Nuclear magnetic resonance is a non-destructive and non-invasive technology that is highly suited for research in psychiatry. It is establishing itself as a versatile means of studying brain morphology, chemistry and function and is finding a place in the diagnosis of disease, monitoring of treatment and the study of basic brain processes.

A literature review was undertaken.

Magnetic resonance spectroscopy has been shown to distinguish between psychiatric disorders, and has provided evidence of their pathophysiological mechanisms.

Spectroscopy in particular opens a window, for the first time, on the study of in vivo brain chemistry.

The treatment of sexual dysfunctions underwent a great change when sex therapy was developed more than 25 years ago. Since then the treatment programme has been modified in various ways, the response to treatment evaluated and other treatment approaches introduced.

A review of the literature concerning the application and outcome of sex therapy and other treatments for sexual dysfunction was conducted.

The format of effective conjoint sex therapy is now fairly clear and there is good understanding of the sexual dysfunctions that respond best to this treatment and the couples most likely to benefit. Less is known about the effects of treatment of individuals without partners, bibliotherapy and combining sex therapy with marital therapy and with physical methods of treatment.

Sex therapy is now a well-established form of treatment. It should be more widely available for patients seen in psychiatry departments.

An exploratory study was undertaken of the importance of personality disorder in predicting the long-term outcome for both episodic disorders and social functioning.

In 1966–67, a representative series of patients with children, free of episodic illness for at least one year, was sampled from the Camberwell Psychiatric Register and systematically assessed over a four-year period, using measures of known reliability and validity. Psychiatric disorder was measured using a PSE-compatible instrument. The follow-up after 15–20 years used the PSE and a systematic assessment of social functioning.

Overall outcomes were similar across diagnoses, but an initial categorical diagnosis of personality disorder predicted much poorer outcomes on psychiatric and social measures for patients with unipolar depressive disorders than for those with other diagnoses.

The findings indicate the importance for prognosis of including a systematic assessment of personality disorder in the clinical assessment of patients with depressive disorder.

Little is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK.

Patients meeting criteria for DSM–III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks.

The prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups.

There was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.

This study compared long-term outcome of serious mental illness in two states using a matched design to assess psychiatric rehabilitation programmes; Vermont subjects participated in a model psychiatric rehabilitation programme, while the Maine group received more traditional care.

Maine and Vermont subjects (n = 269) were matched by age, sex, diagnosis, and chronicity. Demographic, illness, and life history information were abstracted from hospital records by clinicians blind to outcome. DSM–III criteria were applied retrospectively. Outcome was assessed by clinicians blind to history.

Vermont subjects alive at follow-up (n = 180) were more productive (P < 0.0009), had fewer symptoms (P < 0.002), better community adjustment (P < 0.001) and global functioning (P < 0.0001) than Maine subjects (n = 119).

Outcome differences may be due to Vermont's model programme and a policy of allowing an earlier opportunity for community life.

This paper supplements the cross-sectional outcome comparisons of the companion paper by providing a brief account of the longitudinal courses of the Maine and Vermont samples across several outcome domains.

A Life Chart method was used to document changes in individual lives over the domains of residence, work, income source, and use of community resources over a 20-year period. Reliability studies between states were conducted.

Throughout much of the period, more Vermont subjects lived independently, were working, and were less likely to use community resources compared to Maine subjects.

Differences in both policies and programmes contributed to course differences between the groups. System characteristics that may lead to better outcomes are discussed.

This study examined the pattern of cerebral blood flow observed in chronic schizophrenic patients while they performed a paced verbal fluency task. Such tasks engage a distributed brain system associated with willed action. Since willed action is impaired in many chronic schizophrenic patients we hypothesised that task performance would be associated with an abnormal pattern of blood flow.

Positron emission tomography (PET) was applied to 18 chronic schizophrenic patients stratified into three groups on the basis of verbal fluency performance and current symptoms. Regional cerebral blood flow (rCBF) was measured while the patients performed (a) verbal fluency, (b) word categorisation, and (c) word repetition. Results were compared with six normal controls matched for age, sex and premorbid IQ. Analysis was restricted to six brain regions previously identified in studies of normal volunteers.

