There can be few more impressive sights in contemporary neuroscience and biological psychiatry than the imaging of neurotransmitter receptors in the brains of living human subjects by positron emission tomography (PET; Sedvall et al, 1986). How has such technology advanced our understanding of the pathophysiology and/or treatment of major psychiatric disorders?

Seclusion is a commonly used management technique in some areas of psychiatric practice. However, its theoretical and empirical underpinnings are greatly wanting in many respects. This paper reviews the present state of our knowledge and ignorance about seclusion, and suggests some strategies for much-needed research.

The authors review the development of liaison psychotherapy in general practice, and argue that a 'skill-sharing’ approach, where the general practitioner retains the treatment role, is a more efficient model than a ‘consultation’ approach. Skill-sharing models are reviewed, and the need for psychiatrists and psychotherapists to be more directly involved in teaching basic psychotherapeutic skills to general practitioners is emphasised.

Considerable attention has been paid, both by regulatory authorities and clinicians, to the side-effects of antidepressants, but despite the known high suicide risk in depression, toxicity in overdosage has been largely ignored. On the basis of the evidence currently available, ‘older’ antidepressants appear to be more toxic than ‘newer’ agents. A case can be made for limiting the use of some of the older tricyclic antidepressants, especially in patients who remain in the community, when continuous supervision is lacking, in favour of newer, safer drugs.

The basic unit of study for psychiatric investigation is the individual human being in interaction with the environment. The psychological understanding of human biography provided by psychodynamic observation is now being supplemented by knowledge derived from phenomenological and neurobiological research. Phenomenology and neurobiology are at present primarily concerned with detecting correlations between clinical syndromes and pathological brain states; they are static rather than dynamic in approach. However, currently emerging techniques of brain imaging aimed at elucidating neurophysiological processes provide the basis for going beyond structural neuropathology to neuropathophysiology. It is suggested that the observations derived from the psychodynamic study of patients constitute markers of underlying brain function, and that the future investigation of psychiatric illness must include a correlative study of both psychodynamic and neurobiological processes.

One hundred and eighty-three patients suffering from functional psychoses were diagnosed according to ICD–8, RDC, and DSM–III criteria, and the concordance rates for the diagnoses compared. The heterogeneity of the diagnosis 'schizoaffective psychosis' as defined by these systems became clear. With respect to prognosis, the DSM–III diagnosis of schizophrenia was most closely related to poor outcome. Affective psychoses and schizoaffective psychoses, as well as DSM–III 'schizophreniform disorders', demonstrated a favourable prognosis.

Case notes of all patients admitted from two adjacent catchment areas with a diagnosis of schizophrenia, schizoaffective disorder, or psychosis were examined for information concerning the patient's family. On average, case notes contained only 9–25% of the basic information looked for. Family trees were rarely drawn. A record was made of contact with families of only half the sample. It is suggested that information concerning families is not considered of major importance in the management of such cases.

One hundred and fifty middle-aged and elderly adults with a diagnosis of major depression were assessed initially as inpatients, and were reinterviewed 6–32 months later. Both size of social network and subjective social support were significant predictors of depressive symptoms at follow-up, with baseline depression scores and other predictors of outcome status statistically controlled. Subjective social support was most strongly associated with major depression; this effect was significantly stronger for middle-aged than older adults, and for men than women. Differences in the effects of marital status, size of social network, and subjective social support also suggest the importance of distinguishing between involvement in and quality of interpersonal relationships.

Out of 194 chronic schizophrenic inpatients, depressed mood (item 23 of the PSE) was present in 25 (13%). When compared with 25 matched controls, the patients with depressed mood had significantly higher scores on the MADRS and the Beck Depression Inventory. Serious suicidal ideas and auditory hallucinations were significantly more common in the depressed group. However, there were no significant differences between the matched groups in terms of negative symptoms, Parkinsonism, tardive dyskinesia, anticholinergic medication, or current dose of antipsychotic drug, which suggests that the depression identified was not related to drug treatment, nor was it a direct manifestation or misinterpretation of negative symptoms. Over three-month follow-up, the MADRS and Beck scores covaried closely with the presence or absence of depressed mood. This depressive syndrome persisted over the three months in the majority of patients originally depressed.

This is the initial report of a prospective study by computerised tomography brain scan of first episode schizophrenia. Twenty-seven patients who met Research Diagnostic Criteria for schizophrenia were compared with volunteer controls on ventricular: brain ratio, sulcal: brain volume ratio, and the widths of third ventricle and Sylvian and interhemispheric fissures. The results provide evidence that sulcal enlargement, but not ventricular abnormalities, may be detected at first admission for schizophrenic illness, and are discussed in relation to findings from other studies.

The paper describes the two-year follow-up results from 323 out of 386 patients fulfilling a modified version of Feighner's criteria for diagnosis of schizophrenia, in Lucknow, Vellore, and Madras. There was remission in 66% of cases. Short duration of illness, consistent compliance with medication, positive attitudes of relatives and neighbours, absence of economic difficulties, increase in religious activities on the part of patients, a rural background, and a non-schizoid pre-morbid personality were associated with good outcome. Features of depression, dangerous behaviour, and absence of agitation were associated with poor outcome.

