The motor disorder of 100 patients with severe psychiatric illness is described and the contribution of previous treatment, hospitalization and possible neurological disorder is considered. The conflict of paradigms between the concept that this motor disorder has two distinct aetiologies, psychiatric and neurological, and the concept that both motor and mental disorder are an expression of underlying cerebral disorder is discussed. An attempt is made to resolve this conflict by description of motor disorder without reference to neurological or psychiatric diagnosis.

There has been a considerable range in both the prevalence of ventricular enlargement and values for ventricular size of both schizophrenics and controls, in studies using computerised tomography (CT). The CT scans of 19 unrelated chronic schizophrenics, all of monozygotic (MZ) twin birth, and 36 age-and-sex-matched normal twins from 18 MZ pairs were examined by linear, planimetric, and semi-automated computerised methods. All methods distinguished schizophrenics from controls at approximately the same level of significance, but partial volume artefact led to a greater than two-fold variation in apparent ventricular size, and significantly reduced the validity and reliability of mechanical planimetric and linear measures. Measurement error may be an important source of artefact in uncontrolled studies using those techniques, and when comparing absolute values across studies, but the use of computerised methods should significantly reduce this source of artefact and allow more meaningful comparison.

Using an ultrasound technique, the widths of the third ventricle in a group of normal subjects was compared with groups of chronic schizophrenics and acutely ill schizophrenics. While the chronic patients showed a significantly wider ventricle (p < 0.5) from the other two groups, only 14% of the chronic patients had a third ventricle greater than the accepted normal maximum of 8 mm. Neuropsychological tests confirmed organic brain impairment in both chronic and acutely ill patients but there was no significant difference between chronic patients with large ventricles and those with normal size ventricles. This suggests that third ventricle size is not part of the schizophrenic disease process and is not related to the dementia seen in the late stages of the illness.

Ninety-one patients admitted as emergencies, suffering from neurosis, personality disorder, or adjustment reaction, were randomly allocated to day hospital or to continued in-patient care. Follow-up was for up to one year. Clinical outcome was similar in the day care and in-patient groups, but patient satisfaction was significantly greater in day patients. Day hospital care was only about two-thirds of the cost of the cheaper of the two in-patient regimes, even though contact with it was on average twice as long as for in-patients.

In a prospective screening of emergency admissions of patients suffering from neurosis, personality disorder or adjustment reaction, 100 were assessed as suitable for early transfer to day hospital treatment, 101 as unsuitable, and 39 as not requiring further intervention. Of the unsuitable patients, 39 were grossly disturbed; the remainder did not differ in severity from those thought suitable, but there was a specific reason against day treatment in all but 13 of the 62—most commonly alcohol abuse, physical problems, social problems or aggression. Patients' attitudes were also important. Recruitment of patients had to be active, with regular visits to the wards by day hospital staff.

Psychiatric reform in Piedmont following new mental health legislation in Italy (1978) is described. The process of reform is characterised by a drastic reduction in psychiatric hospital populations and the setting-up of a new system of community-based services. The number of hospital admissions remains stable, but the character of inpatient care has changed. The reform involves problems of care for chronic patients.

This study examines the quality of residential care in non-psychiatric nursing homes and psychiatric group homes for a representative epidemiologically-based sample of patients discharged from a psychiatric hospital in West Germany. There were twice as many chronically ill patients in sheltered accommodation as in hospital, 85% of them in nursing homes, which scored badly on all measures of therapeutic environment. This poverty of social environment was correlated with severity of symptoms for schizophrenics, especially with flatness of affect and poverty of speech. Nursing homes were just as likely as hospitals to promote chronic illness and hinder rehabilitation.

The number of dropouts from a long-term treatment study of patients with anorexia nervosa (AN) and bulimia nervosa (BN) was substantial. A variety of social, clinical, parental, and treatment factors were examined for their association with early termination of treatment by the patient or the family. Parents ‘expressed emotion’ (EE) (particularly critical comments), BN, and the type of therapy offered (family or individual) were found to interact in some manner to result in dropping out. Some other aspects of parents' EE were also examined, including a comparison of scores in parental pairs; EE was found to be influenced by social class, and there were significant associations with the patient's symptomatology and social adjustment. There was a strong relationship between mothers' and fathers' scores in parental pairs.

