The history of treatment approaches used to help individuals troubled by sexual deviation or variation is notable for the way it has reflected the changing attitudes of both society and medicine to such behaviour. In recent years the range of behavioural techniques has broadened considerably with the introduction of, for example, cognitive forms of treatment and a change in emphasis away from the suppression of deviant sexual behaviour and towards the positive development of desired behaviour. In addition, as with behaviour therapy in general, a more flexible approach to management has developed with much greater emphasis on designing treatment on the basis of each individual patient's needs. Furthermore, there has been a marked reduction in the number of requests received for help with deviant sexual interest. This reflects both the changes that are occurring in social attitudes to sexuality in general, and homosexuality in particular, which have reduced the pressures on individuals to abandon their personal styles of sexual behaviour, and the development of self-help groups and minority organisations.

It has recently been found that tremor in patients on long-term lithium therapy has a lower frequency than that of normal physiological tremor and is likely to have an extrapyramidal component (Tyrer et al, 1981). Other extrapyramidal signs and symptoms have been found with chronic lithium therapy (Shopsin and Gershon, 1975; Baastrup et al, 1976; Branchey et al, 1976; Asnis et al, 1979). These extrapyramidal effects differ from the pseudoparkinsonism produced by antipsychotic drugs in that they do not respond to antiparkinsonian drug treatment (Schou, 1970; Tyrer et al, 1980).

In a continuing twin study of autism in Scandinavia and Finland, moderately mentally retarded triplets fulfilling Rutter's criteria for infantile autism were reported. Judging by physical appearance the triplets were identical. Behaviourally they were extremely similar though one was intellectually slightly better than the other two. All three showed the physical stigmata characteristic of the fragile–X syndrome, in spite of their overall appearance being non-conspicuous. The triplets had between 8 and 12 per cent of fragile–X positive cells and showed a distinct pattern of urinary excretion of substances yielding absorbency at 280 nM. Their mother and sister also had a high count of fragile–X positive cells.

This study compares the incidence of a variety of cutaneous conditions among 91 patients treated with lithium carbonate with the incidence of such conditions among 44 patients treated with other non-neuroleptic, maintenance medications. Data on cutaneous conditions and allergies were obtained using structured interviews, demographic data, medication histories and personal and family histories.

A significantly greater proportion of the lithium-treated patients than the comparison patients reported a cutaneous condition which may have been secondary to treatment in that it developed for the first time after the medication or appeared to have been exacerbated by the medication. Among the lithium-treated patients, females were found to be significantly more likely to report a secondary cutaneous condition. This effect was found across the whole range of cutaneous conditions. Male lithium-treated patients on the other hand reported approximately the same rate of secondary cutaneous conditions as both male and female comparison patients. Possible reasons for this sexual effect on incidence are discussed.

The literature on cutaneous conditions which have been associated with lithium therapy is also reviewed.

A large sample of women (n = 899) from Dunedin, New Zealand, completed a self-report questionnaire on depressive symptoms. On this basis, about 8 per cent of the sample were identified as having major depressive disorder. These women tended to have a history of previously reported psychological symptoms and formal treatment for depression. A significantly high proportion of the depressed group had been young at first pregnancy and had since been separated from their partners. The depressed women also reported more behaviour problems in their children, but these reports were not confirmed by teachers' reports or by the children's self-reports, suggesting a response bias in depressed women towards reporting problems.

EEG potentials evoked by tactile stimulation of the forearm (tactile-evoked potentials or TEPs) were recorded simultaneously from both cerebral hemispheres in a group of schizophrenics and a group of healthy control subjects. Differences between the groups were found for the early waves of the TEPs: in the control subjects the first two positive waves (P25 and P50) and the first negative wave (N35) recorded from the hemisphere on the same side as the stimulation were slower (i.e. had longer latency) than those recorded from the hemisphere contralateral to the stimulation. This lateralization effect’ was not seen in the schizophrenic subjects. It was concluded that the TEPs recorded from the hemisphere ipsilateral to the stimulus were not being transmitted from the other hemisphere via the corpus callosum and must therefore have been transmitted via direct ipsilateral pathways from the periphery.

In a second experiment the drug pindolol was administered to schizophrenic subjects but differences in P50 latency between ipsilateral and contralateral hemispheres were found equally in both drug and placebo groups. We also found slight evidence to suggest that the more severely ill the patient the more similar the TEP latencies recorded from the contralateral and the ipsilateral hemispheres.

