Since a previous review (Kellam, 1987), the subject of neuroleptic malignant syndrome (NMS) has continued to cause considerable interest, particularly in the USA where there is still controversy about its frequency, despite two attempts to survey prospectively all cases admitted to two different hospitals. Cases of NMS are now being more widely recognised by non-psychiatrists, especially geriatricians.

Psychiatry is under threat from developments within mental health care. In educating future psychiatrists, more emphasis should be placed upon: collaborative research; integrated teamwork, without interprofessional rivalry; work in primary care; the non-scientific components of psychiatry, centred upon relationships with patients; less dogmatic attitudes for or against psychoanalysis; psychiatry as a branch of medicine; and modern management and audit methods. Younger psychiatrists should be encouraged to take responsibility for shaping the future of the profession.

The outcome at two years of patients who were eligible for a study of first schizophrenic episodes was assessed in terms of occupation (n = 237) and in terms of number of days spent as an in-patient from the time of first admission (n = 252), and was related to social, behavioural, mental state and neurological measures during the initial admission. Poor outcome was in general associated with more social withdrawal, inactivity and abnormal social presentation and with more ‘neurological soft signs'. Good occupational outcome in patients with a relatively short pre-treatment duration of illness was associated with the prescription of placebo medication during the follow-up period.

One hundred and twelve alcoholic patients treated by an intensive one-month residential programme were followed up for one year. As a group, they were socially disadvantaged and highly dependent on alcohol. Outcome of treatment was assessed at six months and one year following discharge by multiple measures which included assessments of drinking behaviour, measurements of social stability, neuroticism and self-esteem, and self-ratings of satisfaction with important aspects of day-to-day living. During the first six months following treatment, 37% were abstinent or drinking in controlled fashion; during the second six months, 53% achieved this status. Improvement in drinking status was positively related to improvements in all other outcome variables.

Case-control studies involve ‘cases' being compared to ‘controls' with respect to ‘exposures', possible aetiological (or associated) factors. Associations between a disease and an exposure can be explained by chance, reverse causality, confounding and biases or, lastly, by causality. However, confounders as well as information and selection biases can be adjusted for at the design (or analysis) stage of the study. The strength of an association can be measured by means of relative risk, calculated indirectly using the odds ratio. Well conducted control studies should produce accurate estimates of relative risks in many psychiatric investigations.

3H-imipramine binding in 39 drug-free patients with major depression and 44 healthy controls did not differ significantly between the two groups, in male or female subjects or in subgroups of depressed patients divided by endogenicity or dexamethasone suppression test result. 3H-imipramine binding in depressed patients drug-free for less than three weeks did not differ from those drug-free for longer intervals or from controls. A significant seasonal variation of 3H-imipramine Bmax was found, with lower values in summer and autumn. Treatment of depressed patients with imipramine or lofepramine for six weeks increased KD and Bmax. Methodological modification (in preparation and storage of platelets) does not explain the major differences in results between this study (using frozen platelets), a previous one (using freshly prepared platelets) and others in general, although it might contribute to the range of values reported.

Patients with a clinical diagnosis of Alzheimer's disease were studied using MRI, SPECT, and psychometric tests. Significant correlations between focal perfusion deficits and focal cognitive deficits were found. Significant correlations between regional relaxation time of white matter and psychometric tests of diffuse and focal categories were also found. Pathological examination confirmed Alzheimer's disease as the only diagnosis.

Twenty-five women who were the primary carers for a parent with dementia were rated for expressed emotion (EE) and then divided into two groups: 11 with low-EE ratings and 14 with high-EE ratings. Although there were no differences between these groups in the levels of their parents' cognitive impairment, when such impairment was taken into account, high-EE subjects were found to report higher levels of strain and distress. More efficient coping strategies were reported by subjects who made fewer critical comments and more positive remarks. High-EE subjects more frequently had no living siblings, and were more likely to have had a respite break from caring. EE status was not associated with continuing care in the community at a nine-month follow-up.

The methods of Roth's 1948–49 Graylingwell study, previously applied to a Crichton cohort of elderly patients of the years 1974–76, were repeated in 1984–86. The results support the continuing validity of Roth's classification of mental illness in the elderly, but changes in the diagnostic distribution of the cohort, previously observed in the 1970s study, are further in evidence in the 1980s one. Admissions of dementia cases continued to increase both relatively and absolutely, while the trend of increasing survival in dementia also continued.

A double-blind placebo-controlled trial of 23 chronic benzodiazepine users showed that overall, buspirone did not appear to be helpful in alleviating benzodiazepine withdrawal symptoms. Buspirone (5 mg t.d.s.) or placebo was administered for four weeks before, during and after diazepam withdrawal. Patients taking buspirone had a markedly higher dropout rate (seven out of 11) than those taking placebo (one out of 12). Mean daily diazepam dosage at entry was significantly higher in the buspirone group, but overall initial diazepam dosage was not related to outcome. Higher subjectively rated anxiety at the start of withdrawal was significantly related to higher dropout rate, irrespective of treatment, and was greater (although not significantly so) in the buspirone group.

Accounts of the major DMSs are given using theoretical models of the functional components underlying recognition of familiar people. Thus, Capgras' syndrome is suggested to involve impairment of processes that can support ‘covert’ recognition of familiar faces in prosopagnosia. It therefore forms a potential ‘mirror image’ of the impairments underlying prosopagnosia, and earlier attempts to link the two conditions directly are questioned. Frégoli syndrome and intermetamorphosis are explained as defects at different stages of an information-processing chain. Not only are these accounts consistent with the association of different DMSs with different brain injuries, but they also offer both suggestions for new inquiries and predictions about possible preserved and impaired abilities.

