Seventy-seven patients with diagnosis of schizophrenia (62) or schizoaffective disorder (15) were studied 2–20 years since onset of illness, when in a stable condition. The investigation included clinical assessment, measurement of plasma concentrations of neuroleptics and prolactin, computed tomography brain scan, neuropsychological and neurological examination. Outcome of illness was classified according to the presence of chronic psychiatric symptoms and social impairment, and response to neuroleptics according to the effect of treatment in the most recent psychotic episode. Neither outcome nor response to neuroleptics was related to duration of illness. The groups with good and poor outcome differed in premorbid adjustment, age at onset and symptoms of the initial episode, but not in drug bio-availability or prolactin response. Large cerebral ventricles and cognitive impairment, but not neurological ‘soft’ signs, were associated with unfavourable outcome. The three measures of organicity were not inter-related. No clinical differences were found between chronic patients with and without signs of organic dysfunction. The findings suggest that schizophrenia with good and unfavourable outcome may be separate sub-types. However, the role of organic factors in the latter group remains unclear.

Computed tomography brain scans were carried out on 40 patients with schizophrenia or schizo-affective disorder of 2–20 years duration. Ventricular-brain ratio (VBR) was significantly greater than that of the control group. In six patients the VBR exceeded the control mean + 2 s.d. Among the 13 whose VBR was more than 1 s.d. above the control mean, none had schizo-affective disorder, all but one had chronic illness, and patients with negative symptoms and those with premorbid schizoid traits were over-represented. VBR was unrelated to medical history, age, duration of illness, or neuroleptic treatment. It was not associated with neurological ‘soft’ signs or cognitive deficit. Among chronic patients, clinical features showed no association with ventricular size. The findings suggest that large ventricles may be related to a sub-type of chronic schizophrenia rather than to its particular clinical features.

The writings of Franco Basaglia are critically reviewed, both from a technical psychiatric point of view and from a general political and social one. Basaglia maintained that the causes of psychiatric disorder are essentially social in nature, and that the only valid treatments are political struggle and the revival of the patient's aggressiveness. Therefore, no institution can be therapeutic for the patient, since its aim must be his custody and violent destruction. These statements are considered in the light of the need for institutions which are a therapeutic alternative to the mental hospital. Basaglia's ‘liberal’ defence of the individual against society is analysed, in relation to the negative consequences that the Italian Law 180 of 1978 is having on the care of long-term psychiatric patients. This law ‘forgot’ such patients, as well as adversely affecting the treatment of acute patients, for whom an insufficient number of psychiatric beds was permitted in general hospitals. A revision is proposed of Law 180 that would make possible the setting up of alternative institutions to outdated mental hospitals, but at the same time allow a transformation of their old structures.

An investigation of eating disorders in a population of chronic schizophrenic patients confirmed that there is a distinction between eating disorders of psychotics and eating disorders of the young. All the DSM-III criteria of eating disorders, except one, were observed among the psychotics although no patient fulfilled the necessary criteria for an eating disorder diagnosis except for one anorexic woman. All varieties of schizophrenic eating disorder were reported: in two-fifths of the patients eating disorders were associated with delusions and in one sixth with hallucinations; more than half of the patients had deviant eating behaviour which was not associated with any thought or perceptual disorders. Schizophrenic eating disorders were common, yet not disturbing to the social life of the open mental hospital or to that of the community surrounding it.

Agoraphobia is believed to run in families, but this belief is not well supported by the literature. Data were gathered on the risk of agoraphobia in parents and siblings of 60 agoraphobic probands; 12½% of the relatives were reported to have or have had agoraphobia. This risk is significantly greater than estimates of the population incidence, and requires explanation. The details of the pedigrees do not directly support simple genetic models while investigations into environmental factors in agoraphobia by other workers have been inconclusive. As a putative case has been established for the familial occurrence of agoraphobia, further work is required to shed light on whether genetic or cultural factors are paramount

The two-threshold multifactorial polygenic (MFP) model was applied to blind family study data, collected in a long-term follow-up and family study of major affective disorders. This model tested whether bipolar and unipolar disorders are manifestations of the same underlying factors or if they are independently caused disorders. The hypothesis that bipolar and unipolar disorders are, respectively, severe and mild forms of the same disorder was supported. There was little evidence for different familial aetiologies for bipolar and unipolar disorders in our sample.

The controversial literature about the biological antagonism between schizophrenia and epilepsy involves at least two areas of clinical interest. Firstly, it is frequently stated that convulsive treatment was introduced into psychiatry for the management of psychosis because of this antagonism, and secondly, it has a bearing on the topics of ‘alternative psychosis' and ‘forced normalisation’, as reported in the epilepsy literature. In addition to these, the subject is of theoretical interest in its relationship to other biological antagonisms that may be found in nature, but closer examination of the literature suggests that some of the discussions and controversies surrounding this problem are based on assumptions that may be incorrect. One possible reason for this may be the fact that much of the original work was written in German, and we propose therefore to give a brief account of the origins of the theories, as derived from their original sources.

