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.

The records of all 53 clients who referred themselves to a community mental health centre in the first three years of its existence were studied retrospectively. These showed increasing and generally appropriate use of direct access for the relief of serious, often long-standing emotional distress. Self-referrals were much more often men than women, and some clients would probably not have been reached in any other way. The service seemed to reduce the local GPs' burden, at least subjectively. However, no-one presented with acute psychiatric disturbance or immediately impending breakdown. Any prevention achieved seems likely to be long-term rather than short-term.

In depressive illness disturbance of the sleep pattern is regarded as one of the most important and characteristic of the clinical features. It is commonly believed that the pattern of insomnia is typical or even diagnostic of certain affective disorders. Reactive depressions are said to cause a delayed onset of sleep and endogenous depressions to cause early waking.

Basic, clinical and services research all play important roles in generating scientific knowledge and, ultimately, in discovering and developing cost-effective treatments that help people with a given illness. Benefits of the treatments then extend to patients' families, their communities and the entire society – all of which are impacted by the negative economic and social consequences of the disease.

The case notes of 23 schizophrenic patients who participated in a study of somato-sensory cortical evoked responses were examined for descriptions of the clinical features of their mental state at the time of first illness or most recent relapse. A comparison of syndrome scores derived from Present State Examination with those derived from case notes showed that the latter was a reliable method of mental state description for the purposes of this study. A group of syndromes similar to that described in electrodermal research was identified from the case note review and found to be highly correlated with the presence of an abnormal response in the somato-sensory evoked potentials study.

The possibility that desipramine might prove to be a rapidly acting antidepressant was first raised by laboratory studies. In 1959 desipramine was isolated as a metabolite of imipramine (Hermann et al., 1959; Hermann and Pulver, 1960), and a series of papers then followed (Brodie et al., 1961; Gillette et al., 1961; Sulser et al., 1962) in which it was shown that reserpine-induced inactivity in the rat can be more rapidly reversed by desipramine than by imipramine. This was referred to (Gillette et al., 1961) as an experimental demonstration of the relative rapidity of the “antidepressant” action of the two drugs. Other experimental reports should however warn against incautious interpretation of laboratory findings. Garattini et al. (1962) showed that desipramine is not responsible for all the actions of imipramine: in mice, leptazol convulsions are inhibited by the latter but not by the former drug. Dingell et al. (1964) were able to show considerable species differences in the rate at which imipramine is converted to desipramine and in the rate at which desipramine is then destroyed. Their paper also emphasizes the paucity of information on the metabolism of imipramine in human subjects.

Nowadays the idea of a day hospital is familiar and no longer seems revolutionary or slightly suspect. Considerable growth of such units has occurred since the Marlborough Day Hospital opened in London in 1946. However, there has been no real attempt in this country to accept the challenge of Epps and Hanes (1964) who estimated that 50–75 per cent of patients in psychiatric hospitals could be cared for equally well in day units.

An assessment was made of 100 case records written by junior medical staff working in a psychiatric teaching hospital. Thirty-nine items were rated, and considerable gaps were found in the records. The Mental State was more poorly recorded than the History; the Formulation and Summary were more satisfactory. Possible reasons for the findings are discussed, including methodological difficulties, administrative considerations, and attitudes of junior staff. The implications for the training and assessment of junior psychiatrists are explored.

Ratings on 39 symptoms were examined for patients admitted to the Neuropsychiatric Institute of the University of Michigan Medical Center. A detailed evaluation was made of the clusters derived by a hierarchical clustering algorithm, using complete linkage and a simple matching coefficient on the binary variables of presence or absence of symptoms. The four groups of patients suggested by the cluster analysis can be characterized as follows: (1) generalized multiplicity of symptoms; (2) capacity to cope except for orientation apart from generally held norms; (3) activity level and thought processes speeded up, intensified, and unselected; (4) inwardly punitive, slowed down and distressed. It is shown that these groups received significantly different treatment and that the effect of treatment was significantly different, while no such differences were noted for groups defined in terms of diagnoses. By means of linear discriminant functions, rules are suggested for assigning other psychiatric patients to one of these four groups.

Metronidazole (‘Flagyl’) has recently been said to be of value in treating alcoholism (Taylor, 1964). The drug is, of course, better known for its use against trichomoniasis. Three main claims have been made about it: (a) that it has an effect like disulfiram (Taylor, 1964; Bonfiglio and Donadio, 1966; Lehman, Ban and Nalchayan, 1966); (b) that it cuts short withdrawal symptoms (Lehman et al., 1966); (c) that it reduces craving and thereby allows return to normal drinking (Lehman, et al., 1966; Elosuo, 1966; Bonfiglio and Donadio, 1966). It is this last claim that is particularly important, since other well-tried preparations are in use for the first two purposes. We report a double-blind controlled trial directed to the possible disulfiram-like effects of the drug, and to its ability to reduce craving.

Males with chromatin positive Klinefelter's syndrome are observed to have one or more extra X chromosomes within their cells. Diagnosis is by buccal mucosa smear and chromosome analysis. Clinically they have delayed puberty, abnormal physique, small testicles and little facial hair. This paper presents some observed differences between Klinefelter patients who were being treated in subnormality units and other patients not having the condition but with similar I.Q.s.

We compared three groups of patients with panic disorder, generalised anxiety disorder and major depressive episode with a control group. Methods of comparison included a clinical profile of the patients, assessed by the Arabic version of the Present State Examination (PSE), a psychological battery of tests measuring personality traits and depressive and anxiety states, and the dexamethasone suppression test (DST) as a biological marker. Our data showed that psychological assessment and DST did not significantly differentiate between the three disorders. Despite a symptom overlap between the disorders, however, some symptoms were associated significantly more often with one disorder than another. Patients with panic disorder differed from patients with major depressive episode in showing more situational, avoidance and free floating anxiety, and more anxious foreboding. They showed less self-negligence, ideas of guilt, early awakening and social withdrawal. Compared with patients with generalised anxiety disorder, patients with panic disorder showed more loss of interest and muscle tension and less anxious foreboding, restlessness, inefficient thinking, social withdrawal and delayed sleep. Our conclusion is that the clinical course and the symptom profile of panic disorder justifies its existence as an independent diagnostic category.

A patient with a paranoid schizophrenic illness showed features of two rare syndromes, Capgras and de Clérambault's.