The similarities and differences of comorbidity in treated and untreated samples with anxiety disorders were examined using data from the Munich Follow-up Study: 133 subjects with anxiety and depressive disorders and 101 former in-patients at the Max Planck Institute for Psychiatry. Diagnoses were based on the DIS, not using the optional DSM—III exclusion rules. In these epidemiological and clinical samples, 69% and 95% respectively had at least two diagnoses. The epidemiological sample was clearly differentiated from the clinical sample by age of onset. The development of both depressive episodes and substance disorders in the two samples was mostly secondary to the development of anxiety problems. The outcome for subjects with both anxiety and depressive disorders tended to be worse than that for those with anxiety alone, regardless of whether a depressive episode was present at the time of the follow-up investigation. The usefulness is underlined of the comorbidity concept based on operationalised diagnosis without the exclusion rules offered by DSM—III and DSM—III—R.

Thirty schizophrenic patients (20 medicated, 10 off medication) were compared with 30 normal control subjects matched for age, sex, handedness, and intelligence. During the performance of left-hemisphere cognitive activation tasks, normal subjects had significantly increased EEG alpha coherence in areas related to left focal frontal sites, with decreases in temporal and posterior areas. Schizophrenic patients did not show the same degree of focal activation of left frontal areas. During the performance of right-hemisphere cognitive activation tasks, normal subjects and schizophrenic patients had similar patterns of right posterior increases in alpha coherence. Discriminant analyses were able to classify 81.4% of all subjects correctly. It is suggested that the findings indicate an aberrant functional organisation of the brain in schizophrenia, particularly affecting the left hemisphere.

A study of 50 opiate addicts attending a London service for treatment of drug dependence found that 47 subjects had previously made at least one attempt at self-detoxification. These subjects reported 212 previous attempts. Although 30 subjects reported having managed to complete at least one attempt, the success rate per episode was low (24%). One of the most commonly reported methods, used by 28 subjects, involved an abrupt cessation of opiates (‘cold turkey’). Of the drugs used in their attempts at self-detoxification, benzodiazepines were reported by 24 subjects and opiates by 20. Practical strategies such as distraction and avoidance were also used. Self-help detoxification materials for opiate addicts might be useful.

Whereas the history of the Royal College of Psychiatrists has been reasonably well documented, that of its journal, under its various titles, has received little attention. What follows is an attempt to redress the balance, but this could not have come about if my attention had not been drawn to the existence in the College library of the original, handwritten minutes dating from 1841 of the Association of Medical Officers of Asylums and Hospitals for the Insane and the succeeding body, the Medico-Psychological Association. This historic treasure, to steal a line from one of its pages, written in immaculate handwriting and expressed in elegant Victorian Gothic prose, “contained an unworked mine of golden wealth”.

Persisting positive symptoms largely unresponsive to treatment (Tuma & May, 1979; Macmillan et al, 1986; May et al, 1989) occur in about 7% of patients with schizophrenia but lesser degrees of treatment resistance are common (Hogarty, 1988; Johnstone, 1990) and problems of recurrence of positive symptoms and deterioration of negative symptoms are well known (Johnstone, 1990). Schizophrenic patients have also been found to have persisting non-psychotic symptoms, particularly depression (Cheadle et al, 1978). Disorders of movement in relation to schizophrenia and their treatment have been found to be disabling in a few patients and to cause lesser problems for many (Kane et al, 1985). The assessment of the mental state and of clinical evidence of movement disorder in the patients who form the subjects of the Harrow study was therefore clearly of interest, as it is rarely possible to examine these issues in a large, unselected sample.

All referrals made to the liaison psychiatric service for HIV and AIDS patients over one year were reviewed. ICD–9 and CDC diagnoses were applied to each case at presentation. Sixty HIV-positive patients were assessed, of whom 35 had affective disorder, which was significantly associated with CDC group IV disease (AIDS). Adjustment reaction was seen in nine patients, paranoid states in six, dementia in four, personality changes in four and paranoid schizophrenia in two. CT scans of the brain were performed on 23 of the patients: 17 of these showed abnormalities. The proportion of registered AIDS patients who were referred was five times the proportion of HIV patients.

This paper examines the family background, premorbid personality traits and adverse life events preceding childhood depression. The non-depressed group proved more likely to have experienced pre-school bereavement and familial disturbance, and to come from the more deprived background; there was also an excess of premorbid anxiety and hysterical personality traits in this group. School phobia and premorbid obsessional traits were associated with the depressed group. Although there was an association between depression and the total number of adverse life events, this was more substantial when the perceived impact of the events was taken into account. Of the individual classes of life event, only illness and a change in social relationships were associated specifically with depression.

“Extreme psychotic states offer a human parable … patients see into the depths which do not belong so much to their illness as themselves as individuals with their own historical truth … in psychotic reality we find an abundance of content representing fundamental problems in philosophy …. The philosopher in us cannot but be fascinated by this extraordinary reality and to feel its challenge.” (Jaspers, 1963)

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness had been made. DSM–III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a ‘schizodepressive continuum’, but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.

