Despite the relatively high incidence of therapy-resistant depression, there is little clinical evidence to suggest that there are significant biochemical differences between therapy-resistant and therapy-responsive patients. A major problem for investigators is the lack of an internationally recognised definition of resistant depression. Also, it is possible that depressed patients with delusional symptoms or rapidly cycling affective disorders form subgroups that are more likely to be resistant to tricylic antidepressant treatment and are therefore classified as therapy-resistant. Evidence is presented to show that an abnormality in serotonergic function may characterise some therapy-resistant depressed patients.

The association between the familial risk for schizophrenia and season of birth was studied in 88 schizophrenic patients. An increased risk for schizophrenia and ‘spectrum’ disorders was demonstrated among the first-degree relatives of winter and spring-born schizophrenic patients. However, patients with a family history of schizophrenia and ‘spectrum’ disorders did not differ from patients with no family history with respect to season of birth. Season of birth was unrelated to the sex of the patient, birth order, age at onset, or clinical subtypes (paranoid vs non-paranoid, as defined by the RDC, and ‘narrow’ vs ‘broad’, as defined by Taylor & Abrams' 1975 criteria). The morbid-risk data support a ‘stress-diathesis' hypothesis whereby environmental factors (in this case a seasonally varying viral insult may be implicated) interact with genetic vulnerability to increase the risk for schizophrenia.

Forty-two long-stay hospital patients with chronic schizophrenia were divided into age and sex-matched groups with and without temporal disorientation, and assessed for premorbid academic performance and past physical treatment. The schooling of schizophrenic patients who had cognitive impairment, as identified by gross temporal disorientation, did not differ from those who were cognitively intact. The groups did not differ in past history of ECT, insulin coma, neuroleptic treatment, or psychosurgery. Patients with age disorientation were on lower mean doses of neuroleptic or anticholinergic medication. Gross cognitive impairment thus appears to occur in the course of the disease and is not due to physical treatment.

Of 49 schizophrenic patients followed up 12 months after their first admission to hospital, only about 45% had experienced no relapse and had no schizophrenic symptoms; a poorer outcome was more often found in Feighner positive than Feighner negative schizophrenic patients. The patients' overall level of unemployment had more than doubled to 51%. In patients whose acute episodes responded to treatment, pimozide taken once weekly as maintenance therapy was as effective as intramuscular flupenthixol decanoate, but tardive dyskinesia appeared in two patients receiving weekly pimozide; the repeat psychometric assessment at 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relatives still showed significant psychological distress, which correlated with patients' schizophrenic symptoms, and the relatives' social functioning remained poorer than that of a normal community sample.

A review of all known schizophrenic people living in Nithsdale in South-West Scotland identified long-stay in-patients, patients living on their own and those living with relatives showing low or high expressed emotion (EE). A prospective 12-month follow-up identified relapsing patients, defined as those readmitted to hospital with exacerbation of schizophrenic symptoms or a fresh episode of illness, or, if not readmitted, with a significant increase in antipsychotic medication. There was no difference in relapse rates in patients living on their own, with low-EE, or with high-EE relatives. Amount of contact with high-EE relatives did not affect relapse rates. The different results obtained from the Nithsdale group compared with one from Camberwell are discussed.

A case-control study was undertaken to evaluate the effects, if any, of sibship size, birth order and parents' age at birth on the risk of a person's developing schizophrenia. Information was obtained, during an 18-month period, from 221 schizophrenic patients in the only mental-health hospital of the region of Peloponese, Greece, and from an equal number of matched patients. The data were analysed by modelling through logistic regression. No relationship was found between the occurrence of schizophrenia in a patient and either father's or mother's age at patient's birth, or sibship size, or birth order, when demographic and socio-economic variables were accounted for in the analysis. Although patients with schizophrenia were of similar socio-economic status to the comparison patients, they came from families with higher original socio-economic status, a fact which appears to reflect the decline of both schizophrenic and pre-schizophrenic people in the social ladder.

In this study, we compare the rates of psychiatric disorders found among women in a random sample of the general population with those of patients referred to specialist services. Both these groups were drawn from the same geographical area. The ratio of prevalence rates is less than the ratio between inception rates in the two groups. When only those with affective disorders were considered, the results revealed that the point prevalence in the treated-disorders group was only 1% of the community-group prevalence, while the inception into care in the former group was nearly 6% of that in the latter. Single women and older women were over-represented in the hospital sample.

