Identification of 5-HT receptor subtypes — 5-HT1A, 5-HT1B, 5-HT1c, 5-HT1D, 5-HT2 (possibly A and B), 5-HT3 subtypes, and possibly 5-HT4 — has encouraged the manufacture of 5-HT receptor inhibitors with greater subtype specificity. However, it appears that the receptors interact, and drugs initially thought to be specific may have multiple actions. For some conditions such as anxiety/depression, almost all receptors are implicated. Clinical studies provide clear evidence that manipulation of the 5-HT system has a role in treating depression, anxiety, obsessional illness, migraine, and eating disorders. Interactions between the various receptor subtypes make it difficult to identify specific clinical functions. The 5-HT1A receptors may be involved in aggression, anorexia, and hypotension. The 5-HT1B receptors may be involved in aggression, while the 5-HT1C receptors may play a role in central aversion systems and anxiety/depression. The role of the 5-HT1D receptors remains speculative; 5-HT2 receptors appear to be involved in depression, anxiety, appetite, sleep, vasoconstriction, and hypertension. Many drugs that are effective in treating migraine are potent 5-HT2 antagonists. 5-HT3 antagonists at high doses are effective in treating nausea and at low doses in treating anxiety. Treatment of aggression, suicidal behaviour, addiction behaviour, memory impairment, dementia, and schizophrenia with 5-HT inhibitors requires further testing.

The prevalence and significance of physical diseases, and health-care-seeking behaviour, were examined in a sample of 218 chronic psychiatric patients from an urban community psychiatric unit. Only 14% declined medical screening. Of the respondents, 53% had one or more probable or certain physical diseases warranting further medical attention. The majority of the diseases found were minor and typical of primary care problems. A severe (i.e. life-threatening) disease was present in 7% of respondents. Of the patients, 87% visited their GP at least once a year. The implications are that frequent consultation with primary care specialists and health-care-seeking behaviour should be noted, and included in any evaluation of the medical needs of chronic patients in community psychiatric care.

The prevalence of Huntington's chorea in Grampian region is high at 9.94 per 100 000. The 46 individuals (26 female, 20 male) were ascertained from 98 pedigrees. Difficulties in ascertainment, family studies, sex ratio and use of resources are discussed.

The admission records of 271 long-stay chronic schizophrenic patients, resident in a large psychiatric hospital, were examined in order to identify those who had presented in stupor at the onset of their illness. Twelve patients were found (ten men and two women). When compared, in terms of current mental state and behaviour, with a similar sample of schizophrenics in whom stupor had been absent, significant differences between the two groups were detected, with those presenting in stupor demonstrating a less favourable outcome.

Current interest in vulnerability to schizophrenia has been stimulated mainly by the work of Zubin and associates (Zubin & Spring, 1977; Zubin & Steinhauer, 1981). Figure 1, which was first published by Zubin & Spring in 1977, illustrates the basic idea common to every diathesis-stress model: The outbreak of a psychotic episode cannot be explained solely by referring to environmental events: a susceptibility of the individual has also to be taken into account. Ways to identify vulnerable individuals were discussed by Zubin & Steinhauer (1981), who introduced the important distinction between trait as opposed to episode markers. Only stable characteristics relate to vulnerability.

Three current techniques for estimating body size (Image Marking, Visual Size Estimation, and Distorting Video techniques) were compared. Anorexia nervosa and bulimic patients and normal control subjects were required to make size judgements of the way they ‘knew’ they looked, the way they ‘felt’ they looked, and of the width of an inanimate control object. Results from the three techniques were not the same, thus implying that research findings can no longer be cross-compared. Moreover, while all subjects were similar in the accuracy of their estimation of a control object, anorexia nervosa and bulimic patients overestimated their own body size significantly more than normal controls. This difference was even more marked when affective instructions were compared.

The efficacy of antidepressants for panic disorders has had major effects on our understanding of the classification, pathophysiology, and treatment of anxiety disorders. Psychiatric practice has also been significantly affected, but important issues remain unresolved, such as the mechanisms of therapeutic effect, optimal duration of therapy to minimise relapse, and the interaction and sequencing of medication with cognitive behavioural treatments.

It has become customary to classify the typical abnormalities of the mental state of schizophrenic patients into positive and negative features, with reference to behavioural excesses and deficits. Positive features are pathological by their presence and negative features represent the loss of some normal function. Positive features are generally considered to include delusions, hallucinations and positive formal thought disorder (Fish, 1962). Some studies (e.g. Johnstone et al, 1978) have also included incongruity of affect under this heading. Negative features include affective flattening, poverty of speech, retardation, apathy, lack of sociability. There is some evidence that the clinical correlates of positive and negative features may not be the same (Owens & Johnstone, 1980). Some workers (Andreasen & Olsen, 1982) but not others (Pogue-Geile & Harrow, 1984) have found that among schizophrenic patients positive and negative symptoms were negatively correlated. Although the nature of the relationship between positive and negative features is not entirely established and may not be simple (Wing, 1978) certain generalisations may be applied:

1. (a) Positive features are characteristic of earlier and negative of later phases of the illness (Pfohl & Winokur, 1982).

2. (b) The effects of drugs upon positive features are greater than those upon negative features. Thus neuroleptics produce more marked improvement (Johnstone et al, 1978; Angrist et al, 1980) and amphetamine more marked exacerbation (Angrist et al, 1980) of positive than of negative features.

3. (c) Positive features have been said to be relatively variable and negative features relatively stable (Ovchinnikov, 1968; Snezhnevsky, 1968).

