In a retrospective analysis of 100 cases of mania (1981–1985), the incidence of subsequent depression was found to be 30%. Its occurrence was significantly associated with three factors: cyclothymic premorbid personality, family history of affective disorder, and past history of depression. By discriminant analysis, outcome could be predicted successfully in 81% of cases.

I should like to express my deep gratitude to you, Mr. President, to the immediate Past President, Dr. L. C. Cook and to the Association for the great honour that has been bestowed upon me by your invitation to deliver a lecture in this august series. It is a custom that the lecturer should pay homage to Henry Maudsley to whose memory these lectures are dedicated: may I reserve my homage until we come to the active part Maudsley played in the course of events with which this lecture will be concerned.

The pilot intervention project at Leros PIKPA asylum sought to change the management of residents by decreasing care staff's tendency to view people with learning disabilities with attitudes of custodial segregation (e.g. “they should all live in institutions”) and categorisation (e.g. “they are all alike”). To that end, staff were trained on the job in resident management and participated in seminars, sensitisation groups, clinical case presentations and visits to model rehabilitation units. To investigate whether staff attitudes towards people with learning disabilities had been influenced, staff members responded to a questionnaire of such attitudes, in March 1991 (initial assessment) and a year later (reassessment). Factor analyses of attitude ratings at initial assessment revealed a strong negative attitudinal construct, “Rejective and custodial segregation – Categorisation”, according to which institutionalisation was the only appropriate type of care for people with learning disabilities, regardless of individual differences. At reassessment, however, this factor had split into two independent ones, “Rejective and custodial segregation” and “Categorisation”, suggesting that the staff had understood that custodial care did not apply to all persons with learning disabilities indiscriminately. Reassessment factors further indicated that staff had comprehended the appropriateness of alternative care forms – community and home care. Analysis of Categorisation and Custodial segregation attitude ratings showed that only staff's tendency to view the disabled as “all alike” (Categorisation) had decreased at reassessment. The latter change and the structural change revealed by the factor analyses imply that staff's attitudes underwent a small but significant modification.

The finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. It also highlights the necessity for developing evidence-based interventions for these women. P.C. / Evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral and ethical not psychiatric or scientific. M.O. et al.

The multi-disciplinary team of Becker and colleagues elegantly present their findings addressing aspects of the impact on Fijian schoolgirls of exposure to Western television (Becker et al, 2002, this issue). These findings support the notion that such exposure has generated disordered eating, underlying body dissatisfaction and intergenerational conflicts within the family that may, in part, be fuelling the process. Focusing on the expected escalation of such disordered eating in this population under these circumstances, their study was naturalistic in capitalising on the recent introduction of television to Fiji, with the first survey of these schoolgirls taking place within 1 month of its advent. The second survey was 3 years later in 1998. The authors point out that the traditional Fijian culture has ‘supported robust appetites and body shapes'.

The identification of a reliable and valid severity index for borderline personality disorder has vexed researchers for decades. A simple, clinically intuitive severity index for borderline personality disorder with predictive validity has now been identified. This index could usefully guide treatment planning, but other contextual factors should also determine the need for specialist treatment.

The introduction of neuroimaging techniques for the study of brain structure and function has revolutionised the endeavour to elucidate the pathology of psychiatric disorder, the Holy Grail in psychiatry (Krishnan, 1990). Emil Kraepelin discovered the two major mental disorders, dementia praecox and manic-depression, and conceived their aetiology in brain pathology. It was Alois Alzheimer, however, his most successful student, who discovered the neuropathology of Alzheimer's disease. Sigmund Freud, who started his inquiries in brain science, lost faith and shifted to the study of the mind. Brain science and mind ‘science’ rapidly became odd bed fellows and parted company. The breakdown in communication fostered a mistrust in both parties, aborting endeavours of reconciliation. The evidence for the neuropathology of the ‘functional’ psychoses has, however, been inconclusive. It was the advent of brain-imaging techniques that rejuvenated brain sciences and modern neurosciences. The introduction of neuroimaging techniques, such as the electroencephalogram (EEG) in the 1920s and the whole-brain blood-flow techniques (Berger, 1929; Kety & Schmidt, 1948), antedated the discovery of psychotropic drugs. Pneumoencephalography was also applied to study brain structure in schizophrenia (Storey, 1966). The true methodological leap, however, was the introduction of computerised methods to construct three-dimensional images from two-dimensional data, enabling the development of computerised tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET) and single-photon emission computerised tomography (SPECT).

Psychiatrists have long recognised that routine clinical practice needs to be shaped and informed by external evidence (Lewis, 1958). Psychiatric researchers were among the first to utilise multi-centre randomised controlled trials (demonstrating the effectiveness of antipsychotics), and psychologists were among the first in the health field to develop techniques of meta-analysis. Social workers, too, point to their tradition with the publication of one of the earliest controlled trials (Lehrman, 1949).

As part of its concern with the environmental causes of disease, medical research tries to comprehend the nature of social processes and their implications for human health: an endeavour calling for sociological concepts and methods (Susser et al, 1985). Medical needs are mirrored within sociology, which has never been confined to study of the workings of society, but has always concerned itself also with their impact on individuals and on public health. The importance of cooperation between the two disciplines is thus indisputable. Nevertheless, interprofessional relationships have never been easy, and Pflanz's dictum, that “the history of the relationship between sociology and medicine is … mainly a history of unsuccessful encounters” (Pflanz, 1976), remains substantially true today. The difficulties have been ascribed to interdisciplinary tensions of the kind that arise when a relatively young academic profession seeks to assert its autonomy in a relationship with an older-established and more powerful one. Martin (1976), stressing the dangers that can result from mutually false expectations, invoked the analogy of a marriage in which:

Seizures induced by movement were first described by Gowers (1901), who considered them a variant of epilepsy. Several reports have appeared since then of attacks of choreo-athetoid movements precipitated by sudden movement (Lishman et al., 1962; Whitty et al., 1964; Stevens, 1966; Kertesz, 1967). The case described here is one of Lishman's et al's original group (Case No. 5); along with the movement-induced seizures he had developed over the years an increasing agoraphobia which had grossly restricted his activities. This paper reports on the successful treatment of this agoraphobia by ‘flooding’ and the associated amelioration of his movement-induced seizures.

In a random sample of 500 British women Coppen and Kessel (1963) found that certain menstrual symptoms—those of the premenstrual syndrome—i.e. depression, irritability, swelling, as well as menstrual irregularity, were positively correlated with Neuroticism on the Maudsley Personality Inventory. In a further study on the prevalence of menstrual symptoms in psychiatric patients (Coppen, 1965), a high incidence of menstrual symptoms was found in all groups, particularly neurotic women. Both these surveys were conducted by means of a menstrual questionnaire completed by each woman. This approach allows different groups to be investigated and compared, using a standardized measuring instrument. The purpose of this investigation was to see if cultural factors have any influence on the prevalence or severity of menstrual symptoms by administering a translation of the menstrual questionnaire to a sample of Spanish college students.

Psychiatric research has elucidated many unrecognized facts, and added much to our knowledge of the causes of criminal behaviour in mentally abnormal persons. At the same time the fluidity of modern psychiatry, itself evidence of progress, makes it difficult always to present simply and clearly modern views in a court of law. “”