Enema abuse is a pernicious disorder, not extensively reported in the psychiatric literature. It may occur as an isolated paraphilia, klismaphilia (Denko, 1973, 1976), or as a symptom reflecting more pervasive illness or abnormality of attitude (Engel, 1975; Greenberg-Englander and Levine, 1981). Our patient had been using enemata excessively for sixteen years and presented in a state of cachexia; she had both obsessive-compulsive and affective symptoms, both frequently found in association with anorexia nervosa (Snaith, 1981).

A case of procyclidine abuse is described in which the clinical presentation was indistinguishable from mania. The patient was a long-standing poly-drug abuser and was obtaining the drugs from medical sources. Controlled exposure on the ward to drugs of abuse, including a double-blind comparison with placebo, confirmed that procyclidine caused a manic response in this patient.

N-acetyl-β-glucosaminadase (NAG) is a renal enzyme which is an early, sensitive and reliable indicator of renal damage. NAG assays of midstream spot urines were not significantly different in a group of controls when compared to patients starting lithium for the first time, or to a group of patients who had been taking lithium for more than one year. However, a small number of lithium-treated patients may have evidence of renal damage, identifiable by NAG assay.

Within the past 15 years, it has become clear that the continuing administration of neuroleptics can produce several long term side effects, the two most important being tardive dyskinesia (TD) and skin pigmentation. In mental hospital surveys, the proportion of patients with TD has been described as about 30 to 40 per cent. At this point, there is no recognized treatment although some cases improve if the drug is discontinued (Jeste et al, 1979). In addition, TD may increase mortality (Mehta et al, 1978).

Over a six-month period, 142 referrals of patients aged over 65 to a community-orientated psychogeriatric service in North London were studied, and their progress followed for a further two years. The emphasis was on domiciliary management by initiating and supporting caring networks. More active involvement in the community by hospital staff is suggested.

Three patients suffering from major depressive disorder with melancholia and unresponsive to a three-week trial of adequate dosage of phenelzine, received lithium. Each responded within a five-day period. The similarity to lithium augmentation of tricyclic treatment is noted and discussed.

Schizophrenics show a deficit in a variety of verbal memory tasks, except recognition memory, and incidental learning when recall is preceded by an ‘orienting task’ which ensures effective encoding. These two exceptions provide experimental evidence for the currently prevailing theory that it is a defect in effective encoding which is responsible for the observed schizophrenic verbal memory deficit. The present review concludes that these two exceptions are probably artefacts of unmatched tasks, and cannot be used to support the theory.

Describing the occurrence of pseudocyesis and its treatment in a 15-year-old girl, Hardwick and Fitzpatrick (1981) pose the question whether there is any association between pseudocyesis and child stealing. They comment that such an association has not so far been reported. However, cases of presumed pseudocyesis have previously been noted among child stealers (d'Orbán, 1972; 1976; 1981) (based on patients' accounts which could not be verified) and three characteristic offence patterns were described:

This paper deals with an aspect of the law relating to the use of a mentally handicapped victim as a prosecution witness in a criminal trial. Here the particular question was of the victim's competence to act as a witness, and the likely reliability, or otherwise of her evidence. The results of psychological testing were found to provide guidelines by which the court could distinguish between areas of the reliable and the unreliable in her evidence.

Much of the psychiatric morbidity which presents to general practitioners remains hidden, especially when the patient offers somatic symptoms or is already suffering from an established illness (Goldberg and Blackwell, 1970). This failure to recognize patients who need psychiatric help stems largely from inadequacies in the practitioner's interviewing skills (Goldberg and Huxley, 1980). Deficiencies in the content of their consultations which correlate with low recognition include the failure to screen for the possibility of psychiatric symptoms and the absence of any questions about the patient's family. Interviewing skills associated with a high detection rate include the establishing and maintenance of good eye contact, clarification of the patients' presenting complaints, picking up verbal and non-verbal cues, using open questions, and the ability to control the course of the interview.

