A case of obsessional disorder is described in which a combination of tranylcypromine and thought stopping was effective in markedly reducing obsessional ruminations. Thought stopping appears to have had a major role in preventing relapse on withdrawal of the tranylcypromine. Isberg (1981) and Jenike (1981) have reviewed the literature regarding the response of obsessive compulsive disorders to monoamine oxidase inhibitors, the results of such treatment may be quite dramatic but there is a tendency to report positive results and not to report treatment failures.

Four cases of obsessive-compulsive neurosis following head injury are described, three of which are from a consecutive series and the fourth from a discordant monozygotic twin pair. The aetiological significance of head injury in this disorder is discussed in the context of the clinical findings and of previous series of brain injured patients.

The extraversion–introversion dimension of personality is believed to have an inverse relationship with cortical arousal. Brain capillary perfusion is a well established index of brain function and arousal. Regional cerebral blood flow was measured in 51 right-handed females whose personality structure was examined with the Eysenck Personality Inventory (EPI). Significant inverse correlations were found between the brain blood flow and the extraversion–introversion score of EPI.

90 patients with a primary depressive illness, admitted consecutively to one psychiatric ward were studied. All patients had the dexamethasone suppression test (DST) done before initial treatment. First treatment response was correlated with the DST results. The non-suppressors, as a group, improved with treatment better than the suppressors. However, unlike in previous studies, no relationship was found between non-suppression and poor response to antidepressant medication.

Forty-one demented patients admitted to a psychogeriatric assessment unit in 1977–78 were matched by diagnosis, sex and living group prior to admission with forty-one patients admitted to the same Unit in 1981–82. While the two cohorts showed no significant difference in their overall levels of disability at the time of admission, the latter group were more disabled at the time of discharge and were more likely to be placed in long-stay hospital care. The 1981–82 cohort stayed significantly longer in the assessment unit. These differences suggest that health and social service resources are failing to keep pace with the rising numbers of demented elderly patients.

From a population of long-stay patients with a diagnosis of schizophrenia according to the St Louis criteria, a group of 21 patients with ‘age disorientation’ was selected, and compared on a series of tests of intellect and learning capacity with a matched control group of 21 schizophrenic patients without this feature. The age-disorientated patients demonstrated substantial impairments on tests of orientation and general knowledge, associational learning, the ‘famous personality’ test, tests of vocabulary and aphasia, Raven's matrices, the digit–symbol substitution test and the mental test score. We conclude that profound ‘organic-type’ psychological deficits (global impairment of intellectual function associated with temporal disorientation) undoubtedly occur in chronic schizophrenia. The findings on the ‘famous personality’ test and the Peabody vocabulary test did not exclude the possibility that such impairment arises early in life, at a time preceding the onset of the illness which leads to hospital admission.

In 23 acute, unmedicated, schizophrenic patients, psychotic behaviour and β-endorphin serum level were measured before and during four weeks of neuroleptic therapy. Prior to drug treatment, β-endorphin level of all patients was within the normal range. Neuroleptic therapy induced marked elevations of β-endorphin in eight subjects; statistical analysis revealed a slight but significant increase for the whole group. This endocrine effect was not correlated with therapeutic efficacy of neuroleptic treatment.

Several studies have suggested that schizophrenics have a deficit in their ability to recognize the affect expressed in photos of human faces. In this study, the performance of 17 chronic schizophrenics was compared to that of 17 controls on both a test of facial affect recognition and a control task involving facial recognition. Compared with controls, chronic schizophrenics tended to perform more poorly on the test of facial affect recognition, but this difference was eliminated when facial recognition was entered as a covariate. When all test items, including those with poor reliability and discriminatory power, were included in the analysis the schizophrenics showed a significant deficit in facial affect recognition which persisted even when facial recognition was used as a covariate.

In a group of schizophrenics of twin birth, no evidence of ventricular enlargement was found where there was a family history of major psychiatric disorder. Among those schizophrenics without such a family history, cerebral ventricular size was significantly increased (P <0.01), and there was also evidence of birth complications. Among normal control twins, those who reported complicated births had significantly larger ventricles.

We have recently demonstrated that some patients with atypical bipolar affective disorders, characterized by psychotic manias and depressions, have fluctuating and episodic high urinary phenylethlamine (PEA) excretion. We treated a 30 year old woman, who has this disorder, with 200 mg/24 hours of carbidopa. Her psychosis was ameliorated and the urinary PEA output stabilized to a low normal level. Upon withdrawal of carbidopa her psychosis worsened and improved again when carbidopa treatment was reinstated. Carbidopa did not affect the duration or severity of the patient's mood cycles.

