We investigated linkage between schizophrenia and the loci DXYS14, DXYS17, and MIC2 within the pseudoautosomal region in 85 families with two or more siblings suffering from schizophrenia or schizoaffective disorder. A maximum lod score of 2.44 was reached at MIC2, with a dominant model of inheritance at a recombination fraction of 0.367 in females and 0.046 in males (a F: M sex ratio > 1, i.e. opposite to that expected with a pseudoautosomal locus). Evidence consistent with linkage (P = 0.01) was also obtained with a sibling pair analysis at the MIC2 locus. These data do not support (although they do not definitively exclude) a locus within the pseudoautosomal region; they are consistent with the presence of a gene that predisposes to schizophrenia in the sex-specific regions of the X and Y chromosomes.

Schizophrenics have been repeatedly found to experience more obstetric complications (OCs) at birth. The meaning of such a finding is debated, and the aim of this study is to contribute to the understanding of OCs' aetiological role in schizophrenia. We compared a group of schizophrenic patients with their siblings and controls, on the basis of obstetric files stemming from the same University Hospital Maternity Ward. Schizophrenic patients had more frequent umbilical cord complications and atypical presentations, as well as higher scores on a scale measuring OCs linked to possible neonatal asphyxia.

The issue of whether the incidence rate of schizophrenia may have declined over recent decades has generated considerable controversy. This study sought to ascertain and interview all patients who satisfied contemporary diagnostic criteria for schizophrenia within a defined and unusually homogeneous region of rural Ireland having a total population of 25 178 people; morbid risk for schizophrenia was then examined by quinquennia of birth from 1920–24 to 1965–69. Morbid risk appeared essentially constant for persons born between 1920 and 1939 but fell by 37% for those born between 1940 and 1969, the fall being considerably more prominent in females (–56%) than in males (–19%). Attention is focused on sexual dimorphism in cerebral development and on temporal changes in endogenous or exogenous factors that influence the rate of occurrence of schizophrenia in females.

In a sample of 120 long-stay in-patients who fulfilled DSM–III–R criteria for schizophrenia, chronic akathisia and pseudoakathisia were relatively common, with prevalence figures of 24% and 18%, respectively. Compared with patients without evidence of chronic akathisia, those patients with the condition were significantly younger, were receiving significantly higher doses of antipsychotic medication, and were more likely to be receiving a depot antipsychotic. Patients who experienced the characteristic inner restlessness and compulsion to move of akathisia also reported marked symptoms of dysphoria, namely tension, panic, irritability and impatience. The findings support the suggestion that dysphoric mood is an important feature of akathisia. Male patients appeared to be at an increased risk of pseudoakathisia. No significant relation was found between chronic akathisia and tardive dyskinesia, although there was a trend for trunk and limb dyskinesia to be commonest in patients with chronic akathisia while orofacial dyskinesia was most frequently observed in those with pseudoakathisia. Akathisia may mask the movements of tardive dyskinesia in the lower limb. There was no evidence that akathisia was associated with positive or negative symptoms of schizophrenia nor with depression.

Two hundred and forty-two Nigerian schizophrenic patients (63% male, 37% female), whose mean age was 42 years and length of illness 12 years, were examined for movement disorders using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Twelve patients had never received antipsychotic medication; and none of these had dyskinesia. Dyskinesia was found in 5 of 49 patients (10%) who had taken medication throughout the course of their illness for a total of up to 3 months, 13 of 74 (18%) who had taken medication for 4–12 months, 14 of 41 (34%) for 1–5 years, and 29 of 66 (45%) who had taken medication for more than 5 years. Of 77 patients who were receiving antipsychotic medication at the time of examination, 9 (12%) had Parkinsonism and 12 (15%) akathisia. Examination of the patients' mental state by the Positive and Negative Syndrome Scale showed an association between dyskinesia and positive, but not negative, schizophrenic symptoms. Nigerian patients showed a low level of negative symptoms.

We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices - fear, reassurance, engagement and resistance - reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either ‘benevolent’ or ‘malevolent’. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31 % of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and, unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.

The data presented are those from a two-year prospective study of 69 patients identified in the Nottingham field centre of the WHO Study of Determinants of Outcome of Severe Mental Disorders. Premorbid personality, childhood adjustment and adolescent adjustment were assessed at the patients' first presentation to psychiatric services with a psychotic illness. Ratings were made blind to diagnosis. Premorbid explosive and paranoid traits were commoner in patients with schizophrenia than in patients with other non-organic psychoses, and these traits were associated with later onset of schizophrenia. Premorbid schizoid traits were significantly commoner in patients with schizophrenia compared to patients with other psychoses, but only in those patients for whom a parent was the informant. Schizoid traits were no commoner in men with schizophrenia than in women, and were not associated with earlier age of onset. The findings suggest that premorbid personality, in men and women, may shape the expression of symptoms produced during an illness episode.