All men receiving hospital orders (Section 60) in the UK in the year 1963–64 (excluding those receiving restriction orders (Section 60/65)) were followed up over 15 years with regard to (1) subsequent offences and convictions, (2) hospital admissions, and (3) death. Nine per cent of the patients involved could not be traced. Sixteen per cent had died by 1978, a quarter of them by suicide.

Of the mentally ill only 4 per cent subsequently committed serious offences (manslaughter, wounding, GBH, robbery, rape or arson), although a further 4 per cent committed assaults repeatedly. Sex crimes were uncommon. Among the mentally subnormal, 7 per cent committed serious sex crimes subsequent to committal. A further 9 per cent were considered to be persistent sex offenders and another 9 per cent were judged to be persistently violent. In general the mentally subnormal were much younger and were detained for much longer than the mentally ill. Since 1964 the use of hospital orders for the detention of such people has become much less frequent.

The best predictor of subsequent offences was found by multiple regression analysis to be the number of previous offences: this was especially true for acquisitive offences committed by the young. The mentally ill were less often reconvicted than the mentally subnormal.

The cloze procedure was used to examine predictability in speech samples from schizophrenic, depressive, manic, schizoaffective and normal subjects. Each speech sample was also rated for particular indices of thought disorder using the Andreasen Scale for the Assessment of Thought, Language and Communication. Schizophrenics were found to be less predictable than other patient groups or normals. Depressives were found to be the most predictable. Correlational analyses of cloze scores and specific thought disorder ratings suggest that reduced predictability is associated with traditional indicators of thought disorder.

This study compared the effects of social-skills training, remedial drama and group discussion on the conversation skills of chronic schizophrenic patients. After 16 one-hour treatment sessions only the social-skills training resulted in significant improvement, which was maintained at two-month follow-up. Although there was little evidence to support generalisation, the results are seen as indicating the usefulness of social-skills training in improving the performance level of chronic schizophrenic inpatients and in maintaining their social functioning. The implications for future rehabilitation practice are discussed.

In this double-blind, four-week study, 28 chronic schizophrenic patients receiving neuroleptic medication plus the antiparkinsonian drug, benztropine mesylate, were either switched to placebo or maintained on benztropine. Patients withdrawn from benztropine reliably increased their overall scores on the Wechsler Memory Scale in comparison with the drug group. Sub-test scores suggest that deficits in attention and concentration were induced by treatment with benztropine. Psychotio decompensation appeared to develop simultaneously with extrapyramidal symptoms (EPS) in some patients, but only 14.2 per cent of the placebo group experienced extrapyramidal symptoms severe enough to require resumption of benztropine therapy. It is suggested that antiparkinsonian agents should be prescribed only if and when EPS occur.

The offenders committed to local hospitals in 1962 and 1964 under a hospital order with restriction of discharge were followed up for 15 years with regard to subsequent court appearances, hospital admissions, and death. One hundred and forty-six were traced. Of these, 49 per cent had been diagnosed as mentally ill: most of this group were committed for violent offences. Thirty-five per cent were mentally subnormal: they were frequently committed for sexual offences, arson and property offences. Twelve per cent were diagnosed psychopathic: this group had a wide variety of committal offences.

Fourteen per cent of the mentally ill and 17 per cent of the mentally subnormal were still in hospital after 15 years, but 51 per cent of the mentally ill and 36 per cent of the mentally subnormal were released within three years. Sixty-one per cent of the psychopaths were released within two years. Few of the subsequent offences were serious in any of the diagnostic groups.

Since 1973 there has been a dramatic fall in restriction orders, especially for mentally subnormal patients.

The 30-item General Health Questionnaire (GHQ) (Goldberg, 1972) was administered to 196 consecutive new dermatology out-patients and 40 consecutive admissions to dermatology beds. Thirty per cent of the outpatients and 60 per cent of the in-patients obtained high scores, while half the high scorers in each group scored high on the Wakefield Self-Assessment Depression Scale (Snaith et al, 1971). These findings suggest that dermatology out-patients have a higher prevalence of psychiatric disorder than the general population, and dermatology in-patients a higher prevalence than general medical in-patients.

High GHQ scores were associated with (a) diagnoses of acne, eczema, psoriasis or alopecia; with (b) extensive lesions on exposed parts of the body; and with (c) the use of high potency topical steroid. We indicate other areas that might be profitably explored in a full-scale study.

