Patients with late paraphrenia were typed for HLA-A, -B and -C. Increased frequencies of BW55 (P= 0.036), B37 (P= 0.008) and CW6 (P=0.056) were found relative to controls. Unlike findings in paranoid schizophrenia, there was no HLAA9 association, suggesting that paraphrenics may be genetically distinct from schizophrenics. The primary association seems to be with B37, which has the lowest corrected P value and highest relative risk; if this were replicated, it would make possession of this antigen a strong risk factor for developing the disorder.

Bebbington (1986) draws attention to a possible cause for concern regarding the comparability of recent epidemiological research utilising the PSE-ID-CATEGO system of psychiatric caseness deter mination. In taking issue with our observation that cases in our recent community survey (Brown et al, 1985) were broadly similar in terms of severity to those reported in a recent series of out-patients (Sashidharan, 1985), he makes the point that such conclusions are only justifiable when it can be con fidently assumed that thresholds for symptom in clusion are applied uniformly between research centres. He argues that this assumption may well be invalid and marshalls two arguments to suggest that the Bedford team may have adopted less stringent rating thresholds. Firstly, he draws attention to the very different population prevalences of disorder reported in recent surveys, contrasting one-year prevalence figures for the Bedford College survey in Islington (Brown elal, 1985) withthelowerrates reported for other investigations in Edinburgh (Dean eta!, 1983) and Camberwell (Bebbington et al, 1981). Secondly, he reminds us of the body of evidence which suggests that psychiatrists operate stricter criteria for PSE symptoms than their lay colleagues (Wing et al, 1977a; Sturt et al, 1981).

A computer search of the literature revealed that the oldest documented patient to receive electro convulsive therapy (ECT) was a 94-year-old woman (Bernstein, 1972) who was diagnosed as having ‘anorexniearvosa’, but the history was suggestive of paranoid schizophrenia. She received a course of five ECTs and became much less paranoid, ate well, and put on weight. Her daughter lamented the fact that ECT had been deemed to be contra indicated 15years earlier on the grounds of advanced age.

Extrapyramidal symptoms, including oculogyric crisis, are well recognised side-effects of clopenthixol medication, but precipitation of prolonged oculogyric crisis on addition of nifedipine to an ongoing clopenthixol regime has not so far been reported.

Three patients suffering from bipolar affective disorder, manic phase, and who were resistant to conservative treatment were successfully treated with clonidine. This would support the nor-adrenergic hyperactivity theory of mania. The rapidity of action of clonidine and its lack of relatively serious side-effects renders it a potential alternative to conventional anti-manic agents.

Sociobiology was published in 1975. Four years earlier its author had published “an enormous and definitive book” on social insects, a work which established him as the world authority on that subject. In Sociobiology, Wilson set out to apply evolutionary theory to social behaviour not only in insects but throughout the animal kingdom. As a biologist he naturally included man among the animals, but it was this which caused the uproar. Had he omitted his last 33 pages-the chapter on “Man: from sociobiology to sociology” - his book would probably have led a quiet life as a well-written semipopular textbook on social animals.

Epilepsy can occur in patients without any changes apparent in the electroencephalogram. Thus the diagnosis of epilepsy is essentially made on clinical grounds. The clinical features of epilepsy are rela tively easy to learn to mimic. Feigned epilepsy can occur in adulthood or it may occur in childhood, as part of a Munchausen syndrome by proxy as described by Meadows (1984). We would like to describe a case of feigned epilepsy with global amnesia, and several other symptoms of aberrant illness behaviour.

Data from five behaviour management (token economy) units were analysed for periods of 10–20 weeks before and after the use of a food substitute (Complan®), provided when insufficient tokens had been earned to buy a full- or part-meal. The efficacy of this form of negative punishment to control disturbed and aggressive behaviour was examined. No evidence was found to suggest that the contingent use of a food substitute made any contribution to the therapeutic process.

The use of ephedrine for medicinal purposes dates back over 5000 years, when native Chinese physicians Ma Huang in the late 1800s, but was considered too toxic for clinical use; it was rediscovered by Chen & Schmidt (1930), who demonstrated its sympatho mimetic action and introduced it into Western medicine, where it was found to be a big improvement on adrenaline in the treatment of asthma. That the structure of ephedrine is very similar to that of amphetamine is not a coincidence, since Alles (1933) synthesised the latter as a synthetic substitute for ephedrine.

Delusional parasitosis, originally described by Ekbom in 1938, is an illness in which the individual believes small animals such as insects, lice, vermin, or maggots are living in or thriving on his/her skin. The delusion is not secondary to another psychiatric ill ness, and in general the personality remains otherwise preserved. Munro (1980) classifies delusional parasi tosis as a subtype of monosymptomatic hypochon driacal psychosis, and has shown that a substantial proportion of patients with MHP respond to pimozide. Prior to the introduction of that drug, the prognosis of the condition was held to be very poor.