The failure rate in long-term lithium treatment of bipolar affective disorder is in the range of 20 to 30%, even with rigorous diagnostic criteria and adequate serum lithium levels. This may be due to a variety of biologic and psychosocial factors. Psychosocial factors affecting treatment outcome were studied in 60 RDC diagnosed bipolar patients treated with lithium for one year. Outcome was measured using an affective episode score, a social adjustment scale and a global assessment scale. Social support was the factor most strongly correlated with a good outcome on all three measures.

Compared to healthy controls, unmedicated schizophrenic patients had significantly higher plasma concentrations of taurine, methionine, valine, isoleucine, leucine, phenylalanine, and lysine. Except for taurine, these amino acids share the L-transport system for neutral amino acids. In the patients, homovanillic (HVA) acid levels in CSF were decreased and the plasma levels of the amino acids competing with tyrosine and tryptophan for transport into the brain, were all negatively correlated to the CSF concentrations of HVA and 5-HIAA. These findings could be explained by a change in the affinity of the L-system or by a decrease in its overall capacity in schizophrenia. Raised plasma levels of the competing amino acids may limit the brain uptake of tyrosine, leading to a diminished dopamine turnover, and resulting in a compensatory development of supersensitive dopamine receptors.

In a double-blind cross-over trial, 20 chronic schizophrenic patients were treated with sulpiride and haloperidol in two 12-week periods. The final median dose of sulpiride was 2000 mg/day (range 800–3200) and of haloperidol 12 mg/day (range 6–24). Sulpiride had an antipsychotic effect and therapeutic profile not significantly different from that of haloperidol. In spite of the high doses of sulpiride, extrapyramidal side-effects were seen less frequently during the first four weeks of the sulpiride period than during the corresponding haloperidol period (P < 0.05), whereas autonomic side-effects were equally rare for both drugs. A positive correlation was found between daily dose and plasma concentration of both sulpiride (P < 0.001) and haloperidol (P < 0.05), but no correlation could be established between clinical effects and plasma levels of either neuroleptic.

Rehabilitation and support services in psychiatric hospitals and general hospital psychiatric units serving two-thirds of the population of Scotland were reviewed. Although there are wide between-hospital differences, especially between rural and urban areas, the National Health Service in Scotland is making considerable efforts to provide staffing, accommodation, occupational activities, and support services for the long term mentally ill. Services provided by local authorities, with the exception of group homes, are seriously deficient. The total number of services provided by an individual hospital correlated highly with an assessment of its adequacy in providing such services in relation to other hospitals. A simple count of services may therefore be used to assess adequacy. There was also a correlation between the range of a hospital's services and numbers of misplaced new chronic in-patients.

In a successful attempt at extending the construct validity of the Dutch version of the Maudsley Marital Questionnaire (MMQ), its sub-scales were correlated with the Marital Deprivation Scale, the Sexuality Experiencing Scale, the Marital Communication Inventory, and the Hopkins Symptom Checklist.

Although it is widely believed that behaviour modification is successful in an institutional setting, the lasting efficacy of such programmes for adolescents with acting-out and conduct problems has long been questioned. A follow-up enquiry was carried out at one and two years on adolescent patients who had been through an institutional behaviour modification programme. The results were compared with those obtained for a similar group of patients who were accepted for the programme but not admitted; significantly more of the treatment group than the comparison group had improved in terms of behavioural outcome measures, and their level of independent living was greater.

Indalpine 150 mg per day and mianserin 60 mg per day were compared in a double-blind study of 65 depressed out-patients: 52 patients completed the 4-week trial. At the end of four weeks there was no significant difference in antidepressant effect between the two drugs; but in the first two weeks, improvement in the mianserin-treated group was significantly greater than that in the indalpine group. The mianserin-treated group reported more side-effects of sedation (eg. drowsiness, clumsiness, heaviness of limbs etc.) and one patient on indalpine developed a mild leucopenia.

Accidents may often have been far more traumatic psychologically and emotionally than appears to be the case at first sight. Attention is drawn to such “Cryptotrauma” and illustrated with three clinical vignettes. Emphasis is placed on the need for painstaking analysis of the accident in all its details. Without such careful investigation “Post traumatic stress disorders” can easily be overlooked, since patients tend not to offer the information spontaneously.