The non-fatal deliberate taking of overdoses in Cork city during 1982 was investigated from records in the general hospitals. In one of the hospitals, those attending after an overdose were personally interviewed. For both sexes, the greatest incidence of overdoses was in the younger groups; for females, there was a seasonal variation. Those taking overdoses were grouped by electoral wards, and the social characteristics of these wards determined. The frequency varied greatly throughout the city; some wards, particularly in corporation northern estates and part of the city centre, showed a rate of up to three times the average; these areas were the most likely to show social deprivation.

Patients with ischaemic lesions of the left cerebral hemisphere were examined for depression and intellectual impairment: in non-depressed patients, the severity of impairment was related to both lesion volume and location, as assessed by CT scan analysis. Cognitive impairment in patients with major depression was greater than predicted by lesion volume alone, and when patients were matched for severity of impairment, depressed patients had smaller lesion volumes than the non-depressed. After six months, non-depressed patients had significantly less cognitive impairment than depressed patients who showed no improvement. Both depression and lesion volume were significantly and independently related to cognitive impairment. These findings suggest that post-stroke depression can produce a true dementia in Its own right, and that treatment of post-stroke depression might benefit cognitive function.

Late components of brain event-related potentials reflect aspects of selective attention, stimulus evaluation, and possibly memory update mechanisms. Several of these components were measured during an auditory target detection task, performed by 20 schizophrenic and 20 normal subjects. Both the amplitude of those components and a more general late amplitude measure were significantly reduced in schizophrenics, for both target and non-target stimuli. One general late amplitude measure, from the scalp vertex, could alone correctly classify 85% of patients and 95% of controls. The source of these differences may lie in a protracted positive potential shift.

The incidence of parental loss by death before the age of 15 was investigated in a series of 200 depressed patients, sub-divided into unipolars, bipolars and neurotic-reactive depressives, and in their healthy siblings at risk. The age of onset of illness of patients who had lost a parent before 15 was compared with that of depressed controls. No excess of parental loss at any age was found in any of the patient sub-groups, as compared with their healthy siblings, nor did parental loss affect the age of onset of later depression. The results do not support the assumption that the loss of either parent by death in early childhood is significantly associated with depression in adult life, though parental death may be an important variable for individual patients.

Evidence for an organic component in patients with delusional misidentification syndromes is reviewed and three described who developed the Capgras symptom after a course of ECT which produced a mild organic psychosyndrome. The delusion was a complicating factor during treatment, but remitted in all cases as the organic brain syndrome cleared and the underlying condition improved.

The routine use of screening instruments for psychiatric and cognitive impairment in hospital in-patients has been recommended in the United States. The validity of the scaled version of the General Health Questionnaire (GHQ-28) and the clinical utility of the Mini-Mental State Examination (MMSE) were therefore evaluated in a consecutive series of neurological in-patients (N=102). Using Receiver Operating Characteristic (ROC) analysis, the discriminating power of the GHQ was very good, and best when using a threshold score of 11/12. The patient sample turned out not to contain any with generalised cortical damage, which casts some doubt on whether the MMSE should be used routinely in all neurological in-patients units in the UK.

The neuroleptic malignant syndrome (NMS) occurs as a hypersensitivity response in certain patients exposed to neuroleptics. It is a relatively rare, but potentially lethal complication, the incidence of which may have been underestimated. Recent interest in NMS has arisen due to the recognition that specific therapy may now be available. This review summarises the clinical features and discusses recent ideas regarding aetiology and treatment.

The incidence of traumatic events during the first ten years of life was investigated in two groups of patients suffering from major affective disorder, as well as in mixed psychiatric patients and in healthy subjects. While there were no significant differences between the two groups of affective patients or between the two control groups, the incidence of subjects who underwent such trauma was significantly higher in depressives, compared with controls. These differences are small and are further reduced if events secondary to psychiatric disturbances of family members are excluded.

We describe six pairs of monozygotic twins, in which at least one member of five pairs were homosexual, and one of the remaining pair was bisexual, from a series of 55 pairs, reared apart from infancy; all the female pairs were discordant for homosexual behaviour. This and other evidence suggest that female homosexuality may be an acquired trait. One male pair was concordant for homosexuality, while the other was not clearly concordant or discordant; this suggests that male homosexuality may be associated with a complex interaction, in which genes play some part.

Plasma drug concentrations and clinical response were measured in two groups of hospitalised depressed patients, who received amitriptyline or Imipramine double-blind, in a dosage of 250 mg for four weeks. Virtually no significant linear or curvilinear relationships were found between any plasma measure and any measure of clinical response. Modest but significant direct relationships were found between age and concentration of parent drugs but not demethylated metabolites. Blood drug level measurement therefore appears to be of little value in monitoring drug treatment of depressed in-patients.

Hospital records for 104 schizophrenic patients, 15 of whom subsequently committed suicide, were rated blindly for individual depressive symptoms comprising DSM III major depressive episode, and for hopelessness. Our results indicate that a large proportion of schizophrenic patients experienced major depressive episodes, and that these can be reliably identified. Presuicidal schizophrenics also experienced depressed mood, but only a minority developed the full syndrome; they typically exhibited the psychological, but not somatic symptoms. The relationship between depression and suicide disappears when hopelessness is taken into account.

