It is possible that genes contributing to the development of schizophrenia may be identified within the next decade. Genetic methods are improving rapidly, and are surrounded by great public interest. Requests for genetic counselling are keeping pace with this increased attention, but the problems faced by psychiatric genetic counsellors are complex, and the experience of offering such counselling and the issues involved are rarely discussed. In this context the paper describes a year's work counselling for schizophrenia in the Maudsley Hospital Genetic Clinic.

Using multiple diagnostic and epidemiological criteria, three samples of general practice (GP) depressives were studied: those prescribed a new course of antidepressants, those given other treatment, and those missed by the GP. The majority of patients qualified as psychiatric cases on the PSE Index of Definition, the Bedford College Criteria, and the Research Diagnostic Criteria. Most satisfied diagnostic criteria for depression, or (fewer) anxiety. The disorders were relatively mild and often borderline on all three systems. Depressives given other treatment most often failed to meet diagnostic criteria. About half the antidepressant treated patients received RDC diagnoses of major depression. Among the other treatment sample, only one-fifth met these criteria, and half had non-depressive diagnoses. Most cases of depression treated by GPs satisfy criteria for psychiatric disorder, but tend to be relatively mild and borderline in quality.

General practice (GP) depressives prescribed an antidepressant were compared with those given other treatment, and with antidepressant-treated psychiatric out-patient depressives. GP depressives were considerably less severely ill than out-patients, with fewer depressive symptoms and shorter illness, as well as less primary and less endogenous depression. The two groups of GP depressives differed less, but those receiving other treatment tended to have less severe depression than those receiving antidepressants and were less likely to satisfy diagnostic criteria for depression. Depressives in GP differ considerably in clinical characteristics from psychiatric out-patient depressives, and clinical features influence the GP's decision to treat with antidepressants.

The heading of ‘Irritable Mood’ was introduced into the Index Medicus in 1985 and it is noted that this term is frequently used but seldom defined. It is therefore important that a consensus is reached concerning its definition in the context of psychopathology and a definition is offered. It seems important to distinguish irritable mood and its outward manifestations from violently assaultive behaviour although there may be a continuum of disturbance from mildly to severely disordered behaviour. Irritability has so far not attracted much attention from clinicians and yet it is a common mood associated with many psychiatric and non-psychiatric conditions. Severe irritability may cause considerable distress both to the patient, his associates and sometimes also those attempting to treat or otherwise help him. It may overshadow other symptoms and the correct diagnosis and management may be missed. The validity and reliability of a convenient self-assessment scale is re-examined in the light of further data. Data from previous studies in the context of mood disorders suggests that irritability is a mood state which is independent of the other major moods of depression and anxiety; the severity of irritability probably has an inverse correlation with age. The most important associated factors are listed in order to inform researchers of the possible methodological pitfalls.

Serum antibody titres to eight neurotropic viruses were measured by enzyme immunoassay in 450 psychiatric in-patients and 143 controls. A seasonal variation in schizophrenic births was observed, with a peak incidence between March and April. Both herpes simplex virus and cytomegalovirus antibody titres correlated with age and, when this was controlled for, no significant differences emerged between any patient group and the controls. Mumps antibody titres were significantly lower in patients with mental subnormal and neurosis or personality disorder; measles and rubella antibody titres were lower in male but not female mentally handicapped patients; males had lower antibody titres to mumps, cytomegalovirus and Epstein-Barr virus than females in all groups. A decrease in mumps antibody titres was also found in schizophrenics if the medication factor was excluded. These low antibody titres may indicate an impaired immune response. Thus perinatal or childhood subclinical viral infections of the central nervous system, particularly of mumps, might lead to a range of possible psychiatric outcomes in later life.

CSF and matched serum antibody titres to seven common viruses were measured in 20 chronic schizophrenic patients, and 17 of these were age and sex-matched with orthopaedic controls. CT scans were carried out in patients and age and sex-matched radiological controls. There was a trend for CSF viral antibody titres (except CMV, HSV and VZV) to be decreased in the patients compared to controls, statistically significant for mumps and IgG. The CSF/serum ratios showed a reduction in the patients, compared to controls, statistically significant for measles and rubella as well as mumps and IgG. Cerebral ventricular size was significantly increased in the patients compared to controls, but did not correlate with any of the antibody data. These findings suggest that there is a reduced immune response to certain common viruses in the CNS of schizophrenic patients, but possible effects of institutionalisation or current medication could only be adequately excluded by further prospective studies.

