The long-term treatment outcome of 248 bipolar patients in an out-patient lithium programme was assessed. Over half of the patients (138 or 56%) had no affective episodes in the year observed. Patients were divided into outcome groups according to GAS scores: the outcome for 40% of patients was good, for 41% fair, and for 19% poor. More frequent psychiatric admissions before starting lithium treatment was the best predictor of poor outcome, followed by a negative affective style in the family and lower social class. Current alcohol and drug abuse was associated with poor outcome. Although familial and psychosocial factors were significantly associated with outcome, the findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.

Auditory evoked potentials were recorded in a choice reaction-time task. This test paradigm elicited the attention-related P300 component and was used to study cognitive processing. Compared with age-matched controls, 17 patients with dementia of the Alzheimer type were shown to have significantly longer reaction times as well as delayed latencies of several components of the auditory evoked potentials. The fractional increase in the reaction times was much greater than that of the P300 peak latency. The latter is commonly accepted as an index of stimulus-evaluation time. These findings suggest a delay in both response selection and stimulus evaluation.

“41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 μg/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness.”

Ninety-four Canadian-born psychiatric patients who committed suicide were compared with 23 foreign-born patients committing suicide in Canada. East Europeans were over-represented, and significant differences were found in the age distribution, stress, level of education, social isolation, and methods of suicide. Most foreign-born patients had come to Canada for family or economic reasons but were unemployed, with poor social integration. Employment, homing, education, social integration and a support network seem to be important in preventing these deaths. Cultural evaluation of the patient and early intervention is recommended.

A case-control study was performed using 90% of all first-contact patients with a clinical diagnosis of schizophrenia residing in the London borough of Camberwell between 1965 and 1984. Cases and controls were obtained from the Camberwell psychiatric case register. Controls were those presenting with first episodes of non-psychotic disorders, matched for age, sex and period. The risk of schizophrenia was greater in those of Afro-Caribbean ethnicity, irrespective of age, gender or place of birth. This risk increased over the study period. The results cannot be explained by changes in the age, gender or ethnic structure of the local population. Effects of misdiagnosis or change in diagnostic practice were reduced by using uniform operational criteria. Possible explanations include maternal exposure to unfamiliar infective agents, a differential fall in the age at onset of illness, or worsening social adversity.

Two hypotheses were tested concerning the nature of the cognitive dysfunction in schizophrenia: (a) that there is a broadening of selective attention; and (b) that there is an impairment in associational learning. RDC-diagnosed acute and chronic schizophrenics and normal controls carried out a choice reaction time (RT) task in which conflict between the correct response to a target (a letter in the centre of a computer screen) and that cued by simultaneously presented flankers (two letters either side of the target) increased RT. For 80 (‘valid’) trials, flankers and targets were consistent in the response cued (pressing a button with either left or right hand); on 8 (‘invalid’) trials they conflicted. On invalid trials there was a slowing of RT, and an increase of errors for left-hand responses. Chronic schizophrenics showed the same reactions to cue validity as normal controls, both groups differing significantly from acute schizophrenics. For the latter, the RT data supported hypothesis (b), but the error rates appeared to support hypothesis (a).

Among 24 chronic schizophrenic patients, the 10 with high ratings for negative symptoms had significantly higher left-frontal: temporal–cortical T2 ratios. This finding was unrelated to age, dose of medication, length of illness or handedness. No T1 or T2 changes were found to be associated with positive symptoms or tardive dyskinesia in the regions examined.

In a prospective study of 20 patients with NMS, those who received dantrolene (2 patients) or bromocriptine (2 patients) or both (4 patients) tended to have a more prolonged course of illness and a greater incidence of sequelae than those treated with supportive care alone. These results do not indicate a useful role for dantrolene or bromocriptine in the treatment of NMS.

The condition termed ‘delusional atmosphere‘ belongs to the ‘precursor phenomena‘ of delusion and has always attracted special attention because its peculiarities evoke the hope of obtaining better insight into the conditions governing the emergence and formation of delusion. The following considerations represent a review of the most important topical hypotheses about the nature of the delusional atmosphere and its progression into finalised delusional elaborations as seen in the perspective of the psychopathology of German-speaking countries.

Of 107 recently admitted psychiatric patients screened for eating-disorder symptoms by questionnaire, 17% met DSM–III–R criteria for eating disorders. Eight patients (one male) had bulimia nervosa. Ten patients had eating disorder not otherwise specified: seven (three male) bulimic type, and three (one male) anorexia nervosa type. The most common concurrent diagnoses were mood and personality disorders. As eating-disorder symptoms are relevant to the diagnosis and management of other psychiatric disorders they should be assessed routinely in all psychiatric patients.

The prevalence and inception rates of treated schizophrenia in the population of inner-city Salford were compared with those from a similar survey, ten years earlier. Data were obtained from a computerised case register and a postal questionnaire sent to GPs, and case notes rated on the SCL and screened using ICD–9. The point-prevalence rate of 6.26 per 1000 adult population was higher than that previously reported (4.56), despite decreases in total inception rate and in the general population. Changes in rates are presumed to be related primarily to population movements and ageing of the schizophrenic sample. Compared with 1974, the numbers of in-patient days and long-stay in-patients had fallen substantially by 1984, although annual admissions increased over the decade; day-patient and out-patient attendances, and extramural contacts with psychiatrists, community psychiatric nurses, and social workers had also increased. Almost 62% of cases were maintained on depot injections as out-patients in 1984. Over 75% of identified schizophrenic patients were in contact with psychiatrists, but only 7 out of 557 were solely in contact with their GP. In spite of the emphasis on community care, responsibility for schizophrenic patients was still carried overwhelmingly by hospital psychiatric services.

Seven cases are described in which the central symptoms were fear of contracting AIDS, avoidance of related cues, rituals and reassurance-seeking, Associated features include previous illness phobias and obsessive-compulsive disorder. Treatment with exposure and response prevention (plus a cognitive session in one case), led to improvement sustained up to three months after discharge, although one patient stopped treatment prematurely. Controlled trials of behavioural treatment in hypochondriasis are required.

A group of 64 Falklands war veterans who were still serving in the British Army were studied and compared with a group of matched controls. Half the veterans reported some symptoms of post-traumatic stress disorder, and 22% were rated as having the complete PTSD syndrome. Presence of the symptoms was associated with intensity of combat experience and the retrospective report of emotional difficulties in the initial period on return from the war.

Psychotic in-patients who consume caffeine may present complications in the course of their illness. Two cases are described which illustrate the clinical profile of such patients, whose caffeine-associated complications are often misdiagnosed.

“Since time immemorial, delusion has been taken as the basic characteristic of madness. To be mad was to be deluded” (Jaspers, 1963, p. 93).

A case of severe mania due to thyrotoxicosis responded to propranolol and propylthiouracil.

When 42 cases of primary dissociative states from India were classified according to DSM–III–R and ICD–10 criteria, DSM–III–R was found to be unsatisfactory, with 40 (95.2%) cases receiving a diagnosis of dissociative disorder not otherwise specified. The majority fit well into simple dissociative and possession disorders. ICD–10 was found to be more satisfactory, with 36 (85.5%) patients fitting into specific subcategories, which, however, need to be defined and described more explicitly.

Two cases of pre-partum psychosis are described. Both patients had previous episodes of puerperal psychosis but no non-puerperal illnesses. The possible relationship of pre-partum and post-partum psychosis is discussed.