Depression assessed by clinical examination and Hamilton rating scale was found in half of 37 untreated new acute schizophrenics, and in about a third of chronic schizophrenics who relapsed whether treated with depot injections (89) or not (79). A significant part of depressive illness in schizophrenics is thus not drug-related. However, depression was commoner in those on higher doses of depot neuroleptic (P <.05) or who showed extrapyramidal side effects (P <.001), suggesting that drugs can play a part. Patients maintained in remission on moderate doses of depot drug had the lowest prevalence of depression.

A two-year follow-up study was conducted, mainly from case notes, of patients who had originally taken part in a study of the influence of relatives' expressed emotion on schizophrenic relapse. It was found that in the two years following discharge from hospital patients from high expressed emotion homes had a significantly greater relapse rate than those from low expressed emotion homes.

The prophylactic effect of maintenance drugs was no longer evident for patients from high expressed emotion homes at the two-year follow-up. By contrast, a significant protective effect of maintenance therapy emerged for patients from low expressed emotion homes.

The interpretation of these findings is discussed.

Fifty-three hospitalized chronic schizophrenic patients were treated with either propranolol, chlorpromazine or placebo in a double-blind randomized trial for up to three months. Propranolol in a usual dose of 640 mg/day, produced marked cardiovascular effects but no improvement in schizophrenic symptomatology relative to placebo. The effects of chlorpromazine were small and inconsistent.

Ten hospitalized chronic schizophrenic patients were given chlorpromazine alone and chlorpromazine plus high dose propranolol in two 7-week treatment periods according to a randomized crossover design. In the six patients who completed the whole study, plasma levels of chlorpromazine and chlorpromazine sulphoxide, total serum levels of neuroleptic and serum levels of prolactin were consistently and significantly elevated during treatment with chlorpromazine plus propranolol relative to levels during treatment with chlorpromazine alone. These effects are sufficient to explain previously reported clinical improvement in schizophrenic patients given propranolol in addition to neuroleptics.

A small (n = 20), double blind, controlled trial failed to show that propranolol has any beneficial effect in chronic schizophrenia.

The present report is of the effect of variations of auditory input on hallucinatory experiences in seven schizophrenic patients. Nine experimental conditions, each of two minutes' duration, were compared with a control condition. At the end of each period subjects were required to rate the duration, loudness, and clarity of hallucinations during that time. Experimental conditions varied according to the amount of structure present in the material and in its attention-commanding properties. One condition required the active monitoring of material presented and resulted in the greatest decrease in hallucinatory experiences. For the passive conditions, findings were broadly consistent with predictions, indicating that it is not stimulation per se, but rather the extent to which structure is present and attended to, that is important in determining the occurrence of hallucinatory phenomena.

Women who had a psychiatric illness requiring hospital admission within 90 days of delivery were compared with a control group matched for age, Research Diagnostic Criteria diagnosis and year of admission. Those with a diagnosis of major depressive disorder differed significantly from non-puerperal controls in being more deluded or hallucinated, more labile and more disorientated. There was no difference between puerperal and control cases of major depressive or manic disorder with respect to treatment received, or responded to, or length of stay in hospital.

Thirty Kenyan patients of black African origin undergoing treatment for clinical depression in Nairobi, and 40 matched non-psychiatrically disturbed controls in the community were studied for life events using the Brown-Harris model. It was found that the depressed group had significantly more life events (P <0.001 with Yates correction for continuity) in the twelve months preceding the onset of their depression than the controls in the same period. These results are similar to those obtained by several workers in Western settings. Their implication for the practice of psychiatry in an African context is examined, and some myths about psychiatry in Africa re-examined.

A review of studies which used standardized interviews as a means of data collection indicated that the issue of reliability was frequently neglected in the psychiatric literature. It is suggested that this may be due to a misinterpretation of the concept of reliability which is apparently perceived as a permanent feature of an interview instrument. The importance of reliability is discussed, and recommendations are made as to how a methodologically adequate assessment of reliability might be undertaken.

