Much current research in psychiatry proceeds in the absence of an integrated model of brain function. It is based instead on the effort to relate clinical syndromes to single, localised abnormalities in the brain. Such an approach is inconsistent with existing data, inadequate for linking research findings with clinical practice, and, probably, fundamentally misdirected. A model of brain function is presented that is based on Luria's notion of cerebral functional systems and on the proposition that the neural substrates of emotion are those processes that integrate different brain regions. Some of the implications of this model for research are discussed.

One hypothesis concerning the nature of the link between negative self-appraisal and certain psychological disorders is that low self-esteem may be a consequence of both early and current experiences, and may predispose to breakdown. An alternative view is that the negative self-concept is only to be found in the presence of illness, which is the primary cause. Results are reported from a community survey, confirming the influence of certain biographical factors on self-esteem in the absence of illness, whereas other factors appear to operate only after the onset of illness. Anxiety as well as depression, has effects on self-esteem.

The relationship between neurotransmitter metabolite concentrations and measurements of ventricular size on CAT scans and pneumoencephalographs was investigated in 15 patients with severe affective disorder. An association was identified between reduced levels of plasma free tryptophan and ventricular enlargement and also between raised ventricular CSF levels of 5 HIAA and ventricular enlargement.

We studied 371 psychiatric admissions in an attempt to relate primary and secondary diagnosis, psychopathology, and stated reasons for drinking to alcohol consumption and alcoholism. No diagnostic group other than the alcoholics drank significantly more than the mean, and the schizophrenics drank less. One-third of those with bipolar and minor depression increased their drinking in the month before admission, but this was almost offset by those with similar diagnoses who drank less. Alcoholism, though not alcohol consumption, was related to a high prevalence of affective syndromes, but these did not amount to secondary diagnoses. Drinking for ‘escape reasons' was significantly associated with consumption levels, but the reasons patients gave did not correspond well with the objective presence or severity of the associated psychiatric symptoms.

Two methods for predicting steady-state serum lithium level were compared prospectively in in-patients suffering from affective disorder. A single-point prospective administration model that required a single 24-hour serum lithium level, following a test dose produced statistically similar predictions of the observed steady-state lithium levels as did a model that required 12- and 36-hour levels. However, the latter two-point method produced significantly more accurate predictions from clinical interpretation. Although the two-point approach is preferable, the single-point method is clinically acceptable if its limitations of accuracy are taken into consideration.

The non-fatal deliberate taking of overdoses in Cork city during 1982 was investigated from records in the general hospitals. In one of the hospitals, those attending after an overdose were personally interviewed. For both sexes, the greatest incidence of overdoses was in the younger groups; for females, there was a seasonal variation. Those taking overdoses were grouped by electoral wards, and the social characteristics of these wards determined. The frequency varied greatly throughout the city; some wards, particularly in corporation northern estates and part of the city centre, showed a rate of up to three times the average; these areas were the most likely to show social deprivation.

Late components of brain event-related potentials reflect aspects of selective attention, stimulus evaluation, and possibly memory update mechanisms. Several of these components were measured during an auditory target detection task, performed by 20 schizophrenic and 20 normal subjects. Both the amplitude of those components and a more general late amplitude measure were significantly reduced in schizophrenics, for both target and non-target stimuli. One general late amplitude measure, from the scalp vertex, could alone correctly classify 85% of patients and 95% of controls. The source of these differences may lie in a protracted positive potential shift.

We describe six pairs of monozygotic twins, in which at least one member of five pairs were homosexual, and one of the remaining pair was bisexual, from a series of 55 pairs, reared apart from infancy; all the female pairs were discordant for homosexual behaviour. This and other evidence suggest that female homosexuality may be an acquired trait. One male pair was concordant for homosexuality, while the other was not clearly concordant or discordant; this suggests that male homosexuality may be associated with a complex interaction, in which genes play some part.

There is insufficient information on the prevalence of psychological morbidity in the workplace. The theoretical base of industrial psychiatry is traced here, and examined within a framework of systems analysis, the input being identified in terms of human and social factors. Internal processes of organisation and management produce conditions of practice which determine the health status of the workplace; some statutory protection is necessary to safeguard mental health in industry.

