Little did I think when I accepted the invitation to become the Patron of your College that you would finally catch up with me, in your 150th year, by strapping me to a lectern and forcing yourselves to listen to me. However, I can only assume that if your professional reputation is anything to go by I should at least be guaranteed the best audience I have ever had!

Patients with Alzheimer disease (AD) had reduced regional cerebral blood flow (rCBF) in the posterior parietotemporal region compared with controls, as determined with technetium-99m hexamethyl propyleneamine oxime and single photon emission tomography. Central cholinergic stimulation with physostigmine produced a focal increase in rCBF in the posterior parietotemporal region in the patients with AD but not in controls.

Studies in North America and Europe indicate that the prevalence of blood-borne viruses (BBVs) is elevated in individuals with severe mental illness; there are no comparable data for the UK. We offered routine testing for HIV, and hepatitis B and C in an inner-London in-patient psychiatric unit as a service improvement. Of the patients approached 83% had mental capacity to provide informed consent for testing and 66% of patients offered testing accepted. Although it was not our objective to establish the prevalence of BBVs, 18% of patients had serological evidence of a current or previous BBV infection, we found that offering routine testing in an in-patient psychiatric setting is both practical and acceptable to patients.

The subject matter of this paper is the psychological treatment of negative symptoms. However, before embarking on a review of the available literature, it is worthwhile considering some conceptual issues and distinctions which are relevant to research in this area.

The aetiology of psychiatric morbidity associated with education in Africa was explored using two different screening methods (as described in paper III, this supplement). The interactive effect of psychosocial variables was examined by Log linear analysis which demonstrated five independent factors: (a) the financial implications of education which represented the change from subsistence to cash economy; (b) fear of envy and bewitchment which represented the intense cultural response to education; (c) parenting in the pre-school years which was the independent family variable; (d) academic ability; (e) attributes of the school. Age of starting school and birth rank had a marginal effect. Current family adversity in terms of unstable parental union, paternal use of alcohol, polygamy and sibship size operated by interactive or additive effect. Gender and social status had no effect. The brain fag syndrome can be related to the complex social changes during rapid social transition where education is a major agent of change.

Twenty-seven families, 14 with a history of child physical abuse and 13 with no such history, were studied over the course of intensive in-patient treatment. The families in the former group differed significantly from those in the latter group in terms of current circumstances and background histories. Families where abuse was admitted benefited significantly more from treatment than families where abuse was suspected but not admitted. The ability of mothers to remember good relationships from childhood and to establish good relationships during treatment was an important prognostic factor for successful treatment.

Of 107 recently admitted psychiatric patients screened for eating-disorder symptoms by questionnaire, 17% met DSM–III–R criteria for eating disorders. Eight patients (one male) had bulimia nervosa. Ten patients had eating disorder not otherwise specified: seven (three male) bulimic type, and three (one male) anorexia nervosa type. The most common concurrent diagnoses were mood and personality disorders. As eating-disorder symptoms are relevant to the diagnosis and management of other psychiatric disorders they should be assessed routinely in all psychiatric patients.

Throughout the two million years of human existence, it is without precedent that the elderly should now constitute such a large proportion of the world's population. Although it is already trite to emphasise this remarkable change in the global population structure, the increase is nothing less than an awesome imperative for public health as a socially responsible science. By the year 2025 AD, the United Kingdom will have 14 million persons aged over 60, which would be 26% of the population. Just under two million of them will be over 80 years old (United Nations, 1985). In Australia and New Zealand, 24.8% of the population will be aged 60 years or more. About one million Australians will be 80 years or over. West Germany will have 2.4 million aged over 80, the USA 7.7 million. The People's Republic of China will have 19.3% of its 1.5 billion people who will be aged over 60, and over 25 million will be over 80 years.

An epidemiological approach to the problem of suicide may help to identify high risk groups and aid in the design of preventive programs. The aim of the present study was to determine the incidence of suicide among various population groups in Israel and to assess the methods employed. All records of suicide in Israel during the years 1962-63 were extracted from the files of the Central Bureau of Statistics, where data had been obtained from police records. Presentation will be limited to the Jewish population due to a lower reliability of data in the Arab segment.

The presence of a birth order factor in the aetiology of schizophrenia is indicated by evidence of two kinds. The evidence, however, is apparently conflicting.

Like recent medication studies, it appears that when cognitive-behaviouraltherapy is tested in pragmatic effectiveness trials involving routineclinical populations it does not fare as well as in efficacy trials. Giventhe multitude of factors that can ‘muddy the waters’ in clinical trials, howdo we best make sense of the findings?

Group therapy is one of the more recent advances in psychiatry and is a logical development which fits in well with the spirit of our time. The modern trend in psychiatry is to see the patient not only as an individual but also against his social background. This paper is a factual account of group therapy as carried out in Wormwood Scrubs Prison. The pioneer work was done by Mackwood (1949) and described by him. We should like to acknowledge our indebtedness to him.

Autism and psychotic disorders such as schizophrenia co-occur more frequently than would be expected by chance alone. Exactly why this should be remains unclear, but a better understanding would have important implications for diagnosis, treatment and for biological explanations of both conditions.

A 50-year-old man presented with hyperosmolar nonketotic diabetic coma associated with the neuroleptic malignant syndrome (NMS) after intramuscular treatment with haloperidol. It is suggested that NMS may occur as a complication of uncontrolled diabetes mellitus with dehydration. Conversely, NMS might precipitate diabetic coma in patients with previously well controlled blood glucose.

This editorial describes current considerations regarding psychiatric diagnoses for transgender and gender-diverse (TGD) people. In addition to offering an assessment of the limitations in current diagnostic standards, the authors articulate a vision for psychiatric practice marked by renewed commitment to an affirmative framework that reduces stigma.

For some years following the war the number of patients admitted to mental hospitals whose illnesses were associated with alcohol definitely decreased, but recently the number again appears to be on the increase. During the past eighteen months 50 patients whose illnesses were the result of alcoholic excess were admitted to St. Ebba's Hospital. As this hospital is set aside for recoverable cases, it is possible that the number is in excess of that admitted to other mental hospitals, owing to the fact that many alcoholic psychoses such as Korsakov's disease and delirium tremens have a good prognosis. Nevertheless, in my capacity as consultant to an observation ward I have found that many patients who are suffering from delirium tremens, “pathological drunkenness “, etc., are admitted to such wards, who rapidly clear up and are discharged without being admitted to a mental hospital, and the impression gained is that the number of alcoholics is steadily increasing. It is not proposed to discuss the symptomatology of the various forms of alcoholic psychoses, which are well known, but to discuss various points of interest which arose during the investigation of these patients.