Torture is one of the most important preventable causes of psychological morbidity. Amnesty International (1987) has reported the use of “brutal torture and ill-treatment” in over 90 countries in the 1980s. In some countries torture has been applied on such a widespread scale and in such an arbitrary manner that whole populations are affected. In Kampuchea under the Pol Pot regime, for example, genocide and torture took place on a massive scale; indeed, merely wearing spectacles became for many a capital offence (Amnesty International, 1983). Similar reports abound from many other countries and regions.

In the 19th century the triumphs of neuropathology and the clinico-anatomical method led to the evolution of neurology as a separate ‘organically’ based discipline associated with the concept of functional localisation. At the same time the growth of psychodynamic psychiatry contributed to the progressive separation of the two disciplines, with neuropsychiatry sitting uneasily in the middle. Psychiatrists are now showing increasing interest in the structure and function of the nervous system, but are having difficulty in integrating their findings into ‘functional’ diseases. This may be because disorder of function in the nervous system is much more complex than previously envisaged. The function of the nervous system is profoundly affected by psychological and social factors. The view that neurology is wholly ‘organic’ and synonymous with structural disease of the nervous system is fallacious. Neurological patients have complex dynamic disorders of function in the nervous system whether or not structural disease is present.

In alcohol withdrawal, abnormalities occur in a number of neurotransmitter systems: there is reduced inhibitory function, and increased activity of excitatory systems. The former, indicated by reduced GABA and alpha-2-adrenoceptor activity, acts in conjunction with, and is exacerbated by, the latter, which itself may be due to the potentiation of NMDA activity by depletion of magnesium, and overactivity of catecholaminergic and CRF neurones. These dysfunctions produce immediate effects and may also contribute to the long-term changes in brain excitability by a kindling-like process. It is possible that early and active treatment may oppose this process. Present strategies for treatment of alcohol withdrawal enhance GABA and alpha-2 inhibitory, or reduce excitatory, mechanisms. Future possibilities include the use of CRF and/or NMDA antagonists.

A system of outcome indicators for mental health care is urgently needed in order to ensure that clinicians, district health authorities, and directors of public health can monitor and evaluate mental health care. Theoretical aspects of health care indicators and the various classes of outcome measures available can be used to draw up a preliminary system of indicators of health care input, process and outcome for the major categories of mental illness, including schizophrenia, affective psychosis, neurosis, dementia, mental handicap, child psychiatry, forensic psychiatry, alcohol and drugs. Such a system is not intended to be definitive or exhaustive but rather to form a basis for development by clinicians, researchers and planners for their own requirements.

When 54 Afro-Caribbean and 49 white British consecutive psychotic in-patients were prospectively studied for clinical differences in course of illness and pattern of symptoms, no major differences were found. This does not support the hypothesis that misdiagnosis within the psychoses can explain the higher admission rates of schizophrenia calculated for Afro-Caribbean populations.

Attitudes towards eating, weight and shape were examined in 479 Caucasian, Afro-Caribbean and Asian British women. The Asian women were found to have significantly more disordered eating attitudes than the Caucasian women, but no difference was found between the three groups in their concern with their body weight and shape. However, while in the Caucasian group disordered eating attitudes were significantly positively correlated with feelings of anxiety and depression, this was not true in the other two groups. Although the concerns of British Afro-Caribbean and Asian women are similar to those of the Caucasian women, there may be ethnic differences in the relationship between feelings about eating, weight and shape and mood.

The suicide rates in England and Wales and Scotland converged during the late 1960s, and from 1970 were higher in Scotland. The convergence occurred because of differences in the falls in rates of those aged over 45 years and not because of differences in frequency and decline of coal gas suicide. Male suicide increased more rapidly in Scotland during the 1970s. In England and Wales overall female suicide rates fell during 1958–76 whereas in Scotland there was no clear trend. Suicide by car exhaust increased similarly in both countries, but that by hanging and drug poisoning increased more rapidly in Scotland.

The official suicide rate in Ireland increased markedly between 1970 and 1985. This is a genuine increase in suicide and not an apparent one due to previous deficiencies in recording practices. Possible reasons for this change include an increase in ‘anomie’ shown by a rise in the rates of crime, illegitimacy and admissions to hospital for alcoholism, a decline in social cohesion revealed by a fall in the marriage rate and a rise in the number of separated couples, and an increase in unemployment.

Childhood precursors of symptoms of depression and anxiety were investigated in a national population sample of over 3000 men and women, aged 36 years. Early-life data had been collected prospectively for all subjects. A number of factors, differing for men and women, were found to be significant predictors of adult disorder. Some factors showed strong effects but tended to apply to relatively few individuals, while other more common circumstances had modest influences. Overall, early environment did not seem to hold great significance for adult affective disorder, although multiple disadvantages had a cumulative deleterious effect. There was little evidence of early benefits being protective.

In order to study putative differences in central neurotransmitter function in depressive subtypes, serum Cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD–9, DSM–III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or Cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal Cortisol levels and Cortisol response to fenfluramine did not distinguish between any of the subtypes.

Confirmation is reported of an earlier finding that the symptoms of patients with chronic schizophrenia segregate into three syndromes: psychomotor poverty (poverty of speech, flatness of affect, decreased spontaneous movement); disorganisation (disorders of the form of thought, inappropriate affect); and reality distortion (delusions and hallucinations).

