Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1, relaxation time rose immediately after the fit reaching a maximum 4–6 h later. The T1, values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

Forty-six patients, 9 male, 37 female, presenting to an ear, nose and throat department with a principal complaint of globus sensation were investigated by radiology, manometry, endoscopy and prolonged ambulatory pH monitoring to exclude a physical basis for their symptoms. Patients also underwent assessment by the Eysenck Personality Inventory (EPI) and General Health Questionnaire (GHQ). The only organic abnormalities detected were an abnormal degree of oesophageal acid exposure (seven patients) and oesophageal spasm (one patient). Female patients were neurotic introverts on EPI testing; males were stable ambiverts. High GHQ scores were present in 13 females (35%) and one male and there was a significant correlation between N scores (in the EPI) and GHQ scores. We propose that globus is a useful, single-symptom model for the study of conversion disorders.

The current characterisation of dementia as a state of global cognitive failure (DSM-III-R, 1987) cannot differentiate it reliably, in cross-sectional diagnosis, from other states of compromised cognition. This is likely to contribute to both the over- and under-diagnosis of dementia in clinical practice (Marsden & Harrison, 1972; Fleminger, 1975; Ron et al, 1979; Smith & Kiloh, 1981; Garcia et al, 1984; Klein et al, 1985). However, diagnostic discrimination between true dementia and its behavioural phenocopies (e.g. depressive pseudo-dementia, quiet delirium, etc.) can be improved in a number of ways. One such is the longitudinal assessment of symptom-clusters (e.g. those related to memory, personality, and cortical syndromes); another is the inclusion of new symptoms into the definition of dementia. The first of these strategies has been given more attention than the second.

With the recent advances in artificial intelligence (AI), patients are increasingly exposed to misleading medical information. Generative AI models, including large language models such as ChatGPT, create and modify text, images, audio and video information based on training data. Commercial use of generative AI is expanding rapidly and the public will routinely receive messages created by generative AI. However, generative AI models may be unreliable, routinely make errors and widely spread misinformation. Misinformation created by generative AI about mental illness may include factual errors, nonsense, fabricated sources and dangerous advice. Psychiatrists need to recognise that patients may receive misinformation online, including about medicine and psychiatry.

It is argued that there are two kinds of benzodiazepine dependence: a therapeutic and a morbid kind. The therapeutic dependence is acceptable in that it mitigates the clinical manifestations in patients with long-standing and fluctuating anxious–depressive symptoms. The morbid dependence is an unfortunate complication which can arouse therapeutic concern because it ties patients to an excessive dosage, unless the penalty of a sometimes grim abstinence syndrome is paid on drug reduction. The present, often strident and threatening, damnation of benzodiazepines oversteps the mark and causes avoidable misery to patients whose well-being has become largely and therapeutically dependent on the drug.

The point prevalence of tardive dyskinesia (TD) as assessed by means of the Simpson rating scale was determined for 14 psychiatric wards with 347 patients (213 and 134 female) at the time of the study. TD was found to occur in 17.3 per cent of the patients, the prevalence being significantly higher in female than in male patients. The frequency of TD increases with age.

A random group of TD patients was matched with a group of patients without TD and the total medication for both groups was calculated. No differences were found as concerns total amount of high or low dosage neuroleptics, or anticholinergic drugs, for the two groups. However, significantly more TD patients than controls had received dosage neuroleptics, or anticholinergic drugs for the two groups. However significantly more TD patients than controls had received anticholinergic drugs.

There was no significant relationship between severity of TD: age, duration of treatment, total amount of high or low dosage neuroleptics. On the other hand a significant relationship was found between severity of TD and amount of anticholinergic drugs. Significantly more patients in the TD-group than in the control group had a past history which might suggest possible brain damage prior to the neuroleptic medication.

Detailed case reports of incidents of suicide and attempted suicide on the London Underground railway system between 1985 and 1989 were examined for the presence of suicide notes. The incidence of note-leaving was 15%. Notes provided little insight into the causes of suicide as subjectively perceived, or strategies for suicide prevention.

Ten years after the passing of the Italian psychiatric reform bill, the author assesses the state of the national mental health services. Albeit slowly, the decrease in the number of in-patients in mental hospitals is accompanied by a numerical increase in district and out-patient services. However, the quality of care provided and the regional distribution of services are not acceptable. The reorganisation has benefited hospital and out-patient services, but community care facilities remain inadequate. The mental health of the general population seems to be unaffected by the ongoing transition in psychiatric care.

