The facts that neither the International Classification of Diseases (ICD) nor any other major standard diagnostic system have offered a full definition of psychiatric illness and that earnest definitional attempts reported in the literature (e.g. Spitzer & Endicott, 1978) have not received wide acceptance, have led distinguished nosologists (e.g. Kendell, 1985) to suggest that all we can say about psychiatric classifications is that they are classifications of kinds of problems which psychiatrists currently deal with. However, one immediate difficulty with this characterisation is that it is based on what psychiatrists do, when in fact psychiatric problems are dealt with also by other professionals of various types and levels of training. Another difficulty is that it implies that there is not even an approximate common denominator or core concept underlying the various forms of psychiatric disorder listed in the ICD or other standard diagnostic systems.

In a systematic prospective study of 71 patients with acute spinal cord injury carried out in the acute and rehabilitation phases of treatment, 14 patients meeting the DSM-III criteria for major depressive disorder were identified. A further 13 patients had transient periods of depressed mood, while the majority of patients showed no clear evidence of depression. The BDI was found to be valid in this group of patients.

The quality of life of chronically mentally ill patients in acute wards in a district general hospital, a hostel ward and group homes was compared. Within the spectrum of care of these patients, the severity of psychopathology corresponded to their placement. Analysis, including adjustments for the influence of psychopathology, showed differences between the three types of facility. Although differences existed between all types of care, residents in group homes and the hostel ward shared more similarities in quality of life than those in the district general hospital. Problems of caring for the chronically mentally ill on acute wards are highlighted.

Psychiatric symptoms among medical inpatients in an Indian hospital were assessed: the SRQ was used as a screening instrument, and those with probable psychiatric disorders were given the PSE and MSE, for further, detailed assessment. The prevalence of psychiatric disorders was 34%, with a further 15% reporting distressing psychiatric symptoms only. The most frequent complaints were delirium and adjustment disorders. They were largely associated with connective tissue, as well as cardiovascular and endocrine, disorders, and were characterised by depression, worrying and irritability. The reliability of the SRQ varied with the cut-off score, which gave optimal specificity and sensitivity when set at 9.

The concept of reactive or psychogenic psychoses has had a peculiar fate. Especially at the beginning of the century, under the influence of the writings of Jaspers (Jaspers, 1913) which included definitions of ‘psychogenic’ and ‘psychoses’, the term ‘psychogenic psychoses’ came into common use in European psychiatry. In Scandinavia, this trend was greatly reinforced by August Wimmer's monograph in 1916 on the subject. In the later editions of Kraepelin's standard textbook, the concept appeared quite frequently, and the same was the case in other leading textbooks, for instance in the Soviet Union and Japan.

A rating scale for drug-induced akathisia has been derived that incorporates diagnostic criteria for pseudoakathisia, and mild, moderate, and severe akathisia. It comprises items for rating the observable, restless movements which characterise the condition, the subjective awareness of restlessness, and any distress associated with the akathisia. In addition, there is an item for rating global severity. A standard examination procedure is recommended. The inter-rater reliability for the scale items (Cohen's x) ranged from 0.738 to 0.955. Akathisia was found in eight of 42 schizophrenic inpatients, and nine had pseudoakathisia, where the typical sense of inner restlessness was not reported.

Twenty-six patients seen at a regional adolescent psychiatry unit between 1974 and 1979 with a discharge diagnosis of obsessive-compulsive disorder were followed up after an average of ten years. Of 24 subjects traced, outcome information was obtained from 20. At the point of follow-up, ten patients remained psychiatrically ill, six having persisting obsessive–compulsive symptoms. Poor outcome was associated with a family history of psychiatric illness and lack of response to therapy at initial contact. All patients who were asymptomatic at discharge had remained well.

A descriptive study of suicides in 74 Chinese schizophrenic out-patients (43 male) is presented. The mean age at death was 31.3 years. The mean duration of illness was 8.5 years and 50 of the 74 died within ten years of onset of illness. Only five lived alone; 35 were openly employed and 20 were married at the time of death. Twenty had a history of depression, and 27 had attempted suicide previously. More females had been depressed or had attempted suicide than males. Over half were last admitted for reasons other than schizophrenic symptoms alone and ten died within one month of discharge. Eight of 71 patients followed up expressed suicidal ideas at the last psychiatric contact, but only 15 were symptomatic. Jumping was the commonest method used. Analytical studies are needed to identify risk factors in Chinese schizophrenics.

To determine the usefulness of the DST in differentiating depression from dementia, the test was administered to three diagnostic groups of psychogeriatric patients: depression; dementia; and dementia with depression. Clinical assessments were supplemented by ratings on the HRSD and SCAG, as well as by EEG and CT. All three groups showed a high incidence of abnormal DST results unrelated to presence or severity of affective symptoms, but showing a better association with SCAG and its ‘organic’ subsets. The mechanism(s) underlying these abnormal results may reflect organic brain disease. The usefulness of the DST in differentiating depression from dementia in the elderly was not confirmed.

The establishment and first 18 months of a psychiatric liaison service to a general hospital obstetric unit are described. The service was initially intended to predict antenatally those at risk of postnatal depression and to offer follow-up throughout pregnancy and in the postnatal period. However, a large proportion of referrals were of women currently unwell. Furthermore, postnatal follow-up in the community proved difficult. Referrals, diagnoses and disposal are analysed, leading to conclusions about the effectiveness and problem of such a service. The components of a comprehensive obstetric liaison provision are proposed, emphasising the need for strong community links built around a CPN service, allowing adequate postnatal psychiatric care.

