All patients with puerperal psychosis admitted to the Royal Edinburgh Hospital within 90 days of childbirth during the periods 1880–90 and 1971–80 were compared. The majority of cases in both groups had an affective illness with an acute presentation and a fixed interval of onset. The 19th-century cases had a more florid presentation and a greater length of admission (mean, 151 days) to the hospital than the 20th-century ones (mean, 39 days). The incidence of the disorder rose from 0.34 per 1000 childbirths per year in the 19th-century group to 1.04 in the 20th-century one, but this could be explained by nosocomial factors. Most 19th-century cases occurred in mulitgravid women, which questions the association of puerperal psychosis with primiparae.

A British pedigree multiply affected by the Gilles de la Tourette syndrome and spanning six generations is described. Of 122 members identified, 85 were individually interviewed, and 50 were diagnosed as ‘cases'. ‘Cases' consisted of 29 with definite or probable Gilles de la Tourette syndrome, 17 with definite or probable chronic multiple tics, and four with definite or probable obsessive-compulsive behaviour. Only eight of the 50 ‘cases' had consulted a doctor for their symptoms. ‘Cases' and ‘non-cases' could be distinguished on the basis of echo-phenomena, obsessive-compulsive features, self-injurious behaviour, and the trait score of the Leyton Obsessional Inventory, but did not differ significantly on any other psychopathological variables. The pattern of inheritance of the Gilles de la Tourette syndrome in this pedigree is consistent with autosomal dominant transmission.

Local cerebral uptake of glucose labelled with fluorine-18 was measured by positron emission tomography in 13 patients with schizophrenia and 37 right-handed volunteers. Patients received no medication for a minimum of 31 days and a mean of 30 weeks. The subjects were administered the labelled deoxyglucose just after the beginning of a 32-minute sequence of blurred numbers as visual stimuli for the Continuous Performance Test. In normal controls, task performance was associated with increases in glucose metabolic rate in the right frontal and right temporoparietal regions; occipital rates were unchanged. Patients with schizophrenia showed both absolutely and relatively reduced metabolic rates in the frontal cortex and in the temporoparietal regions compared with normal controls.

The number of moderate to severe undesirable life events and the quality of friendships were compared between a consecutive series of 100 childen aged 7–16 years with emotional disorders and a series of community controls matched for age, sex, and social class. Undesirable events and friendship difficulties exerted independent direct effects of similar magnitude on the probability of developing emotional disorders; 33% of disturbed children experienced both adversities compared with 6% of controls. An additive interaction was found for the two factors. The results were uninfluenced by the sex or pubertal status of the subjects. There appears to be no greater probability of being anxious rather than depressed in the presence of life events, alone or in combinations with friendship difficulties. Recent undesirable life events and friendship difficulties arise through independent social pathways and may exert their effects through different psychological mechanisms.

Between October 1983 and December 1985, 268 patients were brought by police to a psychiatric hospital in south London under section 136 of the Mental Health Act 1983. Comparisons were made between ‘blacks' and ‘whites' on several clinical and demographic variables. The vast majority of admissions received a psychiatric diagnosis. An excess of black admissions was recorded. Black men were younger, were more likely than whites to be given neuroleptics, to be put on compulsory orders, and to be given an out-patient appointment when discharged from hospital. More black men were given a case-note diagnosis of schizophrenia or drug-induced psychosis. The differences in clinical management between ethnic groups could be at least partly accounted for by these differences in diagnosis. Treatment did not appear to be independent of diagnosis among the black admissions.

During the course of the psychoanalytical treatment of patients whose morbid jealousy is of the non-psychotic type it is possible to identify the unconscious causes of the pathological mental state. This material can provide an insight into the unconscious determinants of the contents of delusions of jealousy.

In 25 Jewish and 26 non-Jewish depressives resident in Hackney, the PSE revealed that ‘hypochondriasis' and ‘tension’ were more common in the Jewish group, and special features of depression, containing symptoms connected with guilt, was less common. These differences could not be explained by variation in severity of illness as both groups had similar scores on the HRSD. The ‘social maladjustment’ scores were similar, very probably reflecting an elderly, deprived, inner-city population.

Linked hospital and death records for 10–20–year-olds admitted with a diagnosis of poisoning were analysed. Between 1980 and 1985 there was a significant decline in admission rates, which was mainly attributable to a decline among 16–20–year-old females. There was no evidence of a decline in the admission rates among 12–15–year-olds. Ten per cent of the study population had at least one further hospital admission for poisoning during the mean follow-up period of 3.6 years. Female admission rates were substantially higher than those in males but readmission rates, given a first admission, were similar. The death rate in the study cohort was significantly higher than would be expected in the general population of this age and nearly all the deaths were from violent or unnatural causes.

A total of 158 women presenting with clinical eating disorders have been investigated using a self-report questionnaire and subsequent interview concerning their recollections of sexual experiences with adults before the age of 16 and later adverse sexual experiences. About a third reported events in childhood and over half described some adverse experiences. It may be that these experiences are relevant to the subsequent illness in some cases, but greater certainty must await further research. In the meantime, inquiring about such matters would seem to be advisable in the assessment and therapy of eating-disordered patients.

