In May 1981 a new disease caused by widespread food-poisoning (probably with adulterated rape-seed oil) appeared in Spain. More than 20000 people were affected, and about 350 patients have died. The clinical syndrome consisted of pulmonary, neuromuscular and systemic symptoms, which evolved to produce mild or severe physical disabilities. Although the disease is not primarily a psychiatric condition, more than 6000 TOS patients have been referred to a psychiatrist: these patients show a well-defined ‘reactive disaster syndrome’, vulnerability being associated with female sex, low income and class, and a personal history of ‘nervous' disorders. The enormous public repercussions of the disease and the specific administrative measures it provoked are discussed and evaluated. This unique experience of a specific disaster can contribute to our knowledge of the psychological and psychiatric aspects of disasters in general; and it suggests that teams of psychologists and psychiatrists should play a significant role in managing the effects of major catastrophes.

Efforts were made to follow up 168 young teenage school refusers ten years, on average, after they had been treated as inpatients in an adolescent psychiatric unit. Almost half were well or much improved throughout the follow-up period. Outcome was most satisfactory in intellectually bright children treated under the age of 14 and among those who were well or substantially better shortly after discharge. Thirty per cent of the group had received treatment for psychiatric illness, 14% had seen a psychiatrist and 5% had been admitted to hospital for psychiatric treatment during the follow-up period. Thirty per cent appeared to be disturbed at the time that they were reviewed. The ‘decennial-inception’ and ‘point-prevalence’ rates for psychiatric disorder appeared unduly high by comparison with local and national rates of disturbance.

An increasing number of psychiatrists are now working partly in primary care settings. This paper describes how the movement began and how both psychiatrists and other members of the specialist psychiatric treatment team have explored ways of working with family doctors in the diagnosis and management of psychiatric disorders. Various styles of collaborative work, the declared advantages of such attachment schemes, the reservations being expressed about their further extension, and their research and educational potential are explored. If such enterprises, designed to help the family doctor identify psychiatric morbidity in the practice and to extend his skills in managing such patients and their relatives, are to be commended, they must be carefully monitored so that the cost-benefit balance can be established.

The value of the spin lattice relaxation time (T1) obtained during nuclear magnetic resonance imaging of the brain was studied in patients with idiopathic Parkinson's disease, with and without dementia. T1 increases significantly in the basal ganglia and cerebral white matter of the demented and non-demented groups. T1 of the cerebral white matter correlates with the severity of dementia.

A new type of hostel ward is described in which domestic activities take the place of attendance at a day centre or industrial workshop. Residents no longer depend on the institution for meals, cleaning, or social activities. The programme is resident-orientated, and individual treatment plans are designed and effected using a points system. The emphasis of group activities is on communication and living skills. The hostel ward is able to care for our most disabled patients who are thought to need 24-hour nursing care.

Melatonin and Cortisol values in plasma were measured hourly over 24 hours in six depressed patients and six normal volunteers before treatment and after one and three weeks of treatment with desipramine. The normal volunteers were further tested one week after withdrawal of desipramine. The mydriatic effects of tyramine and phenylephrine eye drops were also recorded in the normal volunteers.

In neither group of subjects did desipramine treatment reduce melatonin secretion, suggesting that functionally significant down-regulation of beta andrenoceptors was not caused by this treatment. Melatonin secretion was significantly increased after three weeks of treatment in depressed patients. This increase was not found in normal subjects.

The DSM-III diagnostic criteria for dementia can be criticised because they treat dementia as a categorical rather than dimensional disorder, and thus ignore the problem of placing appropriate cutoffs. They are also too broad and may result in diagnostic unreliability because of varying interpretations of the criteria by different diagnosticians. Strategies for overcoming these problems are discussed and some improved criteria proposed.

The SCL-90 is a self-report inventory of psychopathology, which has not previously been validated in the UK. In the present study, the scale was found to correlate well with other measures of mental state, namely the Present State Examination (PSE) and the Comprehensive Psychopathological Rating Scale (CPRS). The scale was able to distinguish psychotic from non-psychotic patients on its paranoid ideation sub-scale, but not on its psychoticism one, nor any of its seven neurotic sub-scales. It is suggested that in research or population screening studies, this type of questionnaire should be supplemented with information relating to psychiatric history and motivation for treatment.

