Drinking practices and attitudes to alcohol among the members of a Southampton church were investigated by questionnaire (602 subjects) and by interviews (126 subjects). Teetotallers were older than drinkers, and included a higher proportion of women. They perceived their childhood upbringing and the teaching of the Bible as the main factors influencing them to abstain. Both teetotallism and alcoholism were more common among relatives of teetotallers than among relatives of social drinkers.

Seventeen fasting patients with anorexia nervosa and 15 who also binged were compared in terms of their psychosocial functioning and associated psychiatric symptomatology, using the Delusions Symptoms and States Inventory (Foulds & Bedford, 1975). Both groups scored very highly on the state of anxiety, depression, and elation sets of the DSSI, but less highly on the compulsive and ruminative symptoms sets and on the phobic dissociative and conversion symptom sets. The bingeing anorexic group was significantly older and heavier than the fasting group and experienced more feelings of self-harm and guilt. The bingeing group reported sexual interference during childhood, and currently experienced a desire to vomit during sexual activity to a significantly greater degree than the fasting group.

Schizophrenics appear to be unable to regulate adequately the effects of external stimulation, but the cause of this deficit is unclear. Recent evidence suggests that input activation can normally be inhibited by an appropriate leading or conditioning stimulus; such inhibition has been found to be diminished in schizophrenics. Based on this evidence, a feed-forward regulating mechanism that serves to stabilise reactivity to environmental events is described; it is hypothesised that failure of the mechanism to inhibit adequately surges of activity is an underlying cause of schizophrenic symptoms. Some ways to test the validity of the mechanism are proposed, and an outline presented of steps to link the mechanism's dysfunction to schizophrenia.

Zopiclone, a non-benzodiazepine hypnotic, was compared with temazepam in the treatment of 36 patients suffering from insomnia; the trial period was two weeks, with cross-over of medications at one week and a randomised order of administration. There were highly significant improvements with both drugs, as compared to the control period in respect of: sleep latency, number of times waking during the night, and quality and duration of sleep. The incidence of side-effects was very low. No significant between-drug differences were found in respect of any of the assessment measures or of the incidence of side-effects.

There is doubt whether schizophrenia, the most common and most devastating serious mental illness, existed much more than 200 years ago. Many authors who have written recently on the history of schizophrenia suggest that it is a disease that first appeared towards the end of the eighteenth century and rapidly increased in prevalence throughout the nineteenth. Cooper & Sartorius (1977) ask “Why are good descriptions of what can now be recognized as chronic schizophrenia so scarce in European medieval and earlier literature?” and they associate schizophrenia with industrialisation. Torrey (1980) argues that although descriptions of madness, including hallucinations and delusions, date to ancient times, schizophrenia as we know it with an onset in early adulthood and progressive deterioration, is not described. He associates schizophrenia with civilisation, and proposes an infectious cause. Hare (1979, 1982) supports this hypothesis, providing detailed evidence for a real increase in hospitalised psychiatric patients who most probably had schizophrenia in the last century (Hare, 1983), and also states that there are no good earlier descriptions of schizophrenia.

Recently there has been an increase in the number of reports of anorexia nervosa in non-Caucasian subjects. This paper describes three patients of Afro-Caribbean extraction with anorexia nervosa and/or bulimia nervosa seen at a specialist eating disorders clinic at the Maudsley Hospital between 1981 and 1983. No cases had been seen prior to this. The key clinical features were found to be, in the main, typical.

One hundred and fifty anxiety neurotic and neurotic depressive twin probands were differentiated into three groups by means of discriminant analysis, 50 in each group. The groups were named: pure anxiety neurosis, mixed anxiety-depression, and pure neurotic depression. Analysis of concordance rates indicated that only pure anxiety neurosis seemed to be influenced by hereditary factors.

The offence of attempted infanticide has hitherto been unknown in English Law. A case is here described in which a woman was convicted of infanticide, and attempted infanticide, having been charged with murder and attempted murder. The relevance of this is discussed, together with an aspect of infanticide previously unreported in the English literature, i.e. repetition of the offence.

A review in South-West Scotland of all patients prescribed lithium for the first time during the years 1972–82 showed that on average, 12 per 100,000 of the general population start this drug each year. By the end of the period, lithium had been stopped in 58% of patients; the most common reason for discontinuation was the development of side-effects, of which tremor was the most frequent. In only 15% was lithium stopped as it was considered no longer necessary; 44% of patients discontinued lithium within one year of starting it.

A case of folie à trois affecting a mother and her children is described. The subjects fully recovered with treatment, but all relapsed two months later, when the primary subject discontinued medication.

Twenty-one children who conformed to DSM-III criteria for anorexia nervosa, and who were aged 13 or younger at onset, were followed up after several years (mean = eight) using a range of outcome parameters. Comparison of these results with previous studies of later onset cases suggests that the age of onset of anorexia nervosa carries no prognostic significance.

