Sovner et al (1985) proposed that the presence of Down's Syndrome (DS) precludes the possibility of concomitant mama, and this is not a new claim, since Earl (1961) had stated that neither cyclothymia nor manic-depressive psychosis occurred in the mentally retarded. While Sovner et al conceded that cases of mania in individuals with DS may simply have gone unrecognised or unpublished, they felt this to be unlikely. However, lest this suggestion enter the canon, we present a previously unreported case of a young adult with both DS and recurrent mania.

The Capgras syndrome was first described as an ‘illusionf doubles' in 1923 by two French psychiatrists, Capgras and Reboul-Lachaux. Since then, a number of cases have been reported of this syndrome co-existing with functional as well as organic disorders. Enoch & Trethowen (1979) regarded the syndrome as purely functional – a manifestation of schizophrenia. Recently, there have been case reports describing the occurrence of Capgras syndrome with diabetes (MacCallum, 1973), hypothyroidism (Madakursira & Hall, 1981), hepatic encaphalopathy (Pies, 1982; Cummings, 1985), pseudo-hypoparathyroidism (Hay et al, 1974), temporal lobe epilepsy (Chawla & Virmani, 1977) and vitamin B12 deficiency (Zucker et al, 1981).

The following report discusses the presence of Capgras syndrome in a patient with dementia.

In recent years, there has been renewed appreciation of the morbidity which can result from unusual or overwhelming stress and while many situations can give rise to post-traumatic disorder, the most frequently studied of these is probably military combat. Psychiatric disorder pursuant to combat experience can not only become chronic, but may intensify with advancing age, decades after the original trauma (Archibald & Tuddenbaum, 1965; Wilmer, 1982). Moreover, a high percentage of combat veterans are believed ultimately to develop chronic psychiatric morbidity (Walker & Cavenar, 1982). The drug treatment of such post-traumatic states remains an important question, largely over looked until the last 2 years but recent case reports suggest that doxepin and imipramine (White, 1983; Burstein, 1984) are beneficial in treating post traumatic stress disorder (PTSD), which may be either combat or non-combat related. Hogben & Cornfield (1981) described five veterans whose PTSD improved when treated with phenelzine, while Van der Kolk (1983) has described beneficial results with antidepressants, lithium, benzodiazepines, beta blockers, and neuroleptics in uncontrolled studies of PTSD.

A computer search of the literature revealed that the oldest documented patient to receive electro convulsive therapy (ECT) was a 94-year-old woman (Bernstein, 1972) who was diagnosed as having ‘anorexniearvosa’, but the history was suggestive of paranoid schizophrenia. She received a course of five ECTs and became much less paranoid, ate well, and put on weight. Her daughter lamented the fact that ECT had been deemed to be contra indicated 15years earlier on the grounds of advanced age.

Epilepsy can occur in patients without any changes apparent in the electroencephalogram. Thus the diagnosis of epilepsy is essentially made on clinical grounds. The clinical features of epilepsy are rela tively easy to learn to mimic. Feigned epilepsy can occur in adulthood or it may occur in childhood, as part of a Munchausen syndrome by proxy as described by Meadows (1984). We would like to describe a case of feigned epilepsy with global amnesia, and several other symptoms of aberrant illness behaviour.

The use of ephedrine for medicinal purposes dates back over 5000 years, when native Chinese physicians Ma Huang in the late 1800s, but was considered too toxic for clinical use; it was rediscovered by Chen & Schmidt (1930), who demonstrated its sympatho mimetic action and introduced it into Western medicine, where it was found to be a big improvement on adrenaline in the treatment of asthma. That the structure of ephedrine is very similar to that of amphetamine is not a coincidence, since Alles (1933) synthesised the latter as a synthetic substitute for ephedrine.

Delusional parasitosis, originally described by Ekbom in 1938, is an illness in which the individual believes small animals such as insects, lice, vermin, or maggots are living in or thriving on his/her skin. The delusion is not secondary to another psychiatric ill ness, and in general the personality remains otherwise preserved. Munro (1980) classifies delusional parasi tosis as a subtype of monosymptomatic hypochon driacal psychosis, and has shown that a substantial proportion of patients with MHP respond to pimozide. Prior to the introduction of that drug, the prognosis of the condition was held to be very poor.