Anorexia nervosa is a geographically distinct psychiatric disorder; it is rapidly increasing in incidence in Western countries, while being virtually unreported in China, or in the Chinese community of Hong Kong. This is surprising when the Chinese preoccupation with food and their reported readiness to somatise dysphoria are considered. Three Chinese anorectics born and living in Hong Kong and exhibiting mostly typical clinical features are reported. The rarity of the disorder in the East could be related to protective biological and sociocultural factors specific to the Chinese, and while it may become more common, anorexia nervosa is unlikely to reach Western proportions.

Several attempts have been made to relate subtypes of schizophrenia to dopaminergic status. For example, Crow's hypothesis states that Type I schizophrenia is characterised by positive symptoms, increased activity of the dopaminergic system, good response to neuroleptics, and no brain structural changes; and Type II by negative symptoms, reduced dopaminergic activity, poor response to neuroleptics, and brain structural changes. Testing of this hypothesis has, however, been inconclusive, and it seems more likely that both types are inter-related.

Further analysis of outcome data from the Sheffield Psychotherapy Project suggested that one of the principal therapists was responsible for most of the reported advantage of Prescriptive over Exploratory treatment.

Results are presented of five consecutive annual examinations using the Abnormal Involuntary Movement Scale for 101 community-based chronic psychiatric patients. These 101 patients had a history of longer and more consistent neuroleptic treatment than the 231 patients who initially entered the study, so no conclusions about prevalence of TD can be drawn. At each examination two-thirds of this group showed signs of TD; however, only 45% were TD positive at most examinations and 24% were best described as having fluctuating TD status. Of those patients who were consistently TD positive, 82% showed no overall significant change in summed AIMS scores, 11% improved and 7% became worse.

Frequencies of abuse and dependence assessed continuously within a drug surveillance system were analysed as a contribution to risk-benefit evaluations of benzodiazepines (BZDs). In 4.7% of 15 296 patients admitted to psychiatric hospitals between 1980 and 1985, BZDs had been involved in some kind of abuse or dependence. Primary BZD dependence, defined as physical dependence on BZDs in patients who had not been dependent before, was observed in about 1% of admitted patients. Linking these data with psychiatric diagnoses revealed a high risk of primary BZD dependence for inpatients (11.8%) with anxiety neurosis (ICD-9, 300.0), and a lower risk for neurotic (300.4) and for endogenous depressives (296.1) (risk 3.7% and 2.7% respectively). Older age was also related to primary BZD dependence. For depressive inpatients, the risk was twice as high in females as in males. Anecdotal observations advocate more systematic investigation of the emotional effects of long-term therapy with BZDs.

Fifty-one outpatients presenting with generalised anxiety disorder were included in a double-blind trial, and treated with either buspirone (a new non-benzodiazepine antianxiety drug) or diazepam over 6 or 12 weeks, after which they were abruptly withdrawn and continued on placebo to 14 weeks. Ratings of anxiety and other symptoms were administered fortnightly and additional withdrawal symptoms noted. Forty patients completed the study; 8 of the 11 drop-outs were taking buspirone. Both drugs reduced anxiety, diazepam more rapidly, but with greater withdrawal symptoms, particularly after 6 weeks. Regular treatment with diazepam for 6 weeks leads to a significant risk of pharmacological dependence that is not present with buspirone.

A case is reported of a young woman presenting with symptoms of so-called multiple personality disorder. It is proposed that this condition should be viewed as a non-specific psychiatric symptom.

Thirteen patients presenting with morbid jealousy were treated using a cognitive approach adapted from Beck's cognitive therapy for depression. Cognitions in morbid jealousy showed the characteristics of automatic thoughts as described by Beck, and were based on faulty assumptions derived from interpretations of past experiences. The cognitive treatment directed mainly at the faulty assumptions resulted in improvements in ten patients and no change in one; two patients dropped out of treatment. The results are considered encouraging.

The history is traced of observations made of the phenomena associated with self-cathexis and other-cathexis. Owing to personal and other conflicts in the history of psychiatry and psychotherapy, the development of these observations was disturbed, and they were re-observed and re-described using different terminologies in accounts which have not hitherto been collected and compared. When this is done, a consensus appears which can be stated in a common language to facilitate further accretion of observation, and further research and debate.

Absence of sneezing or inability to sneeze was found in 2.6% of psychiatric patients, although only half complained of the symptom spontaneously. This was the most frequent of a triad of features, the others being infrequent attacks, of coryza and light-headedness. Endogenous depression was the commonest psychiatric diagnosis, followed by schizophrenia, but ‘asneezics' differed significantly from controls in their diagnostic distribution; they also tended to be older, poorer, and less educated. The course and outcome of the asneezic triad ran almost parallel to those of the primary psychiatric illness.

