Over the past several years there has emerged a family of highly sophisticated but technically complex procedures for the visualisation of a range of cerebral functions in living man (Andreasen, 1988). The images they produce are so beguiling not just because of their potential to give new insights into the pathophysiology and treatment of major psychiatric disorders, but because they convey information through a quite fundamental modality: people are only convinced by what they can see. However, initial applications of such new technology have appeared just as likely to generate new questions and contradictions as to provide answers to current issues. This is readily illustrated by recent studies on the imaging of brain dopamine receptors in schizophrenic patients by positron emission tomography (PET) (see Waddington, 1989a).

The manifold presentations of dystonia have been acknowledged as a spectrum of illness. Dystonia is primarily idiopathic or drug-induced; purely psychogenic causes would seem to be rare, although such an aetiology is commonly assumed. Response to medication in idiopathic cases is unpredictable, although anticholinergic medication and behavioural programmes are being evaluated.

Some of the major effects of alcohol, and alcoholism, on the brain are reviewed, with reappraisal of evidence drawn from brain imaging, neuropathology, clinical psychology, and laboratory experimental work. A hypothesis is developed which may help to account for the wide variability encountered in individual susceptibility to alcoholic brain damage and its varied manifestations. Therapeutic implications are considered.

Throughout the two million years of human existence, it is without precedent that the elderly should now constitute such a large proportion of the world's population. Although it is already trite to emphasise this remarkable change in the global population structure, the increase is nothing less than an awesome imperative for public health as a socially responsible science. By the year 2025 AD, the United Kingdom will have 14 million persons aged over 60, which would be 26% of the population. Just under two million of them will be over 80 years old (United Nations, 1985). In Australia and New Zealand, 24.8% of the population will be aged 60 years or more. About one million Australians will be 80 years or over. West Germany will have 2.4 million aged over 80, the USA 7.7 million. The People's Republic of China will have 19.3% of its 1.5 billion people who will be aged over 60, and over 25 million will be over 80 years.

Considerable advances have been made in the family management of schizophrenia but there remains a major challenge for the psychiatric services to integrate these innovations into clinical practice. A number of important issues need to be considered in developing routine clinical services: the problem of engaging families in a therapeutic programme; the utility of the concept of ‘expressed emotion’; and procedures for clinical practice. The latter include the needs of low-EE families; maintaining quality of intervention in a clinical context; responding to the multiplicity of needs of the patient and family; and integrating family interventions with ongoing rehabilitation practice. A model of service provision is described.

Of all 89 long-stay residents in four psychogeriatric wards at a large London psychiatric hospital, 18 had a previous functional psychiatric diagnosis. Although the total group was markedly impaired overall, male sex, younger age, and a previous functional diagnosis were independently associated with better cognitive performance. Males and those with previous functional disorders also had less behavioural disability. These subgroups within the psychogeriatric inpatient population must be recognised if an in-built distortion in community reprovision of hospital psychogeriatric services is to be avoided.

Of 390 residents in 12 local-authority homes for the elderly, 93 had evidence of depression on screening and underwent standard clinical assessment. Half had an affective disorder, and a further third had depressive symptoms in the setting of an organic mental disorder. The 93 residents had a high rate of physical illness and disability, undertook little social activity, and were visited infrequently. A range of interventions for depressed residents, the majority social in type, mostly proved difficult to implement. There was no evidence of efficacy of psychiatric intervention at three months; at one-year follow-up a quarter of study participants had died, and 28% of those who were reassessed for depression showed evidence of recovery.

Elderly patients with depression and Alzheimer-type dementia (ATD) were compared with age-matched control subjects using a protocol which measured Cortisol, adrenocorticotrophic hormone (ACTH) and N-terminal pro-opiomelanocortin (N-POMC) to determine diurnal variation and the effect of dexamethasone administration. Depressed patients had significantly elevated Cortisol concentrations both before and after dexamethasone administration. Basal ACTH and N-POMC concentrations were normal in depressed patients but were both elevated, compared with controls, after dexamethasone. By contrast, in ATD patients, Cortisol was elevated only after dexamethasone, as was ACTH, but not N-POMC. This may imply that the pattern of secretion of POMC-derived peptides underlying increased Cortisol secretion is different in ATD from that in depression.

Desipramine, a monoamine reuptake inhibitor, was used to stimulate release of growth hormone (GH) in 29 DSM-III major depressives and in 10 healthy controls. Eighteen of the depressives showed a blunted response. The GH-stimulation test was unable to distinguish endogenous from non-endogenous patients. The 13 dexamethasone non-suppressors were more likely to have a blunted GH response than the 14 suppressors. The results indicate that at least a subset of non-endogenous depressives have significant neuroendocrine abnormality.

