The discovery that tricyclic antidepressants blocked the re-uptake of both noradrenaline and 5-hydroxytryptamine (5-HT) was a significant step on the road to the development of the monoamine hypotheses of depression (Healy, 1987). The subsequent demonstration that the de-aminated metabolites of amitriptyline and imipramine, nortriptyline and desipramine, were antidepressants tilted the balance toward noradrenaline as the pertinent neurotransmitter, as these latter drugs were clearly inhibitors of noradrenergic rather than 5-HT uptake.

Child psychiatry in developing countries has recently attained the status of an established specialty. This review looks at available epidemiological data, and factors contributing to similarities and differences in rates of disorder. The relevance of child psychiatry to child health in these countries has service, training and research implications.

The shortening of the periods of detention for treatment, deterrence or retribution have made a live issue of whether (or when) it is justifiable to detain violent and sexual offenders solely for the protection of others. Anti-protectionist arguments have made ‘dangerousness' a dirty word, but are based either on actuarial statistics of doubtful relevance or on confused moral reasoning. A typology of ‘dangerousness' is tentatively offered, and the impossibility of adequately supervising some dangerous offenders in the community is emphasised. That said, offenders detained solely for the sake of others are entitled to more than merely ‘humane containment’.

Variation in their year and month of birth was studied in the 13 661 schizophrenics born between 1914 and 1960 known to the Scottish Psychiatric Case Register. Year-to-year fluctuations in the number of schizophrenics per 10 000 live births were outside chance limits. So were month-to-month fluctuations between January 1932 and December 1960, and this was largely due to fluctuations in the numbers of schizophrenics born in February, March, April and May. Time-lagged correlations with mean monthly temperatures suggest that in these same four months the incidence of schizophrenia is influenced by temperature six months previously – the lower the temperature in the autumn the higher the incidence of schizophrenic births the following spring. If these findings can be confirmed in other data sets, they would suggest that some influence which varies consistently with season and temperature is contributing to the aetiology of schizophrenia and may exert its effects as early as the third or fourth month of foetal development.

Although it is well recognised that schizophrenic patients are more often born in winter, the significance of this finding remains obscure. Data relating to season of birth and family history were analysed for 561 patients with an ICD–9 diagnosis of schizophrenia. Patients with no family history of any psychiatric disorder group were significantly more likely to be born in winter than patients with a first-degree relative affected by schizophrenia. In comparison with normal population controls, only those without a family history exhibited a significant excess of winter births, suggesting an environmental factor of greater aetiological significance in these patients.

Among 16 chronic schizophrenic in-patients, all had at least one neurological soft sign (NSS), and 6 (40%) had definite neurodysfunction. NSS and TD scores were highly intercorrelated, and NSS were significantly correlated with neuroleptic drug exposure. NSS correlated positively with both positive and negative symptoms and cognitive impairment but not with cerebral ventricular size on CT. Patients with neurodysfunction had more positive and negative psychopathology, cognitive impairment and TD than those without. Cerebral ventricular sizes and family histories of schizophrenia were similar in both NSS groups. The presence of NSS may be a simple but important way of identifying a subgroup of schizophrenics with neurodevelopmental predisposing abnormalities, and vulnerability to TD.

Reports of suicidal behaviour from four countries using the same measures were higher for girls than for boys, and higher in self-reports than in parent reports for both referred and normal adolescents. In a sample of 480 referred adolescents, patterns of ‘low’ and ‘high’ suicidal scores were different when age, sex and diagnosis were considered. The probability of high scores for girls showed only a marginal increase with age, while there was a striking rise for boys. An affective diagnosis doubled the probability of high scores for both boys and girls, while it had no effect on low scores. Psychosocial stressors also increased the probability of high suicidal scores, particularly in adolescents with an affective disorder. Sex differences in suicidal behaviour were marked in the low-scoring groups.

