Definite conclusions about the origin of schizophrenia concerning hereditary as well as psychosocial factors can be obtained when different forms of schizophrenia are investigated separately.

The nature of the relationship between anxiety and depression has been much debated. The research in the past 15 years is reviewed in the context of three conceptual models: (a) anxiety and depression differ quantitatively; (b) anxiety and depression differ qualitatively; and (c) combined anxiety and depression syndromes (anxious depressions) differ both quantitatively and qualitatively from either pure anxiety or pure depression. The major areas of research—phenomenological, treatment, course and outcome—are considered and findings in support of each position reviewed.

For many years we and other colleagues in the Department of Psychiatry at Washington University School of Medicine in St Louis, Missouri have been concerned with the need to develop widely accepted, valid diagnostic criteria for psychiatric disorders. The aim has been to identify patient groups as homogeneous as possible. Diagnostic criteria, such as those used in this study, were therefore developed with the goal of maximising specificity (i.e. reducing false positives) while keeping sensitivity as high as possible (i.e. keeping false negatives low).

Hysteria has been a topic of interest throughout the history of medicine; those who have been concerned with it include Galen, Paré, Sydenham, Charcot and Freud. Anyone who chooses to proclaim its importance, therefore, might be asked to provide some reason for gilding the lily. Controversies have always attended the subject, and different disciplines still disagree over it. The diagnosis, which occurs in the International Classification of Diseases (ICD-9, 1978) has been deprecated on both sides of the Atlantic (Slater, 1965; DSM-III, 1980) and also advocated with varying degrees of fervour (Walshe, 1965; Lewis, 1975; Merskey, 1979). It is a subject of historical study (Veith, 1965; Walker, 1981; Shorter, 1984); there have been at least nine monographs on it since 1977 (Horowitz, 1977; Krohn, 1978; Jakubik, 1979; Merskey, 1979; Roy, 1982; Riley & Roy, 1982; Colligan et al. 1982; Weintraub, 1983; Ford, 1983), and there is a steady flow of paper on the topic of hysteria or its major subdivisions (eg, hysterical personality, conversion symptoms) or pseudonyms and partial pseudonyms (eg, somatisation disorders, borderline personality, and operant pain).

Charcot's term ‘hysteroepilepsy’ implies brain mechanisms in common between epilepsy and hysteria. No such direct link between these two conditions exists. Nevertheless, there are a number of indirect associations between epilepsy and hysteria that can lead to confusion in the differential diagnosis and management of the patient with seizures.

Levi-Strauss (1977) describes what happened to a child, in a primitive tribe, accused of sorcery–a crime punishable by death. The child invented more and more complex stories by way of self-justification. In the end his accusers believed his outlandish explanation because “the choice is not between this system and another but between this system and no system at all-chaos.” The child's plight can represent the close affinity between magic and hysteria; his accusers might represent those contemporary psychiatrists who would prefer any system of classification of hysteria, however absurd, to no system at all (Sheehan & Sheehan, 1982a, b; DSM-III, 1980).

Twelve patients with neuroleptic-induced akathisia were treated in a randomised, double-blind, cross-over design with propranolol and matching placebo. Propranolol caused significant decrements in both subjective and objective ratings of akathisia, but not in anxiety scores. This confirms prior findings of the efficacy of propranolol in akathisia induced by neuroleptic treatment.

The case notes of 23 schizophrenic patients who participated in a study of somato-sensory cortical evoked responses were examined for descriptions of the clinical features of their mental state at the time of first illness or most recent relapse. A comparison of syndrome scores derived from Present State Examination with those derived from case notes showed that the latter was a reliable method of mental state description for the purposes of this study. A group of syndromes similar to that described in electrodermal research was identified from the case note review and found to be highly correlated with the presence of an abnormal response in the somato-sensory evoked potentials study.

This paper argues that recent research on normal-belief formation is relevant to our understanding of the establishment and maintenance of delusions. Bayesian theory provides a normative model of the way in which evidence relevant to normal beliefs may be evaluated: this makes it possible to classify delusional beliefs in terms of deviations from optimal Bayesian inference. Some hypothetical forms of deviation appear to correspond closely to cognitive processes observed in some groups of deluded patients. Theories of the precise nature of the abnormal judgemental processes also have implications for psychological approaches to treatment of deluded patients. The role of hallucinations in the formation and/or maintenance of delusions and the extent to which the distortions of cognitive processes associated with delusions are content-specific or mood-specific are also considered.

Of 105 patients admitted to a surgical ward with acute abdominal pain, 18 were considered to be without evidence of any organic aetiology for this symptom. These ‘non-organic’ patients were almost all female and differed from the ‘organic’ patients in state anxiety and in the illness behaviour questionnaire scales of psychological versus somatic perception, denial and affective disturbance. The two groups of patients could be differentiated on the basis of scores derived from the Illness Behaviour Questionnaire, and the State-Trait Anxiety Inventory.

