Previous reports have suggested an increased prevalence of minor physical anomalies (MPAs) in schizophrenia.

A review of the literature was performed to examine the relationship between MPAs, schizophrenia and other disorders.

Previous studies demonstrate a number of methodological shortcomings. Moreover, MPAs are found in several other psychiatric disorders. Proponents of the neurodevelopmental model of schizophrenia have focused on an environmental explanation for the increased prevalence of MPAs. We argue that this may be overly simplistic and propose various ways in which genetic factors may also be involved.

Better studies should be performed to examine more precisely the nature of MPAs in schizophrenia and other disorders and also the relationship between MPAs and other developmental abnormalities. At present, it is unclear if MPAs are directly related to the pathogenesis of the disorder or even if they are related to the timing of critical events.

The assessment and management of childhood emotional abuse is of increasing importance in psychiatric practice. At present there are no consensus views about the definition of emotional abuse and information from research is limited.

Information about emotional abuse from the medical, psychological, social science and legal literature is summarised. Definitions and proposed mechanisms of damage are discussed. Current research data and an overview of childhood and adult sequelae are presented. Proposals for clinical and medico-legal practice are made.

Theoretical models of emotional abuse and its consequences are derived from theories of childhood psychological development. Empirical research is beginning to show that emotional abuse may have a profound effect on aspects of psychological development in children.

The developmental theories and methods of assessment well established in psychiatry are useful approaches to the clinical assessment and further understanding of emotional abuse.

The new reversible MAOI moclobemide was compared with placebo in the treatment of elderly patients with DSM–III diagnosis of dementia and/or of major depression.

Six hundred and ninety-four elderly patients with symptoms of depression and cognitive decline entered an international, multi-centre, double blind trial in which they were randomly allocated to treatment with either moclobemide 400 mg daily or placebo for 42 days. Five hundred and eleven patients met DSM–III criteria for dementia and were also depressed (DEM+D); 183 did not meet DSM–III criteria for dementia but met the criteria for DSM–III major depressive episode and also suffered from cognitive decline (MDE+CD).

Analysis of the 17 and 24-item Hamilton Depression Scale scores showed that moclobemide, compared with placebo, produced significantly greater improvement in both the demented and depressed groups (P = 0.001 both diagnostic groups). There was an improvement in cognitive function as measured by the SCAG Factor 1 in moclobemide treated patients (P = 0.005 DEM+D; P = 0.02 MDE+CD). There was no evidence of decline in cognitive function as the result of treatment Clinical global assessment of tolerance was ‘excellent’ and ‘good’ in 88% of the moclobemide and in 92% of the placebo treated patients. The proportion of patients discontinuing treatment prematurely was similar in both treatment groups. There were no significant differences in side-effects between treatment groups. There were no significant changes in vital signs, ECG or laboratory findings in either treatment group. There were no dietary restrictions and no report of any tyramine reaction.

Moclobemide was shown to be a safe, well tolerated and effective antidepressant, which did not cause impairment of cognitive function in elderly patients with a DSM–III diagnosis of dementia and/or DSM–III major depression.

Investigation to see if there are key psychological risk indicators for autism in a random population study of children at 18 months of age; and to assess how well these discriminate children who receive a diagnosis of autism from other forms of developmental delay.

Sixteen thousand children in the southeast of England were screened for autism by their health visitor or GP, during their routine 18-month-old developmental check-up, using the CHAT (Checklist for Autism in Toddlers). From a previous high-risk study we predicted that children at 18 months of age who failed three items (‘protodeclarative pointing‘, ‘gaze-monitoring‘, and ‘pretend play’) would be at risk for receiving a diagnosis of autism. From other evidence, we further predicted that those 18-month-olds who failed one or two of the key items (either pretend play, or protodeclarative pointing and pretend play) would be at risk for developmental delay without autism.

Twelve children out of the total population of 16 000 consistently failed the three key items. Of these, 10 (83.3%) received a diagnosis of autism. Thus, the false positive rate was 16.6% (2 out of 12 cases), and even these 2 cases were not normal. When the 10 children with autism were reassessed at 3.5 years of age, their diagnosis remained the same. Thus the false positive rate among the cases diagnosed with autism was zero. In contrast, of 22 children who consistently failed either protodeclarative pointing and/or pretend play, none received a diagnosis of autism, but 15 (68.2%) received a diagnosis of language delay.

Consistent failure of the three key items from the CHAT at 18 months of age carries an 83.3% risk of autism; and this pattern of risk indicator is specific to autism when compared to other forms of developmental delay.

Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines.

Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database.

Data were obtained on populations in excess of 1.5 million people, and over 80 000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants – lofepramine and the SSRIs – are prescribed comparatively well.

Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.

