The Arabic version of the HAD scale was validated in a sample of 50 Saudi patients. The scale scores were assessed against the principal author's clinical evaluations. Spearman correlations of all items of the scale, except for one, were statistically significant. The non-significance of one item was probably related to the way it was translated into Arabic. The study furnished evidence that the Arabic version was a reliable instrument for detecting states of anxiety and depression in Saudi patients in a primary health care setting.

The first-degree relatives of 50 obsessive-compulsive patients and those of matched controls completed the General Health Questionnaire (GHQ) and the Leyton Obsessional Inventory (LOI). Relatives who were identified as possible ‘cases' by their high GHQ scores, or by their own or informant relatives' reports, were interviewed using the Schedule for Affective Disorders and Schizophrenia. Index relatives had a significantly higher lifetime prevalence of mental illness (36%) than had those of controls (17%), due mainly to an excess of depressive and neurotic disorders. However, only one relative from each group was diagnosed as having definite obsessive-compulsive neurosis. In addition, the LOI scores were similar for the index and control relatives.

A preliminary controlled investigation of the effectiveness of Anxiety Management as a treatment for generalised anxiety disorder (GAD) is described. Patients with a primary diagnosis of GAD, in which the current episode had lasted for at least 6 months but not more than 2 years, were included. Anxiety Management, a self-help treatment including procedures for managing somatic and cognitive symptoms, and for dealing with avoidance and low self-confidence, was given either immediately or after a 12-week waiting period. The average length of treatment was 8.7 sessions. Highly significant changes in anxiety, depression, and problem ratings were shown after treatment. These changes were replicated when the waiting list group had also received treatment, and gains were maintained by both groups for 6 months. Similar degrees of improvement and maintenance of change were shown in subgroups with and without minor depressive disorder or recurrent panic attacks.

A high incidence of brief schizophrenia-like psychosis in Africa and other parts of the developing world has been repeatedly documented by many psychiatrists working in these regions (Dembovitz, 1945; Carothers, 1953; Jilek & Jilek-Aall, 1970; German, 1972; Leighton et al, 1963). This report does not deny that typical schizophrenia occurs in these countries, but the common culturally based schizophrenia like psychosis may be misdiagnosed as schizophrenia, and thus inflate prevalence and improve prognosis data.

The social and demographic characteristics, drug history and current levels of drug taking, drug-related illnesses, and criminal records of a one year cohort of attenders at the Southern General Hospital are described. The findings are compared with those of previous studies at the same clinic; made when methadone was prescribed for a limited period in reducing dosage and when this policy was being replaced by one of the use opiate-free drugs to cover withdrawal.

Using the newly revised DSM-III-R criteria for substance-abuse diagnoses, we examined dependence syndrome elements among 83 psychiatric patients. The sample included 14 with no history of substance abuse. The remainder abused alcohol (52), sedatives (31), hallucinogens (12), stimulants (33), cannabis (44), cocaine (52), or opiates (47). Many patients (52) had abused more than one type of drug. Ten items assessing the proposed dependence symptoms for each type of drug were factor-analysed. The dependence syndrome items formed a single factor for opiates, cocaine, and alcohol, but not for other drugs. When the items were combined into cumulative scales, they had excellent internal consistency. Furthermore, they formed good approximations of unidimensional Guttman scales on which higher scores indicated greater syndrome severity. The items associated with higher scores differed across drugs, with opiates having the most striking differences from the other substances. Medical-psychosocial consequences were relatively independent of the dependence syndrome, although alcohol and cocaine dependence had some association with other problem areas. These findings support the utility of a common dependence syndrome concept for drugs of abuse as well as alcohol, and provide empirical support for the current revision of the DSM-III diagnostic criteria.

Spinal fluid concentrations of the three major monoamine metabolites were examined in 25 infantile autistic children and 12 children with other childhood psychoses, and were contrasted with results obtained in normal children and in groups of children with neurological and neurodevelopmental disorders. Autistic children showed absolute and relative increases of the dopamine metabolite homovanillic acid. The group with other childhood psychoses also showed an increase in HVA level; in this group there were also indications of high levels of serotonin and norepinephrine metabolites. The results are discussed in the context of a pathogenetic model for autism involving hyperfunction of dopaminergic nerve fibres in the brain stem-mesolimbic system.

