In a health centre, 3.6% of the registered patients were found to have received at least one prescription for psychotropic drugs in each quarter of a year. These patients were mainly elderly and female. Psychiatric interviews were held with randomly selected index patients, and with matched controls. Most index patients reported taking psychotropic drugs for several years, mainly anxiolytics, antidepressants and non-barbiturate hypnotics, and mainly in low dosage. Index patients had much higher levels of psychiatric morbidity, as shown by the Present State Examination, history of specialist psychiatric treatment, and previous drug overdoses. In index patients the main diagnoses were neurotic depression and phobic disorder. Index patients reported more problems with finances and with social isolation.

HIV disease often leads to neuropsychiatric disturbance, either through direct infection of the brain by the virus or through CNS disease secondary to immunodeficiency. Neuropsychiatric complications of AIDS and AIDS-related disorders may present clinically as acute or chronic organic mental syndromes, or may mimic functional psychiatric illness, in particular depression, anxiety, or psychotic states. Two cases of hypomanic states in homosexual men suffering from AIDS are reported. Neither of the two men had a personal or family history of affective disorder. In one man, hypomanic symptoms were caused by early HIV encephalopathy; he rapidly developed typical HIV dementia with a marked downhill course. In the second case, a clear connection between the hypomanic symptoms and direct HIV brain involvement was not established.

Eight chronic psychiatric in-patients with polydipsia, and polyuria, up to 22 litres per 24 hours, were studied by frequent timed body weight and urine volume measurements, and episodic plasma electrolyte estimations. During the day they all showed irregular water retention, with hyponatremia in proportion to the weight gain. During the night they always lost water and weight, returning to their individual lowest weights and to normal plasma sodium. Measurement of weight in chronic psychiatric patients can be used to identify patients with significant polydipsia, to monitor those with the disorder and permit targeted fluid restriction, and to assess the efficacy of treatment procedures such as medication.

Flash and pattern-reversal visual evoked potentials (VEP) were recorded in 35 elderly patients with dementia, and 19 controls of equivalent age. Dementia produced a slowing of the major positive (P2) component of the flash VEP but did not affect the latency of the flash P1 component or the P100 pattern-reversal component. This unusual type of abnormality was found in both primary and multi-infarct types of dementia, and has previously been found in primary presenile dementia. The results show that the VEP can be used for the diagnosis of multi-infarct, and primary presenile and senile dementias.

Research into the clinical features of dementia has concentrated almost exclusively on the cognitive impairment. Perhaps this is not surprising, since deteriorating cognitive function is the most prominent feature, and a necessary one from the point of view of diagnosis (American Psychiatric Association, 1980; McKhann et al, 1984). However, this emphasis on cognitive function has led to the neglect of the other major feature of the disorder; namely, the changes in behaviour which have long been recognised. For example, Bleuler (1924), describing a sub-group of people with senile dementia, wrote that “the patients are always engaged in an apparent activity”. Some of the behavioural changes in dementia are a major source of distress for the carers of these patients (Argyle et al, 1985; Rabins et al, 1982; Gilleard et al, 1982) and often it is the disturbed behaviour which results both in patients coming to medical attention and in them requiring institutional care (Sanford, 1975; Chenoweth& Spencer, 1986). Frequently encountered examples include aggressive behaviour and ‘wandering’. The disturbed behaviour can take many other forms, including changes in eating, the hoarding and moving of objects, marked sleep disturbance, alterations in sexual behaviour, and incessant trailing behind people.

This paper reports on goal-oriented group treatment for adolescent girls who have been sexually abused within the family. The treatment approach on which the therapeutic work was based and the treatment programme are described briefly. The group treatment was seen as part of a family approach to child sexual abuse in the family. The membership and structure of the group and the aims of treatment are described. Some characteristics of the specific group processes are detailed and illustrated by clinical examples. Clinical results on outcome and results from an independent follow-up study are described, and some relevant clinical issues are discussed.

Post-ictal psychoses have so far received little attention. The clinical details of 14 cases, diagnosed according to newly formulated criteria, were examined. Psychoses were usually precipitated by a run of seizures and occurred after a lucid interval. The seizures were partial complex with secondary generalisation in 11 cases. Catego analysis of the Present State Examination confirmed pleomorphic phenomenology. Follow-up details were available in all cases, for up to eight years. Psychoses tended to recur. Similarities with chronic epileptic psychosis are discussed, and a possible organic aetiology for post-ictal psychosis is proposed.

In Prudhoe Hospital, a large mental-handicap hospital of 1000 residents, it was found that of the 94 deaths that occurred between 1982 and 1986, three were closely associated with the habit of pica. These deaths occurred in severely and profoundly handicapped males, whose average age was 32, compared with an average age of death of 58 for the combined groups of severely and profoundly mentally handicapped patients (22 cases), and an average age of death of 60 for all degrees of handicap (94 cases). It seems likely that the habit of pica constitutes a cause of considerable morbidity and mortality in certain institutionalised patients.

