Adults attending general health facilities in Guiné-Bissau were screened for the presence of mental disorder; minimum estimate of definite mentally ill cases was found to be 12%. The proportion correctly identified by general health workers was low: only one of every three patients with a mental disorder was recognised and of every 100 non-cases 12 patients were wrongly diagnosed by the health worker as suffering from psychiatric illness. On the basis of these results health workers are now being taught how to detect mental illness.

The relationship between neurotransmitter metabolite concentrations and measurements of ventricular size on CAT scans and pneumoencephalographs was investigated in 15 patients with severe affective disorder. An association was identified between reduced levels of plasma free tryptophan and ventricular enlargement and also between raised ventricular CSF levels of 5 HIAA and ventricular enlargement.

Nineteen patients with an episode of major depressive disorder who did not recover within two years of prospective follow-up were compared with an equal number who recovered within a year of the initial evaluation and remained well through the two-year follow-up date. The groups were individually matched for age, sex, primary/secondary status, and prior duration of episode. The only psycho-social variable that predicted chronicity was increased neuroticism on self-report personality inventories administered during the index evaluation. Early loss, recent life events, and recent social supports were not predictive of outcome.

This study compared the performance of groups Alzheimer, Korsakoff, and depressed patients and a group of healthy controls at various clinical tests of memory, and wide differences were found in the discriminatory power of the different tests. In addition, the patterns of performance of the Alzheimer and Korsakoff groups differed, and to some extent this was understandable in terms of what is known about the nature of organic amnesia. Depressed patients showed relatively mild impairments, which were not correlated with the severity of their depression.

A case series is reported in which nine patients who experienced phobic and/or non-phobic panic attacks were given a cognitive-behavioural treatment based on the supposition that catastrophic interpretations of sensations produced by hyperventilation played an important role in their attacks. Large and rapid reductions in panic attack frequency and questionnaire report of fear were observed. Patients' resting pCO2 was significantly lower than controls and rose to normal levels during treatment.

Standardised measures of mental state were used to compare patients with bulimia nervosa with those with major depressive disorder. The two groups were found to be similar in terms of severity of psychiatric disturbance, as measured by the Montgomery & Åsberg Scale and the Present State Examination. Noteworthy symptomatic differences were a greater frequency of obsessional ruminations and anxiety amongst the first group, and a greater frequency of depressed mood, apparent sadness, and suicidal ideation amongst the second. Discriminant function analyses revealed that the two patient groups had a different pattern of symptoms. Examination of the character of the psychiatric symptoms of patients with bulimia nervosa suggests that the anxiety and depressive symptoms are likely to be secondary to the eating disorder itself, rather than of primary significance.

All patients formally detained in a Scottish psychiatric hospital between 1974 and 1979 were identified and their outcome determined 2½–8½ years later. A matched group, detained under Emergency Orders only, were also followed-up. Those formally detained had more previous psychiatric contact: functional psychoses were significantly more common in them. They remained in hospital longer, and required extensive community support when discharged. Those detained under Emergency Orders only, consisted of two sub-groups–one who left the area within two years of admission and could not be traced, and the remainder, who continued to require hospital treatment but for shorter times and with less continuous support. Amongst those detained, lack of insight was a predominant feature, which may create difficulty with regard to informed consent to treatment, given the present Amendments to the Mental Health Acts.

We studied 371 psychiatric admissions in an attempt to relate primary and secondary diagnosis, psychopathology, and stated reasons for drinking to alcohol consumption and alcoholism. No diagnostic group other than the alcoholics drank significantly more than the mean, and the schizophrenics drank less. One-third of those with bipolar and minor depression increased their drinking in the month before admission, but this was almost offset by those with similar diagnoses who drank less. Alcoholism, though not alcohol consumption, was related to a high prevalence of affective syndromes, but these did not amount to secondary diagnoses. Drinking for ‘escape reasons' was significantly associated with consumption levels, but the reasons patients gave did not correspond well with the objective presence or severity of the associated psychiatric symptoms.

In an investigation to find the prevalence of the fragile X (Martin Bell) syndrome in a mental handicap hospital, chromosomal investigations were carried out in 196 males selected out of a total of 512, and also in 20 female patients who were related to some of the selected males. Fragile X cells were found in 41 of the males and two of the females; in 21 of the males it was associated with macro-orchidism. The overall prevalence in the hospital for males (8.0%) ranks this syndrome next in importance to Down's syndrome as a known cause for mental handicap.

Our analysis of the problems of the Italian psychiatric services has drawn a lively correspondence challenging our findings. In September 1985, we undertook a second study tour in Italy. This is now reported, with notes on specific criticisms of the earlier paper.