The clients in an institution for the mentally retarded were screened for signs of psychopathology with the Psychopathology Instrument for Mentally Retarded Adults (PIMRA). Of the 168 clients, 146 satisfied criteria for DSM–III axis I disorders, and 153 satisfied criteria for at least one disorder on either axis I or II. Multiple diagnoses were common, and a total of 288 diagnoses were found. No particular disorder was found to be more prevalent in those with organic brain dysfunction. The level of functioning was not found to predispose to any particular diagnosis. There was a positive relationship between the presence of a psychiatric disorder and the resources available to the clients and the activities offered. The prevalence of psychiatric disorders was extremely high in the population studied, with the exception of the affective disorders, of which no case was found. One possible reason for this high prevalence is that deinstitutionalisation leaves behind those with the more severe behavioural problems.

Thirty-two epileptic patients with RDC diagnoses of schizophrenia were tested for handedness on the Annett Handedness Schedule, and handedness was assigned on the basis of Annett–Maudsley criteria. They were compared with three other groups of patients. Five (15.6%) of the epileptic schizophrenic patients were mixed or left handed. The prevalence of mixed and left handedness did not differ between the samples studied. However, there was a significant reduction of mixed and left handedness in male epileptics with schizophrenia. Mixed or left handedness in male epileptics appears to be protective against the development of psychiatric illness in general.

Thirty in-patients received one of three treatments – medication (nortriptyline) alone (MA), relaxation therapy plus medication (RT&M), or cognitive therapy plus medication (CT&M) (each n = 10) – along with ward milieu. The relaxation and cognitive therapy groups participated in 12 therapy sessions. Symptoms of depression and related cognitive variables were assessed at sessions 1, 6 and 12, and at discharge. All groups improved over the course of the study. CT&M and RT&M groups reported significantly fewer depressive symptoms and negative cognitions at discharge than the MA group. The number of subjects judged depressed at discharge was lower in the CT&M group than in the MA and RT&M groups. It is proposed that a consistent rationale for treatment is a significant facilitating factor in achieving behavioural and cognitive changes in depression.

An out-patient alcohol detoxification service based in a psychiatric emergency clinic is described. Of 173 patients referred during the first year, 76 (44%) were accepted for the programme; 60 (79%) of these successfully completed detoxification with no medical complications. Compared with previous years, during the year of operation of the service there was a 50% fall in the number of in-patient admissions for detoxification to the local hospital. We conclude that a structured out-patient detoxification programme is safe and effective, and may obviate the need for many patients to be admitted, freeing psychiatric beds for other uses.

Asian and non-Asian referrals to the department of child psychiatry at the London Hospital in 1987 were analysed. Asian referrals were under-represented with respect to the local population but, contrary to our expectations, there were no significant differences between the groups with regard to demographic data, the nature of the presenting problem, and attrition rates.

The frequency of psychotropic and anticonvulsant drug use in 168 institutionalised mentally retarded adults was studied. Use of neuroleptics and anticonvulsants was more frequent and use of hypnotics and antidepressants less frequent than in the general population. Neuroleptics were given to 49% of the population. Clients with no psychiatric diagnosis consumed less neuroleptics than those with such a diagnosis, and there was a non-significant trend for those with a more serious diagnosis (e.g. schizophrenia) to take a higher dosage. The degree of disruptive behaviour and the availability of a physician were related to dosage of neuroleptics. The various psychiatric diagnoses given could explain only a small proportion of the variance in dosage.

Magnetic resonance imaging (MRI) was used in patients with epilepsy and psychosis. From 50 patients with epilepsy, a subgroup of 12 patients were categorised by the Present State Examination (PSE) as having nuclear schizophrenia (NS) and then compared with an epileptic control group with no psychiatric history. Further, patients with hallucinations were compared with patients without hallucinations. No differences in T1 relaxation times in any regions of interest were noted in the NS group compared with the other group. However, patients with hallucinations had a significantly higher T1 value in the left temporal lobe. These findings support the concept that specific abnormalities in limbic system structures relate to the phenomenology of the psychoses of epilepsy, especially left temporal lobe epilepsy.

This study distinguishes between processes that cause individuals to experience symptoms – destabilisation – and those that are associated with loss of symptoms over time – restitution. It is shown that different clinical, social, and personality variables are associated with each of these processes. Where destabilisation is concerned, it is shown that different variables were associated with the development of symptoms of anxiety and those of depression. Different variables were associated with restitution, and they did not show the same relationship with the symptom dimensions of anxiety and depression as those which were associated with destabilisation.

The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1 – specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

In four hospitals for the mentally handicapped, 302 patients died during the decade 1976–85; of these, 53 (17.5%) died from cancer. The percentage of deaths from all types of cancer during that period showed an increase, particularly in gastrointestinal cancer, as compared with the previous four decades.

Overnight plasma melatonin level was measured in ten healthy women before and after a 4300 kJ (1000 kcaI) diet in which they lost an average 3.1 kg. This weight loss did not significantly alter melatonin levels.