One hundred and thirty-eight patients satisfying NINCDS/ADRDA criteria for Alzheimer's disease (AD) and 36 normal controls underwent cranial CT. A comparison of methods of scan analysis showed good agreement between computer-assisted methods and visual ratings and planimetry. The CT scans of controls differed significantly from patients and a discriminant analysis, based on all CT measures, predicted group membership (control or patient) in 81% of cases. Within the AD group, cortical atrophy correlated with age and duration of illness. Global tests of cognitive function correlated significantly with both cortical atrophy and ventricular size. Subjects who died in a three-year follow-up had more atrophy and larger third ventricles than survivors, but this effect was due entirely to increased age.

The literature is reviewed on children variously described as having ‘schizoid’ personality disorders, Asperger's syndrome, and schizotypal personality disorders, with the aim of clarifying the nature of these clinical syndromes, and in particular the features of those children whose follow-up characteristics are described in the following two papers.

In a controlled follow-up study into adulthood of 32 children diagnosed ‘schizoid’, three-quarters fulfilled DSM–III criteria for schizotypal personality disorder and two developed schizophrenia. Overall their psychosocial adjustment was somewhat, but not markedly, worse than that of other attenders at a child psychiatry clinic, although as a group they remained more solitary, lacking in empathy, oversensitive, with odd styles of communicating, and often with circumscribed interests.

The childhood case records of 32 ‘schizoid’ children and 32 matched controls were analysed. ‘Schizoid’ children were characterised by solitariness, unusual fantasies, special interests, and specific developmental delays, especially of language-related skills. They were of average or above-average IQ, and half presented with other, common, child psychiatric syndromes. It is important to distinguish ‘schizoid’ children from children with reactive psychiatric disorders.

Thirty schizophrenic patients (20 medicated, 10 off medication) were compared with 30 normal control subjects matched for age, sex, handedness, and intelligence. During the performance of left-hemisphere cognitive activation tasks, normal subjects had significantly increased EEG alpha coherence in areas related to left focal frontal sites, with decreases in temporal and posterior areas. Schizophrenic patients did not show the same degree of focal activation of left frontal areas. During the performance of right-hemisphere cognitive activation tasks, normal subjects and schizophrenic patients had similar patterns of right posterior increases in alpha coherence. Discriminant analyses were able to classify 81.4% of all subjects correctly. It is suggested that the findings indicate an aberrant functional organisation of the brain in schizophrenia, particularly affecting the left hemisphere.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD–10 and DSM–III–R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM–III–R and proposed ICD–10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD–10 and DSM–III–R regarding substance abuse and dependence disorders.

Fifty-six consecutively admitted elderly (65 and over) patients with depression were assessed on mental, physical and social states. They were followed up and assessed at home one year later. A group of 24 depressed in-patients aged under 65 years admitted to the same ward during the same period was also assessed. Outcome was different for the two groups, with 68% of the elderly ‘well’ at one year, against 50% of the younger group. The younger group were more likely to have ‘poor’ outcome (41 %) than the elderly (16%). However, there were more deaths than expected, particularly in the elderly. These findings differ from some previous studies, and indicate an excellent prognosis for depression in the elderly. Outcome in younger patients is less good.

Clinicians have reported a link between sexual abuse and eating disorders, but research evidence to date has been equivocal in supporting that link. This study presents data on reported sexual abuse from 67 anorexic and bulimic patients. Bulimics were substantially more likely to report a history of unwanted sexual experience than anorexics. The method used (clinical interview v. questionnaire) did not affect reported rates of abuse. It is suggested that sexual abuse per se may not cause eating disorders, but may determine the nature of those disorders when they have been prompted by other factors.

We present evidence that analgesic (as distinct from anaesthetic) nitrous oxide is superior to placebo in the treatment of the alcohol withdrawal state. ‘Carbogen’ as a placebo is as effective as oxygen or medical air. However, placebo alone offers a means of treating the alcohol withdrawal state with a minimum of pharmacological intervention. Analgesic nitrous oxide for those not responding to placebo is a very rapid, effective, and extremely safe treatment which also reduces the use of highly addictive sedative pharmacological agents. This therapy also provides a rapid method of screening those patients requiring intensive monitoring and treatment in hospital from those who might benefit from out-patient therapy alone.

