Five consecutive cases of the NMS are presented, in all of which a catatonic state preceded the onset of the condition. Catatonia would appear to represent a highly significant risk factor for the NMS and a possible causal link between the two disorders is suggested.

To our knowledge Pisa syndrome in childhood or adolescence has not previously been described. The syndrome developed in an adolescent girl following administration of neuroleptic medication for psychotic features, and was transiently thought to be abnormal illness behaviour. This case emphasises the need for early diagnosis and rapid effective treatment.

A case of psychogenic amnesia in a 58-year-old man supports the view that complete loss of personal identity can follow a traumatic experience. He regained his memory by being helped to develop an affective link with the painful event.

A woman with pituitary microadenoma presented with panic attacks. This case illustrates the need both for routine medical screening of psychiatric patients and for psychiatrists to remain aware of the clinical features of medical syndromes.

A woman with a mental handicap developed SLE. This magnified the level of her handicap, and because of her difficulties in giving a history, mildly abnormal results of tests in any one system were dismissed over long periods of time. This resulted in very late diagnosis of a potentially treatable disease.