Four experimental interview styles, designed to differ in the extent of their use of active fact-oriented and active feeling-oriented techniques, were compared in relation to their use in the initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. All four styles proved to be effective in eliciting emotions and feelings, but the findings suggested that each was effective for different reasons. It appeared that emotional expression could be encouraged by the interviewer's response to emotional cues, by a reflective style with little factual cross-questioning, by the use of direct requests for self-disclosures, by the optimal (but not necessarily maximal) use of interpretations and expressions of sympathy, and by direct requests for feelings.

Erythrocyte transketolase activity and the effect of adding thiamine pyrophosphate (% TPP effect) were measured in subjects suffering from Wernicke-Korsakoff syndrome both before and during treatment with thiamine and/or thiamine tetrahydrofurfuryldisulphide (TTFD). Transketolase activity was significantly lower in untreated patients than in healthy volunteers. Treatment with either thiamine or with TTFD restored enzyme levels to control values but TTFD produced a greater increase than thiamine in enzyme activity. In a group of seven patients there was no correlation between duration of TTFD therapy and either increase in erythrocyte transketolase activity or % decrease in the TPP effect. However, when three patients were followed at intervals during treatment with TTFD, their erythrocyte transketolase increased progressively. Neither thiamine nor TTFD produced clinical improvement in the mental symptoms of Wernicke-Korsakoff psychosis unless administered early in the course of the disease.

A pair of monozygotic twins, one suffering from the Wernicke-Korsakoff syndrome, verified at autopsy, and the other healthy, was studied biochemically. The erythrocyte transketolase of each twin showed abnormalities, though these differed in the two individuals. In the healthy twin, the basal transketolase was low, but responded normally to thiamine pyrophosphate (TPP) added in vitro. In the twin with the Wernicke-Korsakoff syndrome the basal level of the enzyme and its response in vitro were normal, but a period of treatment with thiamine tetrahydrofurfuryldisulphide, led to loss of the in vitro response. It is suggested that, initially, an inborn error of metabolism may have been common to both twins.

Sarcoidosis is defined by Scadding (1967) as “a disease which is characterized by the presence in all of several affected organs or tissues of epithelioid cell tubercles … proceeding either to resolution or to … (the formation of) fibrous tissue”. The organs which are most commonly involved are the lungs, skin, eyes, liver, spleen and joints. Clinical evidence of involvement of the central nervous system may be found in 5 per cent of all cases (Silverstein et al, 1965; Wiederholt and Siekert, 1965; Delaney, 1977). Typical lesions are cranial nerve palsies, intracranial space-occupying lesions, pituitary or hypothalamic lesions and, less frequently, lesions of the brainstem or spinal cord (Waldenstrom, 1937; Matthews, 1965; Wiederholt and Siekert, 1965; Scadding, 1967; Delaney, 1977).

Opportunities exist for psychiatrists to spend a short term, from two weeks to four months, in underdeveloped countries under the auspices of the Inter University Council, (IUC, 1978). This is accepted as a desirable part of training and experience, as outlined in the Royal College of Psychiatrists Handbook for Inceptors and Trainees in Psychiatry (1980), and allows first-hand experience of symptom patterns and features peculiar to another culture. The present case showed a number of features characteristic of African psychiatry, including ‘brain fag’ syndrome (the syndrome which owes its name to the patient's explanation of his illness as being due to tiredness of the brain), a bizarre colourful presentation of the condition at the onset, and at one point a concern with witchcraft. Behind the illness lay family problems and significant life events which could be grasped by the outsider.

All choices are personal but some more personal than others. The task of selecting from the vast literature of psychoanalysis has felt like the task of the castaway on Desert Island Discs; should I include old faithfuls of long ago or replace them with the shining prizes of today? My selection will not be the same as that of any other psychoanalyst and reflects my position as a therapist who works with individuals, groups and institutions, and who tries both to clarify the different frames of reference appropriate to these areas, and to seek unifying common factors.