Maternal age is a neglected variable, with obvious implications for aetiology, in psychiatric research. In samples of schizophrenic patients, the distributions by month of birth and maternal age at birth show remarkable anomalies. These phenomena may be connected, because the seasonal distribution of births varies with maternal age, probably as a result of the age-dependent changes of fertility. Preliminary attempts to describe the seasonal effect in schizophrenia as a function of the shift in mean maternal age are not wholly successful at the quantitative level. Southern-hemisphere findings do not seem to fit the predicted pattern. Examples from other areas of research are discussed (sudden unexpected death in infants, congenital dislocation of the hip, and handedness) in which the seasonal distributions of births, and the findings on maternal age, conform to different varieties of the expected relationship.

Eighty-nine consecutive admissions with primary depressive illness were prospectively ascertained and diagnosed in 1965–66 by R. E. Kendell, who also allocated each a position on a neurotic-psychotic continuum on the basis of previous discriminant function analysis. In 1983–84, 94% of the survivors were personally interviewed by a psychiatrist blind to index admission data. Operational outcome criteria were employed and longitudinal data were established for 98% of the series. Mortality risk was doubled overall, and increased sevenfold for women under 40 years at index admission. Less than one-fifth of the survivors had remained well, and over one-third of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within three years. Readmissions occurred even after 12 years of being symptom-free, and conversely patients recovered after as long as 15 years of illness. There was a high incidence of other disorders (schizoaffective disorder, alcoholism, schizophrenia), and only four patients showed pure recurrent unipolar histories. Patients at the psychotic end of the continuum were more likely to be readmitted and to have very poor outcomes.

One hundred and forty-five patients with primary depressive illness admitted to a university hospital between 1966 and 1970 were followed up an average of 15 years later. Adequate data were obtained on 133 (92%) of the 145. During the follow-up period, 7% of the 133 had suicided, 12% had remained incapacitated by illness and only 20% had remained continuously well. Patients for whom the index admission was not their first were especially likely to be readmitted during the follow-up period. Patients with endogenous depression, none of whom developed schizophrenia during the follow-up period, were more likely to need readmission than patients with an index diagnosis of neurotic depression. In all other respects the prognosis for the two types of depression was the same, with considerable morbidity evident in both.

The study was carried out on 25–34-year-old, British-born, married women, living on a south-east London housing estate. The reported early and current family relationships of 50 depressed and 40 non-depressed women were compared. Significantly more of the depressed women reported a poor early relationship with their mothers, but not with their fathers. This finding was confirmed by corresponding low care and high overprotection scores (for mothers only) on the Parental Bonding Instrument. On the basis of what the women and their husbands said, the marriages of the depressed women were rated as much poorer. This was confirmed by the women's and their husbands' scores on a Partner Rating Questionnaire and the Ryle–Scott-Heyes Marital Patterns Questionnaire. The depressed women reported a poorer current relationship with their mothers and a much poorer relationship with their husbands' mothers and fathers. Significantly more depressed women reported four or more poor family relationships.

The Present State Examination was conducted upon 328 recently admitted psychotic patients, of whom 23 were later found to have underlying organic illness. The phenomenology in these 23 was compared with that of 92 matching controls drawn from the parent sample who conformed to DSM-III criteria for schizophrenia, mania and depression. Few significant differences were present and there was considerable overlap between the diagnostic groups.

Sixty individuals are described who have lifelong eccentricity and social isolation and who have sought psychiatric treatment as a direct or an indirect result. They were predominantly young and, as in other samples of autistic people, male (6M: 1F). Most of them were of normal intelligence. They were all profoundly socially handicapped: few had lived independently, had lasting sexual relationships or spent much time in employment. Nearly a half of the subjects had been involved in antisocial behaviour at some stage. Nearly a quarter had committed a criminal offence. Violence was usually domestic, most often directed against the mother. Forty-eight per cent of subjects had a second psychiatric disorder (11.7% had a psychosis).

Several scales are described for measuring aspects of eccentricity and social isolation; in particular, for assessing schizoid and schizotypal personality and for rating abnormal non-verbal expression. The latter is shown to be reliable, and the former to have a measure of validity. There was an association between schizoid personality traits and abnormalities of speech and non-verbal expression. However, abnormal non-verbal expression, but not schizoid personality traits or DSM–III schizotypal personality disorder, was particularly likely to occur in those subjects who had evidence of neurological deficit, and childhood symptoms indicative of developmental disorder. Abnormal non-verbal expression, but not personality disorder, was also associated with other characteristic features of Asperger's syndrome, such as unusual, 'special’ interests. It is suggested that Asperger's syndrome is a distinct syndrome from either schizoid or schizotypal personality disorder, but may be a risk factor for the development of schizoid personality disorder.