The total population of 15-year-olds in Göteborg, Sweden, were screened in 1985 for anorexia nervosa using brief questionnaires, growth charts and individual school nurse reports. An accumulated frequency of anorexia of 0.84% for girls up to and including 15 years of age was obtained, with 85% of the cases fulfilling DSM–III–R criteria. Boys were affected just over one-tenth as often as girls. The frequency of anorexia nervosa appeared to be much higher in private than in comprehensive schools. The peak age of onset seemed to be 14 years.

A longitudinal investigation of psychiatric epidemiology in a general population (the Stirling County study) has indicated that the incidence of depression and anxiety disorders is low relative to prevalence, because these disorders have long durations. In an average year approximately nine adults among 1000 experience a first-ever episode of one of these disorders. Incident cases over the course of a 16-year follow-up were more likely to have had premonitory symptoms than to have been asymptomatic at the beginning of the study. Among the relatively small number of people who exhibited the clearest prodromal manifestations, incidence was 20 per 1000 annually. It might be possible to intervene before such disorders become fully formed and persistent if the precursors are given attention.

A survey of laboratory investigations in the management of 1007 non-geriatric admissions to a district general hospital adult psychiatric unit showed a wide variation in the number of tests performed, and in the abnormal proportion between test types. Despite a policy of screening on admission, 40% of admissions had no tests. Physical illness attributable to mental illness was common, but rarely serious and usually apparent clinically. Mental illness attributable to physical illness detected by laboratory tests was rare: five cases of thyroid disease in women with affective disorder, and two cases of chest infection with raised white cell count in sustained mania. The findings show that tests are frequently used in circumstances where the result is of no apparent value. Test use might be improved by restricting screening to thyroid function and laboratory urine analysis, each in women. There are particular indications for white cell count in sustained or unexplained relapse of mental illness, and for syphilis serology when disinhibition may have exposed the patient to infection.

The efficacy of lithium prophylaxis in bipolar affective disorder in clinical practice was investigated. Comparison was made between 41 patients who were prescribed prophylactic lithium after two admissions in two years or three admissions in five years and a group of patients who did not receive lithium. The benefits conferred by the prescription of this drug were modest compared with the results from clinical trials.

The studies reported had two purposes: (a) to identify psychological symptoms commonly experienced by mothers in the first few days after childbirth; (b) to use psychometric methods to develop a questionnaire for detecting and measuring these symptoms. A draft 49-item questionnaire was derived by asking 100 newly delivered mothers to volunteer suitable items. The number of items was systematically reduced to 28 while testing the questionnaire on two further samples of newly delivered mothers (n = 100 and n = 50). Cluster analysis of the 28 items yielded seven clusters, the robustness of which was established in a further sample of 87 newly delivered mothers. The validity of the 28-item questionnaire was established. The questionnaire was quick and easy to administer, suitable for repeated administration on consecutive days, and well accepted by mothers.

The Manchester Scale (Krawiecka et al, 1977) was developed as a short, easy to administer instrument, sensitive to change, for screening patients with chronic psychosis.

Five patients with trisomy 21 (Down's syndrome (DS)), referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in DS, and suggest that electroconvulsive therapy is an effective treatment for major depression in DS.

Data from a cross-sectional community survey of 2852 children were used to provide estimates of the prevalence of a ‘DSM–III-like’ major depressive syndrome in children aged 6 to 16. The severity of symptoms required to define a ‘case’ was varied to generate three levels of diagnostic certainty (DC). The overall estimates of prevalence made with high DC were 0.6% for pre-adolescents and 1.8% for adolescents. Corresponding rates determined with medium DC were 2.7% and 7.8%, whereas the figures for low DC were 17.5% and 43.9%. Utilisation of mental health and social services, comorbidity (combined disorders), poor school performance, problems in getting along with others and need for professional help all increased as diagnostic certainty increased. There was wide disagreement in data supplied by the different groups of respondents, i.e. parents, teachers and adolescents.

Administration of moclobemide – a relatively short-acting, reversible inhibitor of monoamine oxidase-A (MAO-A) – to experimental animals potentiates the pressor responses to intravenously injected tyramine, but such effects are moderate, short-lived, and much less apparent when the tyramine is given orally. The ability of moclobemide to potentiate the pharmacological actions of amine substrates for MAO-A in in vitro preparations is very weak, unless the drug is ‘activated’ by prior incubation with the tissues. However, animal experiments, both in vitro and in vivo, can give realistic indications not only of the mode of action of inhibitors of MAO and any toxicity, but also, in the case of MAO inhibitors, of the chance of potentially life-threatening hypertensive crises following inadvertent ingestion of amine-containing food or medicaments. Animal tests may also reveal any influence MAOIs have on amines released from non-neuronal stores.

The presence of non-psychotic neurotic and dysphoric symptoms in schizophrenia has been recognised from the days of Bleuler (1908) and Kraepelin (1896) and is inherent in the hierarchical schema explicated by Foulds (1976) and commonly employed by psychiatrists in the diagnosis of psychotic disorder. Of such symptoms, those which may be characterised as depressive in nature have been the focus of much recent interest in view of claims that they may be iatrogenic. That such symptoms occur widely in schizophrenia is beyond dispute, but their relationship to the process of the illness and its treatment remains a subject of contention.

During transcutaneous PCO2 (PtcCO2) monitoring of 15 freely ambulant patients suffering from panic attacks, all the patients experienced a typical attack. Seven were identified as hyperventilators, as PtcCO2 fell to abnormally low levels during the attack. This group could not be distinguished on the basis of either their usual symptoms of panic or the hyperventilation provocation test. There was no apparent association between absolute levels of PCO2 and the nature of symptoms. The anxiety ratings of hyperventilators were lower than those of non-hyperventilators. These data do not support the hypothesis that hyperventilation causes panic attacks or contributes to their severity. Hyperventilation may be better understood as a consequence of panic.