The measure of expressed emotion (EE) of the relative has been found to be an important predictor of schizophrenic relapse. Electrodermal measures were recorded when the schizophrenic patient was talking to an experimenter, and when the patient was talking to a relative. Although there were no differences during the relative-absent period, patients with a high-EE relative present exhibited significantly higher frequencies of non-specific skin-conductance responses (NS-SCRs) than patients with a low-EE relative present. Patients show a significant decrease in NS-SCRs on the entry of low-EE, but not high-EE relatives. Patients with high-EE relatives show overall higher levels of skin-conductance levels (SCLs) than patients with low-EE relatives. Although patients with high-EE relatives rate themselves significantly more tense and anxious on self-rating scales, there are no significant correlations between self-ratings and electrodermal measures. The use of electrodermal reactivity as an assessment measure of relapse risk is discussed.

An index of brain tissue density was obtained from the CT scans of 37 elderly depressed patients by measuring Hounsfield Units (HU) in 12 predefined brain areas. Comparisons were made with 23 patients suffering from senile dementia and 36 healthy controls. As a group the depressed patients resembled the dements more than the controls, although analysis of variance indicated differences between all three groups, controls showing the highest HU values and dements the lowest. In the depressed patients ventricular dilatation, which had already been shown to predict increased mortality, was also associated with lower HU levels. The significance of these and other findings is discussed.

Psychiatrists, psychologists, and nursing staff are increasingly making direct observations and ratings of ward behaviour. Characteristically, a nurse may be asked to complete a multi-item rating scale on a group of patients during the course of a drug trial. Several factors are involved in the choice of an appropriate scale for a particular purpose. Among these factors are the number of points per item, which defines the sensitivity to change of the item, and the total number of items in the scale, which affects the time taken to complete the scale and hence the frequency of rating that can be permitted in an assessment schedule.

Callous–unemotional traits have been incorporated into the DSM-5 and may be considered for the ICD-11. Despite the centrality of callous–unemotional traits, it is only one of three dimensions of child psychopathy. It is proposed that the grandiose–manipulative and daring–impulsive traits should be considered and potentially accepted as specifiers for conduct disorder in the DSM-5 and ICD-11.

The hypothesis that cognitive impairment in Alzheimer's disease is related to cholinergic degeneration in the brain is still, a decade after its formulation, subject to critical evaluation. In marked contrast to the monoamine hypotheses of affective disorders or schizophrenia – based primarily on the mechanisms of action of therapeutic drugs, and yet lacking convincing pathological data on the human brain itself – the cholinergic hypothesis of Alzheimer's disease currently rests largely on evidence of neurochemical pathology in affected tissue, but still depends on effective therapy for its ultimate validation. The urgent need for a means of countering cognitive impairment in degenerative dementias such as Alzheimer's disease (probably the most important cause of intellectual decline in old age) hardly needs emphasising. In this annotation, a number of key questions specifically relating to the cholinergic involvement in Alzheimer's disease are considered. These questions are already being answered both within and, as so often in the history of biological psychiatry, outside the immediate area of investigation.

In recent years there has been increasing experimental evidence that specific disturbances of perception occur in schizophrenia. Reduced size constancy in schizophrenic patients has been reported in studies by Raush (13), Crookes (6), and Weckowicz (16). Further investigations by Weckowicz and his colleagues (17), have also demonstrated reduced distance constancy in schizophrenia. (The retinal image of an object alters proportionately with the distance at which it is perceived. Size and distance constancy refer to our normal ability to compensate for changes in the stimulus and thereby to retain a stable perception of the object.) Brengelmann (3) and Angyal (1) have shown that schizophrenic patients have difficulty in reproducing briefly exposed visual stimuli. Penrose (12) has shown that schizophrenics perform poorly in a variety of tests involving visual discrimination.

Three groups of patients admitted compulsorily from populations with markedly different rates of compulsory psychiatric admissions were compared on a range of social and clinical data. Whilst West Indian and white patients from inner city areas differed in many respects, they were both more likely than other patients to be referred to the psychiatric services through police agencies, with little GP involvement and were often admitted from public places following disturbed behaviour. However, levels of violence and threatening behaviour were no higher among inner city patients, black or white, and once admitted, these groups showed similar treatment compliance to white patients who had been admitted compulsorily from suburban areas. Implications for primary care and delivery of psychiatric services are discussed.