We reviewed data on adverse drug reactions (ADRs) to first- and second-generation antidepressants, recorded by two different drug surveillance systems. The rate of ADRs that led to discontinuation of the drug in the individual case, assessed within a multi-centred hospital-based drug monitoring system (AMüP), was significantly higher in case of exposure to tricyclics (7.4%) than with the second-generation drugs (3.1%). On the basis of voluntary reports to the Medicines Commission of the German Medical Profession (AMK), profiles of ADRs to the drugs under survey were constructed and compared with data compiled by the WHO. The types of ADRs varied more between second-generation drugs than between tricyclics. Special attention was paid to rare but serious ADRs (e.g. seizures during treatment with maprotiline, and blood dyscrasias attributed to mianserin).

In a sample of attenders screened at a London health centre, 13.6% of male and 1.3% of female respondents were drinking at levels considered unsafe by the Royal College of Psychiatrists, and yet revealed few indicators to alert the general practitioner in terms of classical alcohol-related disability. Males, the unemployed, and those of Scottish or Irish origin were over-represented in the ‘at risk’ group. A significant proportion viewed their general practitioner as a source of help.

Two methods for predicting steady-state serum lithium level were compared prospectively in in-patients suffering from affective disorder. A single-point prospective administration model that required a single 24-hour serum lithium level, following a test dose produced statistically similar predictions of the observed steady-state lithium levels as did a model that required 12- and 36-hour levels. However, the latter two-point method produced significantly more accurate predictions from clinical interpretation. Although the two-point approach is preferable, the single-point method is clinically acceptable if its limitations of accuracy are taken into consideration.

Drug-related incidents dealt with by ten Accident and Emergency departments in Greater London during July 1982 were compared with those obtained from an identical survey in 1975. The number of incidents remained high, but there was a significant reduction in them and in the number of drug dependent attenders, compared with 1975: hynotic drugs were used in a significantly smaller percentage of drug overdoses, but there was increased use of minor tranquillisers. The possibility of using A & E departments to monitor drug misuse on a Regional basis is discussed.

What should the general hospital psychiatrist do, and how should he do it? In psychiatric settings, psychiatrists may legitimately confine their attention to those patients whose disorders can be classified according to ICD-9, but in general hospital settings, the same approach defines a very restricted range of activities. Evidence is reviewed which highlights the differences between psychiatric disorders encountered in psychiatric hospitals and those found in primary care or general hospital settings. Different activities proposed for the general hospital psychiatrist, and the results of research comparing these, are reviewed. A recent study is discussed in which alteration of the psychiatrist's method of practice in a general medical unit produced considerable changes in the pattern of psychiatric referrals. Evaluation of the efficacy of their interventions should remain the ultimate goal of general hospital psychiatrists. This can be adequately undertaken only by means of better understanding of the process by which general hospital patients attract psychiatric referral.

Our aim was to test the findings of a study which claimed that if the syntactic structure of schizophrenic speech were subjected to a detailed linguistic analysis, clear differences would be demonstrated between schizophrenic, manic and control populations. It was confirmed that schizophrenics do have less syntactically complex speech which contains more errors. Using linguistic variables in a discriminant function analysis, it was possible to predict diagnoses correctly in 79% of cases.

The outcome of 30 new psychiatric outpatient consultations at which the psychiatrist decided to see the patient once only was examined after 3 months. Patients were referred from general practice, and evaluation was primarily from the viewpoint of practitioners; the majority were satisfied with a single consultation. However, only about half the patients were seen again by their GPs within the 3-month period, and most of the treatments recommended by the psychiatrists were not carried out by the GPs. Suggestions are offered to ameliorate this disturbing state of affairs.

The outcome for a group of outpatients treated daily for 12 weeks in a dynamic group psychotherapy programme, was evaluated on both objective and subjective parameters. In the post-therapy year, the majority (82%) reduced their dependence on psychiatric services and showed considerable change in self-satisfaction, as assessed by an attitude test. Those available for follow-up three years later had maintained the change. There was a sub-group of patients (17%) who demonstrated an increase in service use in the post-therapy year.

Naloxone hydrochloride eyedrops 1 mg/ml dilated the pupils of 36 out of 47 opiate addicts on methadone maintenance treatment, without precipitation of acute withdrawal effects, but not those of healthy unmedicated subjects. The response in addicts was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. The size of the response suggests some potential clinical use for topical naloxone as a diagnostic test of current opioid influence and possibility of physical dependence. The local mydriatic response, which was restricted to the treated eye, indicates that the effect of opiates on the pupil in man is determined, at least in part, by a peripheral action.

Measures of parental affective style were compared for families of schizophrenics participating in a controlled treatment study which contrasted individual and family-based therapeutic programmes. The total number of critical statements and non-critical, intrusive remarks was significantly lower after three months for parents of schizophrenics participating in family therapy, compared to those whose offspring received only individual therapy. An increased risk for relapse was associated with an increase in the number of critical and/or intrusive remarks for patients in individual treatment. A significant increase in non-emotional, problem-solving statements was observed in parents who received family therapy, compared with those who did not. The results suggest that a behaviourally-oriented, problem-solving family approach may have reduced the risk of relapse in the first nine months after discharge from hospital by teaching families concrete ways of solving problems and concomitantly reducing the amount of negative emotional relating between family members.