Three groups of male transsexuals at different stages of the treatment process were examined and shown to match retrospectively in actuarial and psychiatric data. Transsexuals who were on a waiting list for surgery showed lower neurotic scores on the Crown–Crisp Experiential Index than those at the assessment stage of clinic attendance, while post-operative transsexuals obtained scores lower than either of the other groups. Transsexuals during the assessment stage of treatment obtained the lowest scores on items in the Bern Sex Role Inventory that define stereotypical masculine characteristics and the highest scores on items that define stereotypical feminine characteristics, in relation to the other two groups.

A patient in whom a series of treatments of all sorts had failed was given two trials of psychotherapy over a prolonged period. Although the patient judged the trials of psychotherapy to be a failure, and therapy was terminated, he does seem to have matured, and his disturbed behaviour has ceased. The possible reasons for this are discussed.

To determine whether tardive dyskinesia (TD) is a single abnormal movement syndrome or multiple syndromes involving different anatomical areas, we examined 228 out-patients diagnosed with TD at the Connecticut Mental Health Center in New Haven. Application of factor analysis to the seven anatomical severity scores of the Abnormal Involuntary Movement Scale yielded three statistically independent factors involving abnormal movements primarily of the jaw-tongue, face-lips, and extremities-trunk. Using logistic regression to predict the severity of these factors, we found that the severity of the orofacial scores was positively associated with age, schizoaffective or affective disorder, and living alone, while severity of non-orofacial movement was positively associated with current neuroleptic dose, non-use of psychiatric medication, and living alone. Our findings suggest that orofacial and non-orofacial dyskinetic movements may involve distinct clinical syndromes of TD, each having a different set of prognostic and, possibly, aetiological determinants.

A case of shop-lifting involving the father of a severely handicapped school-leaver is described. The need to support families during the transition of the handicapped person from school to a work environment is emphasised.

The performance of the dexamethasone suppression test was assessed in 90 consecutive admissions with a diagnosis of depression, categorised according to two classification systems (DSM-III and ICD-9). Non-suppression was found in most of the diagnostic categories, but there was a highly significant association with the DSM-III classification ‘major depressive episode with melancholia’ (52%) in comparison with the ICD group ‘manic-depressive illness-depressed’ (29%).

Among 115 women referred to a regional psychotherapy unit, childhood sexual abuse was reported at the referral or assessment stage by 19, and referred to covertly by 5. A significant number of cases must remain undetected. For the purpose of this study, sexual abuse includes any form of sexual activity between a female child and a familiar adult or young person older than her, which was perceived by the subject to be of a sexual nature and distressing to her. The symptoms in adulthood have been described as similar to those of Borderline Personality Disorder. Development, treatment and implications are discussed.

A retrospective study of 65 consecutive referrals for behavioural disorder of mentally handicapped patients living in the community revealed that 31 of these were associated with life events sustained in the 12 months prior to the referral. These patients were usually mildly handicapped, while those who presented with behaviour disorder without a history of recent life events were usually more severely retarded. The differences between the two groups are discussed and the need for further research emphasised.

A group of 30 black African patients and a group of 30 occidental patients, all presenting a hysterical structure, were compared with regard to clinical manifestations, provoking psychosocial stressors and histrionic personality traits. Cultural characteristics in several areas are discussed as possible explanations of the differences found.

Two cases of Kleine-Levin syndrome are described in which the onset of symptoms was temporally related to head injury. The possible aetiological role of trauma and an apparent response to treatment with lithium carbonate are discussed.

Depressed patients were carefully matched in pairs with normal subjects for the variables which are known to influence the secretion of melatonin in humans. In contrast to the previous literature, nocturnal melatonin secretion was not lower in the depressed group than in the normal group, and there was no difference in the timing of secretion; indeed, the trend was for greater melatonin secretion in the depressed group. The results are discussed in relation to previous studies, none of which has been so carefully controlled for the relevant variables.

The clinical features of a fatal case of the neuroleptic malignant syndrome are presented. The fatal episode was a recurrence of the syndrome after a milder episode 3 months earlier. Prescription of neuroleptics was continued unchanged following the latter, as a correct diagnosis was not made at the time. The case emphasises the importance of early recognition of the syndrome and the possibility of spontaneous remission of symptoms despite continued neuroleptic treatment.

The aspirations, mores, and family structure in Cypriot immigrants, which are illustrated in four cases of hysterical behaviour, have many similarities to nineteenth century Viennese society. Such behaviour may mask more sinister diagnoses; one of the cases remains diagnostically uncertain and another passed through a transient hysterical psychosis with Ganser-like symptoms. The cultural, dynamic, and nosological issues are discussed.