Combat reaction is a clinical entity which is classified under one of the most complex diagnostic formulations in modern psychiatry-post-traumatic stress disorder (PTSD). Of all the life experiences which may create trauma, war-related stress seems the most complicated and difficult to understand. Despite an abundance of clinical observation, this has been considered from such differing theoretical perspectives that a comprehensive therapeutic conceptualisation has proved elusive.

The theme of this address—that brain and mind are as warp and woof in the fabric of psychiatry—may seem so much a truism as to be a banal choice. I think not. Despite the lip service paid to brain-mind integration, its implications are daily contravened in both theory and practice. At least, this is so in the country where I reside. If the problem is more extreme in the States, as most everything seems to be, recall the words Sir Aubrey Lewis (1953) wrote in commenting on Anglo-American contrasts, some 30 years ago: “the chief differences between your psychiatric scene and ours are differences only of quantity and tempo.” Think of me, then, as an anthropologist describing an exotic foreign culture and reporting on the strange customs of the natives, in hope of shedding light on your own.

Eighty chronic schizophrenic and 16 manic-depressive psychotic patients conforming to Research Diagnostic Criteria were examined in terms of their mental state, cognitive functioning, current behaviour, and neurological status. They comprised out-patients, day-care patients, and long-stay in-patients belonging to two mental hospitals with different social conditions. Assessed deficits were not significantly related to record variables such as age, duration of Illness, duration of hospitalisation, or treatment received. Analysis of the different groups of patients reveals that long-term hospital care has had little effect on the deficits of chronic schizophrenia, and suggests that these are integral features of the disease process.

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.

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.

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.

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.

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.

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.

The interrelationships of ‘blues' and later postpartum depression with a number of biochemical, medical, and psychosocial variables have been examined in 52 subjects. The two syndromes shared only an impressive association with a prior history of gynaecological problems. Puerperal ‘blues' was characterised in addition by associations with primiparity, tearfulness during pregnancy, and reduced plasma total tryptophan in the early Puerperium. Depressive symptomatology up to nine months postpartum was related to an excess of male births and to an altered pattern of decline of non-esterified fatty acids immediately postpartum. In each case, the ‘risk’ variables were statistically independent and combined linearly. Stepwise discriminant analysis successfully discriminated ‘blues' and depression from their respective non-cases. ‘Blues and postpartum depression were only weakly related and, apart from gynaecological history, each was associated with separate and independent causative factors.

We ascertained the one-year prevalence of schizophrenia amongst individuals aged 15 years or older living in six villages in a remote area of Botswana. All cases were diagnosed independently by two experienced psychiatrists, following ICD9 rubrics. DSM-III criteria were also applied, separately. Accurate contemporary population estimates of the villages were available. The age-adjusted prevalence of schizophrenia was 5⋅3 per 1000 in terms of ICD9, or 4.3 per 1000 by DSM-III, which has an upper age limit for onset of 45 years. These figures are well within the range generally reported for industrial communities. Remote village life in Botswana appears to offer no protection against the development of schizophrenia.

We used multiple regression analysis to modify and shorten two scales for measuring practitioners' attitudes to psychotherapy and drug therapy. The resulting scales have been combined in a 21-item questionnaire (Treatment Attitudes in Psychiatry Scales (TAPS)) which is brief and easy to use, and should have wide application in psychiatry. The results of a concurrent validation of the scales, using two large groups of consultant psychiatrists who were members of either the Biological Psychiatry or Psychotherapy Section of the Royal College of Psychiatrists, show the extent to which their attitudes to psychotherapy or drug therapy tend to overlap. Polarisation of attitudes was more evident in the results from the Biological Psychiatry Section. A method is described by which scores obtained with the TAPS can readily be compared with those obtained by the criterion groups.

The terms positive and negative symptoms have slipped into the language of contemporary psychiatry with comparative ease. It is not uncommon for these expressions to be used with little explanation, both at meeting and in written communications, with the implicit understanding that their meaning is understood and that somehow they are of value to our knowledge of psychopathology. However, that there are no clear guide-lines at present for our use of these terms is shown from a recent survey of psychiatrists' opinions from a market research company (Martin Hamblin Research-Personal Communication). As part of a series of questions asked to many psychiatrists of differing age, geographical location, and status, they were asked about the meaning of these terms, positive and negative symptoms and the proportion of schizophrenic patients having them. Of the categories quoted by Crow (1980–81) as positive symptoms, 68% considered that delusions were positive symptoms, 63% hallucinations, and only 35% thought disorder. In contrast, 18% thought that behaviour disturbance was a positive symptom, a similar figure (15%) being given for passivity feelings. Considerable variation was noted, however, with hallucinations being considered positive by only 33% of London psychiatrists, thought disorder by only 11% of those qualified 16–25 years, and one-quarter of all registrars and psychiatrists from Midland Health Districts considered passivity feelings to fall into this category. Even greater disagreement was recorded for negative symptoms. Thus, the symptom most often associated with this category was apathy, by 52% of respondents. Only 26% considered that withdrawal was a negative symptom, the percentage data for lack of motivation and blunting of affect being 37% and 15% respectively.

Appetite, weight, and preference for carbohydrate-containing food were followed in patients treated in double-blind trials of seven antidepressant regimes. Trimipramine and isocarboxazid combined had a significant effect in increasing appetite, carbohydrate preference, and weight; in patients who had lost appetite at presentation and were on this treatment, improvement in Hamilton score was linked to increase in weight–a finding not true of the other treatments.

Benzodiazepine withdrawal has been found to give rise to numerous physical and psychological symptoms. This paper describes, for the first time, Schneiderian first-rank symptoms of schizophrenia caused by such withdrawal.

The diagnosis of manic-depressive psychosis in mentally handicapped people can be easily overlooked, partly because its presentation differs from that in people with normal intelligence. This report illustrates some of the difficulties involved in making the diagnosis of manic-depressive psychosis in a mentally handicapped person and in planning for her future care.

The action of viloxazine on libido and sex drive was evaluated with a randomised controlled double-blind trial against placebo on a population of 26 male out-patients affected by primary depression (DSM III). Modifications in the sexual sphere were assessed by the ad hoc inclusion of a series of items in the Zung Self-Rating Depression Scale. Thus modified, the scale was administered at the beginning and the end of a four-week trial period. Viloxazine proved to have a considerable disinhibiting effect, whose principal expression level was a return to pre-depression levels of frequency in sexual relations.