Cognitive impairment, negative and positive symptoms, primitive release reflexes, and age/temporal disorientation were assessed in 20 male patients meeting the DSM–III–R criteria for chronic schizophrenia and Schooler & Kane's criteria for TD. The control group comprised 20 age-matched male chronic schizophrenic patients without TD. Significant associations were found between TD, cognitive impairment, some negative symptoms, and formal thought disorder. These associations were independent of other illness and treatment variables. The severity of TD correlated significantly with that of cognitive impairment.

Multivariate meta-analysis was performed on 39 studies of ventricular size in schizophrenia which used the ventricle:brain ratio (VBR). The size of the VBR was dependent both upon the date when studies were carried out (more recent studies showing a reduction in the difference between schizophrenics and controls), and upon the diagnostic criterion used in the studies. Methodological factors in study design seemed more important than the characteristics of the schizophrenic subjects, in determining the VBR. Our analysis suggests that there is a difference in VBR between schizophrenics and controls which would seem to be an indisputable characteristic of schizophrenia. However, the difference is smaller than has previously been thought, so that, although of undoubted theoretical interest in accounting for the aetiology of schizophrenia, it is probably too small to be of practical significance in diagnosis, or in the differentiation of subtypes.

The Explanatory Model Interview Catalogue (EMIC) has been developed to elicit illness-related perceptions, beliefs, and practices in a cultural study of leprosy and mental health in Bombay. Leprosy is an especially appropriate disorder for studying the inter-relationship of culture, mental health and medical illness because of deeply rooted cultural meanings, the emotional burden, and underuse of effective therapy. Fifty per cent of 56 recently diagnosed leprosy out-patients, 37% of 19 controls with another stigmatised dermatological condition (vitiligo), but only 8% of 12 controls with a comparable non-stigmatised condition (tinea versicolor) met DSM–III–R criteria for an axis I depressive, anxiety or somatoform disorder. Belief in a humoral (traditional) cause of illness predicted better attendance at clinic.

A female psychopath presented multiple forms of psychopathology, including features of ‘multiple personality disorder’. It is proposed that a diagnosis of borderline personality disorder, or the psychodynamic features of borderline personality organisation, should be the exclusion criteria for this condition.

British Journal of Psychiatry (1992), 160, 541–544

Recent advances in molecular genetics have radically altered the prospects for determining the role of heredity in the transmission of major psychiatric disorders. Identification of the actual gene(s) involved, elucidation of their structure, and determination of their products are the steps which theoretically follow successful demonstration of linkage (Gurling, 1985; Baron & Rainer, 1988). Consideration of the ethical issues raised by genetic linkage studies is therefore now of paramount importance. This article focuses on the problems raised by the research process, and not on the ethical implications of the results eventually obtained.

The notion of a subclinical preschizophrenic condition already present in childhood is given further support by the findings of this follow-back study, which also brings into sharper focus the childhood profile of the likely adult schizophrenic.

The Northfield Experiments took place at Hollymoor Hospital, Northfield, Birmingham, during World War II. The first experiment was conducted by Bion & Rickman. The second evolved gradually; many people contributed to its success, including Foulkes, Main and Bridger. The experiments were an important landmark in the evolution of theory and practice in group psychotherapy and in the therapeutic community movement. They were not carried out solely as responses to the need for mass treatment of neurotic disorders among army personnel; antecedent factors, the theoretical orientation of the practitioners and the nature of army life were equally important. The two experiments differed in pace and in recognition of the needs of higher-order systems, particularly the military hierarchy. They shared many underlying concepts, including responsibility to society, the therapeutic use of groups (including the hospital community) and an emphasis on process. Lessons learned at Northfield remain relevant to the practice of psychiatry today.

Rapid tranquillisation – giving a psychotropic to control behavioural disturbances – is common in medical practice, yet few surveys describe its use in psychiatric populations. Over five months, 102 incidents, involving 60 patients, were retrospectively surveyed. Patients most often involved were young white men. The commonest diagnosis was affective disorder (manic phase) (39%) followed by schizophrenia (33%). Fifteen patients were involved in 57% of the incidents. The majority of incidents involved injury to people or damage to property. The most frequently used drugs were diazepam and haloperidol, alone or in combination. Droperidol, chlorpromazine, sodium amytal and paraldehyde were rarely used. Diazepam alone or in combination with haloperidol delivered intravenously was most rapidly effective and was associated with greatest staff satisfaction. Serious side-effects were rare.

