Functional brain imaging with technetium-99m d,l-hexamethyl propyleneamine oxime (HMPAO) Single Photon Emission Tomography (SPET) allows us to explore the cerebral pathophysiology of Gilles de la Tourette's Syndrome (GTS).

Fifty patients and 20 controls were examined. Patients were rated for tic severity and mood. Scans were analysed quantitatively using internal ratios to the occipital cortex.

Patients differed from controls on measures of relative blood flow to the left caudate, anterior cingulate cortex and the left dorsolateral prefrontal cortex. Severity of tics was related to hypoperfusion of the left caudate and cingulate and a left medial temporal region. Hypoperfusion in the left dorsolateral prefrontal region was related to mood.

The areas found to be hypoperfused in this study are consistent with known functions of fronto-striatal circuits. A wide range of perfusion patterns is seen, however, and no characteristic patterns for behavioural subgroups has been documented with this technique.

Dysmorphophobia may improve after a variety or combination of treatments, but which elements of a treatment are useful is usually not certain.

In a single out-patient case study rational role-play (‘paradoxical discourse’) was added to exposure plus cognitive restructuring (CR) for a dysmorphic delusion study comprised of 20-minute sessions one week apart.

Previous exposure plus attempted CR had improved anxiety, phobias, work and social leisure, but not dysmorphic belief. Added brief rational role-play was followed by resolution of the dysmorphic belief. All measures remained much improved at 18-month follow-up.

Rational role-play deserves a controlled trial in dysmorphophobia and other problems and exploration of its mechanism of action.

Morbid jealousy is an incompletely understood syndrome. The association between morbid jealousy and alcoholism is unclear.

Morbid jealousy was assessed in 207 male patients with alcohol dependence (DSM–III–R) using a semi-structured interview schedule administered both to patients and their spouses.

Thirty-four per cent (71 out of 207) suffered from morbid jealousy. Morbid jealousy had different manifestations. Some patients expressed it only when intoxicated, others even when sober and in some the jealousy took the form of a delusional disorder.

Alcoholism appears to have an aetiological role in the development of morbid jealousy. Detecting morbid jealousy when it is expressed only under the influence of alcohol has preventive implications.

Infection with the human immunodeficiency virus (HIV) is associated with substantial psychiatric morbidity. This paper summarises the main forms of psychological intervention currently used, and reviews research evidence for their efficacy.

Publications on the mental health aspects of HIV infection and psychological interventions were identified through the main HIV journals and general psychiatric and psychological periodicals, with the assistance of AIDS Abstracts.

Publications concerned psychological interventions at the time of HIV testing, interventions for infected people at different stages of disease, and risk-reduction interventions. While many publications were identified describing uncontrolled investigations, only a few studies had involved systematic evaluative research.

There is a need for systematic evaluation of psychological interventions for HIV infection, in terms of both efficacy and cost.

The apolipoprotein E (ApoE) ∊4 allele is associated with an increased risk of senile and probably presenile Alzheimer's disease. It is not yet clear whether the ∊4 allele also influences the duration/rate of progress of illness and the severity of the dementia.

We have retrospectively examined a series of ApoE genotyped presenile and senile autopsy cases of Alzheimer's disease (AD) for length of illness and severity of pathology.

We find no evidence that ApoE genotype affects the rate of progress of AD, but the degree of pathology at death may be increased.

It appears that the rate of progress of AD as a whole is independent of the ApoE genotype.

Difficulties in family functioning have been noted since early descriptions of anorexia nervosa and may be of importance aetiologically. Previous studies have a number of methodological problems.

Thirty-five anorexic adolescents were age/sex matched with psychiatric and community controls. A diagnostic interview and a questionnaire, the Family Assessment Device (FAD) were administered to control subjects and their mothers. Anorexic families only received the McMaster Structured Interview of Family Functioning.

Multivariate analyses of FAD scores showed pathological ratings for psychiatric control but not anorexic families, compared with community controls. By contrast objective ratings revealed marked dysfunction in anorexic families (greater in the purging subgroup).

Family functioning in anorexic families is normal by self-report but not by an objective measure. Anorexic families in the purging subgroup appear most dysfunctional.

In developed countries, most dementia appears to be due to Alzheimer's disease and vascular dementia. We report rates for incidence of subtypes of dementia based on clinical diagnosis.

This study was a 2.4-year (s.d. 2.6 months) follow-up of a cohort aged 75 years and over, seen initially in a prevalence study of dementia. A screening interview in 1173 survivors was followed in a subsample of 461 respondents by a diagnostic interview 1.8 months after screening (s.d. 1.5 months). This comprised a standardised interview with respondent and informant, with venepuncture where possible. Clinical diagnoses of subtypes were made by specified criteria.

The incidence of Alzheimer's disease of mild and greater severity was 2.7/1000 person-years at risk (1.6–4.4); in men 1.5 (0.8–2.7) and in women 3.3 (1.8–5.9). The incidence of vascular dementia was 1.2/100 person-years at risk (0.7–1.9); in men 1.1 (0.4–2.8) and in women 1.2 (0.7–2.0). Alzheimer's disease, but not vascular dementia, showed a marked increase with age, particularly in women. Rates for minimal dementia of different subtypes showed similar age and sex effects, but were much higher for Alzheimer's disease than vascular dementia.

The striking rise in incidence rates of dementia in the very old appear to be due to Alzheimer's disease, while rates for vascular dementia remain relatively constant. These trends are particularly marked for minimal dementia, but emphasise the importance of Alzheimer's disease in the community as a cause of cognitive decline of all degrees.

Psychotic symptoms in dementia have been considered as a single category which may have masked important associations. An exploratory analysis was undertaken to look separately at delusions, visual hallucinations and delusional misidentification.

Psychotic symptoms were assessed with the Burns' Symptom Checklist in 124 patients with DSM–III–R dementia.

Eighty-three (66.9%) patients had psychotic symptoms. Deafness and life events were associated with delusions and visual impairment was associated with visual hallucinations, while senile dementia of Lewy body type and older age were associated with both.

Differences are evident in the associations of delusions and visual hallucinations. Sensory impairments were associated with both symptoms.

Childhood sexual abuse (CSA) is found to have occurred to a substantial minority of women with bulimia nervosa. Its clinical significance is unclear.

We studied 87 bulimic women in a clinical trial. Structured interviews determined the presence of CSA, DSM–III–R disorders, global functioning, and depressive and bulimic symptoms.

Forty-four per cent reported a history of CSA. Bulimic women with CSA reported earlier onset of bulimia, greater depressive symptoms, worse global functioning and more suicide attempts, and were more likely to meet criteria for bipolar II disorder, alcohol and drug dependence, conduct disorder and avoidant personality disorder.

Although those with CSA had greater comorbidity, it was not an important modifier of bulimic symptoms.

Statistical error rates in the medical literature are generally high.

All papers published in the British Journal of Psychiatry in 1993 which presented numerical results were reviewed by the author for statistical errors.

A total of 248 papers were published, of which 164 (66%) presented numerical results.

Sixty-five (40% of 164) papers contained statistical errors. Many errors were not serious in nature, but some were serious enough to cast doubt on conclusions. The error rates are similar to those found in an earlier study.

The statistical error rate is unacceptably high. There is no evidence of a change in the statistical error rate over time.