Seventy-one neurotic patients requiring follow-up were randomly assigned to routine psychiatric out-patient care or to supportive home visiting from community psychiatric nurses as their main treatment agents and were assessed every six months for 18 months. No differences were found between effectiveness of the two modes of service on symptoms, social adjustment or family burden. Patients seeing community psychiatric nurses reported greater satisfaction with treatment. Community psychiatric nursing resulted in a marked reduction in out-patient contacts with psychiatrists and other staff, more discharges, and a small increase in general practitioner contact for prescribing. Care of such patients by community psychiatric nurses is a valuable alternative mode of deployment within the psychiatric team.

Measures of depression and obsessionality were made in patients with dysmorphophobia, psoriasis and control subjects. The depression score distinguished all three groups. Patients with dysmorphophobia had significantly higher scores compared to the patients with psoriasis, who in turn had significantly higher scores compared to a control group. Patients with dysmorphophobia and psoriasis had equally elevated obsessional symptom scores compared to controls. It is unlikely, therefore, that dysmorphophobic symptoms are due to an obsessional state. Depression, however, was found to be an important clinical feature of dysmorphophobia.

One thousand and five patients referred to a psychiatrist were questioned, during a routine clinical interview, about current and previous suicidal ideas and previous suicide behaviour; they were also specifically asked what made life worth living for them at that time. In a four-year case-record follow-up 102 patients (10.1 per cent) were found subsequently to have attempted deliberately to harm themselves. Such deliberate self-harm (DSH) was significantly associated with female sex, with age below 35, and with evidence of suicidal ideation and/or behaviour at the time of and/or before the initial referral. To the question, “What makes life worth living for you at the present time?” a significant number of subsequent self-harmers had answered ‘Nothing’ or ‘Not much’ while a significant number of subsequent non-self-harmers had answered “Spouse and children” or “Family”.

The results suggest that the answers to questions about current and previous suicidal ideas and behaviour and perceptions of what makes life worth living may be useful in the prediction of deliberate self-harm.

The study concerns 46 children who had set at least one fire and had been admitted to a psychiatric ward. Their firesetting behaviour has been related to variables such as age, IQ, and psychiatric disorder in parents, and to the distinction between children who present with firesetting as their chief problem and those in whom it is a secondary complaint. Thirty subjects were followed up after one to five years. Seven, all boys and all less than 13 years old, were still setting fires, but these were less serious than the ones set before treatment. The persistent firesetters may have come from less stable homes and they tended to be more antisocial at follow-up than children who no longer set fires.

Data on the families of 74 probands with autopsy-proven Alzheimer's disease did not support the hypothesis, advanced by Heston and co-workers, of a familial association between Alzheimer's disease, Down's syndrome and immunoproliferative disorders. However, there are difficulties of interpreting negative conclusions in this type of study, particularly those resulting from small sample size and the impossibility of tracing all relatives; only the data for immunoproliferative disorders are incompatible with the hypothesis, those for Down's syndrome being too few to be informative. The incidence of presenile dementia among the first-degree relatives of probands was raised, as in many previous studies, and was consistent with a simple polygenic model. The mean parental age at birth of the probands was significantly raised by about 2 years (P = 0.01), but so also was that of their unaffected sibs, suggesting that the mechanism differs from that occurring in trisomy 21 and certain other aneuploidies.

Twenty-six male compulsive gamblers were seen in one hospital over the last 8 years. Five were single, and only 5 had stable marriages. In most cases the compulsive gambling preceded their marriage. The majority had criminal records arising out of their gambling debts. All were offered treatment based on behavioural principles, but only 5 gained and maintained control over their gambling, 7 lapsed intermittently, and the remaining 14 were gambling when last seen. The problems in treatment are discussed, and modifications suggested.

A double blind trial on the effects of 2 mg of benzhexol on memory was performed on thirteen elderly subjects without cognitive impairment. The tests given 90 minutes after the drug or placebo involved learning a list of ten words, a paired-associate learning task, learning a short story and a test of digit span. Subjects were asked to recall the word list one minute after an interfering task, and 6 items from the story directly. Digit span involved immediate recall and the paired learning was measured by the number of trials necessary to learn. All tests were significantly impaired by the benzhexol except for digit span. This suggests that muscarinic blocking drugs should be avoided in the elderly, as they mimic the memory deficits found in senile dementia of Alzheimer type.

This is a one-year prospective study of one hundred and five 2 to 17 year old children of a consecutive sample of young widows and widowers in the community and of the children of controls. The children's reactions to the parental death were recorded at one month and thirteen months after the event in a structured interview with the surviving parent. The interview included items of general adaption to the death, school performance, behaviour problems, symptoms relevant to psychopathological manifestations (depression, anxiety, etc.) and general health. The results indicate a significant increase of dysphoria which disappears over time (P <0.0001), the persistance of a minor form of depression (P <0.03), an increase in bed wetting (P <0.03), and a significant degree of impairment in school performance (P <0.0001). There were no significant increases in behaviour problems and severe forms of depression. The children's general health was not affected. Those results are compared to currently available data on childhood bereavement and discussed in the light of conflicting reports relating parental loss to adult psychopathology.

A review of all known schizophrenics from a discrete geographical area, Nithsdale in Dumfries and Galloway Region, found a point prevalence of 2.38 per 1000 of the total population; this figure fell to 1.73 when only Feighner positive schizophrenics were considered. Only 3 per cent of the population interviewed had no abnormality in mental state or behaviour; negative schizophrenic symptoms were prominent positive symptoms uncommon. Approximately one quarter were in-patients, who were an atypical group, showing much more obvious social and psychiatric disability. In- and day patient care and state benefits for schizophrenics cost each member of the Nithsdale community approximately £12 a year.

