Lipopigment, identifiable in the fluorescence microscope, is thought to be cellular debris partly derived from free-radical-induced peroxidation of cellular constituents. The volume of neuronal lipopigment has been positively correlated with advancing age, Alzheimer dementia, and the neuronal ceroidoses, while various changes in neuronal lipopigment have been reported in association with the chronic administration of dihydroergotoxine, ethanol, phenytoin, centrophenoxine, and chlorpromazine. An increase in the volume of neuronal lipopigment may indicate increased functional activity of the cell, impaired removal of pigment or anoxia. Chronic administration of agents which can be correlated with decreased neuronal lipopigment in animal models might protect neuronal function against any adverse effects associated with (but not necessarily resulting from) lipopigment accumulation in normal ageing, anoxia, or certain degenerative diseases. Long-term studies of the prophylactic use of such agents, or of drugs which neutralise free radicals, may be indicated. Other clinical applications of such drugs may include protection against the effects of free radicals formed during periods of oxygen deprivation.

While the demand for deinstitutionalisation, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of outpatient psychiatric treatment on length of stay in hospital and length of stay in the community. Outpatient care had a significant influence on read mission, but no effect on the length of inpatient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued inpatient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.

Volunteer college students completed a categorisation task designed to test the hypothesis that adults organise their expectations of relationships in a manner that reflects a functional distinction between attachment and affiliation. Terms associated with the provision of security and with characteristics theoretically identified as definitive of attachment relationships were significantly more likely to be associated with the relationship identified as ‘lover’. There was substantial overlap between attachment and affiliation relationships in functions relating to intimacy and disclosure. These results highlight the need to differentiate close relationships by functional rather than structural characteristics.

The development of an investigator-based standardised interview to assess patterns of specific and general social dysfunction is described. It covers six domains of functioning: work; love relationships; friendships; non-intimate social contacts; negotiations; and everyday coping. Inter-rater reliability was tested by three investigators rating 21 audiotaped interviews, and was shown to be high, with an intraclass correlation of 0.87 for the total score. The pattern of associations between specific and general social dysfunction was examined through determination of sensitivities and specificities and through LISREL modelling. The findings varied across social domains but it was concluded that the total APFA score provided a reasonable measure of general social dysfunction.

In a consecutive sample of 208 male prisoners interviewed on the tenth day (T1) after entry, high levels of psychiatric symptoms as measured by the GHQ were recorded. These GHQ scores were strongly correlated with perceived worries and concerns of the prisoners (‘cognitive stress’). After 60 days of detention (T2), a significant fall in GHQ scores was observed, and they were still correlated with cognitive stress. A significant negative correlation between cognitive stress at T1 and GHQ scores at T2 was observed. The relationship between potential vulnerability factors (life experiences, social network, personality factors) and GHQ scores was not strong at either T1 or T2. Psychiatric symptoms are common during the early phase of imprisonment but are not durable.

Two hundred and four subjects, 22–35 years old, were selected from a surburban part of Khartoum. They were assessed using the Self-Rating Questionnaire, the Eysenck Personality Inventory, and a Sudanese rating scale of anxiety and depression. Socio-economic information was collected. A psychiatric interview and a medical examination were carried out. It was found that 40.3% had at least one psychiatric symptom, and 16.6% received clinical diagnoses according to DSM-III. The most common diagnoses were depressive illness (neurotic and endogenous) (8.4%) and generalised anxiety (3.4%). Alcohol abuse was very rare (0.4%). There was no sex difference.

The fit of the structure of DSM–III major depressive disorder to data from two large epidemiological surveys is assessed by latent class analysis. The surveys were conducted at the Baltimore and Raleigh–Durham sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program. Three classes are required to fit the data, and the third class bears a strong resemblance to major depressive disorder, although it requires slightly more symptoms to be present than DSM–III. The derived structure replicates successfully for Baltimore and Raleigh-Durham, with a prevalence of the major depression category of 0.9% for both sites.

Forty patients under the age of 60 years with a DSM–III diagnosis of bipolar affective disorder were examined for the presence of tardive dyskinesia. The overall prevalence was 22.5%, with an age-related increase. Patients with and without tardive dyskinesia did not differ in terms of duration of affective illness or exposure to neuroleptics, but those patients with tardive dyskinesia had significantly more psychiatric admissions and were on lithium for significantly greater lengths of time.

The prevalence and significance of physical diseases, and health-care-seeking behaviour, were examined in a sample of 218 chronic psychiatric patients from an urban community psychiatric unit. Only 14% declined medical screening. Of the respondents, 53% had one or more probable or certain physical diseases warranting further medical attention. The majority of the diseases found were minor and typical of primary care problems. A severe (i.e. life-threatening) disease was present in 7% of respondents. Of the patients, 87% visited their GP at least once a year. The implications are that frequent consultation with primary care specialists and health-care-seeking behaviour should be noted, and included in any evaluation of the medical needs of chronic patients in community psychiatric care.