In the mental health field, the attention given to the subjective side of a person's experience is grossly inadequate. The best way to reflect the subjectivity of a person may be by means of the subjectivity of another. To take account of both subjective experience and objective measures in the course of mental disorders, a new concept is needed. This may be the person's story.

Ever since E.C.T. was introduced it has been observed that complaints of impaired memory are very common after this form of treatment, but also that the complaints vary considerably in different patients. That memory performances—as they may be measured by means of tests—are disturbed to a varying degree after E.C.T. has been established by several authors. It is thus reasonable to assume that the varying complaints of impaired memory, at least in part, reflect true disturbances of memory abilities. It is a common impression, however, that patients who have gained an obvious release from emotional distress comparatively seldom complain of memory disturbances after E.C.T. Thus, the complaints of memory impairment seem to be determined also by another factor, acting in the opposite direction, viz., improvement of disease. No investigation of the extent to which various factors have influenced the complaints of memory disturbances after E.C.T. seems to have been made.

This paper describes the application of prospective longitudinal data from an epidemiological sample of young adults to define subtypes of major depression. Depression was classified on a spectrum from subthreshold manifestation of symptoms and duration at one end, to cases with recurrent episodes of depression meeting duration criteria for major depressive episodes at the other. There was a direct relationship between the severity of depression over the longitudinal course and both duration and recurrence of depressive episodes. The subgroup of depression with recurrence of both brief and longer duration episodes could be discriminated on most of the indicators of validity including symptoms, impairment, family history, and suicide attempts. In light of the young age of this cohort, the strong history of suicide attempts and other complications of depression among the subjects with recurrent depression was striking. These findings underscore the importance of employing course as a classification criterion of depression, and the inclusion of subthreshold episodes of depression in the characterisation of course.

The only randomised controlled trial to test high-fidelity assertive community treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from community mental health teams in reducing the need for inpatient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.

Among all the childhood influences that may affect individual development and contribute to breakdown in adult life, the quality of parental care has always appeared of paramount importance. The supposed sequelae of parents’ absence have been the subject of many studies, relating particularly to depression (Dennehy, 1966, and Hill and Price, 1967) and to attempted suicide (Greer et al., 1966). In the latter study a significant association was established between absence of either parent and a later suicidal attempt, especially if the absence started in the first five years of life.

John Bowlby bemoaned the separation between the biological and psychological approaches in psychiatry, and hoped that attachment theory, which brings together psychoanalysis and the science of ethology, would help bridge the rift between them. Recent findings in developmental psychology have delineated features of parent–infant interaction, especially responsiveness, attunement, and modulation of affect, which lead to either secure or insecure attachment. Similar principles can be applied to the relationship between psychotherapist and patient - the provision of a secure base, the emergence of a shared narrative (‘autobiographical competence’), the processing of affect, coping with loss - these are common to most effective psychotherapies and provide the basis for a new interpersonal paradigm within psychotherapy. Attachment theory suggests they rest on a sound ethological and hence biological foundation.

Two similar groups of adult psychiatric patients carrying the diagnosis of anxiety neurosis were compared in their response to different methods of training in deep muscle relaxation. One group received EMG feedback and the other a modification of the Jacobson Progressive Relaxation method. The frontalis muscle was chosen as the target for feedback training and for the measurement of tension reduction in both groups, for the reason that this muscle has been shown to reflect the general muscle tension level in anxious patients. Training was carried out under controlled laboratory conditions, and objective muscle tension levels were obtained. Overall changes in the status of the anxiety symptoms, as determined by global ratings from patients and from primary therapists, were also compared in the two groups at the end of training. The results of the study indicated that both EMG feedback and the progressive muscle relaxation training produced significant reductions in frontalis tension levels. However, EMG feedback was found to be generally superior in producing larger reductions in muscle activity, with a concomitant relief in anxiety symptoms, for a greater number of the patients.