Capgras syndrome in a patient with migraine is reported. It is difficult to establish whether this association, which has only been reported once before, had aetiological significance or was coincidental. Investigating all cases of Capgras syndrome for organic pathology by MRI is suggested.

The presentation of inappropriate penile erections calls for great caution in making a diagnosis. Two patients who had unwanted erections also had obsessive-compulsive disorder – a previously unreported association. Obsessive-compulsive disorder is not inconsistent with unwanted erections and should be considered in assessment.

A case of dependency on prescribed pressurised aerosols in a patient with asthma and mild mental handicap is reported. The majority of reported cases involve young asthmatics, abuse being reported mainly using salbutamol inhalers although other inhalers have also given cause for concern. The agent of addiction is uncertain although it may be the fluorinated hydrocarbons used as propellents, rather than the active substance itself.

An unusual case of pseudocyesis of almost ten-year duration, characterised by a monosymptomatic hypochondriacal delusion and a selective response to pimozide is reported. The nosological status of the diagnosis, delusional (paranoid) disorder, is suggested to be a variety of the Kraepelinian concept of paranoia. The therapeutic pitfalls of relying on a phenomenological distinction between overvalued ideas and delusional beliefs are discussed.