The Stress Profile consists of a number of questionnaires which have been developed to assess the severity of stress in nine areas of life: social habits, social relationships, life events, sexual problems, sleep, psychiatric symptoms, old age, menstrual stresses, and ‘stress and the heart’. The questionnaires have been validated for inter-rater reliability and against the Hamilton anxiety and depression rating scales. Using the Profile, the inter-relationships between different stress areas can be assessed, appropriate treatments advised, and the response to treatment in relation to different components evaluated.

The number of moderate to severe undesirable life events and the quality of friendships were compared between a consecutive series of 100 childen aged 7–16 years with emotional disorders and a series of community controls matched for age, sex, and social class. Undesirable events and friendship difficulties exerted independent direct effects of similar magnitude on the probability of developing emotional disorders; 33% of disturbed children experienced both adversities compared with 6% of controls. An additive interaction was found for the two factors. The results were uninfluenced by the sex or pubertal status of the subjects. There appears to be no greater probability of being anxious rather than depressed in the presence of life events, alone or in combinations with friendship difficulties. Recent undesirable life events and friendship difficulties arise through independent social pathways and may exert their effects through different psychological mechanisms.

A total of 158 women presenting with clinical eating disorders have been investigated using a self-report questionnaire and subsequent interview concerning their recollections of sexual experiences with adults before the age of 16 and later adverse sexual experiences. About a third reported events in childhood and over half described some adverse experiences. It may be that these experiences are relevant to the subsequent illness in some cases, but greater certainty must await further research. In the meantime, inquiring about such matters would seem to be advisable in the assessment and therapy of eating-disordered patients.

This study distinguishes between processes that cause individuals to experience symptoms – destabilisation – and those that are associated with loss of symptoms over time – restitution. It is shown that different clinical, social, and personality variables are associated with each of these processes. Where destabilisation is concerned, it is shown that different variables were associated with the development of symptoms of anxiety and those of depression. Different variables were associated with restitution, and they did not show the same relationship with the symptom dimensions of anxiety and depression as those which were associated with destabilisation.

The names of 412 residents of the catchment population of a district general hospital unit who died potentially self-inflicted deaths in the eight years 1974–81 were identified. They were classified as suicide (245), accidental death (126), and undetermined (41). In each group, over half had a lifetime history of psychiatric treatment and over a third were psychiatric patients at the time of their death. The relative risk of a violent death for those who died within a year of their last psychiatric contact was 27 times greater than that of residents with no recent psychiatric contact. The relative risk was highest for those aged 35–44 and lowest for those of 75 years and over.

It has been questioned whether Asperger's syndrome (AS) is in fact a specific (high-functioning) subgroup of autism, rather than a distinct entity. Thirteen AS patients were compared with 13 autistic patients and 13 developmentally disordered controls. While there was symptom overlap between AS and autism, patients could be separated into one or other group. However, current criteria are based on symptoms, and it is argued that studies of genetics and treatment response are needed to elucidate the relationship between these developmental disorders.

Based on data from the Danish Central Criminal Register, the total number of mentally retarded offenders serving statutory care orders on a census day decreased from 290 in 1973 to 91 in 1984. The reduction was caused by shorter sentences and a dramatic decrease in the number of sentenced borderline retarded offenders; the total number of sentences per year slightly decreased, and the number of first-time sentences was stable. Crimes of property are decreasing among this population, while violence, arson, and sexual offences are increasing. Behaviour disorder was found in 87.5% of 91 offenders serving care orders in 1984. Offensive behaviour was significantly predicted by early institutionalisation, having retarded or divorced parents of low socio-economic status, and behaviour disorder of social-aggressive type. Independent significant effects were attributed to behaviour disorder and low socioeconomic background. All predictors were closely correlated. Biological factors did not have any significant predictive value.

Within the setting of a regional secure unit, all doses of medication given p.r.n. over three months were ascertained and the details of each administration determined from prescription charts and a semistructured interview with the nursing staff involved. Thirty-two patients were resident for all or part of the study, all compulsorily detained. Only 15 were given medication p.r.n.) compared with the other patients they were significantly younger and more likely to be detained under civil orders than under the criminal provisions of the Mental Health Act 1983. Rarely was the medication the sole intervention in a crisis. In terms of effects on the overall treatment programme of the patient, medication given p.r.n. seemed to have an impact in only one small subgroup.

A manic-depressive young woman received mild brain damage from anoxia after attempting suicide by hanging. The case conference was held to elucidate whether her subsequent symptoms were functional or organic, and what courses of treatment should be tried in this very refractory case.