The evaluation of illness behaviour can be complicated by subjective influences in either the patient or the clinician; these often arise in the evaluation of persons seeking compensation for injuries in which the symptoms are apparently exaggerated. The present study attempts to assess the usefulness of the CE Scale in determining the degree of conscious exaggeration by compensation claimants. Comparisons were made between psychiatrists' clinical evaluations of claimants and the scores obtained on this scale. The relationship between these two measures was found to be significant at the 1% level and specificity and sensitivity for less than 25% exaggeration on psychiatrists rating with a CE Scale cut-off of 11.69% and 100% respectively: for less than 34% exaggeration, they were 88% and 83%.

Four groups of depressed patients 47 unipolars, 21 bipolars, 34 with neurotic-reactive depression, and 39 with unspecified depressive disorder completed, after recovery, the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing practices. The results for three factors: “rejection”, “emotional warmth” and “over-protection” and the global judgement scores of “severity” and “consistency” in rearing attitudes were compared with those obtained from 205 healthy individuals. Depressed patients, particularly in the unipolar unspecified groups rated both parents lower than the controls on emotional warmth. Patients tended also to rate their parents as less consistent in their rearing attitudes. The variables emotional warmth and overprotection allowed 64% of the patients and 72 of the unipolar depressives to be classified correctly. These results, like those of previous studies, support the hypothesis that deprivation of love during childhood represents an important psychological risk factor in the background of depressive disorders.

A prime objective in teaching psychotherapy to medical students is to convey a practical understanding of what happens and a sense of the pleasure and responsibility of working with another person to improve the quality of their relationships. In Nottingham an experiential day was developed during the psychiatry clerkship; the teaching is by doing rather than describing, while spontaneity and individual expression are encouraged; the experience is valued by most and forgotten by none; it would be improved by a second experiential day or by a weekly forum for discussion of the personal and patient-care issues raised.

For this open study, we selected 21 chronic psychotic female in-patients (16 of them schizophrenics) who were being maintained on oral neuroleptics. After a wash-out period, they were treated by intramuscular depot injections of haloperidol decanoate, once a month for four months. The dose was calculated from the previous oral dosage, and the amount of the first injection was double that of the three following injections. Relatively stable plasma levels of haloperidol were achieved with the first injection, and corresponded to those observed with oral medication. A very significant correlation was found between plasma level and the dose administered, but not between plasma level and therapeutic effect. The clinical condition of about two-thirds of the patients remained unchanged or improved, compared with the period of oral treatment. During the first two months of treatment, there was more rigidity and tremor, but from the third month, the extrapyramidal symptoms were less pronounced than during the period of oral neuroleptics.

This paper reports upon a longitudinal general population survey of psychiatric disorder among a sample of women in Edinburgh. The course and outcome of the identified disorders, defined according to the RDC, are described. In addition the report documents the consequence, for the description of episodes, of adopting a diagnostic scheme which embodies hierarchical and inter-episode interval rules. Estimates of disease rates per year revealed a period prevalence of RDC disorder of 25.2% (17.6% depressive and 7.6% anxiety disorder) and an RDC new episode inception rate of 12.6%. In spite of the evident nontrivial nature of these conditions, and of the extent to which they were found to endure, contact with the psychiatric services was found to be minimal.

The influence of type of seizure and medication on psychological disability was assessed using the Standard Psychiatric Interview in matched epileptic patients. In comparison to patients with idiopathic tonic-clonic seizures, those with temporal lobe epilepsy complained of more irritability and impaired concentration, and were rated as more depressed and slowed up. Compared to patients on phenytoin, those on carbamazepine complained of more sleep disturbance and were more likely to be taking an hypnotic.

To determine whether high plasma cortisol concentrations are a distinctive feature of depression or whether plasma cortisol is also elevated in other forms of psychosis, cortisol concentrations were measured in 59 patients with acute functional psychoses, six non-psychotic depressed patients and 37 control subjects, all free of antidepressant and neuroleptic drugs for at least three months. Patients with schizoaffective disorder, manic type, had the highest concentrations throughout the day and those with major depressive disorder, psychotic sub-type had higher concentrations than controls in the afternoon and evening. Manic and schizophrenic patients had cortisol concentrations above controls in the afternoon only. Elevated concentrations were not related to the presence of depressed mood or to duration of stay in hospital, and a return to normal occurred irrespective of the type of treatment used. Thus raised plasma cortisol concentrations are a feature of psychotic illness, but in drug-free patients are not specific for severe depression.

There is insufficient information on the prevalence of psychological morbidity in the workplace. The theoretical base of industrial psychiatry is traced here, and examined within a framework of systems analysis, the input being identified in terms of human and social factors. Internal processes of organisation and management produce conditions of practice which determine the health status of the workplace; some statutory protection is necessary to safeguard mental health in industry.

ECG parameters in elderly depressed in-patients were assessed during routine despramine treatment. Significant changes (prolonged PR and PRS intervals and a decreased QTc interval) were found, related only to steady state concentrations of desipramine's major metabolite—2-hydroxy-desipramine. Potentially clinically significant changes developed in 40% of the patients. All serum drug concentrations were within therapeutic limits. Previous assurances about despiramines's cardiac safety in the elderly may need to be re-evaluated.