The aims were to determine the prevalence of psychiatric morbidity among primary care attenders in a poor suburb of Santiago and to study the relationship with health service use.

A cross-sectional survey was made of 163 consecutive attenders to a primary care clinic.

Eleven per cent of the sample gave a psychological reason for consultation and the prevalence of psychiatric morbidity was 53%, defined using the revised Clinical Interview Schedule. Women and those of lower socio-economic status were at higher risk. Physicians recognised 14% of the psychiatric morbidity. Attenders with psychiatric morbidity consulted more frequently.

There is a need to improve the recognition and management of psychiatric morbidity in primary care in Chile and other less developed countries. This could lead to the more efficient use of scarce health care resources in primary care.

An Indian man now in Britain explained his criminal behaviour as episodic ghost possession. Traditional exorcisms failed to help.

‘Western’ diagnosis of dissociative state or paranoid schizophrenia was made. Treatment commenced using trifluoperazine and clopenthixol.

The patient underwent remission during neuroleptic treatment, despite previous evidence of genuine possession.

Many cultures give rise to apparently genuine cases of ghost possession. Neuroleptics may relieve symptoms of exorcism-resistant possession.

The hypothesis that Asperger's syndrome (AS) may go unrecognised in forensic populations was examined by ascertaining the prevalence in Broadmoor Special Hospital.

The entire male patient population was screened by examination of case notes. Identified cases were subject to the next stage of the study, which involved observation and interviewing of patients, and a semi-structured interview of key staff.

A prevalence of 1.5% (0.6% to 3.3%, 95% CI) was found. The addition of equivocal cases increased the prevalence to 2.3%.

The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population.

British Journal of Psychiatry (1994), 165, 679–682

The purpose of this study was to examine the reliability and validity of the newly proposed axis V (disabilities) of ICD-10.

Eighty-six acutely ill men and women were prospectively recruited from the Al Ain psychiatric units, UAE. Both versions of ICD–10, the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research (DCR) were used for coding axis I psychiatric diagnosis and its grade of severity; the WHO Disability Assessment Schedule was used to assess disabilities.

Inter-rater reliability of the DAS items ranged from moderate to good, and axis V ratings correctly predicted 84% of the observed classification on axis I.

Axis V is a valid measure of disabilities, but is limited by its modest reliability.

British Journal of Psychiatry (1994), 165, 683–685

Case reports suggest that recurrent nightmares are alleviated by behavioural treatment. We have administered such treatment to a client by post.

The frequency of nightmares was recorded by the client before and during treatment, and at one and six months follow-up. Nightmare problem and target scales, and treatment expectation were recorded at the end of each period. Treatment was by rehearsal relief, self-administered using written instructions.

A reduction in nightmare frequency from 5.5 per week in the baseline period to an average of one per week resulted after treatment.

The client's chronic nightmares were lastingly relieved after self-administered exposure treatment. A controlled trial is underway.

This study assessed the long-term effects of family intervention on schizophrenic relapse.

Forty schizophrenic patients who had participated in a family intervention trial and who had not experienced relapse at two years after discharge from the index admission were traced through case notes and hospital records. The percentage of patients experiencing a relapse was estimated for patients in the family intervention group, the high-EE control group, and the low-EE control group, at five years and eight years after discharge.

There were significantly fewer relapses in the family intervention group than in the high-EE control group at both five years and eight years. The number of relapses in the low-EE control group was lower than in the high-EE control group, but this just failed to reach significance.

The benefit of family intervention and the predictive power of EE are sustained over eight years. Expressed emotion (EE) has remained a remarkably robust predictor of relapse in schizophrenia. Kavanagh (1992) cited 20 out of 23 prospective studies that showed patients who returned to live with high-EE relatives had higher relapse rates over 9–12 months after discharge than did patients returning to live with low-EE relatives. Seventeen of these studies reported this difference to be significant.

British Journal of Psychiatry (1994), 165, 829–832

We investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.

Elderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.

DSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1 %. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.

Depression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.

The roofless have not been previously surveyed in detail looking specifically at their psychiatric status.

All roofless people in a discrete area were interviewed in their ‘skippers’ using a semi-structured interview. Other roofless people helped in case finding and diagnostic validity was confirmed using a computerised case register.

Sixty-five people were interviewed. High rates of substance abuse (n = 48, 75%), and very low rates of psychotic illness (n = 2, 3%) were found. High rates of serious physical morbidity, of imprisonment and of being the victim of a crime were found.

The roofless have multiple severe medical, social, and psychiatric problems. These all must be addressed when considering the provision of services.

Amok is reviewed from a historical standpoint, tracing how it has changed from the Hindu states of India where it was a war tactic to the sudden incomprehensible violence and mass murder by a single individual associated with the syndrome today.

A typical amok attack is described and the criteria for amok discussed. Amok in Malaysia, New Guinea, Laos, North America and other countries are presented. The possible motives for such violent killings and a possible psychiatric diagnosis in relation to contemporary diagnostic criteria is discussed.

Classification of amok remains unresolved. The reason for its frequency in and around Malaysia remains unknown.

British Journal of Psychiatry (1994), 165, 685–689

3,4-methylenedioxymethamphetamine (MDMA or ‘Ecstasy’) has become one of the most widely used illicit substances in the UK. Little is known of the psychiatric morbidity which may be associated with its use. We have examined this association by collecting a series of psychiatric cases in which MDMA use was a prominent feature.

Patients presenting between 1990 and 1992 with psychiatric symptoms which developed in the context of MDMA use (n = 13) were interviewed, and their psychiatric, medical and drug history, sociodemographic background and mental state were examined in detail. The psychopathology of cases with psychosis (n = 8) was assessed with the Present State Examination and compared with that of substance-naïve psychotic controls (n = 40).

Eight patients presented with psychotic syndromes, two experienced visual illusions, hallucinations and palinopsia, one had panic attacks, one suffered from depression, and one described chronic depersonalisation and derealisation. The psychopathology of the patients with psychoses was very similar to that of controls.

Use of MDMA may be associated with a broader spectrum of psychiatric morbidity than heretofore suspected. Cases with psychosis may be clinically similar to psychotic patients with no history of substance use.

The aim was to identify the amount of psychiatric and physical morbidity identified in suicide victims prior to death.

A survey was made of primary care records of Scottish suicide victims in the years 1988 and 1989.

Less morbidity was encountered than in previous studies. Single persons and persons from lower socio-economic groups were less likely to have a diagnosis of depression. No association was found between physical and psychiatric morbidity. Depressed single persons and depressed persons from lower socio-economic groups were less likely to receive antidepressants. GPs prescribed lower dosages of antidepressants than psychiatrists. Patients receiving antidepressants were more likely to die by drug overdose.

There are groups in whom depression may be being overlooked and others in whom depression could be treated more vigorously. There are risks in prescribing antidepressants which are potentially fatal in overdose.