Concurrent use of lithium and ECT is suspected to increase neurotoxicity.

A retrospective case-control study over an eight-year period was conducted to investigate the adverse effects of a combined lithium/ECT treatment Thirty-one subjects with combined lithium/ECT treatment were compared with a control group (ECT only) of 135 cases matched for age and sex.

Most cases in both groups had no adverse effects. Three (10%) study group subjects and 15 (11 %) controls experienced brief delirium. Three controls and none of the subjects developed a prolonged confusion. There were no significant differences in the profile of other adverse effects between the two groups.

Prescription of lithium together with ECT was not associated with higher frequency of adverse effects.

Measurement of the quality of psychiatric care including assessment of patients' views have become increasingly important as expectations of the standard of care rises.

Attitudes and satisfaction of acute psychiatric in-patients were investigated using a questionnaire looking at satisfaction, patients' views on personal and professional qualities of psychiatrists, empowerment and insight.

The response rate was 79.2% (137 out of 173). Patients with a diagnosis of a non-affective psychotic illness, particularly those lacking insight were significantly less satisfied with their care. Respondents were more satisfied with the personal rather than the professional qualities of the doctors, and less satisfied with their empowerment and doctors' availability.

In-patients' attitudes towards their psychiatric care involves a complex relationship between clinical and sociocultural characteristics. Satisfaction studies can serve as an important monitor and reminder of patient dissent.

The ‘Young Persons Unit’ (YPU) at Broadmoor Hospital offers psychotherapeutic treatment for young adult male patients. The study objective was to report background details, treatment and outcome of the ward's personality disordered patients.

The sample consisted of 49 patients, with the legal classification of psychopathic disorder, treated on the unit for at least one year. Data were collected from existing case records. Outcome was recorded until discharge from statutory supervision. Outcome measures were recidivism and a variety of social factors.

At follow-up 10 patients had reoffended, with four having committed serious violent or sexual offences. Two patients had died. A history of sex offending was the strongest predictor of subsequent reoffending. No patients with good social outcome reoffended.

Young patients with personality disorder can be successfully treated on the YPU. The management of sex offenders in this group requires further attention. Successful social integration within the community after discharge may help prevent future reoffending.

An investigation of the relationship between bipolar affective disorder and schizophrenia, following a severe head injury and removal of the left prefrontal cortex.

A single case report.

An individual with past history of bipolar affective disorder suffered traumatic damages to the left prefrontal cortex with a second lesion in the left temporal lobe. The patient developed typical schizophrenia nine months later. The relevance of his brain lesions in determining the schizophrenic symptoms is discussed.

We propose that the specific pattern of brain injury in this patient was sufficient to change the phenotype from bipolar affective disorder to schizophrenia.

It has been suggested that the key variable in reduced plasma immunoreactive β-endorphin concentrations in autistic subjects may be concomitant self-injurious behaviour.

We studied morning levels of plasma β-endorphin in 33 learning disabled people with self-injurious and/or autistic behaviour.

The β-endorphin level of the subjects with severe self-injurious behaviour proved to be significantly lower than that of autistic subjects without severe self-injurious behaviour (3.6 (1.4) pmol/l v. 5.8 (4.3) pmol/l; t-test: P = 0.045. Replication: 3.7 (1.1) pmol/l v. 5.7 (3.8) pmol/l; t-test P = 0.043). Individuals with mild and occasional self-injurious behaviour were found to have β-endorphin levels comparable to those without self-injurious behaviour. Further, subjects being treated with neuroleptics had lower β-endorphin levels than untreated subjects.

These results stress that in any study of opioid systems of learning disabled people, it is very important to differentiate between people with and without severe self-injurious behaviour. The results support the idea that severe self-injurious behaviour may be related to functional disturbances in the endogenous opioid system.

We examined clinically diagnosed Alzheimer's disease patients and controls, and collected information from informants, to examine the association between Alzheimer's disease and aluminium occupation.

An unmatched case-control study comparing 198 cases of Alzheimer's disease (ADRDA–NINCDS diagnostic criteria), to selected controls (164 other dementias and 176 non-dementing group) in respect of their occupational history. The subjects included all patients referred to and seen by the first author during a 2 year study period.

Twenty-two of 198 patients with Alzheimer's disease (11.1 %) reported having an aluminium occupation at some stage in their working life compared with 39 of 340 controls (11.5%), odds ratio 0.98, 95% CI 0.53–1.75, P > 0.05. Aluminium workers reported to have worked in direct contact with aluminium dust and fumes did not appear to be at any greater risk than other workers who were employed at the same factory, odds ratio 1.19, 95% CI, 0.64–4.18, P > 0.05.

There is no evidence to support an association between having previously worked in an aluminium factory and the risk of Alzheimer's disease later in life.

Previous research has indicated that deluded patients may experience difficulties when testing hypotheses. In this study, hypothesis-testing strategies were assessed in patients with persecutory delusions, depressed patients and normal controls.

Subjects were presented problem items describing typical everyday situations with either positive or negative outcomes and were required to choose strategies to prove that one of three variables was responsible for the outcomes.

Consistent with previous research into sensible reasoning, subjects chose to manipulate the variable hypothesised to be responsible for the outcome (disconfirmation strategy) more when the outcome was negative than when it was positive, and chose to manipulate the remaining variables (confirmation strategy) more when the outcome was positive. No group differences were observed.

No evidence was found of abnormal hypothesis-testing strategies in deluded patients.

Schizophrenia can be diagnosed in adults and requires treatment with antipsychotic medication. Clozapine is used effectively in adults with treatment-resistant schizophrenia but little is published on the use of clozapine in children.

Supported by parental consent and a second opinion, standardised observations were used to chart the progress of treatment with clozapine in a child in-patient detained under mental health legislation with severe drug-resistant schizophrenia and tardive dyskinesia.

Sixteen months of clozapine treatment led to significant reduction of symptomatology with marked improvement in social functioning and diminished tardive dyskinesia.

This case illustrates the successful use of clozapine in treatment-resistant childhood schizophrenia.

Post-traumatic stress disorder (PTSD) typically involves a re-experiencing of traumatic events. In a previous P3 study it was found that PTSD patients react both selectively and involuntarily to combat-related pictures, exhibiting augmented P3 event-related potentials and thus providing a brain activity measure. The clinical application of these findings in differentiating PTSD patients from controls was tested.

Twenty Israeli combat veterans suffering from PTSD and 20 age-matched veterans without PTSD were evaluated. P3 potentials were recorded at Pz and Cz in response to visual motor-task target stimuli (pictures of domestic animals), non-target probe stimuli (combat-related pictures), and non-target irrelevant stimuli (pictures of furnishings and flowers).

Using the Fisher Linear Discrimination Method the P3 measures correctly classified 90% of the PTSD patients and 85% of the controls.

Visual P3s recorded in response to combat-related pictorial stimuli may introduce an efficient tool for studying higher brain activity in PTSD, complementing other behavioural and psychophysiological measurements.

About 25% of primary care attenders are ‘somatic presenters’; individuals consulting for physically-attributed somatic symptoms in the presence of psychiatric morbidity. We tested the hypothesis that somatic presenters differed from psychological presenters on measures of personality and childhood experience.

Case-control study of ‘psychological presenters’ and ‘somatic presenters’.

Psychological presenters reported significantly greater insecurity in intimate relationships, and recalled their fathers as significantly less caring and more over-protective, than somatic presenters. These differences remained after adjusting for differences in the severity and duration of psychiatric symptoms.

Personality and childhood experiences may be associated with specific types of adult illness behaviour, independent of associations with the prevalence of psychiatric disorder.