Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age.

At the end of the 19th century, when the current psychiatric diagnostic concepts used in most countries were being elaborated, in Germany particularly by Kraepelin, French-speaking psychiatrists, who until then had dominated European psychiatry, continued to develop their own system. This difference in classification is most apparent in the non-organic, non-affective psychoses. Although some of the French names used may be unfamiliar to anglophones, when the new ‘consensus' criteria developed by Professors Pull and Pichot are compared with the DSM-III-R criteria it becomes apparent that the French and American concepts are converging.

Evidence is provided in support of the nosological concept which distinguishes schizophrenia from borderline states. Differentiation of these disorders by a computer pattern-recognition program was based on the initial descriptive characteristics of patients. As a result, we observed good correlation between computer diagnosis from data on 215 patients and follow-up data analysed according to the criteria of Kraepelin's model of schizophrenia and its course. According to the findings on outcome, the states designated as 'sluggish schizophrenia’ (or 'slowly developing variant of schizophrenia’) comprise a group of dissimilar psychiatric disorders, including borderline states and cases of process schizophrenia, with the specific initial symptoms of the latter disease.

We have attempted to render this article into intelligible English. The original was generally somewhat cumbersome. On occasion, a more polished translation might have been attempted, but as the reader should be able to estimate the author's intent, we have avoided any possible liberties in interpretation.

In the preceding translation we tried to provide a literal rendering of the complete original article, changing it only for purposes of clarity or comprehensibility. We now offer our own judgements of the content of the article. We have made them short because we believe most of the problems with the article by Smulevitch will be readily evident to anyone who normally has access to the British Journal of Psychiatry, and who may compare our original article (Merskey & Shafran, 1986) with the content of the Smulevitch one.

An individual's responses to Goldberg's 30-item General Health Questionnaire are usually represented as a single score which provides a measure of the number of psychiatric symptoms reported. No account is taken of the nature of the symptoms. Factor analyses of the GHQ-30 were undertaken in ten randomly selected samples of 600 adults each, and also on 12 age-sex groupings covering the age range 18–98. The results indicate an impressive degree of consistency of the factor structure, and the identification of five distinct factors corresponding to anxiety, feelings of incompetence, depression, difficulty in coping, and social dysfunction.

The sensitivity of the GHQ and a revised scoring procedure (CGHQ) for chronic psychiatric complaints was investigated on 175 outpatients. The mean level of severity of symptoms of the groups with and without chronic complaints was not significantly different. However, patients with chronic complaints showed a significantly lower mean GHQ score than patients without chronic complaints. The mean CGHQ scores of the two groups did not differ, suggesting that the CGHQ is a better indicator of the severity of the chronic psychiatric state than the GHQ. The revised scoring procedure resulted in a decrease in the number of false negatives. The strongest reduction in false negatives, however, was induced by a combination of the original and the revised scoring procedures. This reduction was achieved at the expense of only a small increase in the number of false positives. Altogether, the revised scoring procedure proved to be only marginally better.

It has been argued that school refusal may not be a unitary syndrome, but a common presenting symptom founded on differing underlying dynamics. The paper explores this hypothesis empirically. The clinical files of 100 refusers were scored for several variables which could potentially differentiate between school refusal subtypes, and for several commonly accepted beliefs about school refusal. The data were subjected to a variety of analyses, culminating in cluster analysis. Cluster (C) 1 consisted of children who feared separation from dependent, overprotective mothers. C2 youngsters were perfectionistic and depressed. They dominated mothers who had been deprived in childhood. C3 consisted of extensively disturbed children from multiproblem families, who had suffered early separation or loss, and who were fearful and depressed.

Three current techniques for estimating body size (Image Marking, Visual Size Estimation, and Distorting Video techniques) were compared. Anorexia nervosa and bulimic patients and normal control subjects were required to make size judgements of the way they ‘knew’ they looked, the way they ‘felt’ they looked, and of the width of an inanimate control object. Results from the three techniques were not the same, thus implying that research findings can no longer be cross-compared. Moreover, while all subjects were similar in the accuracy of their estimation of a control object, anorexia nervosa and bulimic patients overestimated their own body size significantly more than normal controls. This difference was even more marked when affective instructions were compared.

Five patients with trisomy 21 (Down's syndrome (DS)), referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in DS, and suggest that electroconvulsive therapy is an effective treatment for major depression in DS.