Although chronic depressive illness has not attracted a great deal of attention, it is a source of considerable psychiatric morbidity in the community and occurs in a proportion of the new long-stay patients. Prior to the introduction of specific antidepressant treatments, figures for continued affective illness were high. Lundquist (1945) observed an overall recovery rate of 80 per cent for a first attack. Perhaps the best researched study is that of Winokur who followed up for between two and 20 years 225 depressive patients. He showed that 25–30 per cent of female depressives developed a chronic state, compared with 10 per cent of male patients (Winokur and Morrison, 1973).

The cerebrospinal fluid (CSF) circulation was studied with isotope cisternography in 30 patients with a schizophrenic type of psychosis. All had previously received neuroleptic treatment. Disturbed CSF circulation was found in 10 cases. In four of these, persistent intraventricular radioactivity was observed as well as partly obstructed CSF spaces. In the other six cases a slow CSF circulation was noted as well as evidence of partly obstructed CSF spaces especially of the upper posterior frontal region. Signs of atrophy of the cortex and vermis were found on CT scan in 10 cases. In four of these subjects a local atrophy was noticed in the upper posterior frontal cortex and around the frontal part of the interhemispheric fissure. Seventeen of the patients (57 per cent) had pathological findings at isotope cisternography and/or at CT. Disturbed circulation did not correlate with CT-findings, age, duration of psychosis, alcohol abuse, drug consumption or family history for psychosis. CT evidence of brain atrophy was significantly related to nonfamilial type of psychosis.

Neuropathological examination of the brain of eight adult mentally handicapped patients showed mesial temporal sclerosis. Three patients had cerebral palsy, one had Down's syndrome, three were retarded, and one had an unspecific mental handicap. Although there was a suspicion of fits in most patients, temporal lobe epilepsy was not diagnosed in life.

The current maximum recommended dose of disulfiram, 200 mg daily, is often inadequate. Of 63 patients taking disulfiram under supervision who either risked drinking alcohol or who had a medically supervised challenge with alcohol, only half produced a significant response on a dose of 200–300 mg daily. Some patients need as much as 1.5 g daily but even at high dosage significant side effects are uncommon, reversible and rarely serious.

A modification to the recommended technique for a medically supervised alcohol challenge is described, which minimises distress.

Adolescence is a stage in the development of an individual which links childhood and adult life. Nowadays in Western society adolescence lasts from the early teens, about the time that puberty normally begins, until the early twenties. The main feature of this period is the adoption of adult ways of behaving. There are a number of obvious milestones, the end of compulsory education in the mid-teens and the start of work or further education, the possibility of living independently away from the family and of marriage, as well as the right to drive a car and to vote. Adolescence is accompanied by accelerated physical growth, the development of secondary sexual characteristics, increased emotional maturity, the emergence of a new way of thinking and the formation of a particular identity. A glance at Boorer and Murgatroyd's selected bibliography published in 1972 and the list of references in Rutter's Rock Carling Fellowship Monograph: Changing Youth in a Changing Society (1979) shows the enormous number of books and papers which have been devoted to this period of life. For anyone wanting a readable introduction to the subject of Adolescence, the two relevant chapters of Mussen, Conger and Kagen's (1974) Child Development and Personality can be confidently recommended.

One of the central paradoxes of the Victorian reforms in the treatment of the mentally ill was the curious fact that the “scientific” discovery of mental illness and the adoption of a more rational approach based on this discovery—an approach which aimed at treating and curing the lunatic, rather than neglecting him or incarcerating him in a gaol or workhouse—were associated with an explosive growth in the number of insane people. Edward Hare's recent Maudsley Lecture raises again the interesting question of whether or not this reflects a true increase in the incidence of mental illness in nineteenth century England. As he correctly notes, the aggregate data collected at the time do not allow a “decisive answer”, but I am pleased that his reassessment of the probabilities led him to endorse my prior conclusion that its incidence was indeed increasing. (Scull, 1979).

Summary A group of 24 opiate addicts admitted to an in-patient drug dependence unit received either electrostimulation or graduated oral methadone withdrawal. Addicts treated with electrostimulation showed high levels of withdrawal symptoms during the first week of treatment: these reached a peak on Day 3. In this respect electrostimulation was markedly inferior to methadone withdrawal treatment. However, although progressive methadone withdrawal quickly reduced symptoms to a moderate or low level, there was no reduction in symptomatology as late as one month after admission (i.e. after ten days without methadone). The implications of these findings are discussed.

One hundred and fifty successive referrals to a psychogeriatrician were assessed for visual hallucinations. Forty-four (29.33 per cent) patients reported visual perceptual disturbances. No differences between hallucinators and non-hallucinators were found in terms of sex, age, length of illness, underlying psychiatric diagnosis or cognitive score. There was a significant correlation between presence of hallucinations and eye pathology (<.001) and delusions (<.001). The phenomenological characteristics of the visual hallucinations are analyzed. The “picture” sign is described in 7 patients and the Charles Bonnet syndrome in two. The significance of these findings is discussed.