The terms positive and negative symptoms have slipped into the language of contemporary psychiatry with comparative ease. It is not uncommon for these expressions to be used with little explanation, both at meeting and in written communications, with the implicit understanding that their meaning is understood and that somehow they are of value to our knowledge of psychopathology. However, that there are no clear guide-lines at present for our use of these terms is shown from a recent survey of psychiatrists' opinions from a market research company (Martin Hamblin Research-Personal Communication). As part of a series of questions asked to many psychiatrists of differing age, geographical location, and status, they were asked about the meaning of these terms, positive and negative symptoms and the proportion of schizophrenic patients having them. Of the categories quoted by Crow (1980–81) as positive symptoms, 68% considered that delusions were positive symptoms, 63% hallucinations, and only 35% thought disorder. In contrast, 18% thought that behaviour disturbance was a positive symptom, a similar figure (15%) being given for passivity feelings. Considerable variation was noted, however, with hallucinations being considered positive by only 33% of London psychiatrists, thought disorder by only 11% of those qualified 16–25 years, and one-quarter of all registrars and psychiatrists from Midland Health Districts considered passivity feelings to fall into this category. Even greater disagreement was recorded for negative symptoms. Thus, the symptom most often associated with this category was apathy, by 52% of respondents. Only 26% considered that withdrawal was a negative symptom, the percentage data for lack of motivation and blunting of affect being 37% and 15% respectively.

Thirty-six acute schizophrenics were randomly assigned to dextro (d)-propranolol or placebo in a double blind trial lasting four weeks. All patients had a fixed dose of haloperidol during the first week, which resulted in an initial improvement in both groups. Thereafter, a deterioration towards base-line was seen. Six patients on placebo, but none on propranolol were treatment failures at the end of three weeks (P < 0.001). Comparison of change in scores from week 2 to 4 showed significantly greater deterioration in the placebo group; d-propranolol thus had a better effect than placebo in sustaining the initial improvement with haloperidol. The overall magnitude of clinical change from pre-treatment scores is small, the majority of the patients showing little or no overall improvement. It is concluded that d-propranolol has a detectable therapeutic effect, which by inference must have a novel pharmacological basis, but this is not as potent as standard neuroleptics.

Body image disturbances in anorexia nervosa patients have been assessed in an experimental study which dealt with the following issues: (1) Three different procedures for the assessment of body image disturbances were compared in a discriminant function analysis: (a) a Video Monitor Procedure, (b) the Movable Caliper Procedure and (c) the Image Marking Procedure. The Image Marking Procedure showed the best discrimination between groups. (2) Anorexia nervosa patients showed a statistically significant over-estimation as compared to the control group in the variables ‘waist’, ‘upper thigh’ and the compound measure ‘soft body parts', while they did not overestimate control variables (Kruskal-Wallis-Rank-Analysis of Variance). (3) A standard liquid meal of 240 Kal. had no statistically significant influence on the estimation of body width, irrespective of the amount of calories consumed and instruction given. Possibilities and limitations of various measurement procedures are discussed.

The characteristics of Asian patients admitted to a Birmingham hospital following deliberate self-poisoning were compared with those of British-born white self-poisoners. Asian patients were more likely to be young, female, and married. They were less likely to have previously self-poisoned, received previous psychiatric treatment, be diagnosed psychiatrically ill, or suffer from a personality disorder. Culture conflict was common among the Asian patients and was present in the majority of unmarried Asian females. The rate of self-poisoning for Asian females was higher than for white females, but for Asian males was lower than for white males.

The historical and conceptual aspects of the pseudodementia state are briefly touched upon. A “collective sample”, composed of 61 cases culled from the literature, is analysed and compared with the “Fulbourn sample” consisting of 22 cases reported for the first time. Two sub-types of pseudodementia emerge, one associated with depressive illness and the other with delirium. A follow-up of the Fulbourn sample (1–4 years after discharge) showed 14 patients to be alive and 8 to show no signs of dementia. No variable except the diagnosis “non-specific psychosis” correlated with death during the follow-up period.

Appetite, weight, and preference for carbohydrate-containing food were followed in patients treated in double-blind trials of seven antidepressant regimes. Trimipramine and isocarboxazid combined had a significant effect in increasing appetite, carbohydrate preference, and weight; in patients who had lost appetite at presentation and were on this treatment, improvement in Hamilton score was linked to increase in weight–a finding not true of the other treatments.

The effects of apomorphine, a stimulant of dopamine autoreceptors, were studied in 12 chronic schizophrenics on neuroleptic treatment; both subcutaneous and intravenous administration were used. Apomorphine has been reported to have therapeutic effects in previous studies but, we were not able to confirm any significant and specific differences in psychotic symptoms or tardive dyskinesia scores with apomorphine administration, compared with placebo. These results do not support the importance of dopamine autoreceptors in the regulation of schizophrenic and dyskinetic symptoms in chronic neuroleptic-treated patients.

Do women drink excessively for the same reasons as men? A growing body of opinion suggests not. Beckman's (1975) views are representative— “Alcoholism and heavy drinking in women appear more likely to be linked to psychological stress and a specific precipitating circumstance or situation than is alcoholism or heavy drinking in men”.

Benzodiazepine withdrawal has been found to give rise to numerous physical and psychological symptoms. This paper describes, for the first time, Schneiderian first-rank symptoms of schizophrenia caused by such withdrawal.

A case-report is presented of folie simultanée in a pair of female monozygotic twins with onset at the remarkable age of 81. The twins demonstrated no evidence of dementia or other psychopathology apart from delusions. Folie simultanée in monozygotic twins provides a model example of the potential role of genotype-environment correlation in the etiology of psychiatric illness.

The nature of causal explanation remains a conceptual difficulty for psychiatric research. Most research workers and clinicians can describe their processes of causal inference with reference to some empirical example close at hand. Yet such demonstrations are themselves based on more fundamental abstract models that are themselves left unstated. Psychiatric classificatory schemata presently used in research possess unwritten, underlying assumptions regarding causality, and these assumptions need examination.

Many experimental findings suggest that disturbances of noradrenergic neurons in the CNS are involved in the pathogenesis of depressive disorders. Moreover, evidence indicates that adaptive changes of central noradrenergic neurons contribute to the biochemical mechanism of action of most anti-depressive treatments (Goodwin, 1984; Johnstone, 1982). Accordingly, assessing the activity of central noradrenergic neurons in depressive patients has become important in psychiatric research.

A case of 49, XXXYY chromosome anomaly in an adult male is reported. Features of Klinefelter's syndrome are predominant among the clinical findings. Characteristics suggestive of acromegaly have been associated with this chromosomal anomaly. Despite prognathism and an overhanging brow, acromegaly was not present in this case. Psychological traits sometimes reported in males with the XXY and XYY karyotypes were seen in this patient, but the variability of expression of these characteristics calls into question the validity of their correlation with the presence of supernumerary sex chromosomes.

Professor Rothman's book made a profound impression on me when I first read it. More to the point, perhaps, was the impression it made on his peers. The American Historical Association awarded it the Albert J. Beveridge prize for the best English language book published in American History. It is a beautifully written account of an exciting and ultimately tragic episode in American history: the attempt to use the institution as a means of reforming bad habits and curing mental illness.

Clovoxamine, an inhibitor of neuronal uptake of both serotin and noradrenaline, was compared with doxepin in depressed patients over four weeks. Antidepressant efficacy was comparable for both drugs, but clovoxamine might have a special degree of efficacy for patients with more severe depressive illnesses.