One thousand and five patients referred to a psychiatrist were questioned, during a routine clinical interview, about current and previous suicidal ideas and previous suicide behaviour; they were also specifically asked what made life worth living for them at that time. In a four-year case-record follow-up 102 patients (10.1 per cent) were found subsequently to have attempted deliberately to harm themselves. Such deliberate self-harm (DSH) was significantly associated with female sex, with age below 35, and with evidence of suicidal ideation and/or behaviour at the time of and/or before the initial referral. To the question, “What makes life worth living for you at the present time?” a significant number of subsequent self-harmers had answered ‘Nothing’ or ‘Not much’ while a significant number of subsequent non-self-harmers had answered “Spouse and children” or “Family”.

The results suggest that the answers to questions about current and previous suicidal ideas and behaviour and perceptions of what makes life worth living may be useful in the prediction of deliberate self-harm.

Studies on the relationship between physical constitution, personality and mental illness have been mostly confined to the Caucasian race. There has been no investigation, to our knowledge, of Oriental subjects, though a number of investigations of body type, composition and physiological functions without relation to mental aspects have been carried out on them. It is clearly important that work in this field should be extended to include subjects of different racial composition and socio-cultural background. The intercorrelations found between physical and mental characteristics in Caucasians may not apply to others.

In a previous paper (Kniveton and Stephenson, 1970) we suggested that children with few interests of their own are likely to be more susceptible to the influence of filmed or television models than children with more extensive interests. However, neither we nor any other workers in this field have demonstrated that the tendency to imitate is a consistent behavioural characteristic. In fact, examination of the within-group scores for the subjects in the above-mentioned experiment reveals exceptionally large standard deviations for the amount of time spent imitating. These characterize both middle-class and working-class groups (Kniveton and Stephenson, 1972), although such groups differ consistently in their susceptibility to the filmed model used by the authors.

A survey has already been presented (British Journal of Psychiatry, November 1971) of all patients seen by the senior psychiatric staff of Leverndale Hospital and the Victoria Infirmary, Glasgow, with a view to termination of pregnancy for the period of two years following the implementation of the Abortion Act, i.e. from April 1968 to April 1970. During this time 116 patients were seen, of whom 71·5 per cent were recommended for termination. Follow-up of cases not so recommended showed that one-third obtained abortion elsewhere; the rest apparently made a reasonable adjustment to their situation.

Among patients admitted to psychiatric hospitals are some who are discharged undiagnosed. It can be expected that psychiatric patients, as patients in other medical specialties, who do not meet the criteria for any of the established diagnostic groups, will be considered as undiagnosed until the course of their illness and clinical picture makes the diagnosis evident. The undiagnosed patients are a diagnostic and therapeutic challenge. Because in a space of five years, 256 patients left undiagnosed, it was felt that this group merited investigation.

Over the past several years there has emerged a family of highly sophisticated but technically complex procedures for the visualisation of a range of cerebral functions in living man (Andreasen, 1988). The images they produce are so beguiling not just because of their potential to give new insights into the pathophysiology and treatment of major psychiatric disorders, but because they convey information through a quite fundamental modality: people are only convinced by what they can see. However, initial applications of such new technology have appeared just as likely to generate new questions and contradictions as to provide answers to current issues. This is readily illustrated by recent studies on the imaging of brain dopamine receptors in schizophrenic patients by positron emission tomography (PET) (see Waddington, 1989a).

Cognitive deficits in schizophrenia can be differentiated into state-linked accompaniments of psychotic episodes and trait-linked signs of a more enduring vulnerability to schizophrenia (Zubin & Spring, 1977; Cromwell & Spaulding, 1978). Elsewhere (Spring & Zubin, 1978) we suggested that a marker of psychotic episodes is one that deviates in highly symptomatic schizophrenic patients and normalises as their florid psychotic symptoms remit. A stable vulnerability marker, in contrast, continues to deviate in remitted patients, their biological relatives, and others who are vulnerable to schizophrenia but not floridly psychotic. In addition, Nuechterlein & Dawson (1984) proposed a mediating vulnerability marker which demonstrates characteristics of both vulnerability and episode markers. On such a marker, asymptomatic vulnerable individuals differ from normal; the advent of psychosis magnifies the deviation.

The purpose of this study was to test the effect of gender on the familial risk for schizophrenia and affective disorders in probands with schizoaffective disorder. The sample consisted of 42 DSM–III schizoaffective probands and 149 first-degree relatives from the retrospective cohort family studies, the Iowa 500 and non-500. Survival analysis estimated differences in morbidity risks, analysed by sex of proband and of relative. Findings showed that, among probands, relatives of females had significantly higher rates of schizophrenia and unipolar disorder than relatives of males. Further, among relatives, males were at significantly higher risk for schizophrenia spectrum disorders than females. Results were similar when probands were subdivided into their primary symptom patterns, that is ‘mainly schizophrenic’ or ‘mainly affective’, as well as by ‘schizoaffective, depressed’ or ‘schizoaffective, manic’. Implications for the taxonomy of schizoaffective disorder suggest a stronger relationship with schizophrenia, although the relationship with affective disorder remains unclear.