The Huli people of the Southern Highlands Province of Papua New Guinea mourn in culturally patterned ways that differ for men and women. One difference is that women are expected to express their emotions, while men are discouraged from doing so. In this study the mortality of bereaved spouses was determined by following 100 widowers and 208 widows for four years following their bereavements. Widowers showed an excess mortality in the first year following bereavement while widows showed no such tendency. The possible relationship between these findings and Huli mourning practices is discussed.

Established social ritual and practice such as exist to help one cope with illness or death are not available for coping with the experience of one's child being accused of murder.

A feeling of ‘presence’ is a common but relatively neglected phenomenon. The psychopathology, definition and six clinical associations are discussed. Two case histories are presented to demonstrate the induction of anwesenheit by serotonergic and dopaminergic drugs.

In 107 patients on long-term lithium, those with lower plasma folate concentration had a higher affective morbidity than those with higher folate, both at the time and during the previous two years. The association was not the result of weight change or the concomitant use of other drugs. Animal work reporting a decreased synthesis of 5-HT both in folate-deficient animals and in animals fed excessive amounts of folate suggests that it may be important for lithium patients to receive folate supplements to their diet for maximum therapeutic effect.

Some two hundred psychiatrists from all corners of the globe were gathered together in April for a week in Copenhagen, under the auspices of the World Health Organisation and the Alcohol, Drug Abuse and Mental Health Administration of the National Institutes of Health of the United States Government (ADAMHA). This meeting was the culmination of a programme of several years preparatory work by representatives of these two organisations, which had its origins in an initiative during Dr Gerald Klerman's period as administrator of ADAMHA. The stated objectives of both the preparatory work and the conference itself were to review the current state of work in classification and diagnosis of mental disorders, to identify gaps in present knowledge, and to define priorities for future collaborative research. Implicit in this programme of work is a realisation that there are many fundamental aspects of diagnosis in psychiatry that can only be studied fruitfully by international collaborative studies. Acceptance of this principle is, in itself, a sign of the progress that has taken place in this field in the last 15 years or so.

Of the 1863 women who first gained a registrable qualification from a UK medical school during 1949 to 1951 (early cohort) and in 1965 (late cohort) and believed to be living on 1st October 1977, 74 per cent responded to a postal questionnaire. It was found that 9 per cent of these were not in current practice, and of the remainder, 9 per cent (111) were practising psychiatry. Their participation in medicine was as high or higher than their contemporaries in other branches of medicine. A higher but non-significant proportion (57 per cent) had achieved career posts than other practitioners (54 per cent). Psychiatry was the tenth (early) and sixth (late) most popular choice of specialty on graduation. Psychiatrists resembled other hospital practitioners but not non-hospital practitioners in citing interest, liking, or aptitude as their reason for choosing their current specialty. Of the practising psychiatrists, 37 per cent held the diploma of membership of the Royal College of Psychiatrists; these were engaged in more sessions per week and more often held career posts than the remainder.

It is well recognized that bouts of uncontrolled and excessive eating (binges) occur in both a small proportion of patients who are overweight and in about 50 per cent of patients with anorexia nervosa. However, it has only recently been appreciated that many people who fall into neither category also have an eating disorder which is principally characterized by episodes of binge-eating. These people experience a profound and distressing loss of control over eating which results in a grossly disturbed eating pattern. Despite this, their body weight tends to lie within the normal range. The disorder has attracted various names including ‘the dietary chaos syndrome’ (Palmer, 1979), ‘the abnormal normal weight control syndrome’ (Crisp, 1979), ‘bulimia nervosa’ (Russell, 1979), and simply ‘bulimia’ (DSM III, 1980). The term bulimia nervosa is probably the most satisfactory since it conveys the links with anorexia nervosa and emphasises the central role of binge-eating. Russell (1979) proposed the following diagnostic criteria for this syndrome:

The CT scans of 11 schizophrenics and 26 controls were evaluated for both linear (Evan's and cella media ratios) and volume (planimetry and grid ratios) measurements of ventricular size. There were no differences between the two groups on any of the measures obtained. These results are discussed in relation to previous reports showing ventricular enlargement in schizophrenics. The relatively younger age and briefer period of hospitalization in this present sample are suggested as variables possibly associated with these findings.