Three of 39 first-admission schizophrenics committed suicide during the 10 to 15 year follow-up period of a retrospective, case-register based inquiry. Schizophrenic patients often talk about and attempt suicide. However, there is little reliable knowledge about the clinical characteristics of those who are likely to kill themselves.

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

The amount of intraneuronal lipofuscin in the parietal cortex and in the inferior olivary nucleus was measured in post-mortem tissue affected by Alzheimer dementia and in specimens from non-demented individuals. The results indicate that there is a linear relationship between the accumulation of cell body lipofuscin and advancing age, both in neuronal populations of the non-demented group, and in the olivary neurones of the demented group. However, in the demented group, the lipofuscin fluorescence intensity of the parietal neurones was not significantly correlated with age. The estimated amount of lipofuscin in the olivary neurones in the demented group was significantly higher than in the non-demented group, when age has been taken into account (P <0.01). The possible pathogenic role of lipofuscin accumulation in ageing and Alzheimer dementia is discussed.

In a review of all known schizophrenics (n = 133) from a discrete geographical area, Nithsdale in Dumfries and Galloway Region, 88 per cent were examined for evidence of tardive dyskinesia (TD) and parkinsonism. The prevalence of both TD and parkinsonism was 31 per cent. The TD group was older and more often showed negative schizophrenic symptoms than the non-TD group. The trend was towards a higher prevalence among in-patients and Feighner positive schizophrenics. Parkinsonism was common in patients receiving antiparkinsonian drugs. Ten per cent of patients had both TD and parkinsonism. The findings will act as a baseline for regular reassessment of the population.

One hundred elderly patients with chronic organic brain syndromes were assessed by standard interviews, nursing ratings and from historical information. The data were subjected to cluster analysis and eight clusters were isolated. The significance of these clusters is discussed and other features of the patients reviewed.

Trihexyphenidyl (benzhexol, Artane) is an anticholinergic drug widely used among the psychiatric population in order to control extrapyramidal symptoms from the use of anti-psychotic drugs. In addition to the many well-known somatic and psychiatric side effects caused by the drug (Shader and Greenblatt, 1971), including toxic psychosis, trihexyphenidyl has been reported as causing a euphoriant effect (Bolin, 1960; Jellinek, 1977; Parker, 1978; Rubinstein, 1978; Shader and Greenblatt, 1971; Goggin and Solomon, 1979). Benztropine and biperiden are known to have caused similar phenomena (Jellinek, 1977; Stephens, 1967). Trihexyphenidyl is known as an hallucinogenic agent amongst thrill-seeking adolescents (Rouchell and Dixon, 1977) and among prisoners in the US who abuse the drug either orally or by smoking it as a powder mixed with tobacco (Woody and O'Brien, 1974).

This research assessed the rate of affective disorder in 124 mothers of preschool children, which was found to be lower than in earlier studies, i.e. twelve per cent during the child-rearing years, and eight per cent in the year before interview. In half of those mothers who had an affective episode during the child-rearing years, its onset had predated the birth of the first child. We investigated sociodemographic and social support variables in relation to clinical and subclinical disturbance and found only modest associations.

The apparent discrepancy between the present findings and those of previous research is discussed in relation to environmental and methodological factors.

A double-blind controlled trial of phenelzine, amitriptyline and placebo was carried out in out-patients suffering from depression or mixed anxiety and depression. After six weeks treatment both active drugs were clearly superior to placebo and of similar efficacy; therapeutic effects started to appear at two weeks. Comparisons on symptom ratings showed that both drugs acted as true antidepressants, producing their greatest effects on ratings of depressive mood and thought content. There were additional weak differences, phenelzine producing more improvement on anxiety ratings, while amitriptyline gave greater effects on depressive impairment of work and interests and anergia. Analyses showed little evidence of clinical subgroups responding preferentially to either drug. The findings indicate that MAO inhibitors and tricyclic antidepressants have more closely similar clinical effects than has been thought and that either may be a useful treatment for these patients who are often considered to respond poorly to antidepressant drug treatment.

Medically ill patients diagnosed at index admission as delirious, i.e., suffering cognitive decline and an altered state of consciousness, had higher fatality rates than demented, cognitively intact or depressed patients. At a one-year follow-up the death rate of those who had been delirious was still higher than that of demented patients. Delirious patients were more likely to have a diffusely slow EEG, tachycardia and hyperthermia and lower mean systolic and diastolic blood pressure. These results validate the distinction between delirium and dementia and the importance of alteration of consciousness as a defining characteristic of delirium.

The high incidence of psychiatric disorder in parents of disturbed children is usually explained in reactive terms implying a relationship in time. The records of children attending a child psychiatric service and the psychiatric records of their parents were examined and the time between episodes of illness in parent and child were calculated. Fathers' illnesses preceded those of their daughters, but in general, there was little evidence of any close relationship

Ninety-one undergraduates who had been referred to the Southampton University psychiatrist and matched controls who had not sought psychiatric help were followed up yearly for five years by questionnaire. The response rate for cases and controls was poor, but the difference in psychiatric morbidity was large. At least 26 of the patients subsequently consulted a doctor for emotional problems as against five of the controls; 17 of the patients were again referred to a psychiatrist but none of the controls. It is concluded that students who are referred to a psychiatrist during their University course have a much higher rate of psychiatric morbidity in the five years after they leave University than do students who have not been so referred.