The reduction of mental hospital populations in Britain and the United States has generated a considerable amount of literature on policy, but detailed studies of the effects on patients and the conditions under which they live after discharge are rare. In the United States, a National Institute of Mental Health review of the literature commented that “the question of what actually happens to patients who leave mental hospitals and re-enter the community is largely unanswered” (Bachrach, 1976).

Updated guidelines are presented for the safe and effective use of lithium; covering indications, treatment management, duration of prophylactic treatment, side-effects and their prevention, overdosage, interactions, and contraindications. Alternatives to lithium and patient-doctor co-operation are discussed.

Beyond assuring biological survival, every society must have structures that nurture the young, prepare them for social roles and responsibilities, and that successfully integrate them with a reasonable level of motivation into ongoing patterns of activity. Societies must also have institutions that reinforce a sense of personal commitment to everyday affairs: the lack of a stake in social processes contributes to personal demoralisation and deviant behaviour. Deviance may also occur because of biological vulnerability or handicap, because socialisation fails, because demands exceed capacities, or as a result of sub-group identification being in conflict with dominant values. Psychiatric disorders are a sub-set of deviant behaviour.

Reasons are given why the hospital diagnosis of schizophrenia may be accurate enough for the proper study of certain aspects of its epidemiology. Studies in the seasonality of admissions and of births in schizophrenic patients have produced consistent results in different countries and at different times. The results are summarized, and causal hypotheses based on them are discussed. The idea that schizophrenia is a relatively recent disease is compatible with these hypotheses.

Severe degrees of inattentive and restless behaviour in childhood are a risk factor for later psychological disorders. They have many causes, but a pattern of severe and pervasive hyperactivity with poor concentration in the absence of affective or psychotic disorders should be recognised as a hyperkinetic syndrome. The syndrome is often associated with developmental delays in abilities such as language and motor control. Powerful short-term treatments are available, but long-term ways of promoting normal personality development need more research.

The initial features and progress of depressive symptomatology over 42 to 104 months are presented for 100 elderly patients admitted with severe, non-neurotic depressive states; none had experienced a previous hypomanie episode. Sixty per cent either remained well throughout or had further episodes followed by full recovery; only 7% suffered continuous depressive symptoms. Of potential prognostic factors, only male sex and poor physical health, both at presentation and developing subsequently, were associated with poorer outcomes. The view is supported that treatment with well established methods achieves worthwhile and sustained improvement for most patients.

The effects of children's exposure to parental alcoholism was assessed using records from an existing prospective 40-year longitudinal study of working-class families: 176 men who had grown up with an alcoholic parent or parents were compared with 230 men without such exposure. Degree of exposure to alcoholism in the childhood family environment was highly correlated in later life with alcohol use, alcoholism, time in jail, sociopathy, and death, but not with increased rates of unemployment, poor physical health, or measures of adult ego functioning. Most of the impairments observed occurred in those subjects who actually developed alcoholism. Exposure to alcoholism in the family environment and family history of alcoholism independently contributed to the later development of alcoholism.

Female agoraphobics and their partners were compared with three groups of control couples (non-phobic female psychiatric patients and their husbands, maritally distressed couples, and happily married couples) on measures relating to marital adjustment, intimacy, and needs. Neither agoraphobics nor their partners rated their marriages as more maladjusted or unpleasant than non-phobic psychiatric patients or their partner controls. Instead, agoraphobics and their spouses were found to be more comparable to happily-married couples than to maritally-distressed controls. Non-phobic psychiatric patients and their partners were generally found to rate their marriages as being as distressing and unpleasant as those of maritally distressed controls.

The treated one-year prevalence and point-prevalence of schizophrenia, schizoaffective psychosis, and paranoid state in the city of Salford were derived from the Salford Psychiatric Case Register. The high rates found are attributed primarily to the effects of selective migration from the area. A breakdown of the use of health services in the area by patients with these diagnoses is given; hospital care was found to be the major form of treatment.

HLA haplotypes A and B were studied in eight familes with two or more schizophrenic members. All index cases and all but two sick relatives satisfied Research Diagnostic Criteria for the diagnosis of schizophrenia; 45 subjects were studied. Data were analysed by sequential tests for the detection of linkage and by the affected sib-pair method. The results do not support a linkage between HLA and schizophrenia.

