The use of electricity in British psychiatry during the second half of the 19th century is examined. An account is given of the clinical and theoretical aspects of electrical therapy. Factors leading to its use and eventual decline are considered.

A viable neuropsychology of schizophrenia requires, first, that signs and symptoms be understood in terms of underlying psychological processes and, second, that these underlying processes be related to brain systems. We propose that the negative signs of schizophrenia reflect a defect in the initiation of spontaneous action, while the positive symptoms reflect a defect in the internal monitoring of action. The spontaneous initiation of action depends upon brain systems linking the prefrontal cortex and the basal ganglia. Internal monitoring, carried out in the hippocampus, of spontaneous action, depends upon links between the prefrontal cortex and the hippocampus via the parahippocampal cortex and the cingulate cortex.

Before discussing the relationship of the temporal lobes to the body image, it is necessary to consider briefly some other aspects of the neurology of body image and its disturbances. Further, some clarification of the term body image is required.

One unknown factor in the link between crime and mental illness is whether or not mentally ill offenders are more liable than others to arrest. Ninety-one mentally ill, and 76 normal, criminally offending men were asked about the circumstances of their offence and arrest. A majority of mentally ill men had been arrested at the scene of the crime, and more than a quarter of the schizophrenic group had reported themselves to the police. We argue that when many offenders are either unreported or undetected, the increased vulnerability of the mentally ill to detection and arrest makes them disproportionately liable to detection. Attempting to assess the relationship between crime and mental illness is thus extremely difficult.

This paper describes the phenomenology of depersonalisation and focuses upon the relationship between depersonalisation, self-perception and body image. In discussing this relationship, the influence of certain phenomenological philosophers will be considered. Theoretical discussion of depersonalisation will be limited to those theories that are relevant to the purpose of this paper. Comprehensive reviews of the wide range of theories held to explain depersonalisation have been provided by Sedman (1970) and Oberst (1983).

Eighty-nine consecutive admissions with primary depressive illness were prospectively ascertained and diagnosed in 1965–66 by R. E. Kendell, who also allocated each a position on a neurotic-psychotic continuum on the basis of previous discriminant function analysis. In 1983–84, 94% of the survivors were personally interviewed by a psychiatrist blind to index admission data. Operational outcome criteria were employed and longitudinal data were established for 98% of the series. Mortality risk was doubled overall, and increased sevenfold for women under 40 years at index admission. Less than one-fifth of the survivors had remained well, and over one-third of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within three years. Readmissions occurred even after 12 years of being symptom-free, and conversely patients recovered after as long as 15 years of illness. There was a high incidence of other disorders (schizoaffective disorder, alcoholism, schizophrenia), and only four patients showed pure recurrent unipolar histories. Patients at the psychotic end of the continuum were more likely to be readmitted and to have very poor outcomes.

Recent progress in molecular genetics and neurobiology has attracted much attention and provided a new insight into the nature-nurture controversy in respect of the aetiology of psychiatric disorders. Affective illness, including the various subtypes of depressive and manic syndromes, has been the subject of a considerable amount of research on the relative importance of hereditary and environmental factors. This paper provides a critical review of the most relevant literature on the genetics of depression and mania.

The rationale upon which public policy for the support of psychiatric research has been fashioned and the extent to which the results of that research are used to shape public mental-health policy are examined. Support for research competes with other claims for resource allocation and the decisions made reflect the relative strength of the interested constituencies. When research findings promise cost savings, they are readily adopted (sometimes unwisely so), but when they require substantial new outlays or changes in bureaucratic agencies, they are all too often ignored.

Interest in the long-neglected neuropathology of major affective disorders has recently been rekindled, partly because of the emergence of brain-imaging techniques. We review the literature suggesting that attention be given to the neuroanatomy and neuropathology of primary and secondary affective disorders. Computerised tomography studies show that patients with affective disorders tend to be similar to schizophrenic patients and significantly different from normal control subjects in ventricle:brain ratio, sulcal widening, and cerebellar vermian atrophy. As yet, there are few neuropathological investigations of the brains of patients with primary affective disorders. Suggestions for further research in the neuropathology of affective disorders are offered.

Two groups of patients admitted to psychiatric hospital in Dumfries were studied, drawn from the periods 1880–1889 and 1970–1979. Feighner criteria were applied to make three diagnostic categories – depression, mania and schizophrenia – and the occurrence and content of delusions were noted for each. A significant decline in the prevalence of delusional depressive illness was found between the two periods, and a similar trend was noted for delusional manic illness. In contrast, the prevalence of delusional schizophrenic illness was stable. This decline is taken to reflect a change in the phenomenology of affective illness since last century in South West Scotland. The content of delusions is also discussed.

