Psycholinguistics and sociolinguistics have extended our understanding of the abnormal communication seen in psychosis, as well as that of people with autism and Asperger's syndrome. Psycholinguistics has the potential to increase the explanatory power of cognitive and neuropsychological approaches to psychosis and new methods of assessment and therapy are now being developed, based on linguistic theory.

MEDLINE literature search was used.

Of 205 relevant articles identified, 65 were selected for review.

Greater familiarity with linguistic theory could improve psychiatrists' assessment skills and their understanding of the relevance of human communication to the new cognitive models of psychosis.

A significant proportion of cancer patients experience psychiatric morbidity in association with diagnosis and treatment. If this morbidity is to be reduced, a better understanding is needed of the factors which influence adjustment to cancer.

A review of the literature was carried out to explore those factors associated with poor psychological adjustment to cancer. These are described under four headings: characteristics of the patient; disease and treatment variables; the interaction between patient and illness; and environmental factors.

A number of risk factors for psychiatric morbidity can be identified from each of the four areas. Methodological limitations are highlighted, in particular the preponderance of cross-sectional study designs.

Increased awareness of the risk factors for psychiatric morbidity should lead to earlier detection and more appropriate treatment. Future research should focus on those risk factors which are potentially modifiable.

Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.

Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.

ST allows 40–60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% postoperatively, from 15% in cases of uncontrolled affective disorders is seen.

As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.

Clarification is still required of the nature of pathological love.

A series is presented of 16 personally assessed cases with pathologies of love (erotomania).

The pathologies of love usually involve a mixture of morbid infatuation and a morbid belief in being loved. They occur both in a symptomatic form, as part of an underlying mental illness, as well as in a pure form, where their emergence is to some extent understandable in a vulnerable personality. These disorders often go unrecognised to the detriment of clinical management.

Pathologies of love create distress and disruption to the patient, and place the objects of their unwarranted affection at risk of at best harassment and at worst violence. Although this series of cases, which is drawn predominantly from forensic practice, overemphasises the risk of overt violence, the distress occasioned by pursuit and harassment alone should not be underestimated.

Little is known about men who kill in a sexual context. The present study compares a group of sexual murderers with a group of men who had raped but not killed.

Twenty-one men who murdered women in the course of a sexual attack and 121 men convicted of rape were interviewed in six prisons. Victim statements were obtained in 103 cases (73%). Assessment consisted of a 90-minute semi-structured interview, the Eysenck 1–7 questionnaire, and the Schonell reading test.

The most notable characteristic distinguishing the men who killed was their lifelong isolation and lack of heterosexual relationships.

A better understanding of the social and emotional isolation commonly found in sexual murderers may provide important insights into why some sexual offenders go on to kill.

Sex offences are overrepresented in the mentally handicapped, but information about the characteristics and offence behaviour of this group is limited.

A retrospective case note survey was made of 47 male patients referred for antisocial sexual behaviour.

Of 191 offences and/or incidents committed, 55.5% were heterosexual, 24% indecent exposure, 12.4% homosexual, 13.6% serious and 3.6% involved physical assault. Average age of the offenders was 23.9 years, with a mean IQ of 59.5, and there was a high prevalence of family psychopathology, psychiatric illness, minor physical disabilities, sexual experience, impaired relationship skills and sexual recidivism. Recidivists showed a low specificity for offence type and age and sex of victim. Categorical analysis differentiated a ‘sex offences only’ group from a ‘sex plus other offences’ group in the key areas of psychopathology, offence behaviour and outcome; this was supported by factor analysis.

The finding of two subgroups of mentally handicapped male sex offenders has important implications for prevention, assessment and treatment.

The mind's ability to think about the mind has attracted substantial research interest in cognitive science in recent decades, as ‘theory of mind’. No research has attempted to identify the brain basis of this ability, probably because it involves several separate processes. As a first step, we investigated one component process – the ability to recognise mental state terms.

In Experiment 1, we tested a group of children with autism (known to have theory of mind deficits) and a control group of children with mental handicap, for their ability to recognise mental state terms in a word list. This was to test if the mental state recognition task was related to traditional theory of mind tests. In Experiment 2, we investigated if in the normal brain, recognition of mental state terms might be localised. The procedure employed single photon emission computerised tomography (SPECT) in normal adult volunteers. We tested the prediction (based on available neurological and animal lesion studies) that there would be increased activation in the orbito-frontal cortex during this task, relative to a control condition, and relative to an adjacent frontal area (frontal-polar cortex).

In Experiment 1, the group with autism performed significantly worse than the group without autism. In Experiment 2, there was increased cerebral blood flow during the mental state recognition task in the right orbito-frontal cortex relative to the left frontal-polar region.

This simple mental state recognition task appears to relate to theory of mind, in that both are impaired in autism. The SPECT results implicate the orbito-frontal cortex as the basis of this ability.

To investigate an association between HPA axis dysfunction, depression and cognitive impairment, we assessed subjects with mild Alzheimer's disease (AD).

