The relationship of depression with affect deficit in schizophrenic patients continues to challenge both the clinician and the researcher. Often there is considerable difficulty in differentiating these two affect states in a reliable and valid fashion. On the observational level, depressed affect often appears somewhat restricted, having lost the full range of the euthymic state. On a subjective level, schizophrenic patients often complain of anhedonia, a defect in pleasure capacity which is shared by patients who are depressed. On the prognostic level, there is a large body of literature that links depressive features in acute schizophrenics to favourable subsequent course (Astrup & Noreik, 1966; Vaillant, 1964). We were, therefore, interested in investigating the relationship of depression with impaired affect and with positive/negative symptoms in young acute schizophrenic patients. We used a systematic multidimensional study of affect impairment among 37 young acute schizophrenic patients in a prospective, longitudinal approach over a 2-year span. In addition to a detailed assessment of the affect profile, including depression, both at baseline and on follow-up, we rated patients clinically for a positive and negative syndrome as well as general psychopathology, and we conducted premorbid and outcome measurements.

A woman with a mixed eating disorder is reported. Her disorder did not remit after a head injury which caused her to lose her sense of taste and smell.

In a case of NMS subsequent to administration of trifluperidol to a young man, the patient responded remarkably quickly to bromocriptine. The authors point out the deficiencies in the diagnostic criteria, which need further refinement for a better understanding of the syndrome.

In the past, psychiatry has paid little attention to the relatives of the mentally ill, but this attitude has changed gradually since the 1950s, when increasing numbers of patients began to be discharged from psychiatric hospitals through the introduction of neuroleptics and other changes. Especially for schizophrenic patients, with the low age of onset of the disorder, this development has meant that in many cases, the burden of care fell on their families, and as a consequence of this development, relatives have gradually become an important factor in care (Katschnig & Konieczna, 1987a). This field of involvement of relatives continues to expand, but is becoming increasingly confusing and complex. Our task here is an attempt to offer a structure within which to understand the manifold relative-centred activities that exist today.

The introduction of neuroleptic (or anti-psychotic) medication into clinical practice was a major advance in the treatment of schizophrenia. Numerous well-controlled, double-blind clinical trials have established the therapeutic efficacy of these agents in both the acute and long-term treatment of schizophrenia (Klein et al, 1980; Kane & Lieberman, 1987). In general, the therapeutic benefit of medication has been assessed in terms of the relative reduction in the more florid signs and symptoms of schizophrenia (e.g. hallucinations, delusions, thought disorder, agitation, and hostility) and the ability of maintenance medication to reduce the rate of recurrence of these symptoms and in turn rates of rehospitalisation. At the same time it has been quite apparent that anti-psychotic drugs do not necessarily eliminate some of the major chronic disabilities of patients with this illness, disabilities reflected in impoverished affect, lack of drive and ambition, impaired spontaneity, reduced ability to relate to others, and diminished pleasure capacity. These symptoms have at times been described as negative in that they reflect an absence of or reduction in certain aspects of psychologic, cognitive, and emotional functioning in an attempt to distinguish them from the distortions or exaggerations in normal function which characterise positive symptoms (Strauss & Carpenter, 1974; Jackson, 1904).

A 44-year-old depressed widow in psychodynamic psychotherapy suffered repeated relapses of symptoms following improvement. This was seen as a negative therapeutic reaction.

In recent years, exploration of the distinction between positive and negative symptoms of schizophrenia has provided a fruitful basis for attempts to relate the clinical features of schizophrenia to the accumulating evidence of brain abnormalities in schizophrenic patients. By 1982, there was an extensive body of evidence supporting the hypothesis that negative schizophrenic symptoms, such as poverty of speech and flatness of affect, were associated with substantial brain abnormalities, such as increased ventricular to brain ratio, and extensive cognitive impairment (Crow, 1980; Andreasen & Olsen, 1982). However, at that stage there were several fundamental unanswered questions about the nature of negative symptoms, and their relationship to indices of brain abnormality. This paper presents some findings of a series of studies initiated in 1982 to seek answers to some of these questions.