Erotomanic delusions occurred in a depressed mentally handicapped woman. Although erotomania is generally classified with paranoid disorders, in people with mental handicap, depression may be the more commonly associated illness.

British Journal of Psychiatry (1991), 158, 127–129

Psychoanalytical methodology has been described as causal explanation or hermeneutic understanding. This methodological dichotomy has been introduced into psychopathology by Karl Jaspers. Contemporary authors' contributions in the area are discussed. Although these authors accept a role for both methods, they agree with Jaspers that psychoanalysis should be subjected to the logical limitations of hermeneutic analysis. A logical framework for the interaction of explaining with understanding is presented and discussed in relation to psychiatric research.

Capgras syndrome in association with lithium toxicity is described in a 74–year-old woman. Lithium toxicity should be considered when new delusions occur during lithium therapy.

Recent advances in molecular genetics have radically altered the prospects for determining the role of heredity in the transmission of major psychiatric disorders. Identification of the actual gene(s) involved, elucidation of their structure, and determination of their products are the steps which theoretically follow successful demonstration of linkage (Gurling, 1985; Baron & Rainer, 1988). Consideration of the ethical issues raised by genetic linkage studies is therefore now of paramount importance. This article focuses on the problems raised by the research process, and not on the ethical implications of the results eventually obtained.

In all ages of the world, from the earliest dawning of society down to our own enlightened day—theologians, philosophers, and legislators, those called upon to govern and to guide mankind, have agreed as to the importance to be attached to the physical, mental, and moral training of infancy and childhood. States and societies, and the Church too, have admitted the truth of their theories, and have practically applied them to the affairs of life, to the prevention of crime, and to the advancement of the human race in many social and moral respects. For it is well known to these that it is during infancy and childhood that the being, with a mind plastic and educable, may be taught that discipline and self-control, the application of those principles of responsibility, of justice, and of truth, which are afterwards to fit him to fight the battle of life, and to become a useful member of society.

Suicide by hanging and self-strangulation (‘hanging’) has become more common. We studied people who presented to hospital during a 28-year study period after using these methods for non-fatal self-harm. Hanging increased greatly in frequency during this time. The male:female ratio was nearly 3:1. Females were distinguished from males by far higher rates of psychiatric care, personality disorder and previous self-harm. Compared with matched individuals who presented with non-fatal self-poisoning, more of those who used hanging had high suicidal intent, fewer used alcohol in association with the act, and more subsequently died by suicide. They represent an important subgroup of those who self-harm, who require especially careful assessment and follow-up.

This paper analyses the legal and other social conditions under which the concept of ‘psychopathic personality disorder’ continues to play a strategic part in both the repeated imprisonment of female petty offenders and in the justifications put forward for the rigidity of the disciplinary regimes in women's prisons.

Numerous studies have related psychiatric disturbance to season of birth. Barry and Barry (1961) cited nine independent studies which concluded that mentally ill persons, especially schizophrenics, tend to have been born during the first four months of the calendar year. Hare and Price (1969) reported more recent evidence of similar seasonal birth trends for large groups of hospitalized British schizophrenics and manic-depressives, as compared with neurotics. Barry and Barry (1964) later suggested that the seasonal birth pattern may be more relevant to middle and lower class schizophrenics than to upper class schizophrenics from private mental hospitals. Orme (1963) upheld this seasonality of birth pattern among less intelligent but not among more intelligent psychotics. Norris and Chowning (1962), who confirmed the seasonal birth pattern among Canadian schizophrenics from both public and private hospitals, observed that the significance of seasonal differences between schizophrenics and normal populations depends upon which population birth years are selected for comparison. Norris and Chowning therefore suggest that the seasonal birth trend among schizophrenics may be the result of random variations in birth rate together with post-hoc grouping of the particular years for comparison. While this interpretation and criticism is tenable for a given study, it has become less tenable as evidence converges from the many independent studies.

In recent years, the use of hospital care in Finland has decreased, while out-patient care has expanded; a psychotherapeutic approach and rehabilitative measures have been widely adopted. For schizophrenic patients, these changes may also have improved outcome, which is better than 30 years ago. However, their need for treatment and care has not been reduced to the extent that was hoped; in line with the decrease in use of hospital services, the need for alternative services for the socially disabled has increased. There is an urgent need to develop crisis-intervention. Male schizophrenic patients require special attention from the community care system and possibly a new kind of service which would meet their needs better. The need for care, support and education of patients' families is also increasing.