We report a case of neuroleptic malignant syndrome where the catatonia clearly followed the administration of neuroleptics and where the neurovegetative disturbance was remarkably severe, including episodes of tracheal spasm, apnoea and episodes of bradycardia, and sinus arrest requiring insertion of a temporary external pacing wire. To our knowledge, such severe disturbance has not previously been reported.

Two cases of dysthymia in mentally handicapped patients are described. The absence of publications on dysthymia in the mentally handicapped is noted. The importance of early diagnosis and treatment with advanced antidepressants and psychotherapy is emphasised.

Three cases of a misidentification syndrome are presented. In this syndrome, which may be Capgras' or a new syndrome that we refer to as delusional gross replacement of inanimate objects, patients believe that their new possessions are replaced by inferior copies of the original objects by identified individuals. The patients believe that these individuals want to enhance themselves at the patients' expense, and feel persecuted by them.