When subjects act as their own controls in drug experiments there is a risk of asymmetrical transfer between treatment conditions, with the result that treatment effects are determined largely by order of administration. In such cases the effect of a drug may be reduced or exaggerated, and prior treatment with a drug may affect placebo conditions. Asymmetrical transfer is probably much more common than is generally realized. Suggested causes include inadequate wash-out between treatments, state-dependent learning, adoption of learning strategies, and practice effects. The problem is illustrated by the re-analysis of a paper on the effects of benzhexol on memory, published recently in this journal (Potamianos and Kellet, 1982). The advantages of separate-group experimental design are reconsidered.

The case histories are presented of three 17 year old identical male triplets with Asperger's syndrome. They show the impairments affecting social interaction, non-verbal communication and imagination, the motor clumsiness, and the circumscribed interests characteristic of that condition. They also have some features in their history and present behaviour more typical of childhood autism. Despite marked overall similarities, the three differ in the severity with which their problems are manifested. A relationship can be found between the amount of peri- and post-natal trauma, degree of intellectual impairment and number of autistic features. The findings support the hypothesis that autism and Asperger's syndrome are on the same continuum of pathology.

Twenty-three patients diagnosed as depressed and a matched group of normal subjects were interviewed on three occasions using standardised procedures. Their behaviour was quantified from video recordings. The results indicate that blink rate is increased in depression and falls to normal levels during treatment. The effect on blink rate was found to be independent of medication, but was related to the degree of improvement in the patients' condition. By contrast a sample of schizophrenic patients seen on one occasion showed a reduced blink rate which was probably a result of neuroleptic administration.

A comparison of a group of chronic schizophrenics with controls showed that: the patients had significantly less interest in sex, frequency of intercourse, and satisfaction from sex; the percentage of individuals with sexual dreams and sexual fantasies did not differ between the two groups; the severity of psychopathology influenced frequency of intercourse and satisfaction from sex, and the length of institutionalization influenced interest in sex; the schizophrenics had a variety of sexual disorders, but there was a significant difference between the sexes in disturbances of thought and perception; and, significantly more male schizophrenics, in comparison with females, had sexual dysfunction associated with pharmacotherapy, but feminization in the males was far from predominant.

The patients' sexual disorders are not disturbing to the social life of the open mental hospital or the community surrounding it.

This is an attempt to evaluate the results of planned changes on a long-stay rehabilitation ward in a traditional mental hospital in England. The ward was housing a mixture of groups of patients of differing types and needs. The results of our study suggest that it is possible to improve patient care and staff morale on similar wards without extra staff, money or structural changes. Good planning, collaborative teamwork and dedication were the main tools.

Fifteen patients with bilateral hemisphere brain injury secondary to thromboembolic stroke or trauma were evaluated for depression, cognitive impairment, and functional physical impairment. Analysis of CT scans and standardized mood scales revealed that patients with left anterior brain injury were significantly more depressed than patients without such injury. Depression severity was directly and significantly correlated with left lesion proximity to the frontal pole. Left lesion age, lesion temporal sequence, right lesion location, cognitive impairment, and functional physical impairment did not significantly correlate with depression. Depressive symptomatology previously shown to be associated with single left frontal lobe lesions appeared to dominate post-brain injury psychopathology regardless of location or temporal sequence of other brain lesions.

Several coefficients have been suggested for the measurement of agreement between raters. Recently Maxwell (1977) has proposed, and Janes (1979) has extended, a new coefficient, which they have termed the random error coefficient (RE). This paper criticizes their proposal and suggests that Cohen's (1960) coefficient kappa (K) is still the measure of choice.

To test the hypothesis that suicidal and self-destructive behaviour correlate with subjective and objective measures of hostility and violence, these behaviours in hospitalized schizophrenics were correlated to self-report (Buss-Durkee) and observer-rated (Lion Scale) measures. Self-destructive acts were significantly correlated with six of the seven of the Buss-Durkee self-report hostility subscales. The observed measures of hostility and violence correlated with seclusion and with restraint as a self-protective measure. Neither the Lion nor the Buss-Durkee measures correlated with depression measures. Thus, our data indicate that self-destructive acts in hospitalized schizophrenics may be better predicted by feelings of anger and hostility than by depression, a finding with relevance for clinicians who treat schizophrenic patients.