The rate of treatment-emergent switch into mania has been calculated from all available clinical trial data on the selective serotonin re-uptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline, relative to comparative groups treated with tricyclic antidepressants (TCAs) or placebo. In predominantly unipolar depressives, the rate of manic switch is less than 1% and differences between drugs and placebo are statistically but not clinically significant. In bipolar depressives, manic switch occurs substantially more often with TCAs (11.2%) than with SSRIs (3.7%) or placebo (4.2%).

A patient with a 30-year history of somnambulism and night terrors is described. The use of a home ambulatory sleep electroencephalogram (EEG) recording in clarifying the diagnosis and in monitoring the results of treatment is illustrated and successful treatment using a selective serotonin re-uptake inhibitor is reported.

It has become increasingly evident that Tourette's syndrome (TS) is not as rare as was once thought and substantial cohorts from various parts of the world have been reported. The clinical characteristics seem independent of culture as they appear to occur with some degree of uniformity irrespective of the country of origin. We investigated the point prevalence and report the clinical characteristics of TS in New Zealand. Forty probable cases were identified and the symptoms were similar to those described in cohorts from other parts of the world.

A 59-year-old man with chronic treatment-resistant depression developed severe cognitive impairment. The severity of depression and the mode of presentation led to difficulty in diagnosis between a dementing disorder and a depressive illness. The diagnostic conundrum was resolved by the use of sleep deprivation (SD), which demonstrated clear subjective and objective improvements in his condition. These changes were quantified by a range of psychometric tests, which showed that initial deficits in cognitive performance improved temporarily after SD, and these improvements were maintained after effective treatment of the depression with electroconvulsive therapy.

Three cases of Capgras' syndrome were identified in one psychiatric hospital within a 1-year period. These are presented and their psychopathology discussed. The traditional assumption that this is a rare syndrome is challenged.