Fifty patients suffering from the alcohol dependence syndrome were detoxified over a 10-day period using a reducing regime of chlordiazepoxide. Twenty-four had been consuming minor tranquillisers together with alcohol prior to admission. The severity of the withdrawal syndrome was assessed daily but no differences were found between the 26 who had taken alcohol alone and the 24 who had taken a combination of alcohol and drugs. Four from each group had a transient hallucinosis and none had fits.

Sixty women aged between 30 and 55 years, having hysterectomy for benign conditions, were prospectively studied to investigate psychological adjustment to operation, and to explore social, psychological and physical factors associated with psychological outcome. A further 30 women were included for prospective research on psychological outcome. Investigations took place within two weeks of operation and after four months and 14 months. The findings indicated a high prevalence of pre-operative psychological morbidity (55%), which reduced to 31.7% afterwards. There was no evidence that hysterectomy led to a greater psychological distress. The principal risk factors of poor psychological outcome were the previous scores on the mental health measures and personality inventory. Involvement in the research process did not appear to affect psychological outcome.

Abnormal neuroendocrine responses have been found in depression and eating disorders. It remains unclear whether these reflect an underlying shared biology or epiphenomena. To evaluate this further, we conducted the 1 mg DST and the TSH response to 500 μg i.v. TRH in normal-weight bulimics and controls. Bulimics (n = 18) demonstrated significantly more DST non-suppression (45%) than controls (18%; n = 20). In the bulimic group, non-suppressors were significantly thinner than suppressors, but did not differ from them on any measure of depression. Bulimics (n = 19) and controls (n = 12) responded similarly without blunting on the TSH response to TRH. These data suggest that DST non-suppression may be related to non-specific variables such as weight. Bulimics do not demonstrate TSH blunting as found in some depressed patients. These tests do not support evidence for a biological link between these disorders.

Hospitalised drug addicts were categorised according to the time lapse between onset of their opiate abuse and their first notification to the Home Office. Late notification correlated with a lower level of dependence, a more intermittent pattern of misuse, and a greater likelihood of alcohol abuse. It is postulated that there may be two types of addiction which lie along a continuum.

The coroner's and hospital records of 57 consecutive in-patient or day-patient suicides were examined. There was a preponderance of males, but no difference between the sexes in violent deaths. The patients were generally chronically ill, and risk of suicide continued indefinitely after diagnosis. Risk was recorded in the medical notes for 16 patients and in the nursing notes for 12, but only six were under special observation. Half the patients were thought to be improving at the time of death. Psychiatrists and coroners should pay attention to aspects such as nursing and environmental factors in suicides in order to identify those at risk.

Two-stage screening for minor psychiatric morbidity was carried out with a consecutive sample of 256 patients aged 15–69 consulting an experienced GP in a semirural setting over a seven-week period. Patients completed a short GHQ, and the GP made a standardised assessment of the reason for consultation and the degree of psychological disorder. A 40% random subsample were evaluated using PROQSY, a newly developed computerised psychiatric assessment based on the CIS. PROQSY is acceptable to patients in general practice, and yields an estimate of the prevalence of minor psychiatric morbidity (33%), and validity indices for the 12-item, 28-item, and 30-item GHQs, comparable with those found in similar studies, when the CIS has been administered by an interviewer. PROQSY may be recommended as a research tool, providing a criterion measure of minor psychiatric morbidity in general practice, where it may reduce time and manpower, and eliminate interviewer bias.

Alcoholics and heroin addicts were compared with a normal control group to determine whether there were differences in quality of parenting during childhood, assessed using the Parental Bonding Instrument. Maternal and paternal overprotection were reported more commonly by narcotic addicts. Maternal overprotection alone was implicated in alcoholics. Narcotic addicts seem to have more disturbed parenting than alcoholics, especially paternal parenting.

In a survey of authoritative psychiatric texts, inconsistent, sometimes contradictory use can be found of the terms ‘affect’, ‘mood’, and ‘emotion’. There is some consensus that these terms deal with subsets of the larger domain of feelings, but many authorities, explicitly or implicitly, treat them as at least partially interchangeable. Others see the terms as referring to different phenomena, but disagree on how they differ. In lay usage, feelings are primarily subjective experiences, but the term is used here in a more encompassing, generic sense. In the psychiatric texts, some attributes are frequently used to distinguish among feelings. These include the duration of the phenomena; whether they are subjective, objective or both; the relative involvement of cognition; and whether they are clinically observable or rather reflect the patient's potential for response. Some examples of current usage will be considered before alternative formulations are suggested.

Sigmund Freud's family background holds extraordinary fascination, not just because he is an historic figure but because his very ideas centred around the influence of formative family relationships. In addition, Freud used his own experiences as one means of research, from which he concluded that some personal details only may be available in disguised form. This has proved an irresistible challenge to those interested in the evolution of Freud's theories.

Over the last 10 years I have run 17 psychotherapy groups for aged people who were in hospitals, homes or in the community. The groups were all short, usually running for 12 weeks. The total number in these groups was 121 and their ages ranged from 68 to 100. The average size of each group was seven and there were never more than four men in any group and in 11 groups there were only women. The average attendance was 88% and 36 attended more than one group. One member suffered from motor neuron disease, two from Parkinson's disease and the common causes of infirmity of old age were widely represented. All members had been diagnosed as suffering from senile dementia in two groups. In every group at least one member was hard of hearing and a communicator was used over the hearing aid to facilitate hearing. One member was blind and the sufferer from motor neuron disease continued to attend after losing her speech.