Autoscopy is defined here as a visual experience where the subject sees an image of him/herself in external space, viewed from within his/her own physical body. This paper reviews the literature both historically and conceptually, and includes a quantitative study of accumulated cases.

Cases published since 1935 and meeting the above definition for autoscopy (n = 53) were included, together with three personally-observed patients. A clinical protocol was completed for each case, including information about the autoscopic image. Cases were compared using non-parametric statistics on dichotomised variables.

There were 38 men and 18 women, with a mean age of 39.5 years (range 13–78). Of the subjects, 33 (59%) had a neurological illness, most frequently epilepsy (18 cases). Right and left sided lesions were equally represented. Psychiatric disorder was often present (33 cases, 59%), most commonly delirium, depression or psychosis. The features of the images seen were diverse, but speaking images were associated with younger age, male sex, psychotic illness, longer duration of image, and hypnagogic/hypnopompic experiences.

Autoscopy may arise from a convergence of several variables, including gender, personality factors, neurological and/or psychiatric disease, exhaustion and dissociation, whose interaction may override the normal inhibition of temporal lobe activity. A cognitive neuropsychological hypothesis is proposed, together with avenues for future research.

A study of the influence of life-event stress on the onset and course of acute somatisation in primary care.

Forty-four somatisers were compared with 11 subjects who had psychiatric disorder but complained only of psychological symptoms, 39 patients who had ‘mixed’ conditions involving independent physical and psychiatric illness, 90 patients who had physical illness, and 123 healthy members of the general population.

Severely threatening life events were more common among all subjects with psychiatric disorder. A novel contextual rating of the potential of stressors to produce symptoms for ‘secondary gain’ was developed. In the 38 weeks before symptom onset, somatisers and psychologisers were more likely to have experienced at least one event which had this potential. Somatisers were also less likely to adopt neutralising coping efforts when faced with such a crisis.

The likelihood of adopting neutralising efforts was closely related to the presence of a joint index of parental problems in care and exposure to physical illness in the subject's childhood. In a two-year follow-up, subsequent functional illnesses were also associated with experiences which had secondary-gain potential, and subjects with childhood risk factors continued to have higher rates of crises with secondary-gain potential and to fail to adopt neutralising coping strategies.

We wished to explore the sociodemographic and clinical characteristics associated with admission to hospital in patients with a non-organic non-affective psychosis.

Subjects were 484 first-contact patients with a non-affective functional psychosis from an inner-city catchment area over 20 years from the mid-1960s. Sociodemographic and clinical characteristics associated with admission to hospital were analysed.

Around 20% of patients were not admitted, and the proportion did not change significantly over the years. Ethnicity, sex, and marital and employment status did not predict admission. Factors associated with admission included police involvement, and violence to self or others. A diagnosis of schizoaffective disorder, and persecutory delusions, auditory hallucinations, and bizarre behaviour were all more common in patients admitted to hospital.

The study indicates biases which might arise in research based exclusively on patients admitted to hospital.

This paper highlights the role of the visual scan path as a physiological marker of information processing, while investigating positive symptomatology in schizophrenia.

The current literature is reviewed using computer search facilities (Medline).

Schizophrenics either scan or stare extensively, the latter related to negative symptoms. Schizophrenics particularly scan when viewing human faces.

Scan paths in schizophrenics are important when viewing meaningful stimuli such as human faces, because of the relationship between abnormal perception of stimuli and symptomatology in these subjects.

Although depression in childhood appears to be familial, transmission of symptoms could be genetic or environmental. Twin studies enable us to separate these effects. Our aim was to assess the importance of genetic and environmental factors on depressive symptoms during childhood and adolescence in an epidemiological sample of twins.

Questionnaires (including the Mood and Feelings questionnaire) were mailed to a systematically ascertained sample (411 twin pairs) aged between 8 and 16 years. The overall response rate was 77%.

Data for the whole sample were best explained by an additive genetic model, with heritability of depressive symptom scores estimated at 79%. However, on splitting the sample, symptoms in children (aged 8 to 11) could be explained by shared environmental factors only, while symptoms in adolescents (aged 11 to 16) remained highly heritable.

The results suggest that although depressive symptoms appear to be largely heritable, the influence of genetic and environmental factors may vary with age.

An epidemiological survey was made of war trauma and its consequences in the general population.

One member aged over 15 years from each of 101 randomly selected families in a Primary Health Area in Sri Lanka were interviewed using the Stress Impact Questionnaire.

Nearly one-half had experienced between five and nine war stresses, and one-quarter experienced over 10 (mean 6.66). Only 6% had not experienced any. Sixty-four per cent had developed psychosocial sequelae, including somatisation (41 %), post-traumatic stress disorder (27%), anxiety disorder (26%), major depression (25%), hostility (19%), relationship problems (13%), alcohol and drug misuse (15%) and functional disability (18%).