Psychodrama-Inspiration and Technique, edited by Paul Holmes and Marcia Karp, is published by Routledge, London (£14.99 (pb), £35.00 (hb), 253 pp., 1991). Paul Holmes is a child and adolescent psychiatrist, formerly consultant at St George's Hospital, London, and now based in Mexico. He is a member of the London Centre for Psychotherapy and was the first chairman of the British Psychodrama Association. Marcia Karp trained in psychodrama in the USA under its founder, Dr J. L. Moreno. Since moving to England, where she established the Holwell Centre for Psychodrama Training, she has been instrumental in setting up training schemes throughout Europe.

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8–16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.

From Autothanasia to Suicide–Self-killing in Classical Antiquity, by Anton J. L van Hooff, is published by Routledge, London (£35, 306 pp., 1990). This is the first book by this author who is a senior lecturer in ancient history at Nijmegen University, the Netherlands. Suicide over the Life Cycle, edited by Susan T. Blumenthal and David J. Kupfer, is published by American Psychiatric Press, Washington. DC (£55.95, 799 pp., 1990). Dr Blumenthal is Chief of the Behavioural Medicine Unit and former head of the Suicide Research Unit in Maryland. Dr Kupfer is Professor and Chairman at the University of Pittsburgh, Pennsylvania. Youth Suicide, edited by Peter Cimbolic and David Jobes, is published by Charles A. Thomas, Illinois ($26.75, 122 pp., 1990), Dr Cimbolic is Director of the Counselling Centre at the Catholic University, and Associate Professor of Psychology. Dr Jobes is Assistant Professor of Psychology at the Catholic University,

In the 18th century the main varieties of nervous illness – hypochondria, hysteria, the spleen, the vapours and dyspepsia – became included under the general term ‘nervous disorders'. When no physical disorder of the nerves could be detected in such conditions, the hypothesis of nervous disorder was replaced by the more vague concept of ‘nervous temperament’. The fact that there is still no evidence of pathological change in such cases continues to expose physicians to the alternative hypothesis of a purely psychological cause. The modern era in our understanding of the nervous system may be said to date from 1843 when Du Bois Reymond showed the electrical nature of nervous conduction. The publication of Jordan's Briefe Discourse in 1603 may be taken to represent the start of a discrete period (1600 to 1840) in the history of neurotic illness.

According to Kendell (Kendell, 1975) the classification of psychiatric disorders should “cleave nature at its joints”. The central task of nosology then is to discover ‘nature's joints‘. There are, generally speaking, two major approaches to this task, which as Kendell has outlined, trace their origins to the epistemological debates between Platonic and Aristotelian schools. The first is the empirical approach from Locke and Hume, which is currently in ascendancy as exemplified by DSM—III and DSM—III—R, (American Psychiatric Association, 1980, 1987) while the second can be regarded as the ‘rational‘ approach deriving from the philosophy of Kant (Varghese, 1988). Table 1 outlines the differences between nosological approaches.

A random community sample of subjects aged 65 and over was re-interviewed after three years by psychiatrists using the GMS and HAS. The relationship between drinking history and current psychiatric morbidity was examined. Men with a history of heavy drinking for five years or more at some time in their lives were found to have a greater than fivefold risk of suffering from a psychiatric disorder at the time of the interview. Among this group past alcohol consumption was significantly higher for those with a current psychiatric diagnosis compared with those who were well. This association between heavy alcohol consumption in earlier years and psychiatric morbidity in later life is not explained by current drinking habits.

The WHO launched a multicentre study to explore the nature and prevalence of HIV-1-associated neurological, psychiatric, and neuropsychological abnormalities in persons living in different geographical and sociocultural contexts. The study is being conducted in Brazil, Germany, Kenya, Thailand, the United States of America, and Zaire. A comprehensive instrument for the collection of neuropsychiatric data (including a battery of neuropsychological tests suitable for cross-cultural use) has been developed, and the feasibility of the recruitment and assessment procedure designed for the main phase has now been demonstrated.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD–10 and DSM–III–R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

The frequency and distribution of negative symptoms in a sample of 40 patients admitted to hospital with RDC-definite schizophrenia were examined. There was a highly significant positive correlation between negative symptom scores obtained using three different rating scales, but the presence of negative symptoms was not significantly related to duration of illness or number of episodes of illness. These findings do not support a model of negative symptoms being the consequence of schizophrenic relapse, but are in favour of their being an integral component of the schizophrenic syndrome, as salient in the first as in later episodes.

It has become increasingly apparent that schizophrenic patients can suffer from many cognitive deficits (Hemsley, 1982). These include a decline in IQ (Nelson et al, 1990), loss of concentration (Garmezy, 1978), and various ‘executive’ difficulties similar to those observed in patients with frontal lobe lesions (Morice, 1990). The availability of a large, population-based sample of schizophrenic patients in the Harrow study provided the opportunity to examine the prevalence of these impairments and to relate them to the signs and symptoms of the disorder.

The augmentation of serotonin (5-HT) neurotransmission attenuates alcohol consumption, whereas depletion enhances use. A number of serotonin-specific pharmacological probes appear to be effective in reducing the voluntary consumption of alcohol. The 5-HT1A receptor agonist buspirone is an anxiolytic which has been shown to diminish the desire to consume alcohol in anxious alcoholic patients. Thus, serotonin may represent a common denominator for a spectrum of behavioural disorders including anxiety and alcoholism. Novel serotonin drugs, such as the azapirones, may usefully supplement conventional treatment strategies for substance abuse.