Despite decades of suicide research, our ability to predict suicide has not changed. Why is this the case? We outline the unique challenges facing suicide research. Borrowing successful strategies from other medical fields, we propose specific research directions that aim to translate scientific findings into meaningful clinical impact.

In the study of mental diseases and their treatment physical activity seems to be an important variable. In order to get an objective recording of physical activity, we have applied two methods. In this study we wish to show how a normal group behaves under different circumstances concerning these two measures of activity, and we also report a pilot study in which the two methods were applied to a group of patients with mental diseases.

Under current proposals for new mental health legislation, psychiatrists increasingly will be involved in tribunal processes examining the grounds for compulsory detention and treatment, both in hospitals and in the community. They will lose some authority over admission and discharge, with decision-making instead being given over to legal bodies that will regulate admission and discharge. The proposals for wholesale change in UK mental health law are an opportunity to devise a new type of legal hearing where all ‘sides' are properly represented. However, the new mental health tribunals proposed in the draft UK bill sit in a twilight zone of ‘quasi-criminal’ courts. The use of single joint experts or ‘expert panels', consistent with the recent civil law reforms, means that problems of undisputed medical evidence may become even more acute. American experience shows that judicial deference to clinical opinion, even in overtly adversarial commitment hearings, is considerable (Bursztajn et al, 1997). In this editorial, we argue that these proposals justify a re-examination of the values of law and psychiatry.

In the United States considerable emphasis is at present being placed upon emergency psychiatric services. This is part of a national drive to provide a high level of care for the total population and not just those who can afford the services of private psychiatrists. Investigations have been conducted in various centres in the U.S.A., and subsequent discussion and documentation (e.g. 5) suggest that emergency care is best given by a centre which also provides full in-patient and out-patient services. This echoes and reinforces the recommendations of the “Community Mental Health Centers Act”, which promises Federal matching funds to American states setting up community mental health centres, provided the services are comprehensive. The term “comprehensive” is defined in some detail, and comprises in-patient and out-patient services, partial hospitalization (e.g. day-care), emergency services for 24 hours in the day, and consultation and educational services to professional personnel and to the community at large.

The creation, in DSM-III, of the category ‘major depression’ can be linked to the launch, and success, of Prozac. The consequences of creating this broad diagnostic category are of concern in relation to the treatment of individuals with a diverse variety of depressive disorders.

The majority of subnormal and severely subnormal patients do not present behaviour problems provided planned daily occupation of mind and body is achieved. In a large mental deficiency hospital, however, there is usually a group of grossly disturbed patients whose behaviour is frequently or continually disturbed, and who fail to respond adequately to drug therapy. These patients present a serious nursing problem since they occupy a disproportionate amount of the nurse's time.

A dramatic improvement in a patient with tardive dystonia was obtained with verapamil after the failure of other medicines. The use of verapamil or other calcium-channel blockers should be considered when treating drug-induced movement disorders.

An analysis of recently published family history data on rapid eye movement (REM) narcolepsy was undertaken to determine the goodness-of-fit of a multifactorial (MF) model of inheritance. The analysis revealed that a two-threshold MF model can successfully account for the prevalence of REM narcolepsy and other disorders of excessive sleep (DES) observed in the first-degree relatives of the REM narcoleptic probands studied.

Young married couples, with or without a depressed wife, were divided into three groups according to marital quality. Negative modes of relating were assessed by self-rating and partner-rating questionnaires. The intercorrelation of scores for different modes of relating was higher on partner-rating than on self-rating scales. There was a significant gradient of mean negative-relating scores across the three levels of marital quality. The partner-ratings of depressives and their husbands were higher on all negative-relating scales than those of non-depressed women and their husbands. The self-ratings of the depressives corresponded with these negative ratings while those of their husbands did not. The partner-rating scores differentiated between the depressives with poor marriages and those with better marriages.

To clarify a controversy as to whether melatonin secretion is related to body weight, urinary sulphatoxymelatonin (aMT6s) excretion was estimated in 10 patients with anorexia nervosa before and after weight gain, and compared with 10 age-matched controls. There was no change in aMT6s excretion after weight gain, and no significant difference between the patients and control groups at either point. Significant increases in plasma LH, FSH, and estradiol were detected after weight gain in anorexic patients, independent of aMT6s excretion.

A woman developed delusional parasitosis when taking phenelzine. The delusion occurred in an agitated hypomanic state and was preceded by an intense pruritus. It completely remitted following withdrawal of phenelzine combined with a low dose of haloperidol (1 mg/day) for several days. This unusual psychopathology is probably encountered more by dermatologists than by mental health professionals.

We completed the Newcastle Diagnostic Scale on 152 unipolar depressed in-patients: its validity was supported by the findings that endogenous depressives were, in contrast to neurotic depressives, older, more severely depressed, with better social support, fewer life events, less personality disorder, and a lower morbid risk of alcoholism and antisocial personality in their first-degree relatives. The relationship between Newcastle scores and the morbid risk for alcoholism was non-linear, such that a cut-off score of 4, rather than 5, maximised the difference between the endogenous and neurotic groups with respect to familial alcoholism rates as well as other validating variables.

Clopenthixol is a thiaxanthen derivative (Fig. 1). Its full name chemically is 2-chlor-9-[3-(N-B-hydroxyathylpiperazino)-propyliden]-thioxanthen. Numerous uncontrolled trials to date (2, 3, 4, 5, 6, 7) have reported success with this drug in the treatment of schizophrenia, mania and other psychotic disorders.