Any reader of the handbooks of medical history will know that among the ancient Greeks, the womb was on occasion held to cause various complaints by moving about the body. A particularly graphic account is to be found in the Timaeus (91b–c), where, in likening sexual desire to an actual animal, Plato first mentions “… in men the organ of generation becoming rebellious and masterful like an animal disobedient to reason”, and then alludes to:

What is known about the biology of AIDS is reviewed, and the social factors which influence disease transmission and public attitudes are considered. After an evaluation of the methods available to control the epidemic, the reasons for the limited success of public health measures thus far undertaken are considered. The ethical debate on public health policy is analysed, and the need for a nationwide educational programme on AIDS is emphasised – one which is responsive to the rights and obligations of citizens in a democratic society.

The efficacy of implementing a clinically feasible psychosocial intervention which addresses the needs of carers of the long-term mentally ill is reported. All the relatives of patients in continuous high contact with one clinical team in a local day-care facility were offered the intervention. An interactive education session at home was followed by a monthly relatives group which aimed to reduce components of expressed emotion and to alleviate burden. Patients and relatives were assessed. The controls were the patients in contact with the other teams in the day-care facility, and their relatives. The intervention was effective at reducing EE and improving family relationships. Offering this kind of support to people who are providing long-term care for the severely mentally ill can contribute significantly to the quality of life of both supporters and patients.

A psychosocial intervention is described geared to the needs of carers of the long-term mentally ill, which is feasible for a busy clinical team to implement: relatives were not selected for the group by patient diagnosis or motivation and little extra staff input was required. An interactive education session at home was followed by a monthly relatives group which aimed to reduce components of expressed emotion (EE) and to alleviate burden. The group facilitators adopted a directive but non-judgemental style, and constructive coping efforts were encouraged. The intervention was effective at reducing EE and improving family relationships. The study offers a realistic model of how to offer support to people providing long-term care for the severely mentally ill.

In a prospective study, 153 consecutive new referrals to a psychogeriatrician in Oxfordshire in 1973 were followed up for 15 years. The percentage of the over-65 population at risk was 0.27 and, of those aged over 80, 0.6. Alzheimer's dementia and depressive illness comprised over two-thirds of referrals. A quarter became permanent admissions, half of them with Alzheimer's dementia, 19% of whom were alive five years later. Depressive illness, at ten years, had a mortality 1.2–1.6 times that of the population at risk. The distinction between Alzheimer's dementia and depressive illness, based on their natural history and causes of death, was reinforced.

The cerebral vascular transit time of 17 patients with presenile dementia of the Alzheimer type (ATD), nine abstinent patients with alcoholic Korsakoff's psychosis (KOR), and ten age-matched controls was determined by the bolus intravenous injection of pertechnetate. A gamma camera was used to estimate the median transit time (MTT) of the radioactive bolus in a planar (non-tomographic) projection normal to the vertex. The spread of the bolus arriving at the aortic arch was measured independently by a single external detector over the chest, and correction made for the transit time of this input function in calculating the net MTT for the head. Both ATD and KOR groups showed lengthened net MTTs, compatible with reduced cerebral blood flow, and which were correlated with reduced cognitive function. It is concluded that the method employed gives a simple, inexpensive estimate of function-related blood flow to the brain in presenile dementia.

Nicotine in patients with dementia of the Alzheimer type (DAT) producted a significant and marked improvement in discriminative sensitivity and reaction times on a computerised test of attention and information processing. Nicotine also improved the ability of DAT patients to detect a flickering light in a critical flicker fusion test. These results suggest that nicotine may be acting on cortical mechanisms involved in visual perception and attention, and support the hypothesis that acetylcholine transmission modulates vigilance and discrimination. Nicotine may therefore be of some value in treating deficits in attention and information processing in DAT patients.

The eating habits of 33 patients with dementia were studied. They were assessed by semistructured interview with a relative who was able to act as an informant for the whole period of the dementia. Changes in eating were found to be common and included both increased and decreased food intake, altered food choice, the consumption of inedible substances and disturbances in the process of eating. The clinical significance of these changes and some likely underlying mechanisms are discussed.

