily non-memory neuropsychological tasks to 37 patients with endogenous depression, randomly assigned to either bilateral (B/ECT) or unilateral (U/ECT) electroconvulsive therapy. Testing was done prior to therapy and again shortly after the sixth induced seizure. The two groups did not significantly differ in cognitive impairment, either before or after treatment, and within-group cognitive changes following treatment were small. We conclude that neither B/ECT nor U/ECT substantially worsen non-memory cognitive performance in depressed patients, yet both result in significant clinical improvement.

Coping strategies to adapt to environmental and psychological contingencies have been well studied in the human subject. The typical individual is known to have response patterns that permit automatic, and often unconscious adjustment to changing conditions. Psychological (defence) mechanisms facilitate adaptation to new situations or interactions, and when successful, no additional coping mechanisms need to be invoked. However, situations may arise when such mechanisms are insufficient: this may result from developmental failure, personality factors, inordinate levels of stress, or combinations thereof.

In a prospective study of the 295 admissions in one year to an acute psychiatric ward, 14 subjects without delirium or dementia were found to have developed temporary urinary incontinence. When compared with matched controls (n = 56) the incontinent patients were found to be suffering from psychosis (P < 0.0002) and to have a history of childhood enuresis (P < 0.01). Compared with psychotic controls (n = 22), the incontinent patients were older (P < 0.05), they had been exposed to a greater variety of treatments (P < 0.01), and they had received more thioridazine (P < 0.04).

This paper is an extension of an earlier introductory one (1) and evaluates the results of treatment with parenteral and oral chlorimipramine of 200 patients suffering from depressive states of varying severity. The current research project was started in January 1968, and is still in progress. Further references to the literature may be obtained from the original paper or by application to the author. Fifty-seven of the cases treated were so severely depressed that ECT would normally have been given. All were in-patients and were treated with intravenous infusions of chlorimipramine. The other 143 patients were less severely depressed and were seen as out-patients. They were treated with increasing doses of oral chlorimipramine, but a few cases in both groups also had ECT to expedite recovery. Approximately 50 patients exhibited obsessional features in addition to depression, and their response to treatment was so promising as to merit special mention.

There is increasing concern that a reliance on the descriptive, syndrome-based diagnostic criteria of ICD and DSM is impeding progress in research. The USA's major funder of psychiatric research, the National Institute of Mental Health (NIMH), have stated their intention to encourage more research across diagnostic categories using a novel framework based on findings in neuroscience.

The Koro syndrome, a “special cultural psychiatric syndrome’, is encountered in South China, Malaysia and Indonesia, especially among people of Chinese origin. There are only eight case reports of Koro from the Western hemisphere. We present a typical primary Koro patient from Israel. Jewish cultural mores are a possible contributory factor.