In five brain areas, including the left dorsolateral prefrontal cortex, the patients showed the same pattern of activation as control subjects. However, in the left superior temporal cortex, all patient groups failed to show the normal decrease in blood flow when verbal fluency was compared with word repetition.

These observations suggest that (a) chronic schizophrenic patients can show a normal magnitude of frontal activation when matched for performance with controls, and (b) they fail to show the expected reductions of activity in the superior temporal cortex. This latter result may reflect abnormal functional connectivity between frontal and temporal cortex.

Delusions relating to the body, a ready source of information about the immediate experiences of psychotic patients, have not been systematically studied. We attempted an account of the phenomena, looking for differences between diagnostic groupings in the type and lateralisation of such phenomena, and for evidence of localisation.

Somatic delusions elicited at interview with 550 Research Diagnostic Criteria-diagnosed psychotic patients were categorised according to content, and the results were compared across diagnostic groupings.

Significant differences were demonstrated, both at the level of individual delusions and in the nature and overall pattern of such delusions. There were also differences between diagnostic groups in the choice of body parts involved. Among male patients there were significant differences in laterality between the groups, with schizophrenic subjects locating abnormal phenomena principally on the left and depressive subjects on the right. A provisional taxonomy of bodily delusions was developed.

Phenomenological differences between the psychoses were demonstrated and the results offer some support for current hypotheses of localisation of brain dysfunction in the psychotic illnesses.

A clinical sample was used to investigate whether second-generation Afro-Caribbean children differed from other British-born children in their psychiatric presentation or vulnerability to risk factors.

Second-generation Afro-Caribbean patients (n = 292) were compared with a predominantly white group of patients (n = 1311) who lived in the same inner-city area and attended the same child psychiatric clinic between 1973 and 1989. Data on psychiatric presentation and background factors were systematically recorded at the time of the initial clinical assessment.

Afro-Caribbean patients were exposed to more socio-economic disadvantage but less family dysfunction. The ratio of emotional to conduct disorders was lower among Afro-Caribbean than among the comparison patients – an effect that was not evidently due to demographic factors or diagnostic bias. Most risk factors for emotional or conduct disorders had comparable effects on Afro-Caribbean and comparison patients. Psychotic and autistic disorders were disproportionately common among the Afro-Caribbean patients.

Second-generation Afro-Caribbean children differ somewhat from other British-born children in their psychiatric presentation – a difference that has persisted over the 1970s and 1980s and that deserves more investigation than it has received to date.

This study looks at the outcome of infants exposed to dothiepin in breast milk in an attempt to guide clinicians on the risk-benefit ratio of breast-feeding when on antidepressants.

Thirty women, who had had HDRS scores > 15 within the first five years postpartum from the same women's hospital, were assessed with their children 3–5 years postpartum; half had breast-fed while on dothiepin (study group). Thirty-six non-depressed women were also assessed. Rating scales assessed depression, anxiety, self-esteem, personality, social support, marital relationship, child behaviour and temperament. The children were assessed by the McCarthy Scale.

Comparisons of the two depressed groups showed no significant differences on any measures except marital conflict and child behaviour, which were the most disturbed in the study group (P < 0.001). Overall cognitive scores for the children did not differ between the groups. Higher levels of dothiepin and northiaden were associated with higher cognitive scores on subscales (P = 0.02).

We are cautiously optimistic about the lack of any negative associations between cognitive development and exposure to dothiepin via breast milk.

This study compared the efficacy and tolerability of paroxetine with placebo in the treatment of panic disorder.

After three weeks of placebo, patients received 12 weeks of treatment with paroxetine (20, 40, or 60 mg) or placebo, and finally two weeks of placebo. Dosages were adjusted according to efficacy and tolerability. Standardised cognitive therapy was given to all patients. The primary measure of outcome was reduction in the number of panic attacks.

Analysis of the results showed statistically significant differences in favour of paroxetine between the two treatment groups in two out of the three primary measures of outcome, i.e. 50% reduction in total number of panic attacks and number of panic attacks reduced to one or zero over the study period. For the third measure of outcome, the mean change in the total number of attacks from baseline, there was a positive trend in favour of paroxetine. The results of the primary measures of outcome were strongly supported by the results of the secondary efficacy measures of outcome. In addition, paroxetine, at all doses, was very well tolerated.

Paroxetine plus cognitive therapy was significantly more effective than placebo plus cognitive therapy in the treatment of panic disorder.

