Adolf Meyer was famous when 1 first met him in 1933. I was at that time a psychiatric resident at Bellevue Hospital, and Meyer was Psychiatrist-in Chief at Johns Hopkins Hospital. He had been asked by the sponsors of a fellowship I was given to act as guide and supervisor, and had agreed. I met and corresponded with him throughout the tenure of that fellowship, to 1940, spending a year in his department in Baltimore in 1938–1939, and saw him irregularly thereafter.

Subcortical dementia refers to a clinical syndrome characterised by slowing of cognition, memory disturbances, difficulty with complex intellectual tasks such as strategy generation and problem solving, visuospatial abnormalities, and disturbances of mood and affect. The syndrome was first described by Kinnier Wilson, but further progress in development of the concept has occurred only within the past ten years. Subcortical dementia occurs in degenerative extrapyramidal disorders and has also been identified in inflammatory, infectious, and vascular conditions. Histologic, metabolic, and neurochemical investigations implicate dysfunction primarily of subcortical neurotransmitter systems and subcortical structures or subcortical-frontal connections in the genesis of the syndrome. Subcortical dementia contrasts neuropsychologically and anatomically with disorders such as dementia of the Alzheimer type that affect primarily the cerebral cortex. The clinical characteristics of subcortical dementia reflect the interruption of fundamental functions (motivation, mood, timing, arousal) mediated by phylogenetically and ontogenetically early maturing structures.

A new interview schedule for the diagnosis and measurement of dementia in the elderly is described. The schedule named the Cambridge Mental Disorders of the Elderly Examination (CAMDEX), consists of three main sections: (1) A structured clinical Interview with the patient to obtain systematic information about the present state, past history and family history; (2) a range of objective cognitive tests which constitute a minineuropsychological battery; (3) a structured Interview with a relative or other Informant to obtain Independent Information about the respondent's present state, past history and family history. The CAMDEX Is acceptable to patients, has a high inter-rater reliability and the cognitive section has been shown to have high sensitivity and specificity.

Psychiatric assessment strategies that integrate research findings with daily practice are necessary and clinically useful. This paper uses the example of an attention deficit disordered adolescent to illustrate how double-blind placebo controlled and multi-dose adjustment designs can be successfully implemented in routine clinical practice. These designs are especially valuable In evaluating the therapeutic effect of methylphenidate because of biases that may lead to clinical misuse of this stimulant medication.

Cranial computed tomography (CT) scans of 48 patients with senile dementia of the Alzheimer type (SDAT) and 40 normal elderly volunteers were compared. The demented group were found to have significantly larger lateral ventricles assessed planimetrically and by using a linear measure of the ratio of the maximum width of the frontal horns of the lateral ventricles to the maximum intracranial diameter. Attenuation density was computed for 1 5 brain regions. The demented group did not differ significantly from the normal controls with respect to attenuation density In any of the regions studied.

Forty-three neurologically and psychiatrically assessed patients with idiopathic Parkinson's disease (PD) underwent detailed cognitive assessment. Cognitive deficits typical of senile dementia of Alzheimer's type (SDAT) were found in 7% but the majority showed definite impairments not typical of SDAT. Cognitive impairment was significantly more likely in those with more severe PD symptoms. There was substantial agreement between psychiatric diagnosis and psychological picture of SDAT and some links were found between other diagnostic categories and nature of cognitive functioning. However, cognitive deficits were also found In two-thirds of patients with no psychiatric diagnosis.

Procyclidine was administered to 25 chronic psychotic inpatients, stabilised on chlorpromazine, haloperidol or fluphenazine decanoate injection. We observed a significant reduction in mean serum levels of all three neuroleptic drugs which was reversed on stopping procyclidine and was Inversely correlated with mean serum procyclidine levels. No significant alterations occurred on the BPRS scores or in serum prolactin levels throughout the study In any of the three groups. Possible mechanisms of this interaction and its clinical relevance are discussed.

In a 6-month prospective study of the three main general hospitals in Ibadan, Nigeria, 39 cases of deliberate self-harm were reported out of a total 23, 859 subjects attending the sections of hospital studied. Thirty (76.9%) were under 30 years of age and 36 (86.3%) were under 34 years of age. The male to female ratio was 1.4.1: more than half of the population (51.3%) were students and 25.6%, manual workers. The methods used were mainly ingestion of chemicals (24 patients) and psychotropic drugs (11 patients). Disturbed Interpersonal relationships, especially with parents, were mainly found to have motivated the acts. The implications of these findings are discussed.

Nutritional deficiencies have been implicated in the pathophysiology of various mental disorders. Life in institutions has been associated with development of nutritional deficiencies, the elderly being most at risk especially those with senile dementia. In this study nutritional status, particularly vitamin and essential mineral status was assessed in a group of 64 new admissions to a psychogeriatric unit and 49 long-term patients.

