The background to HIV infection, its mode of transmission, and its neurological and psychiatric complications are described. The management of AIDS-related psychiatric disorder and problems encountered among staff involved in the management of patients suffering from AIDS are considered. There is a need for appropriate educational programmes. Although the incidence of AIDS in the UK has been appreciably lower than in many other countries, there are no grounds for complacency; psychiatric disorder associated with HIV infection will be encountered much more frequently in the future. Psychiatric staff are urged to inform and prepare themselves in anticipation of this development.

The Grammar of Psychotherapy is a method of teaching both communication skills and the elements of psychotherapy. Supervised training is supplemented by self-monitored tasks. The course is economical in terms of tutors' time, and is particularly suitable for trainees in general psychiatry.

This paper describes the development of three self-monitoring forms to enable students to make constructive use of audiotapes of their interviews with patients. Each interactogram is described in detail, with examples where necessary.

Common neurotic and personality disorders account for widespread personal restriction and suffering. The need for effective, economically feasible treatment methods is widely acknowledged and the range of conditions successfully treated by available methods needs to be established. This study is concerned with two methods of brief psychotherapy; our aim was the essentially pragmatic one of investigating how far relatively long-term NHS out-patients with neurotic, personality, and interpersonal problems could be successfully and economically treated by the kind of therapists available in NHS settings. It is generally believed by psychoanalytically-oriented therapists that brief therapy requires high levels of training and experience; this is tested here, in that all the therapies were strictly time-limited, and none of the therapists had completed advanced training.

Consecutive new patients presenting at a Nigerian psychiatric unit over a 14-month period and fulfilling the DSM-III criteria for schizophreniform disorder, (active) schizophrenia and residual schizophrenia were studied. There were no differences between the three groups with respect to background social data. The schizophreniform patients had a lower incidence of previous psychotic episodes. There were no differences between the first two groups with respect to the distribution of PSE symptoms and signs, Schneider's First Rank Symptoms, or severity of psychopathology. Initial clinical outcome, and longer-term clinical and social outcome, assessed 25–38 months after index presentation, was best in the schizophreniform patients and worst in the patients with residual schizophrenia. The findings are consistent with schizophreniform disorder lying on a spectrum of schizophrenic disorders. They also highlight inadequacies in mental health services in Nigeria and other developing countries.

Attempts were made to identify, and include in a two-year follow-up study, every patient living in the catchment area of the Mapperley group of psychiatric hospitals in Nottingham (population 390 000) who made their first-ever contact with the psychiatric services for a potentially schizophrenic illness during a two-year period (1 August 1978 to 31 July 1980). Screening was based upon symptoms rather than diagnosis, covering both in-patient and out-patient services; a consensus diagnosis using ICD-9 was made by the project team. The Nottingham Psychiatric Case Register was used in a retrospective Leakage Study which added nine cases to the 99 identified by the screening procedures. Incidence rates are given for both broad and narrow concepts of schizophrenia, and for DSM-III diagnosis. The Nottingham incidence rates are similar to those reported from other UK centres, and are near the middle of the range found in the other collaborating centres in the WHO study on Determinants of Outcome of Severe Mental Disorders. At entry to the study, 27 patients were out-patients, and 11 were never admitted to hospital at any time in the two-year follow-up period. Reasons for believing that the Nottingham administrative incidence may be close to the incidence in the community are discussed.

The 800 census enumeration districts of Nottingham were used as a basis for the production of 12 distinct ‘clusters’ or neighbourhood types. Plotting the place of residence of the 68 patients with ‘certain’ or ‘very likely’ diagnoses of ICD-9 schizophrenia, identified in the World Health Organization Study of Determinants of Outcome of Severe Mental Disorders, showed the expected concentration in central areas of low social status. A more varied distribution was found for 132 patients with a case-register diagnosis of affective psychosis, contacting the psychiatric services for the first time during the same two-year period as the schizophrenic patients. Some of the highest rates for affective psychosis were found in new housing estates of middle and low status at some distance from the town centre.

A double-blind controlled trial of 50% dose reduction in maintenance treatment in stable out-patients with low BPRS scores and good social function shows a significantly higher relapse rate in the low-dose group at 12 months (P < 0.05). After an interval of 24–36 months from dose reduction, 56–76% had experienced a relapse and 76–79% had resumed their former dosage. No clear advantage was shown for the lower dose in either a reduction of side-effects or improved social function, but a reduced prevalence or lower rate of symptom emergence for tardive dyskinesia was suggested.

In a 6-week double-blind trial, the efficacy of imipramine and high dose phenelzine were compared in the treatment of Major Depression with Melancholia, and Dysthymic Disorder (DSM-III). Both drugs were found to be equally efficacious in the treatment of 32 patients suffering from Major Depression. In 32 Dysthymic patients, phenelzine in high doses was found to be superior to imipramine. The clinical implications of these findings are discussed.