Regions of the brain involved in language and attention were studied using [18F]-fluorodeoxyglucose in PET. In nine chronic DSM–III schizophrenic patients who had persistent auditory hallucinations, ten who had recovered from hallucinations and ten normal controls. In none of the regions examined was metabolic activity significantly different in hallucinating patients compared with that in other groups. However, a pattern of seven significant correlations of metabolic activity between language regions and between frontal and parietal cortex characterised the hallucinating but not the other groups. Three of the seven correlations were significantly greater in hallucinating patients than in the two other groups, and six were greater in hallucinating patients than controls. Metabolism in Broca's region and its right-hemisphere homologue correlated positively and significantly in the hallucinating group, as it did in anterior cingulate and left superior temporal areas, and in right frontal and parietal areas. Hallucination ratings correlated with metabolism in the anterior cingulate region.

The results are reported of a two-year follow-up of a trial of family sessions in the home (including patients) (12 families) versus a relatives' group (excluding patients) (11 families). Subjects were patients with schizophrenia living in high face-to-face contact with high-EE relatives. Patients were maintained on neuroleptic drugs for two years where possible. Relatives' critical comments and hostility were significantly lowered by nine months, but no significant changes occurred subsequently. Relatives' overinvolvement reduced steadily throughout the trial, and reduction in relatives' EE, either alone or in combination with reduced face-to-face contact, appeared to be associated with a lower relapse rate. The relapse rates for patients in the family-therapy and relatives’-group streams were 33% and 36% at two years. When these data were combined with the results of a previous trial, it was found that patients in families assigned to any form of social intervention had a two-year relapse rate of 40%, significantly lower than the 75% relapse rate for patients whose families were offered no help. We therefore recommend that relatives' groups are established in conjunction with some family sessions in the home for patients at high risk of relapse.

Obstetric complications were more common in the histories of those schizophrenic outpatients without a family history of psychiatric disorder, and were associated with an earlier onset of their illness. Those patients with tardive dyskinesia were more likely to have a family history of psychiatric disorder, less likely to have experienced obstetric complications, and showed greater cognitive deficit. Obstetric complications should be considered in juxtaposition with genetic factors in evaluating the putative familial-sporadic distinction in schizophrenia. Additionally, familial/genetic factors appear to contribute to vulnerability to tardive dyskinesia.

Forty-nine chronic psychiatric out-patients (ten were schizophrenic) with tardive dyskinesia (TD) were examined monthly for a mean of 40 weeks (range 1–59 months) after discontinuation of neuroleptic medication. Complete and persistent reversibility of TD was rare (2%), but many patients showed noticeable improvement in movements within the first year of discontinuation, which was sometimes interrupted by psychological relapse. Using three separate outcome measures and appropriate model-fitting techniques for each, we identified several predictors of improvement in TD, including an affective or schizoaffective psychiatric diagnosis, chronic (over 20 years) psychiatric illness, being employed, younger age, and increased neuroleptic dose before discontinuation. Consistent findings emerging from these analyses suggest that the type and history of psychiatric illness affect the course of TD.

Thirteen patients with panic disorder with predominantly cardiorespiratory (CR) symptoms were compared with seven patients with predominantly gastrointestinal (Gl) symptoms in an experimental procedure that involved exposure to phobia talk and voluntary hyperventilation (VHV). The CR patients had not only higher baseline anxiety, but also during phobia talk had a greater fall in pCO2 and reported more respiratory symptoms than the Gl patients. Moreover, the CR group found VHV more unpleasant and more like their panic attacks than the Gl panickers, and reported more physical symptoms after it. These findings suggest that patients with PD are not only heterogeneous with respect to the system to which panic symptoms refer (CR or Gl) but that provoking arousal in one system is more likely to produce distress if that system is the major focus of complaint. These findings, if replicated, would not support the suggestion that panic disorder is a uniform illness.

Using the records of Churchill Hospital, Oxford, and those of genetics centres and other national institutions, the minimum prevalence of HD among immigrants from the Indian subcontinent was found to be almost half that found in the indigenous UK population. However, this observed prevalence was probably depressed, and therefore may not differ greatly from that estimated for European populations. All the identified cases were immigrants from Pakistan, the Punjab and Gujerat; none were from Bangladesh.

In a pair of male monozygotic twins discordant for schizophrenia, MRI revealed no abnormality in the ill proband, but extensive white-matter damage of likely congenital origin in the psychiatrically normal twin. These findings are difficult to reconcile with multifactorial models of schizophrenia, and raise the possibility that some forms of brain damage may preclude expression of the schizophrenia genotype.

The coping strategy of claimed simulation of insanity observed at the onset of psychotic episodes in a manic patient is reported here. There is a need for systematic research on coping strategies in affective psychosis in order to develop techniques to help contain or prevent relapses.

Two patients with moderately severe AD, when asked directly, could identify their own images in a mirror, but also consistently misidentified their own reflections as that of another person. Both patients were paranoid and mildy depressed at times, but had no evidence of other concurrent psychotic symptoms. It appeared that mood substantially modified the nature of the symptom and the patients' reaction to it over time. These cases illustrate the ability of an organic symptom to be modified by a concurrent affective state, indicating the importance of the interaction between biological and psychological factors in the expression of such symptoms.