A 20-year-old man developed generalised rigidity and signs of autonomic instability following the introduction of therapy with zuclopenthixol decanoate. A diagnosis of NMS was made, despite the absence of hyperthermia. He recovered on treatment with thiamine, dantrolene, and bromocriptine.

Electrical measurements were made during treatment of two groups of patients, one group receiving treatment from a constant current ECT machine and the other from a constant voltage machine. The electrical impedance and energy were calculated and compared for the two groups. More energy was delivered by the constant voltage than by the constant current machine, but the spread of energy delivered was comparable. With a consistent technique for applying the electrodes there is little to choose between these machines, but the constant current machine may be preferred where consistency cannot be achieved.

Psychiatric morbidity was assessed in a sample of 88 adult epileptic patients drawn from general practices in South London. Using the Clinical Interview Schedule, 48% emerged as psychiatric cases. When either total CIS score or caseness status was used for comparison, group differences were evident; patients with temporal lobe epilepsy and focal non-TLE did not differ, but each was significantly more impaired than those with primary generalised epilepsy. The groups also differed in their psychiatric symptom profiles. The results suggest that the increased prevalence of interictal psychopathology commonly associated with TLE may also be a feature of other forms of focal epilepsy.

An occurrence of Gilles de la Tourette's syndrome in a 13-year-old Saudi female patient is documented, and treatment is described. It is thought that the improvement noted may be attributed to the hospital environment and reduced contact with the family.

Conversive hallucinations are rare in the psychiatric literature. The authors present a case which demonstrates the psychogenesis and phenomenology of conversive hallucinations in a young female patient.

Suicide was attempted by 1641 people (502 males and 1139 females) in Singapore during 1980. Eleven of these committed suicide during the following three years, giving a suicide rate of 0.67%. Of the eleven suicides, five had schizophrenia and three depression. The risk of suicide in the year following attempted suicide is lower in Singapore (0.5%) than in Britain (1.6%). High risk factors for the Singapore patients were being Chinese, being male, and having a mental illness.

Three cases of self-inflicted eye injuries are described and discussed. A review of the literature shows that several psychiatric diagnoses have been assigned to those who mutilate their eyes, and various unconscious mechanisms proposed to explain this unusual phenomenon.

The effects of nortriptyline, phenelzine, and placebo on 13 symptoms of depression were compared in 75 patients, aged 55 or over, who were suffering from major depression. Nortriptyline and phenelzine were more effective than placebo in treating depression mood, guilt feelings, suicidal ideation, agitation, anxiety, loss of energy, and a.m. diurnal variation of mood. Nortriptyline was better than phenelzine or placebo in improving middle/late insomnia. Most of the symptoms did not show significant improvement until the fourth week of treatment.

The incidence of schizophrenia among psychiatric and general trained nurses was investigated for the period 1955–1979 in Northern Ireland. No difference was found. These results do not support the hypothesis of schizophrenia as a horizontally transmitted infectious disease.

An elderly patient with bipolar manic-depressive psychosis, stabilised satisfactorily on lithium carbonate, developed acute symptoms of lithium toxicity shortly after commencing mefenamic acid. Vulnerability factors for the interaction may have included age, history of cardiac failure, and impaired glomerular function. It is hypothesised that the interaction may have been mediated by inhibition of prostaglandin activity.

A 34-year-old heterosexual intravenous drug abuser presented with a paranoid psychosis and was subsequently found to have the Acquired Immune Deficiency Syndrome (AIDS). The patient died 14 days later of generalised septicaemia. The case is reported and the aetiology and pathogenesis of the organic psychosis are discussed. It is anticipated that similar psychiatric manifestations will occur as the AIDS epidemic increases.

The use of an immunological metaphor allows the incorporation of established theoretical ideas about trauma and stress in an integrative way which enables delineation and illustration of several varieties of combat stress reaction, including subtle forms of that condition which do not often appear in post-traumatic stress disorder literature.

Male sex hormones are ascribed a great importance in the literature from the point of view of sexual activity and aggressive behaviour. Two cases of sexually motivated murder are described, committed by delinquents with low levels of testosterone in plasma: one a patient with Klinefelter's syndrome; the other a man after castration. Even a decreased level of androgens, either primary or secondary, is not an absolute prevention of sexually aggressive behaviour.