Menstrual health questionnaires were completed by a self-selected sample of the readership of a woman's magazine (n = 5457). Sixty-one per cent of subjects described themselves as suffering from pre-menstrual syndrome (PMS) and this was largely corroborated by ratings of symptoms pre-menstrually, menstrually and post-menstrually for the most recent cycle. Mood symptoms were more strongly implicated than physical ones. Self-report of PMS was found to be modestly associated with aspects of parity and oral contraceptive use, but strongly and positively related to the duration of ‘natural’ menstrual cycles (i.e. uninterrupted by pregnancy or steroidal contraception) and to psychosocial stress. There were interactions among psychosocial factors and between psychosocial load and duration of natural cycles.

Of two groups of 20 patients accepted for gender reassignment surgery, one was offered early operation and therefore had had surgery by follow-up two years later, while the second was still awaiting operation at two-year follow-up. Although the groups were similar initially, significant differences between them emerged at follow-up in terms of neuroticism and social and sexual activity, with benefits being enjoyed by the operated group.

Of 106 patients attending a gender-identity clinic, 73% satisfied DSM–III criteria for transsexualism. These DSM–III positives had a significantly younger age of onset and were less likely to experience sexual arousal with cross-dressing than those who did not satisfy DSM–III criteria. They were also significantly more likely to fulfil a definition of ‘core transsexualism’. ‘Core transsexualism’ may represent a subgroup within DSM–III criteria for transsexualism and its defining features in this study were an early age of onset, low sexual activity, lack of sexual arousal with cross-dressing and homosexual orientation. Of the whole sample, 23% were referred for gender reassignment surgery, of whom 100% were DSM–III positive and 60% were ‘core transsexuals'.

“Objective – To assess the severity of psychiatric symptoms among residents of hostels for homeless people. Design – Survey of residents in two hostels in Oxford, comprising three weeks of background fieldwork, a demographic questionnaire, and rating behaviour over two weeks with a behavioural rating scale (REHAB) and mental state with the brief psychiatric rating scale. Setting – Two hostels for homeless people in Oxford. Subjects – 146 Medium to long term residents, of whom 48 were selected by hostel workers by the following criteria: continuous residence for at least two months, signs of persistent severe mental disability, and difficulty in coping independently in the community. Two subjects died during the study; three (previously long term psychiatric inpatients) declined to be assessed on the psychiatric scale. Main outcome measure – Behavioural disturbance and mental state. Results – Only a third of the total sample had been born in Oxfordshire. Subjects had been accepted into the hostel either by arrangement with the local psychiatric service (22) or straight off the streets (26); 43 had had a previous (non-drug related) psychiatric admission. Subjects were significantly more likely than other residents to have spent longer (> 80 weeks) in a hostel in the past three years (p<0.02). With reference to norms for deviant behaviour, the 46 subjects assessed showed considerable deviant behaviour (average weekly scores: 0(11 subjects), 1 (14), 2–3 (16), and ≥4 (5)) not significantly different from that expected in moderately to severely handicapped psychiatric inpatients (χ2 = 1 · 3, df = 3, p > 0 · 7); 22 had scores equivalent to those in most severely handicapped inpatients. Of the 43 subjects assessed with the psychiatric rating scale, 16 had symptoms of neurosis, 29 of florid psychosis, and 32 of a deficit state. Symptoms of deficit state were positively correlated with ratings of low social activity on the behavioural scale (Spearman's rank correlation coefficient 0 · 30, p = 0 · 03). Conclusions – Hostels are having to care for long term severely affected psychiatric patients discharged into the community. The suitability of the services offered to such subjects should be assessed.”

Advanced maternal and paternal age were investigated as putative risk factors for AD in 198 clinically diagnosed Alzheimer patients and in 198 randomly selected healthy controls. No significant differences in average age of fathers and of mothers at birth of the subject were observed. The risk of AD was not significantly different across categories of maternal and paternal age. The association with parental age was not different for sporadic and familial AD. These findings do not support the view of a maternal or paternal age effect on AD.

A group of 16 psychiatric out-patients in remission, who had been taking lithium carbonate as their sole medication for at least three months, were compared with a control group of 22 healthy volunteers. On a computerised driving simulator which produced measures of reaction time, tracking ability and mistakes made, the patient group had a significantly slower reaction time. Patients should be warned therefore that lithium may affect their ability to drive or operate machinery and that psychomotor impairment and sedation are not synonymous.

Three cases of prolonged abuse of Do-Do tablets, an over-the-counter remedy for “coughs, wheezing and breathlessness”, are reported. They have an amphetamine-like action and were used as easily obtained amphetamine substitutes, in one case to relieve social anxiety. Withdrawal symptoms similar to those following cessation of amphetamines occurred in two cases. Do-Do tablets are CNS stimulants and their abuse may be accounted for by the fact that they perhaps affect amine neurotransmitters.

A study of deviant eating behaviour among mentally handicapped adults in community placements is reported. Those individuals with a psychiatric disorder showed more deviant eating behaviour. Depressed subjects, in particular, showed an excess of the amount eaten and time spent searching for food, as well as the tendency to eat all sweet food presented to them. Non-food pica was uncommon, even among the autistic subjects.

Firesetting in children and adolescents is commonly associated with other antisocial acts that comprise conduct disorders. Asperger's syndrome is a rare pervasive developmental disorder. In the case presented we argue that the firesetting arose from the disabilities inherent in Asperger's syndrome. This also indicates that antisocial acts may be symptoms in other psychiatric syndromes as well as a specific conduct disorder.