We describe a case of marked increases in serum creatine phosphokinase (CPK) associated with a dramatic exacerbation of tardive dyskinesia (TD). Chart review of eight additional patients with severe TD revealed three cases with mild CPK elevations. These cases suggest that TD, especially when accompanied by dystonia, may be associated with pathology of striated muscle.

Respiratory dyskinesia is characterised by irregularity in rate, rhythm and depth of breathing. This study reports on the clinical features of 11 patients with respiratory dyskinesia identified from a mental hospital in Hong Kong, together with the results of the 24-hour polygraphic recording of seven patients. Virtually all patients with respiratory dyskinesia had tardive dyskinesia. However, the condition was missed or misdiagnosed in all cases by the case psychiatrists. The respiratory irregularity persisted for most of the day and only disappeared when patients took a prolonged rest or fell asleep. A standardised clinical examination for respiratory dyskinesia is proposed.

Two cases of Capgras' syndrome are described in which patients committed serious acts of violence towards famly members who had become the subject of delusional misidentification. The cases illustrate some typical features of Capgras' syndrome including its potential for dangerousness. Intoxication with alcohol is proposed as a precipitant for violence in these patients.

Two cognitive measures were used to assess 22 patients who met DSM–III–R criteria for major depressive disorder: the Autobiographical Memory (AM) test and the Dysfunctional Attitude Scale. They were followed up over seven months. Measurement of dysfunctional attitudes did not predict outcome at seven months. Overgeneral recall on the AM test at initial assessment, especially for emotionally positive memories, was highly correlated with failure to recover from depression and accounted for 33% of the variance in HRSD score at follow-up. Overgeneral recall of emotional memories did not change during follow-up. It is suggested that overgenerality is a trait marker indicating vulnerability to persistent depression.

Munchausen's syndrome in a man of subnormal intelligence is described. The case is unique for the extent of detailed, corroborated history. This man has been a voracious consumer of NHS and other services, and an estimate has been made of his cost to the health and prison services. The case raises various ethical, forensic, and resource issues.

A dramatic improvement in a patient with tardive dystonia was obtained with verapamil after the failure of other medicines. The use of verapamil or other calcium-channel blockers should be considered when treating drug-induced movement disorders.

A case of multiple personality disorder is described as a coping mechanism protecting the patient from the abuse to which she was subjected throughout her life. The multiple personalities became more prominent following the birth of a severely handicapped child.

A 12-year-old Indian boy presented to a psychiatric unit with catatonia. He was subsequently diagnosed to have Wilson's disease. Symptoms improved on treatment with penicillamine, zinc sulphate, and benzodiazepines.

Investigations of two cases of the Capgras delusion found that both patients showed face-processing impairments encompassing identification of familiar faces, recognition of emotional facial expressions, and matching of unfamiliar faces. In neither case was there any impairment of recognition memory for words. These findings are consistent with the idea that the basis of the Capgras delusion lies in damage to neuro-anatomical pathways responsible for appropriate emotional reactions to familiar visual stimuli. The delusion would then represent the patient's attempt to make sense of the fact that these visual stimuli no longer have appropriate affective significance.

A patient with bipolar disorder and primary generalised epilepsy, and a family history of psychiatric illness and epilepsy, is described. The episodic psychiatric symptoms were temporally correlated with epileptic discharges and absence seizures observed during repeated EEGs.

Pick's disease was diagnosed in a 28-year-old woman without a family history of dementia (or other psychiatric disorder), after an initial diagnosis of functional psychosis and management with ECT and neuroleptics. The case illustrates the need for detailed neurological and cognitive testing and consideration of neurodegenerative disorders even in young patients.

The case is described of a 65-year-old woman who initially presented with delirium caused by polycythaemia rubra vera. Following venesection she was discharged home recovered, but presented again shortly after with an episode of mania associated with relapse of her polycythaemia.

Four men with learning disabilities were considered to show transvestic fetishism, and a fifth to show transvestism. However, developmental retardation and personality problems may modify the concepts behind such categorisation.

A clinical series of male paedophiles who dressed or fantasised themselves as children suggests that certain paraphilias represent developmental errors in locating erotic targets in the environment and that proneness to such errors is a paraphilic dimension in its own right, apart from the specific nature of the erotic target.