Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

Event-related potentials during a two-tone discrimination task were recorded in 24 schizophrenic patients, 16 depressed patients and 59 control subjects. Recordings were made when patients were medication-free. Fourteen schizophrenic and 13 depressed patients were retested at 1 and 4 weeks after the start of treatment, and 13 schizophrenic patients were also tested between 6 and 24 months after the initial recordings. In the schizophrenic group, the P3 latency was significantly prolonged compared with that in the control and the depressed groups, and remained unchanged both after 4 weeks treatment with therapeutic doses of neuroleptic drugs and at long-term follow-up. In the depressed group, the P3 latency did not differ from that of controls. P3 amplitude by contrast was reduced in both the acutely depressed and schizophrenic groups and following treatment became normal in the depressed group but remained reduced in the schizophrenic group. It is suggested that a prolonged P3 latency and reduced P3 amplitude indicate an impairment of auditory information processing in some patients with schizophrenia which is independent of the presence of acute psychotic symptoms and is not influenced by neuroleptic medication.

Patients with chronic schizophrenia were examined by nuclear magnetic resonance imaging of the brain. Subgroups of the syndrome with high positive or high negative symptom scores and ventricular dilatation were compared with each other and with normal controls in respect of regional spin lattice relaxation time (T1) changes. Significant differences were not observed between the schizophrenic subgroups and controls but there were significant differences between the subgroups themselves. The presence of tardive dyskinesia was associated with increased T1 of the basal ganglia. The significance of these results is discussed in relation to findings using other techniques.

Thirty-two chemically dependent alcoholics with significant levels of anxiety or depression were admitted to a double-blind randomised study in which the effect of the substituted benzamide tiapride was compared with that of placebo over a 6-month period. Twenty patients completed the study. Assessments included relevant biochemical and haematological tests, drinking levels and associated behaviour, expressed satisfaction with various areas of life, the Crown-Crisp Experiential Index of neurotic symptoms and questionnaires on self-esteem and alcohol dependence. The results indicated that in comparison with the placebo group, patients treated with tiapride drank less and had longer periods of abstinence. This was associated with improvements in laboratory tests, reduction in neurotic symptoms, gains in self-esteem and increased levels of expressed satisfaction with life situation. The drug was well tolerated and no deleterious effects were noted, suggesting its potential usefulness for this patient group.

A prevalence of depression of 13% was found among 139 coloured persons aged 65 years and over, living in the community in Cape Town, which accords with figures elsewhere. A high rate of hypochondriasis was found, but there was a low rate of suicidal intent, which could be explained by good social support. Observed depression and a depressed mood occurred in almost all depressed patients; as defined in the Present State Examination, these items appear to be an excellent screen for depression.

Patients suffering from unipolar and bipolar affective illness, who began treatment with prophylactic lithium carbonate during a 5-year period, were followed up and 59 out of 101 interviewed. Most had been taking lithium for at least 13 years: 49% had a complete remission, 41% a partial but significant response, and 10% no response. No specific individual or illness factor was found to correlate with favourable outcome, and no correlation between average serum lithium level and outcome. No side-effects could be associated specifically with the long-term use of lithium, but there was a surprisingly high incidence of clinical hypothyroidism.

Times in remission from affective illness were prolonged during treatment with lithium carbonate and carbamazepine, but lithium was the more effective. Similar global scores for the two drugs suggested that other factors may determine their acceptability.

During the period 1979–1982 the incidence of suicide and parasuicide for students aged 15–24 years was found to be lower than that of others of the same age in Edinburgh. A comparison of student parasuicides with matched non-student parasuicides shows similar parasuicide repetition rates, but some differences in respect of precipitants (twice as many students reporting no major event prior to the episode), agent of poisoning (analgesics more commonly used by students; hypnotics, tranquillisers and barbiturates, by controls), and social and clinical characteristics (a greater proportion of controls reporting parasuicide in the family, a criminal record and being the victim of violence).

The calls to a telephone counselling service at Louvain, during a 21-month period, from one telephone zone were analysed. Data were studied in relation to the type of weather, which was recorded every day. Calls made by women about health and interpersonal problems showed a relationship to the weather, while calls apparently motivated by masturbation intentions from male callers increased when the weather improved.

Numerous surveys have attempted to estimate the prevalence of dementia. Despite difficulties of measurement, evidence suggests figures may be lower than is generally realised. Factors which are likely to affect prevalence rates are discussed. Forthcoming changes in the demography of old age indicate that increases in the prevalence of dementia may have been seriously underestimated.

The development and use of a new psychiatric symptom change scale based on the Present State Examination (PSE) - the PSE Change Rating Scale - is described. The advantages of the PSE are retained (the extensive glossary, the diagnostic facility and the standardised interview technique) while improving its sensitivity to change and decreasing its administration time. The scale has been designed to prevent feedback of results and ‘halo’ effects: it has proved highly reliable in use across raters with different backgrounds and experience. The scale has been used to monitor drug effects on clinical state across a variety of diagnoses and examples of its use are given.