A survey of laboratory investigations in the management of 1007 non-geriatric admissions to a district general hospital adult psychiatric unit showed a wide variation in the number of tests performed, and in the abnormal proportion between test types. Despite a policy of screening on admission, 40% of admissions had no tests. Physical illness attributable to mental illness was common, but rarely serious and usually apparent clinically. Mental illness attributable to physical illness detected by laboratory tests was rare: five cases of thyroid disease in women with affective disorder, and two cases of chest infection with raised white cell count in sustained mania. The findings show that tests are frequently used in circumstances where the result is of no apparent value. Test use might be improved by restricting screening to thyroid function and laboratory urine analysis, each in women. There are particular indications for white cell count in sustained or unexplained relapse of mental illness, and for syphilis serology when disinhibition may have exposed the patient to infection.

In a prospective study of late-life onset psychosis, five of the first 27 patients studied had extensive white-matter lesions demonstrated by MRI and/or CT. None of 60 age-matched psychiatrically healthy controls demonstrated such lesions. All five patients had a mild dementia and a frontal behavioural syndrome. In addition, every patient performed poorly on neuropsychological tests of frontal function. Dysfunction of the frontal cortex associated with white-matter lesions appears to contribute to the clinical picture of some cases of late-life psychosis.

Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.

Twenty patients with panic attacks and ten controls were given a standardised interview about thoughts occurring during times of anxiety or panic attacks. The interviewer was blind to the subject's diagnosis. The 20 panic patients underwent a psychophysiological test battery which included a cold pressor test, mental arithmetic task, and 5.5% CO2 inhalation. More patients than controls reported thoughts centred on fears of losing control and shame when anxious. Panic patients rated their thoughts as stronger and clearer than did controls and they had more difficulty excluding them from their minds. A feeling of anxiety preceded anxious thoughts in patients. This suggests that ‘faulty cognitions' are not the initial event in a panic attack, although anxious thoughts may exacerbate or maintain them. Significant correlations were found between the intensity of anxiety-related thoughts in anticipation of mental arithmetic and changes in diastolic blood pressure and heart rate during mental arithmetic.

The hypothesis that the gene for schizophrenia is located in the pseudoautosomal region of the sex chromosomes predicts that same-sex concordance will occur in paternally rather than maternally derived pairs. In 120 families that included at least one sibling pair with schizophrenia, affected members were significantly more likely to be of the same sex when there was a history of illness on the paternal than on the maternal side, the difference remaining significant when parent of origin was assessed by three different methods. The finding is as predicted by the pseudoautosomal hypothesis: therefore a search for the gene should be focused on this small (three megabase) region of the genome. The ratio of same to mixed sex pairs in paternally-derived cases (approximately 3:1) suggests the gene is located in the centromeric one-third of the pseudoautosomal region.

“The first 50 referrals to a newly established liaison psychiatry service for the breast cancer unit at Guy's Hospital, London, have been examined. The majority of referrals were for psychological reactions to malignant disease; most of these were mood disturbances. Patients with sustained psychological reactions to their malignant disease were more likely to have had treatment for previous psychiatric illness and to lack a confiding relationship compared with those whose psychological reactions were transient. Teaching doctors and nurses to deal effectively with the transient psychological reactions of patients to their malignant disease is an important task of liaison psychiatry.”

An elderly lady, of superior verbal intelligence and with no severe psychiatric condition, severely neglected herself, and required prolonged day patient care. Brain scans showed selective frontal atrophy, and both traditional and new computerised neuropsychological testing demonstrated severe frontal dysfunction.

Minaprine is an amino-phenylpyridazine antidepressant reported to be relatively free of anticholinergic effects, cardiotoxicity, drowsiness, and weight gain. Minaprine (100mg t.d.s. and 100mg b.d.) was compared with mianserin (20 mg t.d.s.) in 117 depressed patients, and all three regimes produced significant reductions in scores on the HRSD at the end of six weeks' treatment. There were no anticholinergic effects, but there was a significantly greater incidence of drowsiness with mianserin than with minaprine.

Trichotillomania is reported in a 33-year-old female victim of incest, with a possible causal connection.

Three schizophrenic patients who had transient recurrence of auditory hallucinations during acute dystonia precipitated by neuroleptic medication are reported. If it is accepted that psychotic symptoms result from dopaminergic overactivity, such phenomena suggest that acute dystonia might also have been caused by increased dopaminergic neurotransmission in these cases.

Tardive dystonia is a rare movement disorder. We outline the development of tardive dystonia in a young schizopohrenic, and demonstrate the importance of applying a double-blind, placebo-controlled, crossover trial of any putative successful treatment.