Since nutritional deficiencies might worsen the severity of symptoms and prolong the length of illness in non-nutritional disorders, particularly in the elderly, we examined the nutritional status of 216 elderly women newly admitted to a mental hospital. Compared to healthy elderly women, they had lower values for plasma prealbumin, vitamin C, and B vitamins. This was particularly common in senile dementia, and appeared to be the result of inadequate intake of protein or vitamins. Regular hospital diet for one month corrected the very low levels of prealbumin, but supplements were essential to remove deficiency of the water-soluble vitamins. Although vitamin supplements did not influence the length of stay in hospital, we did not exclude the possibility that nutritional deficiencies have a significant effect on the severity of mental illness.

Body image perception was measured in 50 women with bulima nervosa and 19 age and weight matched female controls, using a visual size estimation apparatus. Both groups overestimated body widths, but not the width of a neutral object, and whilst there was a trend for bulimics to overestimate more than controls this did not reach significance. The part of the body most overestimated corresponded to the part most disliked in only a third of both groups. The bulimics without a previous history of anorexia nervosa overestimated body width more than those with such a history; this may be related to the fact that the former had a significantly greater weight index. Bulimics who were within 5% of mean-matched population weight overestimated body width less than the others, this difference reaching significance when compared with the heavier groups; a similar, but non-significant, trend was demonstrated in controls. This may be linked to a greater dissatisfaction with body size. Duration of illness, frequency of bingeing and self-induced vomiting were not shown significantly to alter body size estimation. The bulimics who completed a 10-session outpatient treatment programme subsequently demonstrated a significant decrease in overestimation of waist and hip width.

Clinical reports have suggested that antidepressant medication may contribute to the sexual dysfunction experienced by some depressed patients. A double-blind trial in a non-psychiatric male population compared amitriptyline (tricyclic), mianserin (tetracyclic) and placebo for their effects on nocturnal sexual arousal. In a three-way crossover design active drug or placebo were taken for two weeks preceding measurement of the frequency, amplitude and duration of nocturnal penile tumescence and synchronous sleep indices. Both active compounds significantly decreased the amplitude and the total duration of nocturnal erections. The effects on sleep indices were as previously reported. Few differences were found between the tricyclic and tetracyclic drugs. Some implications of these findings are considered.

The dexamethasone suppression test (DST) was used in an in-patient crisis unit to determine whether the test could identify suicidal patients who might benefit from tricyclic antidepressants. DST results, DSM-III diagnoses, and measures of symptom levels were obtained for 72 patients admitted for a 3–5 day period; 31 were non-suppressors. Abnormal DST results were not related to DSM-III diagnosis or to scores on measures of depression and symptom levels. Only three patients met DSM-III criteria for major depression with melancholia; 26 patients had a diagnosis of alcohol or substance abuse. The poor specificity of the DST in this patient population suggests that its routine use in such patients could be highly misleading.

A cross-over comparison study of exposure, in the evenings only, to bright versus dim light was carried out on nine female patients with seasonal affective disorder. A significant antidepressant effect of the bright lights was shown. No consistent observable effects were produced by the dim lights. These results support earlier studies demonstrating the efficacy of bright light given morning and evening. The antidepressant effect of light is not mediated by sleep deprivation, and the early morning hours are not crucial for a response.

The relationship between antecedent life events, clinical profile, and hypothalamic–pituitary–adrenal function was examined in 72 depressed patients. Antecedent life events were associated with first episodes of depression and with greater severity of illness, but their presence did not distinguish between patients diagnosed as endogenous or neurotic, and status on the dexamethasone suppression test was not associated with a greater or lesser likelihood of antecedent events. However, urinary free Cortisol levels were higher in those patients with life events and difficulties.

One hundred and four Yoruba Nigerian patients are described who presented with manic disorder over a five-year period; 55 could be classified as suffering from recurrent unipolar manic disorder, while 36 had suffered only one attack of mania. Only 13 patients suffered from bipolar disorder, in contrast to studies from Western societies, in which bipolar disorder is much more common than unipolar. The unipolar manic and bipolar patients could not be differentiated on the basis of clinical and social data, apart from a possible preponderance of the female sex in the bipolar group. The clinical presentation of mania was similar to that described from Western Countries. Long-term prophylaxis with depot neuroleptics may be advisable in such cases.

In 1981, Pippard & Ellam published the findings of their survey of electroconvulsive treatment (ECT) in Great Britain. This was the first such survey to use a ‘medical audit’ approach, and included field visits to ECT clinics and a three-month uncontrolled outcome study of patients. They reported that ECT was used selectively, but that equipment, administration of the treatment, and clinic premises left much to be desired.