A description is given of the coping behaviour of seven men who survived a shipwreck and were not rescued until 13 days later. The principal behaviours shown by the men were attachment ideation, drive to survive, modelling, prayer and hope. Particular attention is paid to the first of these, and consideration given to its likely origins in behavioural evolution. It is proposed as a hitherto inadequately recognized coping behaviour. A follow-up examination 12 to 24 months later showed that five of the seven men available had developed substantial psychiatric disorder, while by contrast one was not only well but claimed to have been enriched by the experience. Exposure to extreme adversity or disaster may have long-term effects on mental health. Further longitudinal studies of disaster victims are necessary for the design of informed after-care.

Patients with acquired immunodeficiency syndrome (AIDS), who present with or develop psychotic symptoms, almost invariably have evidence of cognitive impairment. Three psychotic patients, one with AIDS, and two with AIDS-related complex (ARC), who showed no evidence of cognitive impairment, are reported. It is suggested that the human immunodeficiency virus (HIV) may produce symptoms indistinguishable from those seen in the functional psychoses.

During the past 75 years, the proportion of elderly individuals in the USA has grown twice as fast as the general population. Depression in this age-group occurs four times more frequently than in the general population (Butler, 1975), and the suicide rate for people over 65 years of age is 15 times greater than that of the general population (Lehman, 1980).

The elderly may be more susceptible to depression due to biological and/or psychosocial variables. Elderly people experience significant losses associated with increasing age, including death of spouse and friends, loss of work, social status, and physical and mental abilities (Lehman, 1980). The biogenic amine hypothesis suggests that the aging brain may experience a decrease in the functional availability of neurotransmitters (Lehman, 1980); this decrease may also play a role in the aetiology of depression.

Due to age-related changes in the body, the elderly can be more sensitive to drug therapy. Older patients may require careful dosage adjustments and may also be more prone to experiencing drug-related adverse events. The elderly often receive medication for various indications, and drug interactions are a concern (Thompson et al, 1983). Therefore, efficacy and safety studies of new antidepressants in elderly patients are particularly important. We pooled data from both double-blind and open-label studies to evaluate the efficacy and safety of fluoxetine in geriatric outpatients with DSM-III major depression. Positive results of fluoxetine in the treatment of geriatric depression were reported in one of these studies (Feighner & Cohn, 1985). The favourable safety and side-effect profile of fluoxetine in the general population has been discussed elsewhere (Wernicke, 1985). Plasma concentrations of fluoxetine in elderly subjects are similar to those in younger individuals (I.emberger et al, 1985). These findings, combined with a lack of cardiovascular effects (Fisch, 1985), and low lethality with overdose, indicated promise for fluoxetine as a geriatric antidepressant.

It has recently been pointed out by several authors that the psychometric assessment of the elderly patient has largely been geared to, or preoccupied with, the solution of diagnostic problems, measuring deterioration or discovering early dementia (Post, 1966; Inglis, 1962). Therefore, it appears that little attention has been paid to the use of psychometric tests in the broad area of prognosis. Often the psychiatric diagnosis of an elderly patient is quite clear, and in these circumstances it would be valuable to be able to discern reliable and significant changes in the cognitive status of such patients. For example, it may well prove quite significant, prognostically, to measure the rate of change in cognition of an elderly person suffering from a progressive cerebral disease. The rate of decline could be a prognostic indicator for the future disposal of the patient or for impending death. A variety of studies have shown that scores on measures of physical and cognitive abilities can predict death or discharge from hospital (Cosin et al., 1957; Inglis, 1959; Kleemeier, 1961; Kral, 1963). In the case of patients suffering from depressive “pseudo-dementia” (Post, 1965) it will probably be valuable to know if their cognitive status reflects changes in their clinical status. But probably the most important aspect of the psychometric assessment of the geriatric patient will be found to lie in measuring changes in function which may be the sequelae of treatment affecting brain function in general, i.e. anti-depressant preparations and electroconvulsive therapy.

Folie à deux, the psychosis of association, has been defined as ‘the transference of delusional ideas and/or abnormal behaviour from one person to one or more individuals who have been in close association with the primary affected person’ (8). At least three conditions have been regarded as pre-requisite for its diagnosis: (a) definite evidence that the partners have been intimately associated, (b) identical content of the delusional ideas in both the patients, and (c) unequivocal evidence that the partners share, support and accept each other's delusions (7).

Issues that undermine the early detection of schizophrenia include an inadequate grasp of the construct validity of the concept of schizophrenia, insufficient conceptualisation of psychosis and of the illness onset, and a general lack of a theoretical framework for psychopathology. Subjective experience is emphasised as a potentially promising domain for future research.

It was Bleuler (1917) who introduced the conception of “schizophrenia” as a mental illness and described its characteristics. Since 1957 was the centenary of Bleuler's birth the attention of psychiatrists has been focused on the various problems and difficulties still confronting us today regarding the diagnostic, aetiological and therapeutic aspects of this disease.