Classroom Reality Orientation was investigated with a sample of dements drawn from a psychogeriatric hospital and an old people's home. Treatment effects were examined on a range of cognitive and behavioural measures, and compared with the effects of a specific behaviourally directed orientation training in the ward. Class RO improved cognitive functioning but not behaviour, irrespective of degree of dementia. Highly significant behavioural change was demonstrated for ward behaviour orientation training and this technique is not only cheaper but has potential in managing dements.

The Clifton Assessment Schedule and the Shortened Stockton Rating Scale were administered to 38 elderly, mentally handicapped patients. Inter-rater reliability was high and the CAS was found to be a useful measure of cognitive ability. The tests measure different features of patients, but both correlated significantly with estimated levels of independence.

One hundred patients aged 65 and over were psychiatrically assessed before and in the first week after elective surgery. Thirteen were psychiatrically ill before operation and 21 developed post-operative illness. Post-operative confusional states (14 patients) were associated with physical complications but not with environmental or pre-operative psychiatric variables. Affective disorders either improved following successful surgery (5 patients) persisted or developed after operation in association with continuing physical illness (6 patients).

One hundred children between the ages of 7 and 12 admitted to a hospital for orthopaedic procedures were studied to determine the frequency of depression, according to the DSM III diagnostic criteria for major depressive disorder. Of the total sample, 23 showed evidence of depression. Loss of interest or pleasure was the most frequent symptom. Significantly more parents of these depressed children were themselves found to have adjustment or emotional problems. The authors emphasize the importance of paying special attention to this high risk group of child patients because of their propensity to depression and other emotional disorders.

The records of 79 children whose firesetting led to referral to a Children's Hearing (the Scottish equivalent of a juvenile court) were examined. All but one of the children were boys. They had very disturbed backgrounds, with much family disruption and absent or unemployed fathers. Firesetting was predominantly a group activity and the damage caused was extensive. Although the children frequently engaged in other offences, in over 90 per cent there was no recurrence of reported firesetting within the limited period of possible follow-up.

The communication difficulties of prelingually profoundly deaf patients render psychiatric diagnosis extremely difficult. A study of 12 prelingually profoundly deaf schizophrenic patients revealed that visual hallucinations occurred in 10, and 10 also had experiences analogous to auditory hallucinations although voices may not have been heard.

In an examination of the phenomenology of pain in 78 patients with schizophrenia, 29 had current pain complaints. Of these 13 had an appropriate physical cause, leaving 16 with pain of seemingly psychological origin. The head, leg and back were the commonest sites. Complaints were most often described in sensory terms.

Pain plausibly related to a specific delusion or hallucinatory process occurred only once, and no gross examples of insensitivity to noxious stimuli or to self-mutiliation were seen. Patients with schizophrenia may have less pain than those with anxiety or depression but certainly do experience pain both from physical and psychological causes. The influence of phenothiazines on pain experience is uncertain.

Neurophysiological studies of experimental pain were carried out on two severely depressed patients who complained of an inability to experience emotion. They had normal thresholds for stimulus appreciation but markedly increased thresholds for pain. These abnormal pain thresholds normalized with clinical recovery.

Measurements of spontaneous fluctuations in skin conductance in 20 acutely ill schizophrenic patients were made in a video-tape studio. Recordings were made initially with the patient talking to an interviewer, then during a video-taped interview conducted with the patient's key relative. The Expressed Emotion (EE) of the patient's key relative had been measured previously. Significant differences in the type of spontaneous fluctuation activity between patients who had low EE and high EE relatives were demonstrated when the relative was present, but not when the relative was absent. The findings were not related to phenothiazine medication.

Physostigmine (0.25 mg-1 mg), arecoline (2 and 4 mg) and saline were administered intravenously over 30 minutes in a randomized double blind design to 11 patients with a clinical diagnosis of Alzheimer presenile dementia. Significant improvement was seen on a picture recognition test with physostigmine 0.375 mg and arecholine 4 mg. A trend towards improvement was also seen with physostigmine 0.25 mg and 0.75 mg, and arecholine 2 mg. For the majority of the patients improvement was only slight but in two patients it was clear cut and consistent.

The growth hormone response to clonidine was significantly less in 10 drug-free patients with endogenous depression than in 10 normal subjects who were individually matched with the patients for age and sex. The hypotensive and sedative effects of clonidine in the two groups were similar. The findings may indicate a defect at central a adrenoceptors at least in neuroendocrine systems.

Two patients are described who developed behavioural changes following brainstem injuries. Both patients had neuro-ophthalmological signs indicative of lesions of the rostral brainstem, which were confirmed by CT scanning. It is suggested that the behavioural changes were related to interruption of nearby limbic, hypothalamic and reticular structures.

The development of DSM-III is traced from the Feighner Criteria through Spitzer's Research Diagnostic Criteria. The specific criteria for the diagnosis of schizophrenia are listed, and the symptoms which contribute to the diagnosis are categorized. Differences from the DSM-II concept are highlighted, and the complicated question of schizoaffective disorder is discussed. The DSM-III resolutions to the major controversies in the study of schizophrenia are outlined. Finally, the major strengths and weaknesses of the DSM-III approach are assessed.

Three cases of monosymptomatic delusion of alimentary stench are described. Each patient was referred for behaviour therapy as a last resort, after extensive medical investigation for halitosis or flatulence and failure of other psychiatric treatment. Two of the patients showed clinical improvement after treatment sustained at follow-up. Monosymptomatic delusion is now a treatable condition and is important to diagnose.

This paper evaluates the predictive power of two classes of variables which are thought to be related to psychotherapy outcome: patient characteristics assessed at the start of treatment and process characteristics of the psychotherapy. The treatment was Short Term Interpersonal Psychoatherapy which was performed with ambulatory patients during a major depressive episode as defined by Research Diagnostic Criteria. Univariate correlations indicate that patients with generally healthier functioning on the Prognostic Index received better ratings on measures of psychotherapy process and experienced greater improvement in depressive symptoms and social functioning. However, in a multiple regression analysis, patient characteristics accounted for 64 per cent of the variance in treatment outcome, while psychotherapy process variables were not predictive of outcome.

In a matched controlled study of 71 depressed men, parental loss before 17 years, poor marriage, and unemployment were found to be vulnerability factors associated with depression in men.

Blood platelets appear to have a somewhat schizoid existence. Haematologically they are intimately connected with the process of clot formation (for review, see Zucker, 1980) and, at least from a research standpoint, this aspect of their being is largely separate from their use as models of monoaminergic neurones (for reviews, see Maynert and Isaac, 1968; Abrams and Solomon, 1969; Lingjaerde, 1977; Stahl, 1977; Pletscher, 1978).