Depressive illness is known to be associated with low self-evaluation, but it has been suggested that there may be a reciprocal connection as well, such that low self-appraisal (in the absence of illness) makes the subsequent onset of depression more likely. A prospective study, using a community sample of 376 women, provided data about clinical state over a period of 18 months, and self-appraisal questionnaire scores were determined on two occasions separated by 6 months. There was no evidence that low self-evaluation predicted future episodes of depressive illness, except in women who reported previous psychological episodes for which they had sought medical help, and, even for those with previous episodes, much of the predictive power of low self-esteem was accounted for by individuals who were subsequently recognised to have been in the early stages of illness. Conversely, there was little evidence that prior episodes predicted future illness in people with high self-esteem. One explanation of the findings is that recurrent episodes of illness cause progressive impairment of self-appraisal, but other possibilities are also considered. Women who had recovered from illnesses detected at the first interview still had significantly less self-confidence 6 months later than those who were well throughout.

In a clinical trial investigating the effectiveness of social work intervention with depressed women patients in general practice, 80 women were randomly allocated to an experimental group for referral to attached social workers or to a control group for routine treatment by their GPs. They were reassessed at 6 and 12 months. The results indicated that women who had major marital problems were more likely to be depressed at follow-up than those with good relationships. However, patients with marital difficulties in the experimental group made more improvement than the controls. Women initially assessed as suffering from ‘acute on chronic’ depression and having major marital difficulties were found to benefit most from social work intervention.

Spouses of 24 patients suffering from persistent depression were interviewed to find out how they were affected by the patient's illness. These effects were marked, although mainly endured without complaint, and included restrictions in social and leisure activities, a fall in family income, and a considerable strain on marital relationships. Some of the behaviour shown by patients was hard to bear, and ‘negative’ symptoms such as misery, withdrawal, and worrying commonly caused problems. Few relatives, however, know how to deal with difficult behaviour. Despite this, the majority remained committed to staying with the patient. Spouses had a variety of complaints about the way they were handled by hospital staff, particularly about being deprived of information and advice. These results have considerable implications for the way in which relatives should be dealt with as part of the overall management of persistent depression.

Brain function was evaluated in four psychiatric patients with a history of repetitive purposeless violent behaviour, using EEG, CT scan, and positron emission tomography (PET). Three patients showed spiking activity in left temporal regions, and two showed CT scan abnormalities characterised by generalised cortical atrophy. The PET scans for the four cases showed evidence of blood flow and metabolic abnormalities in the left temporal lobe. Two patients also had derangement in the frontal cortex. The patients showing the largest defects with the PET scans were those whose CT scans were reported as normal. This paper shows the utility of PET in investigating possible brain derangements that could lead to violent behaviour.

A ten-year follow-up on the criminal records of men discharged from Grendon Prison was carried out. These records were compared with those of a matched control group, and no differences were found regarding frequency or severity of post-discharge convictions. The validity of this exercise is questioned, and several case histories presented. An examination of subsequent offending within the Grendon group suggests that for some men, the better motivated and more intelligent, exposure to the Grendon regime may have contributed to a change in their criminal behaviour.

A ten-year follow-up study of 74 opiate (most heroin) addicts referred to the Drug Dependence Clinic in Southampton showed that overall, little use was made of the treatment facilities available. Half of the patients on whom we were able to obtain follow-up data appeared to be no longer abusing drugs. An appreciable number of subjects had committed offences prior to abusing drugs and a large proportion offended during the follow-up period, adding support to the view that most addicts are not driven to crime because they are unable to obtain the help they need. The death rate of 15% is that expected in a long-term follow-up study. The results suggest that the natural history of many heroin addicts is uninfluenced by therapeutic intervention.

There have been reports of a high prevalence of bulimic episodes and the syndromes of bulimia nervosa and DSM-III bulimia in community samples. A group of American authors recently compared the findings of a contemporary survey with those of a survey they had conducted previously and reported a three-fold increase in the prevalence of DSM-III bulimia. The present study replicates a community survey conducted four years ago in Britain. The prevalence of bulimic episodes, self-induced vomiting and bulimia nervosa found in the present survey was very similar to that found in the earlier study.

The Arabic version of the HAD scale was validated in a sample of 50 Saudi patients. The scale scores were assessed against the principal author's clinical evaluations. Spearman correlations of all items of the scale, except for one, were statistically significant. The non-significance of one item was probably related to the way it was translated into Arabic. The study furnished evidence that the Arabic version was a reliable instrument for detecting states of anxiety and depression in Saudi patients in a primary health care setting.

A 20-year-old man developed generalised rigidity and signs of autonomic instability following the introduction of therapy with zuclopenthixol decanoate. A diagnosis of NMS was made, despite the absence of hyperthermia. He recovered on treatment with thiamine, dantrolene, and bromocriptine.

Three cases of self-inflicted eye injuries are described and discussed. A review of the literature shows that several psychiatric diagnoses have been assigned to those who mutilate their eyes, and various unconscious mechanisms proposed to explain this unusual phenomenon.

A 34-year-old heterosexual intravenous drug abuser presented with a paranoid psychosis and was subsequently found to have the Acquired Immune Deficiency Syndrome (AIDS). The patient died 14 days later of generalised septicaemia. The case is reported and the aetiology and pathogenesis of the organic psychosis are discussed. It is anticipated that similar psychiatric manifestations will occur as the AIDS epidemic increases.