A prospective neuropsychiatric study of 31 consecutive subjects with Wilson's disease is reported. Exploratory factor analysis yielded four factors: neurological, cognitive, hepatic/depressive and psychiatric. Significant associations were found between a ‘psychopathic’ personality factor and neurological and dysarthria scores. The d’ and β coefficients of a signal-detection memory task dissociated: the former correlated only with Mini-Mental State and Benton visuospatial task; and the latter with depressive symptoms. Using discriminant function analysis, there was efficient classification of ‘psychopathic’ personality by dysarthria, and of individual depressive symptoms by disturbance of gait. Biochemical markers of hepatic dysfunction were significantly associated with certain depressive symptoms. No evidence emerged to support the putative association with schizophrenia-like psychosis.

A study of 365 women aged 70–79 in a rural community was carried out using the Cambridge Examination of Mental Disorders in the Elderly (CAMDEX). Prevalence rates of dementia are reported by severity for the 70–74 and 75–79 age groups. Differential diagnosis was made according to CAMDEX guidelines. Senile dementia of Alzheimer type accounted for half the dementia cases. The prevalence rates overall did not differ from those reported in other recent studies, but the rates for levels greater than mild/moderate were lower, despite the inclusion of subjects in institutions.

A retrospective study of 92 patients admitted with mania, aged over 65 years of age, found that 26% had no prior history of affective illness; 30% had previously only experienced depression, and half of these had at least three episodes of depression before the first manic illness. Patients with a family history of affective disorders had a significantly earlier age of onset of illness. There was evidence of cerebral organic impairment in 24% of the patients, and this group had a significantly later age of onset of illness. Prognosis was good, with only 8% still in hospital at six months. Half of the patients were started on lithium prophylaxis, but this did not significantly alter the number of readmissions. A quarter of those started on lithium developed evidence of lithium toxicity.

Audiovisual tapes of emotional situations were shown to 34 schizophrenics and 15 controls who were asked to rate the emotional content of the scenes using an adjective check-list. The schizophrenic patients failed to detect the dominant character of the scenes, and perceived the opposite emotions to those perceived by the controls. Such deviant responses were not related to paranoid symptoms, flattened affect, formal thought disorder, general level of morbidity, or duration of in-patient stay.

Of 331 patients admitted to a general hospital to whom the CAGE questionnaire was administered, those who scored 2 or more for alcoholism scored higher on a number of measures of psychiatric morbidity than those with a CAGE score of O. Those patients who scored 1 showed less psychiatric morbidity than those who scored 0. Among the male patients who scored at least one question positively, those who had abstained from alcohol for at least a year showed higher levels of psychiatric morbidity than those still drinking.

A follow-up study of 17 old long-stay psychiatric patients resettled in private facilities for the elderly is reported. Resident satisfaction with the placement and functioning (using the CAPE Behaviour Rating Scale) was assessed, together with the quality of the physical and social environment, and the regime characteristics in the establishments. All residents were satisfied with life and their functioning had improved significantly. The private facilities were more resident-orientated, and had a generally superior social environment to their local authority ‘old people's home’ counterparts. The physical amenities, safety features, and architectural choice available were of a similar standard to those in local authority old people's homes, but there were fewer prosthetic and orientational aids and on-site recreational amenities.

Four major categories of nonspecific or common factors are systematically analysed: relationship, expectancy, reorganising, and impact factors. The placebo control method should be discarded in psychotherapy research for two reasons: (a) sham treatment controls are unworkable because common factors in treatment are manifest only when real treatment is administered; and (b) the very events which were once thought of as ‘nonspecific’ noise are now recognised as active therapeutic factors common to many schools.

Epileptic automatism and violence are seldom found among temporal lobe epileptics. The case of a 19-year-old girl who killed a 20-month-old child during an epileptic attack is described, and the literature and medico-legal issues are briefly reviewed.

A 39-year-old man had his pathological jealousy successfully treated with pimozide. It is suggested that pimozide might be considered the drug of choice in all the monodelusional disorders.

A 12-year-old Chinese boy had a diagnosis of infantile autism at infancy that was finally confirmed as classic phenylketonuria at adolescence. This treatable inborn metabolic disease should be investigated in cases of apparent autism, especially where mass neonatal screening of inborn metabolic diseases has not been established.