A susceptibility locus for schizophrenia in the ‘pseudo-autosomal’ region has been proposed on the basis of the reported excess of sex-chromosome aneuploidies (e.g. XXY and XXX) among patients with schizophrenia and the finding that schizophrenic sib-pairs are more often of the same than of the opposite sex. This hypothesis has been tested in 83 sibships with two or more siblings fulfilling Research Diagnostic Criteria for schizophrenia or schizoaffective disorder. Alleles at the pseudo-autosomal telomeric locus DXYS14, which is unlinked with sex, were analysed using the method of affected sib-pairs. Affected sibs shared alleles at DXYS14 more frequently than expected by random Mendelian assortment, supporting genetic linkage between DXYS14 and schizophrenia.

The hypothesis that the sociodemographic distribution of minor affective disorder can be explained by high-risk groups experiencing more psychosocial stress, defined in terms of life events and chronic difficulties, was tested. Linear logistic analysis of data from 275 subjects identified in a community psychiatric survey provided little support for this. Although high-risk groups uniformly experienced more psychosocial adversity, and adversity was strongly associated with disorder, this did not provide an adequate explanation for the increased risk of disorder. This must therefore be explained in other ways.

Reports of suicidal behaviour from four countries using the same measures were higher for girls than for boys, and higher in self-reports than in parent reports for both referred and normal adolescents. In a sample of 480 referred adolescents, patterns of ‘low’ and ‘high’ suicidal scores were different when age, sex and diagnosis were considered. The probability of high scores for girls showed only a marginal increase with age, while there was a striking rise for boys. An affective diagnosis doubled the probability of high scores for both boys and girls, while it had no effect on low scores. Psychosocial stressors also increased the probability of high suicidal scores, particularly in adolescents with an affective disorder. Sex differences in suicidal behaviour were marked in the low-scoring groups.

Using the Community Placement Questionnaire, the long-stay populations of five hospitals were surveyed. The results suggest that there is little need for large hospitals if adequate community provision is made. However, a small number of patients continue to accumulate for whom community placement is hard to envisage. Investigating the characteristics of the ‘new long-stay’ patients suggests that the usual definition should be extended to include those over 65 years old with no diagnosis of dementia and those in hospital for 1–10 years. About 20% of ‘new long-stay’ patients have organic diagnoses and the needs of this group require assessment.

Data from a two-stage survey of the general population were used to test the proposition that the over-representation of minor affective disorders among women was restricted to those who had had children, independently of current involvement in childcare. Initial analyses supported this proposition strongly. Subsequent linear logistic analyses were largely in favour of an effect of marriage rather than of parity, but it remains possible that part of the gender differences in rates of depression arises because of the effect of parity in raising female prevalence. If substantiated, the parity effect could operate through social or biological mechanisms; although its nature is unclear, it merits further investigation.

Most research into substance misuse has focused on men but the problem among women is considerable and the social consequences and causation differ between the sexes. In the US, one-third of alcohol abusers are women and in the UK 1% of women are estimated to be drinking at a dangerous level. Drug and alcohol misuse holds additional problems for women since abusers tend to be of childbearing age. Rehabilitation units and prevention strategies would benefit more women substance abusers if they were tailored to suit their specific needs.

The striatal D2 receptors of 19 untreated schizophrenics and 14 normal control subjects were investigated with PET and 76Br-bromolisuride. The ratio of radioactivity in the striatum to that in the cerebellum was taken as an index of the striatal D2 receptor density. There was no significant difference between the control and the schizophrenic groups, nor any difference between subgroups of patients defined by clinical type or course of illness, and no relationship between the striatum:cerebellum activity ratio and SANS or SAPS ratings of symptoms. Unlike in the controls, this ratio was not correlated with age in schizophrenics. This study suggests that there is no quantitative abnormality of striatal D2 dopamine receptors in schizophrenia.

The hypothesis that at least a subgroup of familial cases of schizophrenia could be due to a genetic defect on the X chromosome is supported by the observation of an excess of X-chromosome aneuploidies (XXX and XXY) among populations of patients with psychosis. The distal long arm, Xq27–q28, is a candidate region where linkage has been claimed to manic-depressive disorder and a fragile site has been associated with schizophrenia spectrum disorders. The present study excluded linkage to a large part of this region using four polymorphic probes and multipoint lod-score analysis in 10 families with multiple members with schizophrenia.

Forty-one patients with anorexia nervosa, admitted to the Maudsley Hospital between 1959 and 1966, were followed up after a mean of 20 years. An assessment of general outcome (based on the Morgan-Russell scales) yielded three outcome categories: ‘good’ (n = 12), ‘intermediate’ (n = 13) and ‘poor’ (n = 15). Six patients (15%) had died from causes related to anorexia nervosa; at least 15% had developed bulimia nervosa. There was a general consistency between the follow-up at 20 years and that previously conducted five years after admission, although with a few individual patients there were serious prognostic errors at the earlier follow-up. A poorer outcome was associated with a later age of onset, a history of neurotic and personality disturbances, disturbed relationships in the family and a longer duration of illness.

This article reviews eight published studies that describe clozapine's effects on TD and examines the outcome of 30 patients with TD treated with clozapine for up to 36 months. These data indicate that TD response to clozapine is variable but that approximately 43% of cases, particularly those with dystonic features, improved after clozapine treatment. Methodological limitations of the studies described, however, preclude definitive conclusions, which must await appropriately controlled trials.