In-patients referred to a deliberate self-harm team were asked to complete the HAD questionnaire and diagnoses were made using the SCID. The total prevalence of psychiatric disorder by DSM–III criteria was 54%. The HAD performed well as a screening instrument; a threshold score of eight gave a sensitivity of 88% and a positive predictive value of 80%; its use by non-psychiatrists to detect depressive disorder in patients presenting with deliberate self-harm is to be recommended.

In Scotland, procurators fiscal (state prosecutors) can divert certain offenders from the court process into treatment. This paper describes the first diversion scheme in which offenders who are suspected of having psychological difficulties are referred for psychological and psychiatric treatment before, and generally in lieu of, prosecution. It is argued that the procurator fiscal is successful in selecting suitable cases for treatment: most people referred have significant psychological difficulties but have failed to obtain appropriate assistance through the normal channels of referral.

Following in-patient psychiatric treatment under Section 3 of the Mental Health Act, some patients have in the past remained on Section after discharge, and subsequently the Section has been renewed while the patient remained ‘on leave’. People treated thus with ‘extended leave’ probably resemble closely those who would be placed on a community treatment order if this were available. A group of these extended-leave patients was compared with a control group, matched for age, sex and diagnosis, selected by consultant psychiatrists as not requiring treatment using a community treatment order. The two groups showed very few differences, but the extended-leave patients more commonly had a history of recent dangerousness and non-compliance with psychiatric treatment. Use of extended leave improved treatment compliance, reduced time spent in hospital, and reduced levels of dangerousness.

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such ‘nominated’ patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their ‘lifetime’ histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65–72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the ‘nominated’ patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.

The socio-demographic and clinical characteristics of patients attending psychiatric day care in an inner-urban catchment area were assessed using structured techniques. The overall prevalence of the use of day care was high (164 per 100 000 total population), and 86% of attenders were in prolonged psychiatric contact. Of those in prolonged contact, the clinical and social morbidity of 68 attenders at National Health Service day hospitals was strikingly similar to that of 42 attenders at other units. Users of a ‘community mental health centre’ and two work centres were less disabled than attenders at other day units. Implications of these results for the organisation of day services and training of staff are discussed.

Seven units providing psychiatric day care to residents of an inner-city area were surveyed. The extent to which the clinical and special problems of attenders were adequately managed by the services was measured using a ‘needs-assessment’ technique. Units differed in the proportion of clinical and social problems that were rated as ‘unmet needs', although the extent of ‘unmet need’ was not clearly related to the morbidity of attenders at a unit or the available staffing.

Long-stay psychiatric in-patients in South Glamorgan were reviewed using the MRC Needs for Care assessment. The majority were middle aged or elderly and were severely disabled, with problems encompassing symptoms/behavioural difficulties, social skills, and physical health. In most, long-standing psychiatric illness was compounded by physical illness and cognitive deficits as age advanced, producing care needs that were greater than existing community services could meet.

Relatively little is known about the course of TD in patients continuing to receive neuroleptic medication. In a retrospective follow-up study of 192 patients seen two or more times (average 7.7 visits) over 3–55 months in the Yale Tardive Dyskinesia Clinic, 112 (58%) demonstrated a ‘chronic persistent’ pattern, the remainder an ‘intermittent’ pattern. The most important predictors of chronic persistent TD, using multiple logistic-regression analyses, included increased age and the presence of non-orofacial TD at baseline.

Between 1975 and 1985, 3.8% of patients referred to the Maudsley Hospital with anorexia and bulimia were adoptees. This exceeds the rate of adoption (1.5%) in the general population matched for year of birth. The 18 adoptees with eating disorders had significantly more associated behavioural disturbance and lower academic achievement than the 18 matched controls, and different precipitating factors.

“The incidence of schizophrenia is regarded as being similar between different cultures and times. However, several studies, mostly based on first-admission rates, have suggested that the incidence has declined over the past 10–15 years. Data from England and Wales for 1952–86 have been examined: there has been a substantial decrease, beginning in the mid-1960s, in the incidence of schizophrenia.”