Intellectual impairment, negative symptoms, and medication history were assessed in chronic schizophrenic patients with and without abnormal involuntary movements (tardive dyskinesia). Patients with involuntary movements had received neither longer nor more intensive treatment with neuroleptics or anticholinergics. However, the presence or absence of involuntary movements was prominently associated with the presence or absence of intellectual impairment/negative symptoms; these features are characteristic of the defect state/type II syndrome of schizophrenia, in which structural abnormalities of the brain may be over-represented. The role of subtle organic changes in conferring vulnerability to the emergence of such involuntary movements should be re-evaluated.

The point-prevalence of tardive dyskinesia in schizophrenics from a discrete geographical area (Nithsdale, in Dumfries and Galloway Region) in 1981, 1982, and 1984 was 31%, 27%, and 30% respectively. This suggests that the prevalence of tardive dyskinesia in a community of schizophrenics has reached a plateau. In 12% of patients there was persistent dyskinesia, i.e. abnormal involuntary movements were present at all three assessments. Persistent dyskinesia was more common in older patients. The severity of tardive dyskinesia fluctuated between assessments in 41 % of patients, indicating that it is only a transient feature in some cases.

The opinions of patients who had caused deliberate self-harm about the attitudes of doctors, nurses, families and others towards their acts were studied. Their views of the attitudes of hospital staff were found to be markedly different from attitudes reported elsewhere by staff themselves. There were no differences between the patients' views of their handling by nurses, families, and others towards their acts were studied. Their views of the attitudes of families were unsympathetic. A significant association was found between repetition of an act of deliberate self-harm and the perception of an unsympathetic attitude within the family.

The Newcastle diagnostic index was completed on 159 depressedin-patients, who received the dexamethasone suppression test during their first week in hospital. Patients suffering from endogenous depression had a significantly higher rate of DST non-suppression, were older, were more frequently psychotic, and more frequently lost weight; even after con trolling for these variables, DST non-suppression was significantly more frequent in the endogenous group. The relationship between Newcastle scores and the frequency of DST non-suppression was non-linear.

Hypochondriasis was assessed in 60 patients with panic disorder and agoraphobia using the Illness Behavior Questionnaire. Before treatment, IBQ hypochondriasis scores were similar to those of a group of hypochondriacal psychiatric patients. In patients who improved with treatment, significant reductions in somatic preoccupation, disease phobia, and disease conviction occurred. Hypochondriasis appears to be a prominent feature of panic disorder and agoraphobia, and responds to treatment of the primary conditions. Our findings underscore the importance of providing adequate treatment and thereby avoiding wasteful use of medical resources and alienation of patients from doctors.

In three years of clinical practice, the authors saw 35 cases of dermatological disorders of strictly psychological origin-8 patients with dermatitis artefacta, 8 with delusional parasitosis, and 19 who presented with skin complaints but showed no dermatological pathology (‘dermatological non-disease’). All but two initially presented for dermatological opinion rather than psychiatric assessment, and 12 refused psychiatric referral. Demographic and clinical details of all 35 cases are given, including possible related factors, course, treatment, and outcome, and the cases are discussed in the context of the existing literature. Liaison between dermatologists and psychiatrists is strongly advocated.

Clinical data on 30 Korean patients of the authors with Gilles de la Tourettes's syndrome are described, as well as data on seven other Korean cases from the literature. The overall characteristics and EEG findings were similar to those of Western patients, but there were fewer obsessive-compulsive behaviour problems, and family histories were less often positive.

The internal consistency and factorial composition of the eight-item Life Satisfaction Index-Well-being, adapted for use with elderly British samples, were examined. Crossvalidation was carried out with a randomly drawn community sample of 155 rural people aged 65–89 years. The scale was found to have acceptable internal reliability, but may require modification.

A case of severe lactic acidosis following paraldehyde administration is described, and the adverse effects of paraldehyde reviewed.

A man with Munchausen's syndrome was treated for drug dependence, which allowed him to establish and sustain a bond with a hospital, but eventually brought about an ethical dilemma.