SOMA, a questionnaire designed by J. T. Quinn to measure sexual anxiety in patients presenting at a psychosexual clinic, has been used extensively as a clinical and research tool. Its construction and scoring are described, and data are presented for internal consistency, test-retest reliability, principal components analysis, and validity. Practical applications for diagnosis, prognosis, and research are discussed.

A total of 149 children aged 13–17 years were examined. 83 were mildly and 66 severely mentally retarded. These children, especially the severely retarded ones, are representative of all mentally retarded children born in 1966–1970 and living in Göteborg, Sweden. 64% of the severely mentally retarded and 57% of the mildly mentally retarded children were suffering from a handicapping psychiatric condition. Autism-like ‘psychotic behaviour’ was common in the severely retarded. 0.2% of the total child population aged 13–17 years suffering from the combination of mental retardation and ‘psychotic behaviour’. Epilepsy was associated with psychiatric abnormality, but Down's syndrome was generally not so associated.

Out of 1279 first-year undergraduates, two matched groups of students potentially vulnerable to psychological disturbance were identified. One was left to its own resources; the other was offered psychotherapeutic intervention, the effects of which were measured by the number of consultations with general practitioners, type of treatment and rate of withdrawal from university. Although the students in the intervention group had fewer consultations, lower General Health Questionnaire scores at follow-up, and fewer withdrew from university, due to the small numbers involved none of these differences achieved statistical significance.

The total population of children under 10 years in one Swedish urban area and one rural area was screened for infantile autism (IA) and autistic-like conditions (AC). A total prevalence of 6.6 per 10 000 was found, which is somewhat higher than in previous similar studies of the same region. Infantile autism accounted for two-thirds of the cases. Boys far outnumbered girls, but this was entirely accounted for by the IA group. The preponderance of autistic boys was less pronounced among the severely mentally retarded children. Mental retardation was seen in almost 90% of cases and only one child had an IQ exceeding 100; clinical and laboratory signs of brain dysfunction were also found in a majority of cases. Distribution by social class was no different in either patient group from the general population.

By comparison with the PSE-ID system, we showed that the GHQ-60 could be used with good results as a screening instrument in the first of a two stage community survey. Unlike the sensitivity and negative predictive values, the specificity and positive predictive rates reach low figures in this study. The global efficiency and positive and negative predictive values of the test are significantly improved by raising its cut-off score, but at the expense of great reduction in sensitivity. The revised scoring system failed to provide better prediction of caseness' than conventional scoring. The GHQ does not distinguish fully between persons in the community afflicted by ‘transient states of distress' and those whose symptoms would classify them as cases' by the PSE.

Body size estimation was studied in 22 patients with bulimia and 20 normal controls. Two methods of body size estimation were used, a distorting television image method (DTIM) and the image marking method (IMM). The subjects estimated body size of a dummy as well as their own body on the DTIM. When estimating body size on the DTIM the bulimics overestimated and the controls underestimated, there being a significant difference between the two groups. There was no difference between the groups when estimating the size of the dummy. On the IMM a significant difference was found between the bulimic and control groups, the bulimics overestimating body size and the controls being more accurate. Marked directional effects were found with the DTIM. The two methods of body size estimation are compared.

A schizophrenic patient whose severe level of auditory hallucinations had proved refractory to neuroleptic medication was given two treatment techniques derived from Green's theory that hallucinations represent verbal activity in the non-dominant hemisphere. Voice activity was markedly reduced in frequency and severity over a six-month period, and led to general improvements in interpersonal functioning. There was evidence for independent and additive effects of the two techniques.

Patients suffering from obsessional neurosis without other psychiatric diagnosis were examined with reference to the association of the mood disorders of depression, anxiety, and outwardly and inwardly directed irritability. All mood disorders were common, and many occurred together in individual patients, but anxiety was the most prevelant. Inwardly directed irritability was significantly related to the overall severity of obsessions, and to the degree of handicap or interference in everyday life experienced by the patient.

We asked 24 patients with anorexia nervosa and 30 normal controls to estimate their body-size several times, each time using different instructions. The degree of over-estimation was found to vary predictably with the wording of the instructions. Informing the subject that she had made an error without specifying the direction of the error resulted in reduced over-estimation on a subsequent trial, for both anorexics and controls. ‘Internally directed’ instructions were associated with a greater degree of over-estimation than ‘external’ instructions in both groups, but particularly in anorexic subjects. Our results indicate the necessity of controlling the ‘demand characteristics' of such experiments.