Sixteen non-depressed subjects with AD according to NINCDS/ADRDA criteria and 18 normal controls underwent the insulin hypoglycaemia (IH) test and the dexamethasone suppression test (DST).

The AD subjects showed a blunted response of adrenocorticotrophic hormone (ACTH) to IH compared with controls (P = 0.019). ACTH response (area under curve) correlated with a score for cognitive ability (CAMCOG) (r = 0.64, P < 0.01). AD subjects had a shorter time to peak cortisol level than controls (P = 0.004), although total cortisol response was normal.

The AD subjects show evidence of adrenal hyper-responsiveness and normal immediate (rate-sensitive) glucocorticoid feedback. An association between HPA axis dysfunction and organic brain pathology in AD subjects may be mediated by cell loss in the hippocampus.

Information on risk factors associated with high rates of suicide is necessary, if suicide rates among the mentally ill are to be reduced.

We used ICD-9 E-codes to define deaths on which suicide or open (undetermined death) verdicts were returned, among residents of a catchment area defined by OPCS area codes. Relative risks of suicide and undetermined deaths for recent patients (those in contact with a psychiatric service in the year preceding death) were calculated.

Of the 286 persons, 108 were recent patients. Eighty-four per cent suffered from schizophrenia or depression. Risks of suicide and undetermined death for these patients were 31 and 20 times, respectively, those of other residents. Social risk factors varied with diagnosis.

Over 90% of recent patients were receiving medical care at time of death; not all were treated appropriately. Recognising medical and social risk factors in recent patients, and effective monitoring of treatment, is important.

Although previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period.

The psychopathological predictors of outcome were investigated in a subgroup of 51 subjects, originally included in the Northwick Park study of first episode schizophrenia who were followed up 7.3 years (s.d. 1.1, range 5.3– 10.3) after first admission in the Harrow study. Forty-four subjects (24 men, 20 women) were traced. Outcome measures were time to first readmission, occupational level and total duration of hospital admission at five years after first admission.

A survival analysis of time to first relapse revealed that the presence of subjective feelings of depression (CATEGO syndrome SD) during the first admission was associated with early relapse while the presence of depressive delusions (CATEGO syndrome DD) and higher educational attainment protected against early relapse. Total duration of hospitalisation at five years after first onset was positively associated with the presence of CATEGO syndromes SD and OD (biological features of depression) and negatively associated with female sex. Poor occupational outcome was not significantly associated with any psychopathological predictors.

Our findings challenge the conventional view that symptoms of depression are associated with better outcome in schizophrenia.

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.

A two-stage screening procedure was employed. This involved the use of GHQ–12/GHQ–30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD–9 criteria.

Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1 % in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ–12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.

The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.

This paper highlights the role of the visual scan path as a physiological marker of information processing, while investigating positive symptomatology in schizophrenia.

The current literature is reviewed using computer search facilities (Medline).

Schizophrenics either scan or stare extensively, the latter related to negative symptoms. Schizophrenics particularly scan when viewing human faces.

Scan paths in schizophrenics are important when viewing meaningful stimuli such as human faces, because of the relationship between abnormal perception of stimuli and symptomatology in these subjects.

Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders.

Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients.

The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15.

Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain.

The hypothesis that Asperger's syndrome (AS) may go unrecognised in forensic populations was examined by ascertaining the prevalence in Broadmoor Special Hospital.

The entire male patient population was screened by examination of case notes. Identified cases were subject to the next stage of the study, which involved observation and interviewing of patients, and a semi-structured interview of key staff.

A prevalence of 1.5% (0.6% to 3.3%, 95% CI) was found. The addition of equivocal cases increased the prevalence to 2.3%.

The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population.

British Journal of Psychiatry (1994), 165, 679–682

The purpose of this study was to examine the reliability and validity of the newly proposed axis V (disabilities) of ICD-10.

Eighty-six acutely ill men and women were prospectively recruited from the Al Ain psychiatric units, UAE. Both versions of ICD–10, the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research (DCR) were used for coding axis I psychiatric diagnosis and its grade of severity; the WHO Disability Assessment Schedule was used to assess disabilities.

Inter-rater reliability of the DAS items ranged from moderate to good, and axis V ratings correctly predicted 84% of the observed classification on axis I.

Axis V is a valid measure of disabilities, but is limited by its modest reliability.

British Journal of Psychiatry (1994), 165, 683–685

Amok is reviewed from a historical standpoint, tracing how it has changed from the Hindu states of India where it was a war tactic to the sudden incomprehensible violence and mass murder by a single individual associated with the syndrome today.

A typical amok attack is described and the criteria for amok discussed. Amok in Malaysia, New Guinea, Laos, North America and other countries are presented. The possible motives for such violent killings and a possible psychiatric diagnosis in relation to contemporary diagnostic criteria is discussed.

Classification of amok remains unresolved. The reason for its frequency in and around Malaysia remains unknown.

British Journal of Psychiatry (1994), 165, 685–689