The twin register of the Maudsley Hospital was used to select a series of monozygotic (MZ) and same-sexed dizygotic (DZ) twins who had been given an ICD8 diagnosis related to alcoholism. They and their co-twins were traced. Medical and drinking histories were compiled (from records and by interview) for 56 twin-pairs, to permit current and retrospective diagnosis of any neurotic disorders. RDC diagnoses of panic disorder generalised anxiety disorder, obsessive–compulsive disorder and phobias were more common in the alcoholic probands and the co-twins who were also alcoholics than in the normal-drinking co-twins. The Eysenck Personality Questionnaire (EPQ) and the Severity of Alcohol Dependence Questionnaire (SADQ) were completed by 54 individuals. Neuroticism scores were significantly higher for both male and female alcoholics than for their normal-drinking co-twins; and intra-pair differences in neuroticism were significantly correlated with intra-pair differences in severity of dependence. These results suggest that both clinically diagnosed neurotic illness and high neuroticism scores are more often a consequence than a cause of alcoholism.

The diagnostic importance of vegetative symptoms for melancholia was examined through DSM-III, the Newcastle Scale, and Extracted Criteria for melancholia. Statistically significant differences were diagnostically unimpressive in the case of DSM-III and the Newcastle criteria. With the Extracted Criteria, initial insomnia, early waking, anorexia, weight loss, loss of libido, and worsened mood in the morning were all significantly more common in melancholia than in non-melancholic depression, while increased appetite was more common in non-melancholia. Only diurnal variation of mood (worse in the morning) showed predictive value for melancholia; whereas the other traditional vegetative symptoms (disturbed sleep, weight, and libido) did not. Increased appetite and diurnal variation of mood (worse in the evening) were predictive for non-melancholia.

A double-blind control trial of gluten-free versus a gluten-containing diet was carried out in a ward of maximum security hospital: 24 patients were studied for 14 weeks. Most suffered from psychotic disorders, particularly schizophrenia. Various dimensions of behaviour were rated on the Psychotic In-Patient profile (PIP) at different stages. There were beneficial changes in the whole group of patients between pre-trial and gluten-free period in five dimensions of the PIP, maintained during the gluten challenge period; these changes could be attributed to the attention the patients received. Two patients improved during the gluten-free period and relapsed when the gluten diet was reintroduced.

Body image disturbances in anorexia nervosa patients have been assessed in an experimental study which dealt with the following issues: (1) Three different procedures for the assessment of body image disturbances were compared in a discriminant function analysis: (a) a Video Monitor Procedure, (b) the Movable Caliper Procedure and (c) the Image Marking Procedure. The Image Marking Procedure showed the best discrimination between groups. (2) Anorexia nervosa patients showed a statistically significant over-estimation as compared to the control group in the variables ‘waist’, ‘upper thigh’ and the compound measure ‘soft body parts', while they did not overestimate control variables (Kruskal-Wallis-Rank-Analysis of Variance). (3) A standard liquid meal of 240 Kal. had no statistically significant influence on the estimation of body width, irrespective of the amount of calories consumed and instruction given. Possibilities and limitations of various measurement procedures are discussed.

Do women drink excessively for the same reasons as men? A growing body of opinion suggests not. Beckman's (1975) views are representative— “Alcoholism and heavy drinking in women appear more likely to be linked to psychological stress and a specific precipitating circumstance or situation than is alcoholism or heavy drinking in men”.

A case-report is presented of folie simultanée in a pair of female monozygotic twins with onset at the remarkable age of 81. The twins demonstrated no evidence of dementia or other psychopathology apart from delusions. Folie simultanée in monozygotic twins provides a model example of the potential role of genotype-environment correlation in the etiology of psychiatric illness.

The AMDP-System has been developed in Europe by the Association for Methodology and Documentation in Psychiatry the standardised documentation of psychiatric files and for the measurement of change in drug trials. It is increasingly used in the French-speaking and German-speaking countries by clinical psychopharmacologists for teaching classical German psychopathological concepts to students and for the multicentre and multifactorial evaluation of drug changes. The AMDP-System consists of three anamnestic forms and of two comprehensive rating scales on present psychopathology (100 items+ write-in items) and somatic complaints (40 items+write-in items).

Milton H. Erickson, MD. was born in 1901 in a cabin in a desolate part of Nevada where his father was a gold miner. When he reached school age his family returned to rural Wisconsin, where they had previously lived. As a child Milton experienced the world differently from other children in that he had red-green colour blindness, was tone deaf and, probably, also dyslexic. At 17 he had a severe attack of poliomyelitis. He was extensively paralysed but rehabilitated himself, largely by his own efforts, during the following two years.