Response to dextromethorphan (15 mg b.i.d.), an antitussive agent not usually considered to have psychotropic properties, was seen in a 25–year-old man with severe developmental disabilities, congenital rubella, and an organic mental disorder. Dextromethorphan affects CNS serotonergic systems, and this was the probable therapeutic mechanism. This and other published cases suggest the existence of a distinct organic mental syndrome in developmentally disabled persons which responds to drugs that increase indoleaminergic activity.

There has been increasing interest in intermittent medication as a viable alternative to continuous neuroleptic treatment for chronic schizophrenic patients. Considerations supporting the plausibility of a targeted-medication approach include the fact that long-term medication involves certain risks, and that neither favourable outcome in the long-term nor risk of relapse are necessarily dependent on the continuous administration of neuroleptic drugs. An intermittent-targeted administration strategy was developed by Herz et al (1989) in an attempt to abort relapses at an early stage and to stabilise or to improve the course taken by illness.

Nine out of 4044 patients admitted to our institution between 1987 and 1990 suffered an episode of NMS. Neuroleptic rechallenge using clozapine for persisting psychiatric illness was tolerated by eight patients. Clozapine was discontinued in one older, high-risk patient because recurrence of NMS was anticipated. Clozapine should be considered a drug of choice for psychotic patients with a history of NMS.

Eight cases of resistant recurrent depression were treated with a combination of nortriptyline and a new serotonin reuptake inhbitor, with or without concurrent lithium therapy. Significant improvement was seen in all patients where other drug regimes and ECT had been ineffective. No adverse reactions occurred in any of our patients, seven of whom were elderly. The combination treatment was more effective than individual therapies alone.

It is well known that women with a history of manic-depressive or puerperal affective psychosis are at particularly high risk of relapse in the puerperium. This paper describes the use of lithium given during or after pregnancy to women with a history of bipolar illness or puerperal affective psychosis. The rate of puerperal relapse in these subjects was compared with that in a similar group of women not on lithium. The significantly better outcome of the treatment group highlights the need for a prospective controlled trial looking at the effectiveness of lithium in minimising puerperal bipolar relapse.

An 80-year-old widow with delusional infestation in association with post-herpetic neuralgia and EEG abnormalities in the left anterior parietal lobe responded to combined pimozide and carbamazepine. Aetiological factors are reviewed in relation to the literature.

A patient suffering from schizophrenia developed diabetic keto-acidosis and NMS after treatment with neuroleptics. The combination of two uncommon complications of treatment with neuroleptics proved fatal.

We still do not know enough about the aetiology and pathogenesis of schizophrenia, nor are the therapeutic methods generated by our definition of it satisfactory. Therefore, innovative approaches to treating schizophrenic patients, even if they only promise some partial progress, warrant consideration. The purpose of the pilot project ‘Soteria Berne’ is to assess the effectiveness of an open residential programme which has been providing mainly psychotherapy, sociotherapy, and milieu therapy instead of standard pharmacotherapy to about 60 acute schizophrenic patients for more than six years.

A 3 ½-year-old girl was incarcerated in a bamboo cage after it was feared she had contracted rabies. Six years later, when she was released, she had lost almost all motor control, displayed a number of stereotypies, was incontinent of both faeces and urine, and was diagnosed as having grand mal epilepsy. After four years of treatment (aged 13) she had shown considerable improvement and her mental age was seven years.

We report OCD and paraphilia in two male members of triplets (the two males being monozygotic twins), and discuss the possible aetiological factors for this previously unreported occurrence. We suggest that patients presenting with paraphilia should be examined for OCD and that a detailed sexual history should be obtained in all patients with OCD.

A patient who presented with soreness of her eyes was given a diagnosis of dementia of the frontal type (DFT) complicated by a major depressive illness. The report illustrates the multiplicity of presenting symptoms in patients with dementia. Resistance to treatment is often an indication that a depressive disorder is symptomatic of underlying organic brain disease.

A schizophrenic patient with different forms of experiences of inappropriate familiarity is described. The authors discuss traumatic experiences as aetiological factors in déjà vu experiences and reduplicative paramnesia. Finally, the differential diagnostic problem in psychotic and dissociative phenomena is stressed.

The concurrence of Capgras and koro syndromes in a man with affective disorder is reported.

Cognitive disorders have long assumed a central position in describing the pathognomonic characteristics of schizophrenia. Kraepelin's (1902) and Bleuler's (1911) uniquely innovative descriptions of attentional dysfunctions and associational loosening in thought processes laid the groundwork for the concept of basic disorder devised by authors who embraced a phenomenological approach to psychopathology in German-speaking countries (Huber, 1983; Janzarik, 1983), and for experimental research endeavours in English-speaking countries to identify a ‘core psychological deficit’ in schizophrenia (Lang & Buss, 1965). Recent research has identified specific information-processing deficits in affected individuals. These include (a) problems with elementary functions such as selective attention towards relevant stimuli and sustained attention over prolonged periods of time (Oltmanns & Neale, 1975; Nuechterlein, 1977); (b) problems with more complex functions such as encoding and recognition of familiar cues, storing information for future retrieval, or drawing deductive or analogous conclusions from available information (Broga & Neufeld, 1981; Brenner, 1983; Nuechterlein & Dawson, 1984b); and (c) problems with executive functions and response selection (Broen & Storms, 1967; Weinberger et al, 1986, 1988).