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

The literature on household-based measures of mental health in developing countries is limited. Much emphasis is currently placed on the physical well-being of mothers in relation to child care, yet their mental well-being receives little attention. The present study measures maternal mental health in the largest squatter settlement of Rio de Janeiro, Brazil. The proportion of mothers who were probable cases of mental ill-health was 36%.

In a prospective study of 144 consecutive male patients with psychosexual disorders, comprising 93 with Dhat syndrome with or without impotence or premature ejaculation, 21 with premature ejaculation, and 30 suffering only impotence, the commonest associated psychiatric illness was neurotic depression (39%) followed by anxiety neurosis (21 %), while 31% did not receive a psychiatric diagnosis. The common presenting symptoms of Dhat syndrome were weakness (71 %), fatigue (69%), palpitations (69%), and sleeplessness (62%). After random allocation into groups, four types of treatment were given: an anti-anxiety drug, an antidepressant, a placebo, or counselling. The best response was seen with the anti-anxiety and antidepressant drugs. Twenty-one patients dropped out of treatment; 15 of whom were from the counselling group.

The notion of ‘pathology’ presumes an experiential and socially embedded frame of reference which is at variance with some recent attempts to understand the procedures and subject matter of psychiatry. Psychiatric theories remain bound by individual and historical contingencies whose compelling urgency obfuscates the inter-relationship of phenomenon, social context, response, and explanatory model.

“Objective – To assess general practitioners' involvement with long term mentally ill patients and attitudes towards their care.

Design – Postal questionnaire survey.

Setting – General practices in South West Thames region.

Subjects – 507 general practitioners, 369 (73%) of whom returned the questionnaire.

Main outcome measures – The number of adult long term mentally ill patients whom general practitioners estimate they have on their lists and general practitioners' willingness to take responsibility for them.

Results – 110 respondents had noticed an effect of the discharge of adult long term mentally ill patients on their practices. Most (225) respondents estimated that they had 10 or fewer such patients each on their lists. Having higher numbers was significantly associated with practising in Greater London or within three miles of a large mental hospital and having contact with a psychiatrist visiting the practice. 333 general practitioners would agree to share the care of long term mentally ill patients with the psychiatrist by taking responsibility for the patients' physical problems. Only 59 would agree to act as a key worker, 308 preferring the community psychiatric nurse to do it. Only nine had specific practice policies for looking after long term mentally ill patients and 287 agreed that such patients often come to their general practitioner's attention only when there is a crisis.

Conclusions – The uneven distribution of long term mentally ill patients suggests that community psychiatric resources might be better targeted at those practices with higher numbers of such patients. Most general practitioners seem to be receptive to a shared care plan where the consultant takes responsibility for monitoring psychiatric health with the community nurse as key worker. The lack of practice policies for reviewing the care of long term mentally ill patients must limit general practitioners' ability to prevent crises developing in their care.”

Ninety-four Canadian-born psychiatric patients who committed suicide were compared with 23 foreign-born patients committing suicide in Canada. East Europeans were over-represented, and significant differences were found in the age distribution, stress, level of education, social isolation, and methods of suicide. Most foreign-born patients had come to Canada for family or economic reasons but were unemployed, with poor social integration. Employment, homing, education, social integration and a support network seem to be important in preventing these deaths. Cultural evaluation of the patient and early intervention is recommended.

In a prospective study of 20 patients with NMS, those who received dantrolene (2 patients) or bromocriptine (2 patients) or both (4 patients) tended to have a more prolonged course of illness and a greater incidence of sequelae than those treated with supportive care alone. These results do not indicate a useful role for dantrolene or bromocriptine in the treatment of NMS.

A case of severe mania due to thyrotoxicosis responded to propranolol and propylthiouracil.

We report three cases of flashbacks and one case of recurrent psychosis experienced by three MDMA users. We draw the attention of clinicians to the combination of adverse effects observed with this drug of abuse and to the advisability of prolonged treatment should they occur.

A woman developed delusional parasitosis when taking phenelzine. The delusion occurred in an agitated hypomanic state and was preceded by an intense pruritus. It completely remitted following withdrawal of phenelzine combined with a low dose of haloperidol (1 mg/day) for several days. This unusual psychopathology is probably encountered more by dermatologists than by mental health professionals.