The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The α coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.

One hundred and forty-seven mothers were screened for major depression at six to eight weeks postpartum. Using predetermined cut-off points, the Edinburgh Postnatal Depression Scale and the Beck scale were compared in their abilities to identify the 15% of subjects who had major depression according to DSM-III criteria. The sensitivity of Edinburgh scale was 95% and its specificity 93%. The performance of the Beck scale was markedly inferior, with a sensitivity of 68% and specificity of 88%.

Ninety-two women and their first-born children took part in a longitudinal survey of maternal mental health. When the children were four years old, their mothers were interviewed by means of the Behavioural Screening Questionnaire, and the children's problems were rated by a psychiatrist, who was unaware of the mothers' psychiatric histories or of assessments of their current health. As expected, mothers who were concurrently depressed reported significantly more behavioural difficulties in their children. Marital disharmony during pregnancy and a history of paternal psychiatric problems were also associated with later childhood behavioural difficulties. Children who scored below average on the McCarthy scales of cognitive abilities were also reported by their mothers to have more behavioural problems, but the children's behavioural difficulties at four showed no clear links with postnatal depression.

Duke Epidemiologic Catchment Area (ECA) data were used to examine the relationships between: (a) early childhood maternal death, paternal death, and parental separation/divorce, and (b) six-month DIS/DSM-III diagnoses of agoraphobia with and without panic attacks, simple phobia, social phobia, panic disorder, generalised anxiety disorder, and obsessive-compulsive disorder. Associations were found between: (a) maternal death and agoraphobia with panic attacks, and (b) parental separation/divorce and agoraphobia with panic attacks and panic disorder. The associations could not be explained by the effects of potentially confounding socio-demographic factors.

Twenty-six patients seen at a regional adolescent psychiatry unit between 1974 and 1979 with a discharge diagnosis of obsessive-compulsive disorder were followed up after an average of ten years. Of 24 subjects traced, outcome information was obtained from 20. At the point of follow-up, ten patients remained psychiatrically ill, six having persisting obsessive–compulsive symptoms. Poor outcome was associated with a family history of psychiatric illness and lack of response to therapy at initial contact. All patients who were asymptomatic at discharge had remained well.

Hospitalised drug addicts were categorised according to the time lapse between onset of their opiate abuse and their first notification to the Home Office. Late notification correlated with a lower level of dependence, a more intermittent pattern of misuse, and a greater likelihood of alcohol abuse. It is postulated that there may be two types of addiction which lie along a continuum.

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.

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.

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.

We have observed a significantly higher growth hormone (GH) response to clonidine administration (150 μg i.v.) in 14 patients with a major depressive disorder who had never received antidepressant therapy than in 14 matched depressive patients who had not received tricyclic drugs for at least 15 days. Compared with a control group of eight subjects, untreated depressed patients, as a group, had a normal response, while matched patients had markedly blunted response. Results for the group of untreated depressed patients showed that some patients had a blunted response while others had a response in the normal range. The results suggest that studies on the GH response to clonidine in psychiatric patients need to take into account the confounding and long-lasting effects of tricyclics.

It is now widely accepted, especially in the United States, that confining lawbreakers in mental hospitals as insane, without the benefit of a real trial, rather in prisons as criminals, after a proper trial, is a recent, enlightened Western practice. Nothing could be further from the truth. The practice is not recent, enlightened, or typically Western – resembling the Oriental despotic arbitrariness towards troublesome persons much more closely than the Occidental legal respect towards persons accused of crimes. Many 19th-century cases illustrate the procedure and support my foregoing interpretation of it. The following is a typical example.

It would be absurd to suggest that mental health legislation is never abused, that individuals are never detained unnecessarily on inappropriate psychiatric grounds, or that political expediency does not sometimes exert an influence on decision making in this regard. Dr Szasz, however, takes an extreme view in rejecting the moral or legal right of psychiatrists to participate in the compulsory hospital admission of offenders. He rightly points out that if psychiatric involvement is wrong in principle, then “periodic outbursts of indignation against ‘abuses'” are “both naive and foolish”. Nevertheless, he sees fit to support his arguments with examples of what he deems abuses.