This study explored the prevalence of social phobia (SP) in general health care, sociodemographic characteristics of patients with SP, the age at onset and severity of SP, its comorbidity with other psychiatric disorders, and the recognition by general practitioners.

The study was conducted in Paris as part of the WHO study on Psychological Problems in General Health Care. Among 2096 consecutive primary care patients, 405 were interviewed using the CIDI. DSM–III–R diagnoses, severity and disability were assessed.

The one-month prevalence of SP is high (4.9) in primary care, although underdiagnosed by GPs. It has an early onset and leads to substantial disability. Patients with SP are at risk of developing further depression, alcoholism or suicidal behaviour.

SP appears to be a true and frequently severe pathological condition. The awareness of GPs and the general population should be improved.

The aim was to examine suicides by burning (SBB) occurring in England and Wales.

The method was a retrospective case note examination of death certificates, coroners' inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979–1992.

In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide–suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979–1992.

While SBB may be associated with Asian-born women, homicide–suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.

The baseline findings from a controlled study of the effect of a public education campaign on community attitudes to mental illness are presented.

A census of attitudes to mental illness was conducted in two areas, prior to the opening of supported houses for the mentally ill Factor analysis of the Community Attitudes toward the Mentally III (CAMI) inventory revealed three components: Fear and Exclusion, Social Control and Goodwill.

The only determinant of Fear and Exclusion was having children. The main determinants of Social Control were social class, ethnic origin, age, having suffered mental illness and having children. The main determinant of Goodwill was educational level The attitude factors were predictive of respondents' behavioural intentions toward the mentally ill. Respondents with children and non-Caucasians were more likely to object to the mentally ill living in their neighbourhood.

Any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children and non-Caucasians, as these groups are more likely to object.

We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge.

A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally III (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness.

Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account age had no effect on Social Control, and the effect of social class and ethnic origin was diminished Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness.

The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

Education groups for people with schizophrenia have tended to concentrate on compliance with medication. This study examines impact on social behaviour and quality of life.

A catchment-wide service was set up for community-based patients. Patients who indicated an interest in education groups were randomly allocated to either an education group or a waiting list control group. Those who attended groups were compared with the control group.

About one-quarter of community-based patients showed interest in attending education groups. Those who attended showed no change in mental state or compliance with medication (already high) but significant gains in quality of life, social functioning and social networks.

For patients who choose to attend education groups significant gains in social functioning and quality of life are possible without specific skills training.

An excess of late winter and early spring births in schizophrenia has been repeatedly demonstrated. Previous evidence has suggested that the risk for schizophrenia may differ in relatives of schizophrenic probands born in this high risk period v. at other times of the year.

In an epidemiologically based family study conducted in the west of Ireland, we examined the relationship between season of birth in schizophrenia and schizophrenia spectrum probands and the risk for schizophrenia and related disorders in first-degree relatives. Risk was assessed using the Cox proportional hazard method. We examined four birth seasons previously shown to significantly predict risk for schizophrenia.

Neither the risk for schizophrenia nor that for schizophrenia spectrum disorders in relatives was significantly associated with season of birth in probands.

Season of birth does not, in this sample, identify schizophrenic probands with particularly high or low familial vulnerability to illness.

The impact of community resettlement on the quality of life of people with long-term psychiatric disorders, is evaluated in a longitudinal study.

A repeated measures design was used to examine the sensitivity of an adapted version of Lehman's Quality of Life Interview in evaluating change. Completed interviews were carried out with 29 of the original cohort at one year post-discharge. The relationship between quality of life and ratings of client functioning is explored.

Significant changes in the objective quality of life indices include improved living conditions (F = 40.00, P < 0.001), higher levels of social contact (F = 29.52, P < 0.01) and increased leisure activities (F = 4.57, P < 0.05). Apart from increased satisfaction with living situation (F = 6.94, P < 0.01), there were no significant changes in the subjective indices. Ratings of psychiatric state and social functioning did not significantly correlate with global quality of life at one year post-discharge.

Concerns in relation to the sensitivity of life satisfaction ratings in evaluating programme interventions are raised.

A 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent.

The patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and ‘red alert’ status on full blood count.

This is the only patient to continue clozapine despite ‘red alert’ status, and as such is an exceptional case, but may open the way for such patients in the future.

Historical records suggest dyskinesia was observed in severely ill institutionalised patients with schizophrenia in the pre-neuroleptic era More recent work has not found dyskinesia in never-medicated younger and middle aged patients. The present study complements this recent work and avoids the confounders of severity of illness and institutionalism by examining elderly patients in a wide variety of community settings.

Movement disorders were examined in 308 elderly individuals in Madras, India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state was assessed by the Positive and Negative Syndrome Scale.