Five cases of psychiatric illness, presenting as functional psychosis, occurring in male homosexuals with human immunodeficiency virus (HIV) infection are described and compared with similar cases in the literature. The association between psychosis and infection with HIV is discussed with particular emphasis on the significance of functional versus organic presentation.

All referrals from two general practices to psychiatrists in hospital and primary-care out-patient clinics were examined. Women in all diagnostic groups were preferentially referred to the primary-care clinics, which provided especially for psychotic and chronic illnesses, and at which attendance rates on first and subsequent appointments were substantially higher than at the hospital clinics. The hospital crisis-intervention clinic dealt particularly with acute psychosis and personality disorder. Patients referred to the traditional hospital out-patient service were those with the less common neuroses and personality disorder. These results are reviewed in the context of the criticism that psychiatric clinics in primary care serve only the “worried well”.

The term ‘body image’ is used to refer to the picture we have in our minds of the size, shape and form of our bodies; and to our feelings concerning the size, shape and form of our bodies, and its constituent parts.

There is a paucity of literature in English about those people who persistently complain. In Germany and in Scandinavia, a diagnosis of querulent paranoia may be made, although this interesting and uncommon syndrome is rarely recognised in the UK. Five cases of litigiousness or persistent complaining are reported, to illustrate the typical psychopathology and the types of diagnosis that occur. Four of these people are barred from further litigation by the courts (vexatious litigants) and were contacted directly for the purpose of this study.

Differences in the clinical characteristics of clients have not been found to account for the interprofessional differences in community psychiatric nurses' and mental health social workers' practice in Salford. We found the consultant-attached mental health social workers, who worked closely with the specialist psychiatric team and who received supportive supervision from their professional managers, maintained stable case-loads, but the primary-care attached community psychiatric nurses, who were isolated from the specialist psychiatric team, and who received little supportive supervision from their professional managers, carried case-loads of increasing size. Failure to improve the way in which services for the mentally ill in the community are co-ordinated is likely to perpetuate the worst characteristics of life in the old back wards into the era of ‘community care’.

One hundred and forty-five patients with primary depressive illness admitted to a university hospital between 1966 and 1970 were followed up an average of 15 years later. Adequate data were obtained on 133 (92%) of the 145. During the follow-up period, 7% of the 133 had suicided, 12% had remained incapacitated by illness and only 20% had remained continuously well. Patients for whom the index admission was not their first were especially likely to be readmitted during the follow-up period. Patients with endogenous depression, none of whom developed schizophrenia during the follow-up period, were more likely to need readmission than patients with an index diagnosis of neurotic depression. In all other respects the prognosis for the two types of depression was the same, with considerable morbidity evident in both.

The child whose mother is killed by his or her father has to cope with the trauma of violence, the grief associated with the loss of both parents simultaneously, dislocation and insecurity regarding where and with whom they will live, stigma, secrecy, and often massive conflicts of loyalty. These issues and how they affected the 28 children of 14 families in which the father had killed the mother are examined. Recommendations for practice based on this clinical experience are proposed.

The aetiological factors relevant to the development of post-concussional symptoms are reviewed. From the numerous studies carried out to date, it would appear that both physiogenic and psychogenic influences are important in their genesis. However, where mild-to-moderate injuries are concerned, organic factors are chiefly relevant in the earlier stages, whereas long-continued symptoms are perpetuated by secondary neurotic developments, often of a complex nature.

There is evidence that serotonin (5-HT) is involved both in a wide range of psychiatric conditions and in specific behaviours which, in themselves, cannot be considered pathological. Besides the affective disorders (both depressive and manic, and both in full-blown episodes and during the intervals between these, which are seen as vulnerability to relapse) several other conditions need to be considered (Table I). There are also claims that serotonin metabolites or structurally related substances are involved, in their role as false neurotransmitters, in delusions and psychedelic phenomena, as in the case of LSD (Mantegazzini, 1960) or 5-hydroxytryptolines in delusions related to alcoholism (Davis et al, 1967).

This wide range of conditions raises the questions of how specific is the involvement of serotonin, and of what artifacts are present in attempts to investigate its actions. Page, who isolated 5-HT in 1948, stated (1968) that “serotonin has many functions but few have been sharply defined. The great variety of suggested roles can be said to be a tribute to man's ingenuity and his unquestionable willingness to write papers”. Since then, many more roles have been proposed for the involvement of 5-HT in functions of the central nervous system. Nevertheless, good evidence does exist that serotonin has some specific relationships to psychiatric disorders which are worth pursuing, in spite of great methodological difficulties.