A cross-sectional survey assessed all 1,087 patients who were in psychiatric beds provided by a large district health authority. The elderly predominated in all length of stay categories, and a high proportion of them had levels of social and physical incapacity which made it unlikely that they could be cared for other than in residential care. A substantial minority of younger patients with a length of stay between one and two years had levels of incapacity which suggested the need for major treatment, rehabilitation, or training efforts. The findings have major implications for Government policy to replace large mental hospitals.

Changes in the functioning of family members were assessed during a randomly controlled study of community management of schizophrenia. Eighteen families who completed two years community management based upon behavioural family therapy were compared with 18 families who received patient oriented management with family support. Families receiving family management reported less disruption of activities, reductions in physical and mental health problems, and less subjective burden than those receiving the patient oriented approach. It is concluded that the benefits of family management extend beyond the reduction in clinical and social morbidity of the index patient to beneficial effects for the family as a whole.

One hundred volunteers completed a modified version of the Moos Menstrual Distress Questionnaire daily for 35 days. The purpose of the study was disguised. None of the participants was taking oral contraceptives. Significantly more symptoms were reported in the premenstrual and menstrual phases and fewer during the follicular phase of the cycle, but the pattern of response varied considerably between subjects. Symptom reporting was higher, in all phases of the cycle, in women with high trait anxiety or psychiatric morbidity (indexed by the General Health Questionnaire) but these measures did not relate to fluctuations of symptoms around the menstrual cycle. The need for prospective longitudinal studies of menstrual cycle symptomatology is emphasised.

Items such as meals have frequently been used as back-up events in Token Economy Programmes (TEPs) because of their supposed reinforcing effectiveness. However, despite the dubious ethical questions that this raises, there is little research evidence to support the necessity for their use in TEP's with hospitalised chronic mentally ill patients. The effects of introducing meals as a ‘free’ item on patients' performance of a number of target behaviours were investigated in a TEP where they had previously been scheduled as a back-up event. While ‘free’ meals produced a slight increase in the actual number of meals eaten, there were no systematic effects on patients' performance of the target behaviours.

The article describes the outcome of a comparative study of home care, by a trained nurse, versus hospital out-patient supervision in the management of chronic psychiatric patients in Bangalore, India. Twenty-five patients, with a mean duration of illness of nine years, were started on the home care programme while a matched control group of 25 similar patients continued the regular out-patient contact offered by the hospital. Comparative assessments were carried out on the groups at the time of intake and again after two years. The results indicate that hospital admission was less often needed among the home care group.

First admission rates from 1969–78 for Scottish psychiatric units were calculated for discharge diagnoses of affective psychosis for each five-year age-group from 15 years to over 74 years. There were clear-cut linear increases in rates of depressive psychoses, mania, and all affective psychoses, consistent with a relatively steady increase in the rate of first-onset affective psychoses with increasing age. These findings are discussed in terms of social, psychological, and biological hypotheses of the causes of affective disorder. It is argued that no single factor could produce the observed linear increases with age and that the data appear more consistent with an integrative aetiological model of affective disorder.

This is a 13-month follow-up study of 105 two to 17 year-old children bereaved of one parent, with 85 controls. Data were gathered on physical and mental health in the children and surviving parents, the child's sex and age and the bereaved parent's sex and psychopathology being included as risk factors. Dysphoria, falling school performance and withdrawn behaviour were significantly increased in bereaved children of both sexes at all ages, while temper tantrums, bed wetting and the depressive syndrome only increased in the age and sex categories normally associated with these conditions. A global index of psychopathology was increased compared with controls on most subgroups of bereaved children (P < 0.0001), the highest scores for both sexes being associated with having a mentally ill (usually depressed) widowed mother. The results are discussed and suggestions made for future research.