Fifty-nine psychotic patients with acute onset of illness, who had been interviewed about their experience of stressful life events before the episode, were followed up for an average of 42 months. Thirty patients (51%) had experienced a stressful life event in the 3 months immediately before onset (EV +), 29 had not (EV −).

In patients with an RDC diagnosis of affective disorder or unspecified functional psychosis, the presence of stressful life events was associated subsequently with milder symptom severity, less time spent in hospital, more treatment for depressive symptoms and less for psychotic symptoms. In schizophrenia, differences were less apparent, but patients with event associated episodes had less need of anti-psychotic maintenance medication over the follow-up period and tended to have spent more time in complete remission. EV + schizophrenic subjects also had higher morbid risk for schizophrenia in their first degree relatives, and tended to be female and to have less typical symptoms than EV − schizophrenic patients.

A preliminary model is described to account for the ‘reality testing’ of memories (after Johnson & Raye, 1981) in an attempt to explain delusional memory. Two routes are proposed: route one involves evaluation of the factual content of the memories against stored general knowledge. Route two relies on the evaluation of the perceptual and narrative characteristics of memories with the assumption that the stronger these characteristics, the more likely the memory is to be real. The integrity of these routes is examined in four patients with delusional memories, using standardized tests. The results suggest that in these cases, general knowledge is essentially intact while the perceptual characteristics of delusional memories are stronger than real memories which in turn, are stronger than fantasies. This could lead the evaluation system to accept delusional memories as true memories despite their implausibility. The roles of rehearsal and affect are probably important in this and require further study.

Two male patients who presented with unusual pictures of dementia in the absence of other obvious symptoms or signs are reported. Investigations demonstrated changes highly suggestive of multiple sclerosis (MS) on magnetic resonance imaging, cerebrospinal fluid analysis and electrophysiological tests. We suggest this represents a rare presentation of multiple sclerosis.