Using a longitudinal life-table analysis, we assessed the efficacy of lithium alone, administered within the context of a naturalistic clinical setting, by calculating the probability of patients remaining free of an affective episode (manic or depressive) over a five-year course. In addition, for those who suffered a manic or depressive relapse, we attempted to analyse the subsequent course of patients who suffered a manic/hypomanic or depressive relapse and were then restabilised on lithium plus either a neuroleptic, carbamazepine, or a benzodiazepine, or lithium plus an antidepressant. Lithium alone offered an average 83% probability against an affective relapse after one year, 52% after three years, and 37% after five years. For patients who failed on lithium alone, it appeared that combination treatment offered greater protection against subsequent affective relapse than the initial course on lithium alone.

Analyses were undertaken to examine whether a wide range of psychiatric disorders, including anxiety, affective, substance abuse and psychotic disorders, represent variant manifestations of Tourette's syndrome (TS). Previous studies have suggested that chronic tics (CT) and obsessive-compulsive disorder (OCD) are variant expressions of TS since both CT and OCD are elevated among relatives of TS probands. In the current study, no other psychiatric disorder was significantly elevated among the relatives who did not have TS, CT or OCD when compared with a control sample. These findings are not consistent with the hypothesis that a wide range of psychiatric and behavioural disorders are variant expressions of TS.

The World Health Organization's International Pilot Study on Schizophrenia (IPSS) and subsequent Determinants of Outcomes of Severe Mental Disorder (DOSMD) studies have reported that the course of schizophrenia is more favourable in ‘developing’ than ‘developed’ societies. The 1992 DOSMD study attributes this difference to culture. We review studies concerning the course of schizophrenia and conclude that the evidence for a more favourable course in developing societies is not conclusive. Indeed, a favourable course has also been reported in various industrialised societies. We also raise questions about the findings reported in the recent DOSMD study, including the conclusion that the putatively more favourable course is a product of culture. Finally, we argue that longitudinal, direct observation of patients in their natural environments must be carried out before variations in the course of schizophrenia can be adequately understood.

“Nature, in the production of diseases, is uniform and consistent; so much so, that for the same disease in different persons the symptoms are for the most part the same; and the self-same phenomena that you could observe in the sickness of a Socrates you would observe in the sickness of a simpleton. Just so the universal characters of a plant are extending to every individual of the species; and whoever (I speak in the way of illustration) should accurately describe the colour, the taste, the smell, the figure, etc. of the single violet would find that his description held good, there or thereabout, for all the violets of that particular species upon the face of the earth.”

“Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20–48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; P < 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (P < 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; P < 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; P < 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; P < 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders.”

We report five cases of delusions of pregnancy of whom three were women and four had chronic schizophrenia. We draw the attention of clinicians to this symptom which is not as rare as has previously been thought.

An association between seasonal affective disorder (SAD) diagnosed according to DSM–III–R criteria and ‘environmental hypersensitivity’, Candida hypersensitivity, and food allergies is reported in two patients. It is suggested that patients with somatisation disorder may present with symptoms of SAD and other media-popularised diagnoses in a form reminiscent of the cases of multiple media-popularised diagnoses.

We report cases of several side-effects from the antidepressant fluoxetine. We suggest that, at therapeutic doses, fluoxetine may have a beneficial effect on sexual function in some men with erectile failure and premature ejaculation.

A significant difference of plasma interleukin (IL)-1α concentration was found between schizophrenic patients taking neuroleptic drugs (n = 38) and those not taking them (n = 14; P < 0.02); Kruskal-Wallis analysis revealed a significant difference of plasma IL-6 concentration among the patients taking neuroleptic drugs, those not taking them, and healthy control subjects (H = 7.1, d.f. = 2, P < 0.05); also, there was a significant difference of plasma IL-6 concentration between the patients taking neuroleptic drugs (n = 32) and those not taking them (n = 13; P < 0.01). No significant differences were found between the three groups in the concentrations of IL-1β, IL-2 and tumour necrosis factor(TNF)-α. The present results suggest that neuroleptic treatment may change IL-1α and IL-6 production in schizophrenic patients.