Experiences arising from the work of a multi-disciplinary psychotherapy liaison team in the primary care setting are described. Special emphasis is given to the difficulties encountered in working relationships. Attention is drawn to the complexity of the inter-professional relationship, its unconscious roots, and its influence on the quality of patient care.

250 patients referred to a department of psychiatry for the deaf were selected by random sampling and studied. The results underline the need for specialised services for deaf patients of all types, not only those who communicate solely by manual methods. Patients are referred to this department suffering from mental illness and communication disorders, as well as from problems related to their deafness. Some of the difficulties of managing a supra-regional service are discussed.

Primiparous women (n = 627) were screened on state and trait anxiety measures in the post-partum period; sub-groups of highly anxious (n = 89), moderately anxious (n = 29), and minimally anxious (n = 29) mothers were derived and subsequently interviewed. The high-anxiety mothers were randomly assigned to a professional intervention, to a non-professional intervention, and to a control group, and their progress was reviewed over the following 12 months. Compliance, both in responding to progressive assessments and in accepting therapeutic intervention, was extremely high. Changes in anxiety levels for mothers not receiving an intervention were minimal over the study. In the high-anxiety sub-groups, there was a 19% reduction in state anxiety levels for those receiving a professional intervention, a 12% reduction for those receiving a nonprofessional intervention, and a 3% reduction in the controls. A planned contrast analysis determined that only professional intervention had a significant effect, intervention successfully lowering state anxiety levels to a value comparable with the moderately anxious mothers.

The 1 mg dexamethasone suppression test (DST) was carried out in patients with a major depressive illness in order to establish whether the results of this test, given before antidepressant or ECT treatment, could predict eventual therapeutic outcome. No significant difference could be detected in overall therapeutic improvement between those patients with a normal or abnormal DST response respectively, based on the 50 ng/ml cortisol cut-off point. However, using 100 ng/ml as a cut-off point it was found that patients with an abnormal DST response (i.e. a post-DST plasma cortisol concentration ⩾ 100 ng/ml) responded significantly better than those who had a normal DST response. These observations were statistically significant for those patients receiving antidepressants and in the combined treatment groups of those patients receiving either antidepressants or ECT.

A cluster analysis was done on items concerned with the onset and development (including life events) of depressive illness derived from standardised interviews on 70 in-patients with that diagnosis. The resulting groups were compared for symptoms derived from the Present State Examination (PSE) and outcome, five years later. New Groupings were sought, based on onset and development data, to test their predictive power, and to observe how closely they replicated existing binary classifications and whether or not suggestions emerged for narrowing the concept of depressive illness. The groups were clinically recognisable, and measures of five-year outcome differed significantly between the groups. They have been designated as forms of ‘Somatic depression’, type I ‘Slow onset—depression of middle age’; type II ‘Rapid onset—depression of middle age’; type III ‘Slow onset — depression of younger age’; type IV ‘Rapid onset — depression of younger age, and morbid distress. It is suggested that no simple binary classification is likely to prove as satisfactory for depression as a multi-axial method; the concept of ‘morbid distress' is advanced as a way of narrowing the over-extended rubric of depressive illness.

We administered an extensive battery of primarily non-memory neuropsychological tasks to 37 patients with endogenous depression, randomly assigned to either bilateral (B/ECT) or unilateral (U/ECT) electroconvulsive therapy. Testing was done prior to therapy and again shortly after the sixth induced seizure. The two groups did not significantly differ in cognitive impairment, either before or after treatment, and within-group cognitive changes following treatment were small. We conclude that neither B/ECT nor U/ECT substantially worsen non-memory cognitive performance in depressed patients, yet both result in significant clinical improvement.

Zopiclone, a non-benzodiazepine hypnotic, was compared with temazepam in the treatment of 36 patients suffering from insomnia; the trial period was two weeks, with cross-over of medications at one week and a randomised order of administration. There were highly significant improvements with both drugs, as compared to the control period in respect of: sleep latency, number of times waking during the night, and quality and duration of sleep. The incidence of side-effects was very low. No significant between-drug differences were found in respect of any of the assessment measures or of the incidence of side-effects.

A case of folie à trois affecting a mother and her children is described. The subjects fully recovered with treatment, but all relapsed two months later, when the primary subject discontinued medication.

The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic drugs, made up of hyperthermia, muscular rigidity, disturbance of level of consciousness and autonomic dysfunction. It is potentially lethal and should be kept in mind whilst using anti-psychotic drugs; as most patients treated by them require further anti-psychotic treatment, the clinician faces the problem of treating those patients after a NMS episode, yet reports in the literature have generally neglected the problem of late management. A patient suffering from a psychosis and NMS is presented, and a rationale for management offered.

In reviewing the medical literature on the association between affective illness and mental retardation (Sovner & Hurley, 1983), we were intrigued to find that, although there were many cases of major depression and depressive neurosis among people with Down's syndrome, there were no reports of mania in such individuals. This finding provoked us to pursue the hypothesis that Down's syndrome may preclude the development of mania.

A unique case of a homicide committed by a young male psychotic inpatient on a fellow-patient is reported and discussed with regard to the special victim-offender relationship, the relationship between suicide and homicide, the phenomenon of aggression and the question of the management of a highly suicidal psychotic patient, including the issue of continuous observation.