A female psychopath presented multiple forms of psychopathology, including features of ‘multiple personality disorder’. It is proposed that a diagnosis of borderline personality disorder, or the psychodynamic features of borderline personality organisation, should be the exclusion criteria for this condition.

British Journal of Psychiatry (1992), 160, 541–544

The increasing importance of properly controlled drug trials in modern medicine has shown the need for further study of the “placebo response” and the effects of “suggestion”, particularly in the evaluation of the results of treatment of the psychoneuroses. Much of the work on the response to placebos has been done on their deleterious side-effects, i.e., the production of symptoms of various kinds, but some recent investigations have clearly demonstrated the amelioration of symptoms by the administration of placebo.

Patients in the care of the Department of Psychological Medicine, Guy's Hospital, who are receiving moderate and large doses of phenothiazine drugs are regularly tested for evidence of hepatic or haematological disturbance. In the course of such an investigation, when the urine of a schizophrenic patient was tested with modified Ehrlich's reagent for urobilinogen, it was remarked that a deep blue colour was produced. The patient had been receiving 600 mg. of chloropromazine daily in divided doses for the previous 10 days, and as no other cause for this unusual result could be found, the phenothiazine was considered to be responsible.

A two-year follow-up study of 165 teenagers with conduct and emotional disorders treated as in-patients on a regional adolescent unit (YPU) is described. The target types of behaviour for each subject were scored independently by the teenager, the parent or guardian, and the professional referrer before admission and at one month, one year and two years after discharge. The significant overall improvement in behaviour observed at one month after discharge was sustained at one and two years. Thirty-three subjects who abandoned treatment within six weeks of admission had made significantly less progress than the fully treated group at one month after discharge, but there were no significant differences at the one- and two-year evaluations. Two years after treatment, between 69% and 79% of the 132 subjects who completed treatment were regarded as improved, depending on which respondent made the assessment. Adolescents who completed treatment had different characteristics from those who terminated treatment prematurely and were more likely to be girls in care referred by social services.

“Objective - To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. Design - Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. Subjects and setting - 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. Main outcome measures - Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. Results - Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantage of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. Conclusions - The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.”

It has been accepted that the major factor in the aetiology of senile dementia is the organic brain disease which can be demonstrated histologically (Corsellis, 1962). The work of Rothschild (1936) suggested that psychological differences between individuals might be contributory, and Sands and Rothschild (1952) claimed evidence that senile psychotics have similar pre-morbid personality traits to those found in involutional melancholies and that hypochondriasis, dependency and rigidity were prominent features in both. A similar opinion is given by Noyes and Kolb (1958), who believe that, “the person who develops senile dementia has often been characterized by rigid and static habits”.

Psychiatric assessment strategies that integrate research findings with daily practice are necessary and clinically useful. This paper uses the example of an attention deficit disordered adolescent to illustrate how double-blind placebo controlled and multi-dose adjustment designs can be successfully implemented in routine clinical practice. These designs are especially valuable In evaluating the therapeutic effect of methylphenidate because of biases that may lead to clinical misuse of this stimulant medication.

Steinberg et al. (11) have recently described, in a case report in this Journal, a combination of manic psychosis in the course of and following an influenza infection with high levels of complement fixing (CF) antibody titre, with a view to encouraging further research-work in this direction. Following their suggestions, we should like to describe a similar observation. At the same time, we will take the opportunity to make some critical remarks on the comments made by Steinberg et al. as to the correlation between the specificity of an exogenic noxious agent and a mental reaction, since, in our opinion, it might lead to a certain misunderstanding to talk about a direct or even specific relationship between influenza infection and manic psychosis.

Dr Post has been known to generations of students of psychiatry passing through The Maudsley Hospital, London, as a clinician and clinical teacher. He retired in July 1978.

Acute porphyria is a rare disease in this country. Although a typical case was described in the Journal of Mental Science over 50 years ago (Campbell, 1898), Petrie (1948) could find only three cases reported in Britain between 1940 and 1948; since then at least six more cases have been reported. The disease is relatively common in Scandinavia and, to a less extent, in North America—a distribution for which Discombe (1948) has suggested an explanation in terms of relative emigration rates.

Women in academic publishing and academic psychiatry face many challenges of gender inequality, including significant pay differentials, poor visibility in senior positions and a male-dominated hierarchical system. We discuss this problem and outline how the BJPsych plans to tackle these issues it in its own publishing.

The aetiology of those movement disorders characterized by localized, involuntary intermittent, and repetitive muscular spasm remains obscure. They include spasmodic torticollis, writer's and other occupational cramps, and facial spasms. The obscurity is reflected in psychiatric and neurological classification. Some, or all, are frequently regarded as conversion symptoms, although they differ profoundly from those typical of that group, particularly in terms of prognosis. Secondly, some, or all, have been regarded as variants of dystonia musculorum deformans. Otherwise, they occupy an indeterminate or ‘miscellaneous' place in classification. If it could be shown that a substantial number of clinical characteristics are shared by those who exhibit localized spasmodic conditions, they could justifiably be regarded as a distinct nosological entity. This might reasonably be regarded as a step towards clarifying their aetiology.

Androgyny is an expression of relative masculinity and femininity in body-build. Tanner (1962) states “Androgyny can be perhaps best measured by means of scales constructed so as to give the best discrimination between men and women, and the simplest of such scales measures a masculinity score as 3 Biacromial—1 Bi-iliac diameter. This score gives men a mean of around ninety-three units with a standard deviation of about five, and women a mean of about seventy-eight with a similar standard deviation”.