Four case reports are presented of psychotic patients seen in clinical practice in Nairobi over a period of one year, who inflicted serious bodily harm to themselves during that period. Possible psychopathological basis for this self-damage is briefly considered. A review of the literature reveals paucity of similar reports from Africa and the third world. Reasons for this paucity are hard to come by.

Introduced in 1933, Sakel's pharmacological shock treatment [Sakel (1935a, 1935b, 1938)] is now regarded as a valuable method of treatment in schizophrenia. The complications which may ensue during the treatment are, however, both numerous and dangerous, and may be classified according to the system predominantly affected as follows:

1. (1) The Respiratory System.

2. (2) The Cardiovascular System.

3. (3) The Nervous System.

The National Health Service (NHS) was born on 5 July 1948, after a prolonged and difficult labour, and in 1949 it cost the Treasury all of $433 million, or 3.5% of Britain's gross domestic product. In 1997/98 it cost the Treasury $44203 million, 5.6% of gross domestic product, and on 5 July this year it celebrates its 50th anniversary with parades, speeches, television programmes, symposia, much nostalgia and a service of thanksgiving in Westminster Abbey.

Expressed emotion (EE) in the partners of 25 pregnant women with a history of psychosis or severe depression and in 13 pregnant control subjects without any previous psychiatric disorder was assessed in the ninth month of pregnancy. At this time, no patient presented as a case according to RDC. Eleven subjects with a history of psychiatric disorder experienced a further episode of illness in the six months following delivery. Partners of women who became ill had made fewer critical and positive comments about their wives during the pregnancy than the partners of women who remained well. Poor self-rated social adjustment in the partners was also predictive of recurrence of illness after delivery.

A case of a mother and daughter who both believed in their own pregnancy and that of the other is described.

An area of interest presently is the lingering symptoms after COVID-19, i.e. post-COVID-19 syndrome (PCS). Specifics of diagnosis and management of PCS are emerging. However, vulnerable populations such as those with intellectual disabilities, who were disproportionately affected by the pandemic, risk being ‘left behind’ from these considerations.

Excessive alcohol consumption over a prolonged period of time may result in a variety of neuropsychiatric complications (Victor and Adams, 1953). The most frequent of these is alcoholic tremulousness which may be complicated in 25 per cent of cases by perceptual disturbances ranging from transitory misinterpretations of familiar objects to visual and auditory hallucinations (Victor and Adams, 1953). Closely related to this condition are delirium tremens (Victor and Adams, 1953; Lundquist, 1961; Nielsen, 1965), and acute or chronic auditory hallucinosis (Benedetti, 1952; Victor and Hope, 1958). In clinical practice intermediate or atypical forms of these syndromes are seen (Sabot, Gross and Halpert, 1968).

Twenty-six patients with proven myasthenia gravis were interviewed to assess the length of time between onset of symptoms, presentation to the general practitioner and diagnosis. In one third the initial diagnosis was psychiatric and the average time between presentation and correct diagnosis was 2.8 years for men, 1.2 years for premenopausal women and three weeks for postmenopausal women. Diagnosis could have been made much earlier if doctors had been familiar with early symptoms in this relatively rare disease. Symptoms and signs fluctuated and were at times absent, especially in the mornings.

The impression that alcoholism is common among the Irish is a very old one. It has been given some scientific basis by comparative studies of alcoholism in various ethnic groups in the United States. Thus, Hyde and Chisholm (1944) found that the rejection rate for enlistees in the United States army because of chronic alcoholism was higher in the Irish than in any other national group. Confirmatory evidence came from Malzberg (1940) in a study of first hospitalization rates for various diagnostic categories in New York State, and Roberts and Myers (1954) in a prevalence study in New Haven found that the Irish had a far higher proportion under treatment for alcoholism and drug addiction than other national groups.

Maddison and Mackey, in their review article “Suicide, the Clinical Problem” (1966), emphasize “the interpersonal significance of suicide, a viewpoint which is complementary and not alternative to an intensive study of the patient's intrapsychic life.” They continue: “More than usual attention needs to be given to the specially significant individual to whom the suicidal patient is often ambivalently bound in a symbiotic relationship, for highly relevant psychopathology will very frequently be found in this person …”.

This study, in two parts, compares the immediate and more long-term outcome of two groups of schizophrenic patients admitted to hospital before and after the introduction of pharmacotherapy in the form of reserpine and the phenothiazines. There have been differences of opinion as to whether the undoubted improvement which has occurred in the prognosis of schizophrenia, at least in the short term, since the introduction of chemotherapy has been due to the use of these drugs, to changes of administrative treatment, or to both. There has been evidence from mental hospital statistics (Shepherd et al., 1961) that changes in outcome began before the introduction of the drugs and were almost certainly related to the changes of administrative treatment or institutional management which have occurred in the mental hospitals over the same period. It may well be that the use of drugs has facilitated these changes as well as having a more direct effect oh prognosis, but the relative importance of these two factors is difficult to assess from mental hospital statistics. Comparison between results obtained in different hospitals is also of limited value because of the number of uncontrolled variables. There would seem, therefore, to be an advantage in the more detailed examination and comparison of a smaller number of patients admitted to the same hospital, and the present investigation is of this type. The material consists of two groups, of 50 patients each, admitted to the Professorial Unit at the Maudsley Hospital in the years 1952/53 and 1956/57 respectively. Since the policy throughout has been to admit only non-compulsory patients for relatively short-term treatment, administrative changes in this hospital between the two periods are likely to have been minimal. The aim was to compare both immediate and long-term outcome in the two groups and to examine the effect of a number of variables on this. The short-term outcome will be considered in the first and the long-term outcome in the second paper.

A case of psychogenic amnesia in a 58-year-old man supports the view that complete loss of personal identity can follow a traumatic experience. He regained his memory by being helped to develop an affective link with the painful event.

Naylor's recent hypothesis that vanadium ‘poisoning’ could be a factor in the severity of manic-depressive illness drew attention to the normal and even essential presence of vanadium in the diet, and in human living tissues. The whole brain may contain only about 45 micrograms of vanadium (Underwood, 1977; 1979), as against 500 micrograms of manganese, 130 μgm selenium, and less than 20 μgm molybdenum—others of the 12 or so essential metals required in traces. We might take copper as the principle trace metal—an important component of over 50 enzymes, including monoamine oxidase and dopamine β-hydroxylase—with a total in the whole man of about 100 mg. In contrast, metals like potassium (140 gm), magnesium (35 gm), iron and zinc (3–4 gm) are not present in traces but in gram quantities. Lithium, present naturally in the body in extremely minute amounts, is raised in therapy to occupy a borderline position in the scale, rather more than copper, less than zinc.