A videotape lecture and written hand-out containing factual information about lithium were given to 30 attenders at a lithium clinic. A further 30 patients acted as a control group and were not given the programme until later in the study. The educational programme resulted in substantial and significant increases in patient knowledge about lithium, such that knowledge increased from a baseline comparable with that of social workers to a level similar to that of community psychiatric nurses. Patients' attitudes to lithium also became more favourable after education.

The effects of physostigmine on patterns of rCBF in patients with pre-senile Alzheimer's disease were studied using 99mTc-labelled HMPAO SPECT. Regional CBF increased in the left cortex relative to right, with the most significant effect in left frontal and higher frontal regions. Measures of regional brain function, such as SPECT, are an important complement to psychological test batteries in understanding the effects in brain of putative antidementia drugs. SPECT brain imaging could extend our understanding of the action of psychotropic drugs in other major psychiatric illnesses.

This is a preliminary report from a prospective study of the influence of psychosocial stressors on post-natal relapse in women at high risk of psychiatric disorder after childbirth. Forty-three index subjects with a previous history of psychosis or severe depression were compared with 45 pregnant control subjects without any previous psychiatric disorder. After delivery 51% of index subjects relapsed (RDC diagnoses): 28% were categorised as psychotic and 23% non-psychotic. All psychotic relapses were in women with a previous history of bipolar or schizoaffective disorder (46% of this subgroup). Only the non-psychotic post-partum relapses (mostly depressions) were associated with an increased likelihood of a severe life event in the 12 months preceding illness onset.

Recent reports of cytogenetic abnormalities linked to psychiatric illness and the localisations of the genes for the dopamine (D2) receptor and tyrosinase on the long arm of chromosome 11 have suggested that susceptibility loci for schizophrenia and manic depression might be situated in this region. We could find no evidence for linkage in five Icelandic pedigrees between manic depression and markers in this region, and we have excluded candidate genes coding for the D2 receptor and tyrosinase. We conclude that mutations at loci in this region are not a common cause of manic depression in the population studied.

The study was based on an index group of 49 mothers who had had depressive disorders in the post-natal year, and 49 control mothers who had been free from any psychiatric disorder since delivery. Nineteen months after childbirth, the interaction between mother and child was assessed by blind assessors using defined observational methods. Compared with controls, index mother-child pairs showed a reduced quality of interaction (e.g. mothers showed less facilitation of their children, children showed less affective sharing and less initial sociability with a stranger). Similar but reduced effects were seen in a subgroup of index mothers and children where the mother had recovered from depression by 19 months. Social and marital difficulties were associated with reduced quality of mother-child interaction.

In-patients referred to a deliberate self-harm team were asked to complete the HAD questionnaire and diagnoses were made using the SCID. The total prevalence of psychiatric disorder by DSM–III criteria was 54%. The HAD performed well as a screening instrument; a threshold score of eight gave a sensitivity of 88% and a positive predictive value of 80%; its use by non-psychiatrists to detect depressive disorder in patients presenting with deliberate self-harm is to be recommended.

Using a double-blind procedure, 68 patients with putative benzodiazepine dependence were randomly allocated to one of three groups given lorazepam (n = 22), diazepam (n = 23) or bromazepam (n = 23) in doses equivalent to those of the patients' original benzodiazepine. After four weeks the dosage was reduced in 25% quantities until no further benzodiazepines were taken. A total of 23 patients dropped out during the study, ten on lorazepam (one of whom committed suicide), seven on diazepam and six on bromazepam. There were few differences in withdrawal symptoms between the three groups but, despite the higher dropout rate, these symptoms were somewhat less marked in the lorazepam group. Withdrawal symptoms were greater in patients who had taken a benzodiazepine for > 5 years and were most marked in those with personality disorders, predominantly dependent ones.

Thirty elderly demented subjects were assessed in 1985 using a neuropsychological test battery which included tests of parietal lobe function that are allegedly predictive of outcome. Four years later, 29 out of the 30 subjects were followed up. Twelve had died. There were no differences between survivors and deceased in terms of age, pre-morbid intelligence, years of full-time education, or scores on parietal tests. However, proportionally more of the women had died, and those subjects with more global cognitive impairment in 1985 were significantly more likely to have died by 1989. Those who scored lower on an aphasia measure in 1985 were more likely to have died. None of the variables differentiated between survivors and deceased Alzheimer subjects.

Forty-six patients with recurrent affective disorders, who began prophylactic treatment with lithium an average of 20 years previously, were followed up prospectively after a ten-year observation period to assess renal function. Nineteen patients had maintained lithium therapy, and eight patients had died. Tubular function was almost unchanged and patients who had continued lithium had not shown increasing urine volumes, but patients who had received lithium in a single daily dosage at night had a significantly lower urinary output than those on a multiple-dosage schedule. The GFR decreased significantly, but the decline was essentially dependent on increasing age, except in two patients who had developed renal insufficiency. Renal function during chronic lithium treatment is related to age, lithium intoxication episodes, pre-existing renal disease, and treatment schedule rather than to duration of prophylactic lithium therapy.

Changes in relatives' affective attitudes are important contributors to the impact of family psychoeducational programmes on the course of schizophrenia. It remains unclear whether similar changes occur in the interactional style of schizophrenic patients participating in psychoeducational treatment. This study examined changes in the interactional style (coping style) of 33 schizophrenic patients in individual or family treatment. Significant changes were seen in the interactional style of the patients participating in the individual treatment. Similar changes were evident, but not significant, in the family treatment group. The quality of patient interactional style before or after treatment did not predict relapse in either group. Changes in relatives' interactional style early in family treatment are necessary to affect the short-term course of schizophrenia. Modification in patient behaviour during the early phase does not have similar predictive value.