Five patients are described, whose common fear of contracting, or a belief of having contracted, AIDS is the presenting feature. There is a need for liaison with psychiatrists in the provision of counselling services for AIDS patients.

Coping strategies to adapt to environmental and psychological contingencies have been well studied in the human subject. The typical individual is known to have response patterns that permit automatic, and often unconscious adjustment to changing conditions. Psychological (defence) mechanisms facilitate adaptation to new situations or interactions, and when successful, no additional coping mechanisms need to be invoked. However, situations may arise when such mechanisms are insufficient: this may result from developmental failure, personality factors, inordinate levels of stress, or combinations thereof.

Two cases are presented in which psychotic patients with neuroleptic malignant syndrome were treated with bromocriptine and thioridazine simultaneously, with a resulting control of both problems. The authors feel that this method needs further study, in the light of the potentially large number of patients at risk for these illnesses. The use of creatinine phosphokinase level as an indicator of value in NMS is also discussed.

Estimates of seizure length made by the treating psychiatrist were compared with estimates made by six-channel EEG in 100 electroconvulsive treatments in 22 depressed patients. In 70 treatments the doctor observed a fit which was shorter than 25 seconds. No doctor restimulated a patient in such a case and on only three occasions was the electrical stimulus increased at the next treatment. EEG monitoring revealed that only 30 of the treatments resulted in a seizure of less than 25 seconds, and this was detected in almost all cases by the treating doctor. The potential value of EEG monitoring was to identify patients whose visible seizure was short but where cerebral seizure length was satisfactory. Trainee psychiatrists often mismanage patients who have short seizures.

Life events in 82 self-poisoning subjects were studied using the Bedford College LEDS to see whether there was a difference between those who had a clear depressive syndrome (according to the Present State Examination) and the remainder. Equally high levels of severely threatening events were found in the depressed and non-depressed groups, but the former were older, had experienced more chronic difficulties and had been treated more often in the past for depression. Greatest numbers of life events were found in those with high levels of extrapunitiveness (recorded on the HDHQ), whereas those who had not experienced a severe life event showed predominance of intropunitiveness. Suicidal intent was not related to experience of life events, but has previously been shown to be associated with high intropunitiveness. The findings are discussed in the light of current theories linking life events, depression and parasuicide, and emphasise the need for longitudinal studies to examine these factors in relation to repeated parasuicide.

Insights into the cellular and molecular mechanisms of action of anti-depressant drugs have led to the study of possible dysfunctions of monoamine neurotransmitter receptors in endogenous depression. Presynaptic receptors play an important role in the regulation of transmitter release from neurons. The major mechanism that regulates the release of noradrenaline appears to be feedback inhibition by the neurotransmitter located in the synaptic cleft. This inhibition is mediated by stimulation of a presynaptic autoreceptor, the inhibitory α2-adrenoceptor. When this is stimulated, further release of noradrenaline is inhibited; therefore, increased autoreceptor sensitivity could result in insufficient neuronal release of noradrenaline, and lead to depression.

The relationship between extreme temperament in infancy and clinical status at 4.7 years of age was studied in temperamentally different groups of infants matched for sex and SES, and subselected from a large birth cohort representative of the general population. The effects of certain dimensions of family functioning and of other risk factors were examined. By itself, extremely difficult temperament in infancy had no strong direct association with clinical outcome at four years of age, whereas temperament assessed at four, family attitudes to discipline, and stressful events did. However, extreme temperament in infancy might indirectly affect outcome through its association with temperament at four. The interplay between adverse temperament and parental attitudes of discipline previously observed in middle childhood might have antecedents in preschool years.

A 72-year-old man with a 30-year complaint of intractable insomnia had a positive family history of depression. He first came to psychiatric attention in 1958, after attacking his wife. He was prescribed barbiturates, and later was given meprobamate and nitrazepam, but with no effect on his complaint. The patient tended to increase the dosage of any drug given, of his own accord. EEG sleep recording confirmed the diagnosis of nocturnal myoclonus. It was hoped that at the case conference further treatment stratagems would be suggested.

A case of organic brain syndrome in a patient with AIDS is described. The implications for medical and psychiatric services are discussed and problems highlighted.

A case of Gilles de la Tourette's syndrome (TS) is described, in which a state of akinesia developed during an attempt to withdraw lorazepam by diazepam substitution. This was followed by sustained amelioration of the TS symptoms.