The spouses of 40 women admitted to a psychiatric Mother and Baby Unit were interviewed to detect psychiatric morbidity, and aspects of their social and marital functioning. This group was compared with 25 men whose wives had not shown obvious psychiatric disorder in the puerperium. Psychiatric morbidity, using DSM-III (American Psychiatric Association, 1980) criteria, was present in 42% of the index group, and 4% of the comparison group. The main diagnoses were major depressive episode and generalised anxiety disorder. This was associated with poorer marital and social function in the index group. Male psychopathology after delivery has been studied little but may be significant in the management of postpartum syndromes.

A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.

The treatment of obsessive–compulsive disorders with a behavioural therapeutic program consisting of response prevention has proved to be rather successful. A prospective study of the potentialities of predicting the outcome of such a treatment program is described. The results of this research could possibly lead to the development of a decision model for use in the treatment of obsessive–compulsive neurosis.

A randomised treatment design for 49 chronically obsessive–compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11–16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.

Supervision of lithium treatment among three groups of patients treated in different settings – at a lithium clinic, as hospital out-patients, and by a GP – was studied. The lithium clinic maintained lower levels and checked these more frequently. Elevated lithium levels were most frequent in the GP-supervised group, which also included the 13 patients with the most impaired glomerular filtration. In hospital settings GFR-impaired patients received a lower daily dose of lithium; in general practice, affected patients had a higher mean serum lithium level and were more frequently prescribed lithium once daily. We conclude that patients with glomerular impairment who require lithium should be supervised by a specialist, or at least prescribed lithium in divided daily doses.

Rhinoplasty patients and matched elective-surgery controls completed the Facial Appearance Sorting Test, the General Health Questionnaire, a Repertory Grid and the Masculinity/Femininity Scale. Rhinoplasty applicants perceived appearance similarly to, and downrated their own appearance to the same extent as, controls. Impaired appearance and psychiatric symptoms are integral parts of the ‘rhinoplasty applicant syndrome’, but the degree to which they occur is not positively correlated. Interviews and tests were repeated 6 months after operation, when marked improvement in appearance was reported by the rhinoplasty patients, associated with the reduction of psychiatric-symptom scores. Control subjects showed no change.

Thirteen black patients were referred over 5 years to the eating-disorders unit at the Maudsley Hospital. Two suffered from anorexia nervosa and 11 from bulimia nervosa. This group was compared with a matched white control group from the total clinic population during that period. The Blacks had more commonly experienced parental divorce or separation, and premorbid obesity, and were more likely to be referred by the emergency services. Their lower educational achievements, and fathers of lower socio-economic status, reflected variation among the general black and white populations in this country, but their educational levels and social statuses were higher than in the general black population.

Three groups of male transsexuals at different stages of the treatment process were examined and shown to match retrospectively in actuarial and psychiatric data. Transsexuals who were on a waiting list for surgery showed lower neurotic scores on the Crown–Crisp Experiential Index than those at the assessment stage of clinic attendance, while post-operative transsexuals obtained scores lower than either of the other groups. Transsexuals during the assessment stage of treatment obtained the lowest scores on items in the Bern Sex Role Inventory that define stereotypical masculine characteristics and the highest scores on items that define stereotypical feminine characteristics, in relation to the other two groups.

The performance of the dexamethasone suppression test was assessed in 90 consecutive admissions with a diagnosis of depression, categorised according to two classification systems (DSM-III and ICD-9). Non-suppression was found in most of the diagnostic categories, but there was a highly significant association with the DSM-III classification ‘major depressive episode with melancholia’ (52%) in comparison with the ICD group ‘manic-depressive illness-depressed’ (29%).

The clinical features of a fatal case of the neuroleptic malignant syndrome are presented. The fatal episode was a recurrence of the syndrome after a milder episode 3 months earlier. Prescription of neuroleptics was continued unchanged following the latter, as a correct diagnosis was not made at the time. The case emphasises the importance of early recognition of the syndrome and the possibility of spontaneous remission of symptoms despite continued neuroleptic treatment.

Marker loci in 113 members of nine unrelated multiplex families identified by a bipolar proband were tested for linkages with primary affective disorder. Linkage was excluded between the disease locus (assuming that it was a single autosomal dominant gene) and the HLA loci at a recombination fraction of 0.2, the ABO, Rh, and Lu loci at almost 0.05 and the Fy and P loci at 0.001.

Pseudocyesis is an uncommon condition in which the psychological and somatic phenomena are usually thought to arise with neurotic rather than psychotic illness. We report a patient whose pseudocyesis took a course not previously described, culminating in an acute schizophrenic episode. Despite this she demonstrated many similarities with neurotic patients previously described in the literature. A phenomenological explanation, the belief of pregnancy as an overvalued idea, is discussed.