The trauma experienced correlated strongly with psychosocial and somatic symptoms.

The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.

All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.

Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400–2000 h suggesting that OGS may have a diurnal variation.

GS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.

The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals.

Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an ‘untoward incident database’.

From eyewitness accounts, 921 incidents (92%) could be related to one of 15 categories of antecedent involving characteristics of the patient, or of the hospital regime, or interactions with other individuals. Overall, the most common antecedents involved patients who were generally agitated or disturbed (286), restrictions on patients associated with the routine hospital regime (192) or provocation by other patients, relatives or visitors (175). Incidents arising from staff members initiating contact with patients were very rare (7). Twenty-one patients were involved in 10 or more incidents, including 19 (90%) who were detained under the Mental Health Act. These patients were more likely to commit assaults after certain antecedents (self-harm, absconding or arson) which were serious incidents in themselves.

Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.

This study investigates whether anomalies in the sign language of prelingually deaf schizophrenics can be elicited and described systematically.

Thirty schizophrenic and seven manic adults were recruited on the basis of a British Sign Language (BSL) version of the Present State Examination. Thirty-seven controls were matched for sex, age and ethnicity. Each participant became deaf before the age of two, and uses BSL as the primary means of communication.

Analysis reveals: (a) anomalies which are similar to those occurring in the spoken language of hearing schizophrenics; and (b) another series which is closely related to the life experience of deaf subjects and to the visuo-spatial medium itself.

There is evidence that formal communication disorder does occur in sign language. This has implications for more efficient diagnosis and management of deaf persons presenting to psychiatric services, as well as for the mechanisms of schizophrenic symptomatology itself.

The presence of dysphoric symptoms associated with neuroleptic medication is commonly reported.

Neuroleptic treatment of a segmental dystonia resulted in a disabling depressive illness, which when treated with antidepressants led to the return of the involuntary movements.

The use of several different antidepressants and neuroleptics confirmed the association between drugs and symptoms. Genetic studies excluded “poor metaboliser status” as a reason for the patient's sensitivity to these drugs.

The case illustrates a delicate imbalance between dose of neuroleptic medication and depressive symptoms. We should be aware of the possibility of mood changes in patients treated with neuroleptics for a variety of conditions.

Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders.

Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients.

The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15.

Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain.

We compared three doses of a neuroleptic as a treatment for mania.

Forty-seven newly admitted in-patients with mania were randomised to receive 10, 30, or 80 mg a day of oral haloperidol, under double-blind conditions for up to six weeks. All subjects received prophylactic benztropine.

Repeated-measures analysis of variance and survival analysis showed no difference in outcome by the different doses. Excluding drop-outs (38%), most of whom left the study during the first two weeks, 72% of the subjects responded. Side-effects were minimal; there were no differences among the three doses. Non-responders received more adjunctive lorazepam than responders.

The limited data suggest that more than 10 mg a day of haloperidol offers no advantage in mania.

This is an exploratory study of readmission in mood disorder.

The study is naturalistic and employs survival analysis. We identified 821 individuals with ICD–9 diagnoses, drawn from the Tasmanian Mental Health Register.

No demographic variables influence the time to readmission. Two groups emerge: those with affective psychoses, and those with neurotic depression, brief depressive reaction and depressive disorders not elsewhere classified. The former group demonstrated shorter times to readmission than the latter. There was no support for a unipolar–bipolar distinction.

Affective psychoses have a less favourable outcome than expected. There was support for an endogenous-neurotic distinction.

The proportion of children with psychiatric disorders treated in primary care is not known in most developing countries.

In a two-stage epidemiological study, 990 children aged between 7 and 14 years were screened with the parents' version of the Rutter scale. Of these, a stratified sample of 227 was interviewed jointly with their mothers, using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS).

We obtained a weighted prevalence of 19.6 ± 2.5% for the presence of one or more DSM-III-R disorders. Depressive disorders were present in 6.0%, anxiety-related disorders in 4.7%, and conduct disorders in 6.1%.

Psychiatric disorders in children are common in primary care. Doctors working at this level of care need the skills to detect and treat them.

The efficacy of depot antipsychotic drugs in the prophylaxis of bipolar affective disorder was investigated.

Life charts were constructed for 18 outpatients with bipolar disorder receiving prophylactic treatment with depot medication. The durations of affective episodes were compared during periods on or off medication.

The subjects suffered fewer relapses and spent significantly less time in hospital (P = 0.001) for treatment of manic, depressive and mixed affective illness during treatment with depot antipsychotics.

Depot antipsychotic medication may be a useful prophylactic treatment for certain patients with bipolar affective disorder.

British Journal of Psychiatry (1994), 165, 827–829