It is in dispute whether affective relapse disrupts psychosocial functioning to the same extent in depressed and manic patients.

A prospective, naturalistic, longitudinal follow-up of 84 unipolar and bipolar affectively disordered in-patients was conducted to examine the extent of recurrent affective syndromes and their relationship to overall outcome. Global adjustment relative to relapse was assessed at 2- and 4.5-year follow-ups.

Nearly half of the bipolar patients had subsequent syndromes, which were often associated with uniformly poor psychosocial functioning. Fewer than one-quarter of those with recurrences had steady work performance. Bipolar patients taking lithium alone had fewer recurrences than those taking lithium as well as neuroleptics (P<0.05). Bipolar and unipolar patients relapsed with equal frequency, but unipolar relapse was less often associated with readmission to hospital, work impairment, or uniformly poor functioning.

Affective relapse in bipolar disorders was more detrimental to overall functioning than was recurrence in unipolar depression.

Studies of mental health problems of homeless people have used diagnosis as the sole measure of these problems. In this study, the feasibility and reliability of measuring social disablement in the psychiatric assessment of homeless people was investigated.

A random sample of 101 homeless men living in four long-stay hostels was assessed for their social disablement by the Social Behaviour Schedule (SBS). The prevalence of SBS problems in these men and the interobserver reliability were assessed.

The results show that the SBS is a reliable screening instrument which is relatively easy to use. The most frequent SBS problems were ‘Other problems’, ‘Hostility’ and ‘Depression’. Less than 10% of the hostel sample had disablement items similar to those of patients in long-stay wards.

The SBS is a useful and reliable tool in the psychiatric assessment of men in hostels for the homeless.

New cases of erotomania in men, plus cases from the literature, were analysed to explore any association between erotomania and dangerousness, and to identify possible predictors.

Files at two in-patient facilities were examined to determine the presence of DSM–III–R delusional disorder, erotomanic type. The sample (13 cases) was divided into dangerous and benign groups on the basis of serious antisocial behaviour directly related to erotomanic delusions. These cases were combined with all reports of erotomania in men (16 cases), found in the English language psychiatric literature, to allow for statistical analysis.

Two factors, multiple delusional objects (P < 0.0005) and serious antisocial behaviour unrelated to the delusions (P < 0.05), were found to be significantly associated with dangerousness. Using a combination of these two variables it was possible to predict dangerousness with an accuracy of 88.9% (weighted prediction accuracy or ‘hit rate’). We identified no false negatives but three false positives.

The presence of multiple objects, and a history of serious antisocial behaviour unrelated to the erotomanic delusions, are useful predictors of dangerous behaviour in men with erotomania.

The pathogenesis of anorexia nervosa (AN) is controversial.

A retrospective case series was studied to investigate the post-viral onset of AN.

Four consecutive in-patients with severe restrictive AN spontaneously volunteered histories of ‘glandular fever’-like illnesses immediately before the onset of their eating disorder. This association has not previously been described. Possible pathogenic pathways include both non-specific and specific viral disruptions in central homeostasis, particularly involving corticotrophin-releasing hormone (CRH) regulation.

Such mechanisms are speculative, but biologically and historically plausible.

A 71-year-old man with no previous psychiatric history presented with an acute onset of obsessive–compulsive disorder (OCD) symptoms associated with a right inferior parietal infarct. There were no abnormal neurological signs. There were no noteworthy abnormalities on neuropsychological testing.

Whereas a computerised tomography scan showed only a right inferior parietal infarct, a single photon emission computerised tomography (SPECT) scan revealed that in addition to the infarct there was decreased regional cerebral blood flow in the right basal ganglia and temporal areas. There was higher activity in the right orbitofrontal area than in the left.

The patient improved with standard drug therapy and psychotherapy.

SPECT is effective in the diagnosis of neuropsychiatric disorders such as OCD, and the pathological changes in brain metabolism detected by SPECT may be reversed by both drug therapy and psychotherapy.

Some authors have argued that hostels for homeless people are increasingly taking over the role of psychiatric long-stay wards, and that this creates a problem. We set out to test this hypothesis.

The social disablement of a random sample of 101 homeless men, described in Part 1, was compared with that of a sample of 66 psychiatric patients from a long-stay ward.

The study sample rated significantly lower for social disablement than the long-stay ward sample. Thirteen subjects of the hostel sample had psychotic social behaviour problems. These had no history of being long-stay psychiatric patients.

The hostel sample differ significantly in their social disablement from the chronic psychiatric patients. There is a small proportion of severely disturbed residents who might have been over-represented in previous non-random surveys.

Previous studies on self-esteem have focused exclusively on its psychosocial determinants. The goal of the present study is to clarify genetic v. environmental determinants of self-esteem.

Participants were Caucasian women sampled from the Virginia Twin Register: 363 pairs of MZ and 238 pairs of DZ twins were available from the first wave of the study, and 430 pairs of MZ and 308 pairs of DZ twins from the second. Self-esteem was assessed with the Rosenberg's Self-Esteem Scale.

Using univariate twin analyses of self-esteem and a repeated measurement twin model, we found that self-esteem is a moderately heritable trait (heritability = 52% in the repeated measurement model); environmental influences are also very important, and are probably mostly not shared by members of a twin pair.

Aetiological models of self-esteem which examine only psychosocial factors are incomplete; genetic factors need to be integrated.

The study set out to review the relationship between mental disorder and fire-setting.

Sociodemographic, psychiatric, and medical data were retrospectively obtained from case notes of a group of 36 fire-setters referred to the North West Thames Forensic Psychiatry Service over a four-year period.

Of the sample, 28% were female and one-third had no mental illness; 28% had a previous medical history of possible relevance. Psychoactive substance abuse was common. There was a significant disturbance of interpersonal relationships. Eighty-five per cent lived alone, and 44% of the female fire-setters had a history of sexual abuse.

On the basis of this study, a multiaxial classification system of fire-setting is proposed.