The dramatic clinical presentation of parasuicide tends to deflect attention from the repetitive pattern of this behaviour in many patients. In an epidemiological study of annual cohorts of parasuicides for 1972, 1977, and 1982 admitted to the Regional Poisoning Treatment Centre, Edinburgh, it was found that for certain subgroups of the population ‘repeaters' were actually commoner than ‘first-ever’ patients, and a number of risk factors were identified, of which social class was particularly important. The clinical characteristics of patients distinguished by their frequency of repetition were also described, with special attention to the stability of these differentiating features over time. It is suggested that the habitual repeater requires closer study, and that the factors which lead to initiation into a parasuicidal ‘career’ are not necessarily those which conduce to repetition.

A recently proposed relationship between intropunitiveness and depressive states was examined in interview intervention with parasuicidal in-patients. To test the prediction that highly intropunitive parasuicidal individuals would be most responsive to cognitive intervention, a sample of 48 parasuicidal in-patients were administered a battery of individual difference measures, including the Hostility Questionnaire. Subjects were randomly assigned to one of three interview procedures, namely a cognitive interview, an affective interview or a waiting period (control). Highly intropunitive individuals in the cognitive interview group showed the most improvements on a self-report depressive symptom change measure. In addition to supporting theoretical models of depressive state changes, the study has important clinical implications because of the need to identify parasuicidal individuals who are most likely to benefit from brief interventions.

Family history was examined to determine whether suicide in index patients is associated with suicidal behaviour or mental disorder in their first-degree relatives. Twenty-seven suicides occurred within 5½ years among 955 affectively disordered probands. Among 5042 proband relatives aged 18 years and older, 44 had committed suicide prior to proband entry to the study; however, only one was the relative of a proband suicide. Only two of the relatives who committed suicide were themselves related. As to attempted suicide of relatives, neither the number of attempts nor the severity of attempt was predictive of suicide in probands. Comparison of diagnosis between groups of relatives showed more drug abuse among relatives of proband suicides; this appears to be related to drug abuse among the proband suicides themselves. In contrast to the clustering of suicides within biological families found in other research, these data do not support the use of family history as a clinically useful indicator of suicidal potential in affectively disordered probands.

One hundred and seven accidentally injured adults were studied while in hospital and assessed prospectively twice more in a mean period of 28 months. The patients were studied by means of taped clinical interviews, including the Comprehensive Psycho-pathological Rating Scale (which includes the Montgomery-åsberg Depression Rating Scale), and several self-report measures of distress (Schedule of Recent Life Events, General Health Questionnaire, Impact of Event Scale and State Anxiety Inventory) at the three assessments. The total incidence of psychiatric disorders considered to be caused by the accident during the follow-up period was 22.4%. The incidence of non-organic psychiatric disorders caused by the accident was 16.8% at the first follow-up and 9.3% at the final follow-up. Depressive disorders of different severity were most often seen. Only one patient suffered from a posttraumatic stress disorder during the follow-up, and none at the final follow-up (DSM-III). Organic mental disorders were diagnosed in 9.3% of the patients. In 5.6% of the patients this was the only disorder.

In the last paragraph of his paper ‘A defect in training’, Yorke (1988) has a sentence which serves as an excellent link to the opening of this paper – “For all their importance, empathy and awareness of patients' anxieties do not in themselves amount to psychological understanding”. In his paper, he had made a plea for more psychoanalytical psychology to be included in a general postgraduate psychiatric training, and I am in complete agreement with his cogently-argued case.

A woman with persistent obsessive-compulsive rituals showed limited improvement with exposure therapy, because of her refusal to comply fully with treatment and a lack of homework practice. She was negativistic towards therapists. Following a relapse, she was asked to try anti-exposure and to increase rituals. Paradoxically, this led to marked self exposure to the feared situation, and self-imposed response prevention, with resultant improvement, whereas anti-exposure instructions are generally anti-therapeutic in obsessive-compulsive disorder.

Two young adolescents are reported in whom fears of contracting AIDS were a prominent part of their clinical presentation. Public anxiety, specific developmental vulnerability, and exposure to the media information campaign about HIV infection and AIDS are discussed as factors in the genesis and precipitation of emotional disorder in these youngsters.

A case of autoscopy in a 43-year-old epileptic and mentally handicapped woman is described. The possible significance of this phenomenon to the patient is discussed.

A case of mania subsequent to the addition of lithium in unsuccessful treatment by antidepressants is presented. It is suggested that lithium might potentiate some properties of antidepressants which affect their capacity to induce mania.

Two cases of homosexual erotomania are described and the recommended diagnostic criteria applied. The symptoms were found to be very similar to that occurring with heterosexual patients. The case for retaining erotomania as a distinct entity is discussed.

A patient with recent-onset Parkinson's disease was tested for mood, physical disability, and cognition, before treatment and then during and after a period of levodopa-induced hypersexuality. The effects of different anti-Parkinsonian drugs on cognition and behaviour are described. The unique cognitive data from this case support the hypothesis that hypersexuality is a manifestation of enhanced libido and not frontal disinhibition.