In a controlled study, intellectual capacity and memory functions were assessed using standard instruments in a sample of 16 patients with ‘brain-fag syndrome’. The intelligence of the affected group was found to be generally above average and not significantly different from that of the control group. However, the patients had more difficulty in learning new words and in retaining such learning. The psychopathology of the syndrome is discussed.

Behavioural changes have often been noted in patients with epilepsy. This study investigated the converse phenomenon—the occurrence of transient sensory, cognitive and affective changes resembling those described by epileptics, in affectively ill patients. Forty-four patients with affective illness, 37 with complex partial seizures, and 30 hypertensive controls were interviewed to determine the lifetime occurrence of these phenomena. Such symptoms occurred frequently in association with episodes of affective illness and epilepsy, but were rare in controls. Visual, auditory, olfactory and epigastric symptoms, illusions, jumbled thoughts and amnesia were common to both epilepsy and affective illness. Greater numbers of symptoms were associated with better response to lithium and tricyclic antidepressants. Transient sensory, cognitive, and affective phenomena may be more common in affective illness and other psychiatric conditions than is generally recognised, and may be clues to the underlying pathophysiology of these conditions.

Psychomotor retardation is important in some depressed patients. We found that speech pause time (SPT) during a counting test correlated with the reaction time of both depressed patients and controls. It also correlated with global psychomotor retardation measured on Widlocher's scale. We demonstrated increased SPT in unipolar depressives, and also in retarded depressives as a group when compared with controls and with non-retarded depressives. SPT varied diurnally in controls, but not in depressed subjects. It did not correlate with biological markers of depression (REM sleep latency and the dexamethasone suppression test). It did, however, shorten during clinical improvement with antidepressant chemotherapy.

Twenty-six chronic schizophrenic patients on well established depot neuroleptic regimes with stable doses (16 on fluphenazine decanoate, ten on flupenthixol decanoate) had serum neuroleptic levels measured by a radioreceptor assay (RRA) method. The assay was sufficiently sensitive to measure serum levels in all cases, with acceptable levels of inter-assay variation. Blood level measurements were repeated on two occasions, at the same time interval from the last injection, in 18 patients (11 on fluphenazine decanoate, seven on flupenthixol decanoate) and remained reasonably stable in most cases, although others showed a wider variation. Despite a wide range of doses (× 32 fluphenazine decanoate, × 21 flupenthixol decanoate) the serum levels fell in a remarkably narrow range (× 4, × 6). There was a significant correlation between dose and blood level for flupenthixol decanoate, but not for fluphenazine decanoate.

The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic drugs, made up of hyperthermia, muscular rigidity, disturbance of level of consciousness and autonomic dysfunction. It is potentially lethal and should be kept in mind whilst using anti-psychotic drugs; as most patients treated by them require further anti-psychotic treatment, the clinician faces the problem of treating those patients after a NMS episode, yet reports in the literature have generally neglected the problem of late management. A patient suffering from a psychosis and NMS is presented, and a rationale for management offered.

Unusually frequent sinistral motor and sighting dominance have sometimes been reported in schizophrenics, although the majority of patients are still dextral. In this study, assessment of lateral dominance also included a measure of grip strength—a potentially more sensitive index of dominance or lateralised impairment; schizophrenics, non-schizophrenic patients (affective disorder), and normal controls were studied. There were no differences in handedness or sighting dominance. Affective patients, particularly bipolar psychotics, had greater right-handed grip superiority than normals or non-paranoid schizophrenics. Paranoid schizophrenics were similar, being significantly greater in right-sided dominance than non-paranoids, who tended toward a smaller value than normals. Hand grip asymmetry was highly correlated with handedness in normals, but not in patients. The possibility is discussed that these results may reflect asymmetrical patterns of cerebral impairment or attentional bias.

In reviewing the medical literature on the association between affective illness and mental retardation (Sovner & Hurley, 1983), we were intrigued to find that, although there were many cases of major depression and depressive neurosis among people with Down's syndrome, there were no reports of mania in such individuals. This finding provoked us to pursue the hypothesis that Down's syndrome may preclude the development of mania.

A case of erotomania (de Clérambault's syndrome) in a female with Schneider-positive schizophrenia is presented. The factors in her environment which may have precipitated the illness are discussed. The secondary nature of the syndrome is further illustrated by a discussion of the literature. In erotomania, the deluded victim, usually a woman, believes that a man, unattainable because of his social status, is in love with her. The nosological purity of the syndrome, despite its relative rarity, remains a subject of considerable debate. We present a case of erotomania in a female with schneiderian first rank symptoms (FRS) of schizophrenia (Schneider, 1959).