“The philosophy of Community Care has resulted in the closure of several mental hospitals in this country. The ethos of the Worcester Development Project saw the closure of St Wulstan's and Powick Hospitals, and their replacement by a community-based service. This paper briefly describes the outcome of a three-year retrospective study completed in 1988 following the closure of both hospitals. The findings provide a comparison of the two hospitals, including details of the destination of all the patients. It is suggested that the term ‘hospital replacement’ might be preferable to ‘hospital closure’.”

“The Worcester Development Project began in 1968 when the Department of Health and Social Security brought together the Worcester and Kidderminster Hospital Management Committee and the County Council in a co-ordinated joint planning venture. Powick Hospital was chosen as the location for testing the hypothesis that closing a mental hospital and replacing it with general hospital psychiatric units, supported by a variety of community facilities, would provide a more economical and better service. This paper describes the outcome of this unique opportunity to study the problems involved in closing a mental hospital and its replacement with other facilities.”

Four men with HIV infection who were referred to liaison psychiatry for assessment of eating disorders are described. In all four cases the eating disorder had implications for the clinical management of their HIV infection. Investigations of weight loss, dietary intervention, and compliance may all be affected by the presence of an eating disorder. The development of HIV disease may exacerbate the symptoms of an eating disorder.

Forty-two female anorexia nervosa patients, with onset of first illness at 25 or more years of age, are described and compared with 143 patients with onset of first illness between the ages of 15 and 20 years. The data support the view that the older group forms part of the total population of anorexia nervosa patients, but that age exerts a pathoplastic influence on psychopathology and psychosocial stressors. Older patients lost more weight, but did not have significantly higher rates of concurrent mood disorder.

A 67-year-old anxious and depressed woman was withdrawn from a long-term course of a benzodiazepine and soon after was given ECT. This proved ineffective, but ECT given some months later was successful. It is suggested that the chronic administration of the benzodiazepine may have induced changes in the brain that interfered with ECT.

British Journal of Psychiatry (1992), 160, 545–546

A 54-year-old man developed an acute encephalitic illness and subsequently suffered from marked memory difficulties. Considerable improvement with anticonvulsant therapy was demonstrated using a ward-based observation programme and serial neuropsychological assessments. The case report highlights the prominent role played by epileptic activity in determining the severity of the patient's amnesia.

British Journal of Psychiatry (1992), 160, 546–549

Community psychiatric nurses were trained to deliver psychosocial intervention to clients with a diagnosis of schizophrenia living at home with relatives. The training package consisted of family assessment, health education, and family stress management strategies. In a ‘quasi-experimental’ design, a sample of families (n = 54) were recruited to either a control or experimental condition and followed up for 12 months. A number of favourable outcomes were observed in the experimental group, including improvements in the client's target symptoms, personal functioning, and social adjustment. Relatives' satisfaction with services increased and reports of their own minor psychiatric morbidity improved.

Forty-six homosexual men and women who were twins took part in a study of their sexuality and that of their co-twin. Discordance for sexual orientation in the monozygotic pairs confirmed that genetic factors are insufficient explanation of the development of sexual orientation. There was a high level of shared knowledge of sexual orientation between members of twin pairs, and a relatively high likelihood of sexual relations occurring with same sex co-twins at some time, particularly in monozygotic pairs. The implications of these results for the study of the origins of sexual orientation and for twin research are discussed.

A group of 115 female psychiatric in-patients and out-patients were studied, using a self-report questionnaire followed by interview, for evidence of childhood sexual activity with adults. About half of the sample reported some childhood sexual experience, ranging from full sexual intercourse to sexual suggestions. Future research should study the possible role of such experience in the genesis of subsequent psychiatric disorder.

The brains of 41 late paraphrenics, 16 of whom had first-rank symptoms, were examined by CT. Late paraphrenics with first-rank symptoms had significantly less cortical atrophy than those without them.

Central pontine myelinolysis (CPM) is an uncommon disorder initially described in alcoholic or malnourished patients. Recent reports suggest an aetiological association with abnormalities of serum sodium. A physically unwell non-alcoholic chronic schizophrenic patient, whose symptoms led to psychiatric referral, died of CPM. A review of the literature reveals that psychiatric patients may indeed be at risk for CPM.

British Journal of Psychiatry (1992), 160, 550–552