A retrospective study was carried out of all heroin abusers admitted to an acute psychiatric unit to examine their use of the facility of in-patient care. The compliance with treatment was low. Most patients discharged themselves or were discharged prematurely for using drugs while in the ward; only 21% were discharged as planned. The value of hospital admission in the management of opiate abusers may have to be reconsidered in view of the increasing prevalence of heroin abuse and the limited number of psychiatric beds.

A case of Capgras syndrome in a black Zimbabwean patient is described. The syndrome occurs in the setting of a schizophrenic illness, but psychodynamic factors are readily identified despite the patient's different cultural background.

A case of Ganser syndrome occurring in an 11 year-old Indian boy is described, and the psychodynamics and nosological status of the syndrome discussed. Ganser syndrome should be regarded as a hysterical state, and should not be confused with the similar picture observed in organic brain syndromes and psychoses.

A case of folie à deux in a 29 year-old man with Down's syndrome, whose mother had a paranoid psychosis, is described. Successful treatment of the mother's illness also resulted in full recovery of the son without the need for medication.

A patient with Creutzfeldt-Jakob disease is described. Many alternative psychiatric diagnoses were considered, and the true situation only became apparent late in the clinical course.

A case of Capgras syndrome associated with extreme violent behaviour is described. The patient's psychodynamics support the belief that the Capgras delusion initially arises from an altered affective response towards one or more others and proceeds to intolerable ambivalent feelings. This ambivalence is neutralised through the imagined existence of doubles.