Dyskinesia was found in 15% of normal subjects (n=101, mean age 63 years), 15% of first degree blood relatives of younger schizophrenic patients (n=103, mean age 63 years), 38% of never medicated patients (n=21, mean age 65 years) and 41 % of medicated patients (n=83, mean age 57 years). The respective prevalences for Parkinsonism were 6%, 11 %, 24% and 36%; and for akathisia 9%, 5%, 21 % and 23%. Dyskinesia was associated with negative schizophrenic symptoms.

Dyskinesia in elderly schizophrenic patients is an integral part of the illness and not associated with antipsychotic medication.

Studies of the relationship between negative symptoms, neuropsychological impairments and neurological signs in schizophrenia have yielded inconsistent results. In addition, little attention has been directed to address the extent of cultural modulation of negative symptoms.

We carried out cross-cultural validation of the High Royds Evaluation of Negativity Scale (HEN) in 50 Hong Kong Chinese patients with schizophrenia. We then investigated the relationship between negative symptoms, neurological signs and neuropsychological impairment in 204 patients.

Good interrater reliability, internal reliability, convergent and discriminant validity were found with the HEN. The HEN contained four factors corresponding to ‘behaviour‘, ‘functioning‘, ‘thought’ and ‘appearance’. Negative symptoms were correlated with semantic fluency but not with Wisconsin Card Sorting Test performance or sustained attention. Negative symptoms were also correlated with tardive dyskinesia and catatonia but not with soft neurological signs.

Cross-cultural robustness of the negative symptoms construct is supported. Association of negative symptoms with a specific profile of neurocognitive impairment suggests diversity within deficit domains in schizophrenia.

An excess of non-right-handedness has been shown among patients with schizophrenia. However it is not clear whether this finding can be accounted for by an increase in left-handedness, mixed-handedness or both. It is not known whether atypical patterns of hand preferences occur in other functional psychotic illnesses.

The Annett hand preference questionnaire was administered to patients with schizophrenia (n=120); affective psychosis (n=55); schizoaffective psychosis (n=41), and control subjects (n=86). Handedness was classified into three categories: right, mixed and left-handedness.

The hand preference patterns of patients with functional psychotic illnesses were not significantly different from controls. Patients with schizophrenia showed a non-significant excess of mixed-handedness compared with controls. Patients with schizophrenia and affective psychosis showed a non-significant decrease in left-handedness compared with controls.

Although our results showed a trend in the hypothesised direction, we failed to demonstrate that patients with psychotic illness differed from controls on self-reported hand preference patterns.

A 67-year-old man presented with acute onset of spatial and temporal disorientation, memory loss and associated episodic dyscontrol. Investigations showed infarctions of both caudate nuclei. This patient presented a unique opportunity to study the relationship between the lesions, his behaviour, and neuropsychological testing.

Single case report Investigations included interviews to determine cognitive impairment i.e. WAIS-R, MMSE, and neurological examination.

Extensive neuropsychological testing revealed severe impairment on tasks requiring planning, memory or abstract thought. These findings are very similar to those seen in Huntington's disease.

A neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.

Concurrent use of lithium and ECT is suspected to increase neurotoxicity.

A retrospective case-control study over an eight-year period was conducted to investigate the adverse effects of a combined lithium/ECT treatment Thirty-one subjects with combined lithium/ECT treatment were compared with a control group (ECT only) of 135 cases matched for age and sex.

Most cases in both groups had no adverse effects. Three (10%) study group subjects and 15 (11 %) controls experienced brief delirium. Three controls and none of the subjects developed a prolonged confusion. There were no significant differences in the profile of other adverse effects between the two groups.

Prescription of lithium together with ECT was not associated with higher frequency of adverse effects.

We examined clinically diagnosed Alzheimer's disease patients and controls, and collected information from informants, to examine the association between Alzheimer's disease and aluminium occupation.

An unmatched case-control study comparing 198 cases of Alzheimer's disease (ADRDA–NINCDS diagnostic criteria), to selected controls (164 other dementias and 176 non-dementing group) in respect of their occupational history. The subjects included all patients referred to and seen by the first author during a 2 year study period.

Twenty-two of 198 patients with Alzheimer's disease (11.1 %) reported having an aluminium occupation at some stage in their working life compared with 39 of 340 controls (11.5%), odds ratio 0.98, 95% CI 0.53–1.75, P > 0.05. Aluminium workers reported to have worked in direct contact with aluminium dust and fumes did not appear to be at any greater risk than other workers who were employed at the same factory, odds ratio 1.19, 95% CI, 0.64–4.18, P > 0.05.

There is no evidence to support an association between having previously worked in an aluminium factory and the risk of Alzheimer's disease later in life.