Levels of vasopressin, somatostatin, neurotensin, vasoactive intestinal peptide, corticotrophin-releasing factor and adrenocorticotrophin in CSF were determined in lithium-treated and unmedicated euthymic bipolar patients and controls, in a search for a trait marker in affective disorder. No group differences in levels of these peptides were found. Highly significant positive correlations were found among these peptides (with the exception of neurotensin), suggesting that their presence in CSF is functionally significant, as opposed to the result of random diffusion from the interstitial space of the brain.

This study follows the psychological profile of a group of Antarctic explorers on a remote base in British Antarctica. Each month for 1 year the 60-item General Health Questionnaire (GHQ) was administered to the 12-man complement and the results compared to those of a control group. Three men resigned and left, 4 months later, at the end of winter. Their scoring showed marked differences from the others, including the highest scores in the severe depression factor scale. The GHQ was accepted by the men despite the intrusive threat it offered in such a small community; there was also a seasonal variation in scoring, with higher scores in the winter, and no evidence of long-term psychological sequelae in those who stayed.

From a sample of consecutive referrals for psychogeriatric day care, the influence of the supporters' emotional distress and self-reported strain, together with the number of problems presented by the patient, was examined in relation to outcome, 6–7 months after initial attendance. A higher level of problems and the failure to achieve any reduction in reported distress were both found to contribute to the breakdown of community care and to the subsequent institutionalisation of the patient. Day hospital care was associated with a significant reduction in emotional distress for the majority of relatives, although for relatives whose distress was not alleviated by their dependents' attendance, admission to long-term care did produce such a reduction.

We studied 27 patients who complained of pain, for which no organic basis could be found, and 11 patients without pain. All patients were depressed according to clinical diagnosis and Beck Depression Inventory (BDI) scores. Plasma β-endorphin levels were found not to differ between the two groups or across other variables. The patients who complained of pain had significantly higher scores on the BDI.

Three psychosocial variables were rated independently by two clinicians for 140 adolescent referrals to a psychiatric unit. Overall, intraclass correlations for DSM-III Axis IV, Axis V and a psychosocial adversity index (PSAI) were respectively 0.44, 0.58 and 0.68. The main source of unreliability is probably the operational definitions, rather than their application by clinicians; indices similar to the PSAI may be preferable.

Fifty patients in their first manic episode were compared retrospectively with groups of (a) manic patients in other than first admissions and (b) acute surgical cases. They were then followed up for 3–8 years. First manic admissions were linked to life events far more frequently – 66% vs 20% and 8% respectively for the other groups. Within-group comparisons showed patients with life events were much younger. The link between life events and manic episodes appeared immediate and selective, a view further supported by the findings of the follow-up. Later episodes precipitated by life events seem to require smaller amounts of stress. The possible role of life events in relation to mania is discussed.

A study of the case notes of 52 patients with a diagnosis of hysterical personality disorder showed that 27 had no recorded features of that condition, but were frequently described as aggressive, uncooperative, or attention-seeking. Although 60% were recorded as depressed, only 17% received antidepressant treatment. In an experimental study, the core traits of the disorder were found to have a low inter-rater reliability. Two patients, who had received hospital diagnoses of hysterical personality disorder, were shown to display behaviour that caused psychiatrists to make a diagnosis on wholly inadequate information.

Kreitman (1979) reported that up to one-half of patients given out-patient appointments one week after an episode of deliberate self-harm (DSH) fail to attend, and gave a number of possible explanations for this. Firstly, parasuicide is often the result of a crisis which may have resolved (albeit temporarily) by the end of a further week. Secondly, someone in a state of heightened tension may find one week too long to wait, and may resort to other strategies to deal with his problems. Thirdly, many parasuicides may find a psychiatric label unacceptable in the context of their problems, and fourthly, an appoint ment made for a fixed day and a fixed hour may not fit the need for immediate action which the subjects subculture had inculcated in him as a habit pattern. Morgan et al (1976) reported that up to 40% of their DSH patients either did not attend any appointment or failed to complete their treatment. Two possible explanations for this were that they either felt that they did not need psychiatric treatment, or else believed that psychiatric treatment was not an answer to their problems. Kessel and Lee (1962), probably in line with much psychiatric practice, did not give a follow-up appointment to 40% of their self-poisoners; this was for two reasons. Firstly, these patients did not have a problem for which psychiatric treatment was appropriate and secondly, many of these patients had an entrenched personality disorder, which made it unlikely that psychiatric intervention would be beneficial.

For many hundreds of years the fresh leavesof the Khat shrub have been used for their stimulant properties. Several miffion people in East Africa Cathinone is considered the most active ingredient and has been recently isolated and synthesised (United Nations Document, 1975). The effects of cathinone closely resemble those of amphetamine (Halbach, 1972), to which it is chemically related. Regarding the beneficial effects of Khat, Carothers wrote in 1945: The chewing of this weed induces a happy and mellow friendliness and an increased intellectual vigour and acuity, thought tends to rise to a high plane, desire for war and women ceases, and conversation tends to concern itself with ‘the afairs of God’ and the accumulation of wealth by peaceful trade.