The long-term course of seasonal affective disorder has not been well studied.

Using the Structured Clinical Interview for DSM–III–R, we interviewed 75% of a sample of 124 subjects diagnosed from five to eight years previously as fulfilling DSM–III–R criteria for recurrent major affective disorder, seasonal pattern.

In the follow-up period, 38% of the sample continued to fulfil DSM–III–R criteria for seasonal illness; 28% had recurrent major depressive disorder, but no longer displayed a seasonal pattern; 18% were completely well with no further depression; 6% had subsyndromal symptoms; and 5%, although not meeting DSM–III–R criteria for seasonal illness, were still displaying constant periodicity. A short duration of index episode and a high frequency of illness predicted a continuing seasonal course of illness.

Diagnostic criteria for seasonal affective disorder need to be further refined, possibly restrictively, if they are to be used to predict the future course of seasonal illness.

Comparisons were made between two groups of anorectic patients, ‘non-white’ and ‘white‘, on a variety of clinical and social characteristics.

The study is based on a 34-year long database (1960–93) associated with a national tertiary referral centre. Thirty-six non-white patients meeting DSM–III–R criteria for anorexia nervosa (AN) and five with ‘partial syndrome’ are compared with a white group comprising 944 patients with full syndrome.

The main finding is clinical similarity between the two groups, extending to social class and pathological patterns of family relationship. The non-whites are shorter in stature (P = 0.004) and report earlier menarche (P = 0.004); they are younger at presentation (P < 0.001), somewhat less emaciated, and practice veganism slightly more commonly; they less often acknowledge sensitivity to ‘fatness’ (P < 0.003). This sensitivity was exposed later whenever treatment involved substantial weight gain. The proportion of non-white cases accepted for assessment has not changed in respect of year of onset (around 6%) for the last 20 years, or year of presentation (around 6–7%) over the last 15 years. There was a tendency for non-white patients to be referred earlier in their illness.

The clinical and background profiles of non-white and white anorectics are generally similar. The numbers arising and presenting have not changed recently. Non-white patients apparently have as ready access as white patients to assessment and treatment by us.

A susceptibility locus for schizophrenia in the pseudoautosomal region has been proposed on the basis of a possible excess of sex chromosome aneuploidies among patients with schizophrenia and an increased sex concordance in affected sib pairs. Several studies investigating this hypothesis have produced conflicting evidence.

In a series of Icelandic and British families, we used lod score and sib pair linkage analyses with markers for the MIC2 and DXYS14 loci on the pseudoautosomal XY region.

Lod and sib pair linkage analysis with these markers produced strongly negative scores. Heterogeneity testing also produced negative results.

We conclude that the present study provides no support for the involvement of either the pseudoautosomal region or the nearby region of the sex chromosomes in the aetiology of schizophrenia.

Although it is acknowledged that obsessive-compulsive (OC) patients may be slower than healthy controls in performing neuropsychological tests, speed has usually been treated as a confounding variable. It is possible, however, that the slower performance of OC patients is itself the result of a dysfunction of specific neural circuits (in particular of fronto-subcortical systems).

A neuropsychological battery including tests sensitive to fronto- and temporo-subcortical dysfunction was administered to a group of OC patients and a group of healthy controls. Each test provided independent indices of accuracy and speed.

OC patients were significantly slower than controls only when performing tasks involving the fronto-subcortical systems, whereas they did not differ from controls with respect to accuracy indices.

It may be that neuropsychological slowness of OC patients is not merely an epiphenomenon of meticulous concern for correct test execution or intrusion of obsessive thoughts, but reflects the dysfunction of fronto-subcortical systems.

Dysmorphophobia may improve after a variety or combination of treatments, but which elements of a treatment are useful is usually not certain.

In a single out-patient case study rational role-play (‘paradoxical discourse’) was added to exposure plus cognitive restructuring (CR) for a dysmorphic delusion study comprised of 20-minute sessions one week apart.

Previous exposure plus attempted CR had improved anxiety, phobias, work and social leisure, but not dysmorphic belief. Added brief rational role-play was followed by resolution of the dysmorphic belief. All measures remained much improved at 18-month follow-up.

Rational role-play deserves a controlled trial in dysmorphophobia and other problems and exploration of its mechanism of action.