The results indicated that psychogeriatric patients were at risk of experiencing nutritional deficiencies and those with senile dementia were likely to have more abnormalities than those with functional illnesses. Those patients in long-term care would appear to have a better nutritional state than those on admission.

The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when Improvement with psychotherapy did not occur.

Prior studies on weight change and hypothalmic-pituitary-adrenal (HPA) axis functioning are reviewed. Data on 58 depressed and eight anorexic patients is presented. No significant difference in the frequency of cortisol non-suppression in the dexamethasone suppression test (DST) was found between depressed patients with a history of weight loss and those without, nor between depressed patients who lost weight during their first week in hospital and those who did not. Mean weight loss of suppressors did not significantly differ from that of non-suppressors. Of 12 patients whose DST normalised during their stay in hospital, only four gained weight. Five anorexics who were non-suppressors were <70% of their ideal body weight (IBW), while three suppressor anorexics were ≧70% IBW. These results indicate that mild to moderate weight change is not a significant influence on DST response in depression.

Reports have appeared in the literature suggesting an association between physical illness and the later development of anorexia nervosa. The histories of 326 patients with anorexia nervosa were examined for physical illness. A higher rate of severe physical illness was found in this group when compared with controls suggesting that it should be regarded as a risk factor for anorexia nervosa. No statistically significant differences were found when illness was examined by time in relation to onset of anorexia, system involved, or when subjects were stratified by age. Possible explanations for the observed association are discussed.

The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with Impairment of family relationships and adverse social factors. It was concluded that a dimension of Inattentive, restless activity should be separated from one of antisocial, defiant conduct In children with psychiatric disorder.

The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with Impairment of family relationships and adverse social factors. It was concluded that a dimension of Inattentive, restless activity should be separated from one of antisocial, defiant conduct In children with psychiatric disorder.

Sixty boys, aged from 6 to 10 years, were studied after their referral to psychiatric clinics for antisocial or disruptive behaviour. Their scores on reliable measures of hyperactivity, defiant behaviour, emotional disorder and attention deficit were taken for the home, school and clinic settings; and subjected to two techniques of cluster analysis. Both gave a similar set of clusters, one of which had high scores on all measures of hyperactivity and attention deficit. Membership of this cluster was associated with a lower IQ, a younger age of problem onset and referral, an abnormal neurological examination, a history of developmental delay, smaller family size, poor peer relationships and a high rate of accidental injuries; and It predicted a good response to stimulant medication In a controlled trial. Other research on the classification of hyperactivity is discussed, and proposals are made for the criteria of a rather narrow definition of ‘hyperkinetic conduct disorder’.

Four case reports are presented of psychotic patients seen in clinical practice in Nairobi over a period of one year, who inflicted serious bodily harm to themselves during that period. Possible psychopathological basis for this self-damage is briefly considered. A review of the literature reveals paucity of similar reports from Africa and the third world. Reasons for this paucity are hard to come by.

Anorexia nervosa is frequently associated with neurotic traits and symptoms. The symptomatology and history of a housebound 20-year-old woman with anorexia nervosa and dysmorphophobia are described. The role of the family In maintaining the problems, use of external cues to control behaviour, overvalued somatic ideas and the definition of dysmorphophobia are discussed.

A retrospective case-control study was performed using the records of 59 catatonies, 59 non-catatonic schizophrenies, 59 manies, 59 depressives and 59 surgical Controls. The findings suggest that prior brain injury and physical illness at onset of psychosis are much more common in subjects with catatonia. While these findings do not account for all cases of catatonia, they may indicate an aetiology for some phenotypic cases of catatonia.

Schizophrenies who completed suicide were compared with those who made suicide attempts, on the basis of blind ratings of previous hospital records and follow-up interviews with treating clinicians. Results indicated that the two groups were relatively distinct. Suicides tended to live alone and to feel depressed, hopeless, worthless, and suicidal. Attempters, on the other hand, lived with their families or others and were less likely to manifest several features of depression during a period in hospital. In evaluating suicide potential among schizophrenics, living situation and mental state changes indicating depression, suicidal intent, worthlessness, and hopeiessness are more important than a history of suicidal behaviour.

Two bipolar depressed patients and one unipolar depressed patient developed manic Symptoms after receiving trazodone. The Symptoms resolved when the treatment was discontinued or reduced. We believe the two bipolar patients are the first cases of this reaction reported in the literature.

In an era when it is generally believed that the acute Symptoms of schizophrenia can be controlled pharmacologically, the case of a young man who has remained almost continuously floridly psychotic for 13 years, despite treatment, is disquieting. Conventional psychiatrie treatment appears to be rendered impotent. It is in this context that it may be of interest to report a summary of the proceedings of a Special Problems Conference held at the Institute of Psychiatry on 18 February 1985 to discuss such a case.