Psychiatric symptoms among medical inpatients in an Indian hospital were assessed: the SRQ was used as a screening instrument, and those with probable psychiatric disorders were given the PSE and MSE, for further, detailed assessment. The prevalence of psychiatric disorders was 34%, with a further 15% reporting distressing psychiatric symptoms only. The most frequent complaints were delirium and adjustment disorders. They were largely associated with connective tissue, as well as cardiovascular and endocrine, disorders, and were characterised by depression, worrying and irritability. The reliability of the SRQ varied with the cut-off score, which gave optimal specificity and sensitivity when set at 9.

The establishment and first 18 months of a psychiatric liaison service to a general hospital obstetric unit are described. The service was initially intended to predict antenatally those at risk of postnatal depression and to offer follow-up throughout pregnancy and in the postnatal period. However, a large proportion of referrals were of women currently unwell. Furthermore, postnatal follow-up in the community proved difficult. Referrals, diagnoses and disposal are analysed, leading to conclusions about the effectiveness and problem of such a service. The components of a comprehensive obstetric liaison provision are proposed, emphasising the need for strong community links built around a CPN service, allowing adequate postnatal psychiatric care.

Sixty women aged between 30 and 55 years, having hysterectomy for benign conditions, were prospectively studied to investigate psychological adjustment to operation, and to explore social, psychological and physical factors associated with psychological outcome. A further 30 women were included for prospective research on psychological outcome. Investigations took place within two weeks of operation and after four months and 14 months. The findings indicated a high prevalence of pre-operative psychological morbidity (55%), which reduced to 31.7% afterwards. There was no evidence that hysterectomy led to a greater psychological distress. The principal risk factors of poor psychological outcome were the previous scores on the mental health measures and personality inventory. Involvement in the research process did not appear to affect psychological outcome.

Results are presented of five consecutive annual examinations using the Abnormal Involuntary Movement Scale for 101 community-based chronic psychiatric patients. These 101 patients had a history of longer and more consistent neuroleptic treatment than the 231 patients who initially entered the study, so no conclusions about prevalence of TD can be drawn. At each examination two-thirds of this group showed signs of TD; however, only 45% were TD positive at most examinations and 24% were best described as having fluctuating TD status. Of those patients who were consistently TD positive, 82% showed no overall significant change in summed AIMS scores, 11% improved and 7% became worse.

Fifty-one outpatients presenting with generalised anxiety disorder were included in a double-blind trial, and treated with either buspirone (a new non-benzodiazepine antianxiety drug) or diazepam over 6 or 12 weeks, after which they were abruptly withdrawn and continued on placebo to 14 weeks. Ratings of anxiety and other symptoms were administered fortnightly and additional withdrawal symptoms noted. Forty patients completed the study; 8 of the 11 drop-outs were taking buspirone. Both drugs reduced anxiety, diazepam more rapidly, but with greater withdrawal symptoms, particularly after 6 weeks. Regular treatment with diazepam for 6 weeks leads to a significant risk of pharmacological dependence that is not present with buspirone.

The relationship between extreme temperament in infancy and clinical status at 4.7 years of age was studied in temperamentally different groups of infants matched for sex and SES, and subselected from a large birth cohort representative of the general population. The effects of certain dimensions of family functioning and of other risk factors were examined. By itself, extremely difficult temperament in infancy had no strong direct association with clinical outcome at four years of age, whereas temperament assessed at four, family attitudes to discipline, and stressful events did. However, extreme temperament in infancy might indirectly affect outcome through its association with temperament at four. The interplay between adverse temperament and parental attitudes of discipline previously observed in middle childhood might have antecedents in preschool years.

Few, if any, of children's behavioural or cognitive characteristics assessed in the first years of life demonstrate stability until later childhood; early characteristics have so far failed to show an association with future psychopathology. This longitudinal study, from 4–8 months to 4.7 years old, focused on stability and change of extreme temperamental traits in groups of infants subselected from a large birth cohort. Persistent extreme temperament at four and eight months old did not increase stability of temperament to four years of age, relative to other children in the whole population. Sizeable change occurred, and the environmental parameters associated with negative temperamental change did not seem to be the same as those related to positive change. Boys with extreme scores were more stable, while girls appeared more prone to positive change. It is hypothesised that the direction of temperamental change in the first years could be more meaningful for long-term prediction of disorders than any one assessment of temperament taken at any one year.

A mother and her son shared delusional beliefs that doubles of themselves existed and that they were being harassed by the police and social and educational services. The nature of these ‘double double’ symptoms is discussed.

A man temporarily developed an organic personality change, psychosis and epilepsy after a frontal lobe operation for a subarachnoid haemorrhage. While affected, he set fire to his house. The arson is thought to have been a direct result of a seizure. The case and its legal management are discussed.