The anticonvulsant treatment of epilepsy associated with psychological disorders is reviewed in the light of modern knowledge of the clinical pharmacology and adverse mental effects of the drugs. Careful monitoring of individual drug therapy from the onset of treatment improves compliance and seizure control and avoids unnecessary and harmful polypharmacy, and some of the neurological and psychosocial problems of chronic epilepsy. In chronic patients on polypharmacy cautious rationalization may improve mental function but can be hazardous due to withdrawal seizures. A clearer perception of the limits of anticonvulsant therapy will allow more attention to appropriate psychosocial measures.

Using structured psychiatric interviews, we searched for differences between depressed patients with bipolar affective disorder, and with other types of depression. The patients were taken from 2 large series, collected in London and Chicago. Some differences were found, but few more than would be expected by chance, in view of the large number of variables examined. The possible reasons for this failure are discussed. They include contamination of the groups, and the insensitivity of structured mental state inventories.

A pair of identical twins for whom long-term follow-up information was available progressed concordantly from typical ‘affective illness' to process schizophrenia. We discuss a possible genetic basis for a certain form of schizophrenia which may present typical affective features in the initial phase of process schizophrenia.

The charts of 52 hebephrenic/catatonic schizophrenics requiring long-term institutionalization were selected from the Iowa 500 study and reviewed. The presence or absence of 28 different symptoms was noted on a year by year basis over a span of 35 years. Symptoms usually classified as positive symptoms of schizophrenia, such as hallucinations and delusions, were found to have earlier onset and greater tendency to resolve over time than symptoms usually classified as negative such as flat affect, decreased social interaction and sensorium defects.

The view that schizophrenics have been exposed to a parental style of low care and overprotection was assessed in a case-control study of 72 schizophrenics using the Parental Bonding Instrument (PBI) which measures perceived parental characteristics. Those who assigned one or both parents to the low care/overprotection group had an earlier age of initial hospitalization, and in nine months following hospital discharge were more likely to be readmitted. The PBI is a simple measure capable of predicting schizophrenic relapse.

There was a significant rise in the human growth hormone response to intravenous thyrotropin releasing hormone in 5 of 10 chronic schizophrenic adolescents maintained on antipsychotic agents, but in none of 10 age and sex matched control subjects. In 4 of the 5 patients with growth hormone rise there was a positive family history of schizophrenia, but such a family history was obtained in only one of the non-responding schizophrenics.

Four patients with severe drug resistant chronic schizophrenia all committed a dangerous act around the time of their discharge from hospital. Discharge from a long stay ward may be an important life event and might therefore be expected to be associated with some depression. Detection of depression among vulnerable schizophrenics may be important if suicide or other dangers are to be prevented.

Follow-up of a large number of long-stay in-patients who were discharged because of local policy showed a high rate of readmission but also much subsequent re-discharge and low overall dependence on inpatient services. There was a high uptake of other forms of support, especially day care; and little evidence of further movement by the patients towards independence. The rate of mortality for the discharged patients was similar to that for the general population.

Contacts of patients with a large urban day hospital over a decade were analysed in respect of the long-stay population, its patterns of contact and rate of discharge. Two-thirds had been attending continuously for 2–17 years, and a third for 1–2 years; 60 per cent of the latter were readmissions. The majority were admitted more than once and there was great variation in their pattern of contact. The population's growth over the decade was due to a slow average admission rate of 1–2 long-stay patients per fortnight, and an even slower rate of discharge. More men than women attended, especially in the age range 25–44; at the end of the decade the number of long-stay men was still increasing.

A comparison has been made of costs within in-patient units in a large Scottish psychiatric hospital. Cost differences were found between short-stay, rehabilitation and long-stay psychosis units and beds for the elderly with mental disorder. These differences reflected staffing levels, particularly of nurses. The costs were greater than average for psychiatric hospitals and approximated to geriatric units—a finding in keeping with the high occupancy of beds by the elderly. Existing long-stay elderly patients require to be considered separately in distinguishing elderly in-patient costs without total psychogeriatric care offered by society.

Review of studies from the past 16 years employing quantitative measurement of memory functions before and after ECT revealed the following trends: impairment of non-verbal memory functions after less than five unilateral non-dominant ECTs; improvement of non-verbal memory functions after five or more unilateral non-dominant ECTs; no change or improvement of verbal memory functions with unilateral non-dominant ECT; consistent impairment of verbal functions with unilateral dominant ECT, and impairment of both verbal and nonverbal functions with bilateral ECT. The relative lack of impairment in memory functions with unilateral non-dominant ECT is consistent with the theory of asymmetrical hemispheric disorganization in affective disorders, and supports the choice of unilateral non-dominant ECT over bilateral or unilateral dominant ECT in the treatment of depression.

The pneumo-encephalographs and computerized axial tomography scans of fifty patients with severe affective disorder were studied. Measures of ventricular size were compared with those reported by other workers. Findings suggested that some patients suffering from severe affective illness showed abnormalities of brain structure as demonstrated by ventricular enlargement.

Survivors from a group of 40 carefully evaluated subjects with senile dementia who had been scanned over two years previously were followed-up, re-scanned and given simple cognitive tests. Of the 12 survivors, 10 agreed to participate. These fell into two sub-groups: one who showed further deterioration in cognitive function and one who did not. The first sub-group showed an increase in ventricle-brain ratio while the second did not. Although the numbers were too small for clear statistical differences to emerge, there was a tendency for affective admixture to be a favourable prognostic indicator and low radiological attenuation density particularly in the right parietal region to be an unfavourable one.

Enema abuse is a pernicious disorder, not extensively reported in the psychiatric literature. It may occur as an isolated paraphilia, klismaphilia (Denko, 1973, 1976), or as a symptom reflecting more pervasive illness or abnormality of attitude (Engel, 1975; Greenberg-Englander and Levine, 1981). Our patient had been using enemata excessively for sixteen years and presented in a state of cachexia; she had both obsessive-compulsive and affective symptoms, both frequently found in association with anorexia nervosa (Snaith, 1981).

This paper deals with an aspect of the law relating to the use of a mentally handicapped victim as a prosecution witness in a criminal trial. Here the particular question was of the victim's competence to act as a witness, and the likely reliability, or otherwise of her evidence. The results of psychological testing were found to provide guidelines by which the court could distinguish between areas of the reliable and the unreliable in her evidence.

A feeling of ‘presence’ is a common but relatively neglected phenomenon. The psychopathology, definition and six clinical associations are discussed. Two case histories are presented to demonstrate the induction of anwesenheit by serotonergic and dopaminergic drugs.

It is well recognized that bouts of uncontrolled and excessive eating (binges) occur in both a small proportion of patients who are overweight and in about 50 per cent of patients with anorexia nervosa. However, it has only recently been appreciated that many people who fall into neither category also have an eating disorder which is principally characterized by episodes of binge-eating. These people experience a profound and distressing loss of control over eating which results in a grossly disturbed eating pattern. Despite this, their body weight tends to lie within the normal range. The disorder has attracted various names including ‘the dietary chaos syndrome’ (Palmer, 1979), ‘the abnormal normal weight control syndrome’ (Crisp, 1979), ‘bulimia nervosa’ (Russell, 1979), and simply ‘bulimia’ (DSM III, 1980). The term bulimia nervosa is probably the most satisfactory since it conveys the links with anorexia nervosa and emphasises the central role of binge-eating. Russell (1979) proposed the following diagnostic criteria for this syndrome: