The “Italian Experience” in closing down mental hospitals has been highly praised by some British observers, who have seen lessons for Britain in the development of community care. However, it has been the subject of heated debate in Italy—and the policy is now to be reversed by law. Two questions arise: why have the claims been exaggerated? And why have they found such ready and uncritical acceptance in Britain?

Fifty-six patients with RDC schizophrenia (42) or schizoaffective disorder (14), of two to 20 years' duration, were assessed for neurological ‘soft’ signs and cognitive impairment when in a stable condition—the ‘outcome’. Neurological dysfunction (46% of 50 examined patients) was associated with a history of developmental abnormalities, but was unrelated to outcome, psychiatric symptoms, or treatment. Deficits in particular cognitive fields were related to two independent factors: overall severity of residual psychiatric disorder (outcome) and neurological dysfunction. There was no relationship between the size of the lateral brain ventricles on CT scan and either ‘soft’ signs or cognitive impairment.

The findings do not provide evidence for an association between the presence of organic brain disorder (as indicated by the joint occurrence of neurological dysfunction and cognitive impairment) and either poor outcome or particular symptoms of schizophrenia.

The behaviour and self-help skills of mobile, severely or profoundly retarded adults with behaviour disorders, living in hospitals, were compared with those of a matched group in small homes outside hospital. The residents in the homes more often engaged in simple constructive activities. Although stereotypies were as common in the homes as the hospitals, in the former they were more likely to be combined with constructive pursuits. There were no differences between the groups in self-help skills. In the homes, the staff: resident ratios were higher and the staff had more autonomy in management and responsibility for organising their own services. The care practices in the homes were more resident-centred, and social contacts between staff and residents were more frequent. However, there was no evidence that, for this type of resident, placing a small home in a residential street had advantages over other geographical locations.

The term ‘dementia praecox’ was used by Kraepelin to emphasise the tendency towards deterioration to a state of impairment resembling a dementia. Early studies looked for structural brain lesions post mortem, and later using pneumoencephalography; there were positive findings (Haug, 1962), but they were not always replicated (Storey, 1966). The risks and limitations of pneumoencephalography gradually led to its being abandoned. However, studies showing minor neurological abnormalities (Rochford et al, 1970) and cognitive impairment (Malec, 1978) continued to suggest an organic component to schizophrenia.

Several studies have commented upon the false negatives which can result when the General Health Questionnaire (GHQ) is employed as a community screening device for psychological distress. It would appear that some false negatives are the result of individual or cultural factors, whilst others result from the phrasing of the GHQ questions, which may mislead patients suffering from chronic disorders. This paper reports the use of additional questions, designed to detect such chronicity.

Diagnostic patterns for schizophrenia and affective psychosis were examined for all admissions to psychiatric facilities in New South Wales over a ten-year (1967–1977) period, before, during, and after lithium carbonate had been established as an accepted treatment. While the proportion of functional psychoses to total admissions remained relatively constant over the study, there was a relative decrease in schizophrenia, and a relative increase in the affective psychosis group. Analyses of sub-groups suggested, after controlling for the effects of time, that the introduction of lithium has been associated with an increase in diagnoses of mania and a decrease in diagnoses of paranoid schizophrenia, both for first admissions and for readmissions.

Forty agoraphobics had individual exposure treatment over a period of 28 weeks and were followed up for two years. Outcome in the 27 married patients was as favourable as that in the 13 single patients. However, among the married patients greater improvement occurred in those with better initial marital and sexual adjustment although even those with poor initial marital adjustment improved significantly during treatment and maintained that improvement during follow-up. Good initial work adjustment and social adjustment were also predictive of particularly good outcome. Reduction of phobias was accompanied by stable or improved marital, sexual, social and work adjustment.

The challenges presented by the Present State Examination (PSE) in a multi-cultural context are explored. The general approach to the use of this instrument, difficulties with rating items relevant to cultural or subcultural conditions, and particularly the assessment of psychosis are considered, as well as the possibility of additions to and modifications of the PSE-CATEGO system. Though disagreement exists as to whether the research model which the PSE represents is adequate to deal exhaustively with cultural factors, the instrument is useful in cross-cultural research and also in stimulating debate and crystallising issues.

Hospital Activity Analysis data and record linkage were used to investigate repetition of self-poisoning, and deaths, among 2,492 people, aged 12 to 20 years, who took overdoses between 1974 and 1978. Repetition occurred most frequently during the first few months after an initial admission; 9.5% of patients repeated within the study period (mean follow-up of 2.8 years). Ten of the 2,492 subjects died during the study period, and the average annual death rate in the cohort was approximately four times higher than the national average annual death rate in this age-group as a whole. Six of the deaths were probably suicides. Repetition and suicide rates were highest among males aged 16 to 20 years.

Experimental research into language in schizophrenia has been guided traditionally by two main assumptions: that language disturbance is widespread among schizophrenic patients and easy to detect and measure, and that schizophrenia is fundamentally a cognitive disorder in which language disturbance is part of an inability or failure to regulate one's thoughts. However, recent findings have challenged both assumptions. Two experiments are reported here, the first based on monologues, the second on conversations, which were subjected to reconstruction and discourse analyses. Schizophrenic material is found to be harder to follow than normal, and is characterised by poor reference networks and inappropriate use of questions. While some of the results are specific to the schizophrenic group, others are found also in affective patients, but none is the product of formal thought disorder. The central problem lies less in cognition than in the social process of taking the role of the other.

It has been contended that psychological characteristics of the partner of the agoraphobic patient are important factors in the development and maintenance of the patient's symptoms. To examine this hypothesis, male partners of female agoraphobics were compared with those of non-phobic psychiatric patients and of normal controls on a total of 48 measures referring to several symptom complexes and traits, including defensiveness. The partners of agoraphobics as a group were not found to be more defensive or psychologically more disturbed than their control counterparts. Additional within-couple analyses across groups showed spouses in the control couples to be more comparable to each other than were agoraphobics and their partners—a finding which was attributed to the highly elevated scores of the agoraphobic patients.

Seventy-one pairs of same-sexed biological adolescent siblings, discordant for antisocial behaviour and service contact, were compared using matched-pairs analyses along several dimensions which included developmental, family, psychiatric, educational, cognitive, pro- and antisocial behaviour. The antisocial youth had significantly more negative perceptions and experiences than their siblings, who experienced more protective influences. Earlier onset in the antisocial youth of activities such as smoking also significantly differentiated the pairs. The early temperament index alone correctly classified as proband and sibling 95% of the youth, using discriminant analysis procedures. The findings are relevant to the aetiology of antisocial behaviour and to possible treatment interventions.

This study investigated the validity of the Fould & Bedford hierarchical model of psychiatric illness, as compared to hierarchical models based upon prevalence and severity of disorder. The DSSI was administered to 52 American psychiatric in-patients with severe disturbances. The reports of symptoms in this sample conformed to the Foulds hierarchy in 90% of cases, while 94% of cases conformed to a model based upon prevalence. When a cross-method validation was investigated, the Foulds & Bedford classification demonstrated good discriminative capacity, while models based upon prevalence and severity failed to achieve significance. These results suggest that the Foulds & Bedford model is a useful taxonomy of symptomatology in psychiatric illness.

Schizophrenics appear to be unable to regulate adequately the effects of external stimulation, but the cause of this deficit is unclear. Recent evidence suggests that input activation can normally be inhibited by an appropriate leading or conditioning stimulus; such inhibition has been found to be diminished in schizophrenics. Based on this evidence, a feed-forward regulating mechanism that serves to stabilise reactivity to environmental events is described; it is hypothesised that failure of the mechanism to inhibit adequately surges of activity is an underlying cause of schizophrenic symptoms. Some ways to test the validity of the mechanism are proposed, and an outline presented of steps to link the mechanism's dysfunction to schizophrenia.

There is doubt whether schizophrenia, the most common and most devastating serious mental illness, existed much more than 200 years ago. Many authors who have written recently on the history of schizophrenia suggest that it is a disease that first appeared towards the end of the eighteenth century and rapidly increased in prevalence throughout the nineteenth. Cooper & Sartorius (1977) ask “Why are good descriptions of what can now be recognized as chronic schizophrenia so scarce in European medieval and earlier literature?” and they associate schizophrenia with industrialisation. Torrey (1980) argues that although descriptions of madness, including hallucinations and delusions, date to ancient times, schizophrenia as we know it with an onset in early adulthood and progressive deterioration, is not described. He associates schizophrenia with civilisation, and proposes an infectious cause. Hare (1979, 1982) supports this hypothesis, providing detailed evidence for a real increase in hospitalised psychiatric patients who most probably had schizophrenia in the last century (Hare, 1983), and also states that there are no good earlier descriptions of schizophrenia.

Twenty-six chronic schizophrenic patients on well established depot neuroleptic regimes with stable doses (16 on fluphenazine decanoate, ten on flupenthixol decanoate) had serum neuroleptic levels measured by a radioreceptor assay (RRA) method. The assay was sufficiently sensitive to measure serum levels in all cases, with acceptable levels of inter-assay variation. Blood level measurements were repeated on two occasions, at the same time interval from the last injection, in 18 patients (11 on fluphenazine decanoate, seven on flupenthixol decanoate) and remained reasonably stable in most cases, although others showed a wider variation. Despite a wide range of doses (× 32 fluphenazine decanoate, × 21 flupenthixol decanoate) the serum levels fell in a remarkably narrow range (× 4, × 6). There was a significant correlation between dose and blood level for flupenthixol decanoate, but not for fluphenazine decanoate.

40 new neurotic patients who lapsed from out-patient treatment were compared with 40 new neurotic patients who remained in treatment. The lapsed patients more often reported marital disharmony and 40% of them no longer felt ill at follow-up.

We describe psychotic illness in a Nigerian and a Togoese woman respectively. Although the clinical presentation was familiar to the clinical team, neither responded to conventional methods of treatment. Detailed ethnic enquiry revealed cultural beliefs which had a profound impact on each illness. Swift recovery occurred after repatriation. Eisenbruch (1983) has reported a case of ‘wind illness' in a paper described as a 'study of psychiatric anthropology’, which stresses the importance of understanding the patient's own view of his illness and it causes, in arriving at the correct diagnosis and intervening effectively. We describe here two cases of atypical psychosis in West African women, which lead us to endorse this view; as in his case, Western medicine proved useless, although complete recovery occurred once both had been repatriated.

A cohort of 83 British addicts from one clinic was followed-up after 11 years; Home Office records and medical notes were personally searched to trace current status. Twenty-nine were still using drugs, 37 were not known to be using drugs, and 17 had died. The group still using drugs had become markedly more stable on parameters of drug use, criminality, and social stability over the follow-up period.