There is now a well-established link between childhood maltreatment and psychosis. It is, however, unclear what the mechanisms are by which this occurs. Here, we propose a pathway linking the experience of childhood maltreatment with biological changes in the brain and suggest a psychological intervention to ameliorate its effects.

The past four decades have witnessed a transformation in research on the benefits of psychological therapies. However, even though therapists highlight that negative and adverse effects are seen in day-to-day practice, research on the negative effects of psychotherapy is insufficient. Given the unrelenting popularity of therapies, the argument for examining the adverse effects of psychotherapy would seem to be compelling. Such a strategy would extend beyond supervision of individual therapists to the introduction of monitoring systems that allow for a more systematic examination of failed psychotherapy interventions (such as exist for medication prescribing). The starting point could be the development of a consensus on how to define, classify and assess psychotherapy side-effects, unwanted events, adverse reactions, etc. This would provide a conceptual framework for communication, monitoring and research. This approach should not be viewed as an attack on therapies: every branch of medicine learns from mistakes, the same must surely be true for psychological treatments.

Fifteen general physicians were given profiles of symptom combinations representing 80 depressed patients. They were asked to judge the severity of the disorder and to prescribe. There were two phases to the experiment the formal structure of both being the same. In the first phase, all physicians based their judgments only on the cues of the Hamilton Depression scale; in the second, each physician defined his own cues. Multivariate regression analysis was applied to the observations. Agreement between the judges was low. Most had a more complex policy, in regard to both judgment of the severity of the depression and prescribing, when selecting their own cues than when restricted to textbook variables, but used it more consistently. The observations have important implications for training and research in psychiatry and in psychopharmacology.

The files of a cohort of schizophrenic patients who were admitted to hospital for the first time in their lives in 1963, and who were representative of cases in a large unselected population, were examined, first by exclusion criteria, and then by the diagnostic criteria of Schneider's first-rank symptoms, Feighner et al's criteria, and the New Haven Schizophrenia Index (NHSI). Forty-three such cases were found who were schizophrenic on at least two sets of criteria, and who were followed up in 1977. Examination of the outcome showed no relationship with FRS presence or absence or number of first-rank symptoms, nor with the NHSI score, but did show a relationship to the Feighner et al criteria and an even stronger relationship to a simple score derived from these criteria.

Goldstone and Sarbin proposed that auditory hallucinations occur because imagery in a non-preferred sensory mode is more easily misinterpreted as having an external origin. This led to the hypothesis that auditory hallucinators would show less preference for auditory than for visual imagery. Our results suggest that this is true. We also compared the vividness of internally-generated auditory imagery with that of visual imagery, independently of preference, to see whether vividness was impaired in the non-preferred mode in hallucinators. The evidence suggested that this was not the case, but we did find a significantly deficient capacity for creating vivid images of either kind in process patients (i.e. those with poor premorbid status) compared with reactive (good premorbid) patients, regardless of any history of hallucinations. The withdrawal of external attention which characterizes process patients might also be expected to impair their ability to confirm or disconfirm the external origin of an auditory stimulus. We predicted therefore that process hallucinators would be particularly incompetent in spatial location of sounds: our experimental results confirmed this to be the case.

In this article seven cases of frontal brain tumour, all of which were meningiomas, are reviewed and observation of their psychiatric presentation given. For various reasons frontal meningiomas are found more frequently in mental hospitals than in neurological centres (Hunter et al., 1968).

The use of items from the Schedule for Affective Disorders and Schizophrenia and from the Present State Examination scales for assessing positive and negative symptoms in schizophrenia was examined using factor analysis. The factorial structure of the items which putatively assess positive and negative symptoms was examined. A three-factor solution was obtained with factors identified as: a negative symptom factor (factor 1); a positive symptom factor (factor 2); a ‘disorganisation’ factor (factor 3), consisting primarily of items related to disordered thinking. A solution which was highly similar in important loadings was obtained with an independent sample of patients. High correlations of the rotated factors with the external criteria supported the interpretations of the factors. The results indicate that symptoms generally classified as negative or positive are factorially independent. Furthermore, a disorganisation factor, consisting of items previously included in positive and negative symptoms factors, is necessary for a full representation of the factor structure.

The frequency of psychotropic and anticonvulsant drug use in 168 institutionalised mentally retarded adults was studied. Use of neuroleptics and anticonvulsants was more frequent and use of hypnotics and antidepressants less frequent than in the general population. Neuroleptics were given to 49% of the population. Clients with no psychiatric diagnosis consumed less neuroleptics than those with such a diagnosis, and there was a non-significant trend for those with a more serious diagnosis (e.g. schizophrenia) to take a higher dosage. The degree of disruptive behaviour and the availability of a physician were related to dosage of neuroleptics. The various psychiatric diagnoses given could explain only a small proportion of the variance in dosage.

A group of 118 patients with a hospital diagnosis of schizophrenia was reviewed. The incidence of suicide attempts was significantly correlated with more frequent past psychiatric admissions, more frequent past diagnoses of schizophrenia, and poor work function. The apparent relationships could be spurious or based on a reversed causal sequence; for example, suicide attempts are likely to be followed by psychiatric admissions.

A review such as this is not the place, nor has it the space in which to discuss the nature of intelligence. Some conclusion, however, must be reached as to the factors to be considered in estimating any correlation, positive or negative, between level of intelligence and degree of epilepsy.

A raised blood sugar level no more defines a single entity than does a raised bilirubin or a low haemoglobin. Diabetes is a heterogenous group of disorders whose only common factor is hyperglycaemia (Tattersall et al, 1980). The classification of diabetes is being revised, although the changes are of more relevance to epidemiologists than clinicians. Previous standards of normal glucose tolerance were set too low, so that some people were labelled diabetic who had no symptoms and have proved on follow-up not to be at risk of developing complications such as retinopathy (i.e. they had a non-disease). Epidemiological evidence suggests that the cut-off point for ‘true’ diabetes (i.e. a condition which leads to complications and shortening of life span) is a blood glucose level two hours after a 50 G oral glucose load of 11.1 mMol/L (National Diabetes Data Group, 1979). This corresponds to a fasting blood glucose level of 7 mMol/L or below. Hence, a single blood glucose value, either in the fasting state or two hours after a 50 G glucose load, is enough to diagnose diabetes and glucose tolerance tests should hardly ever be necessary.

DSM-III personality disorder clusters had not previously been tested for their ability to distinguish between different population groups. A major obstacle - different demographic characteristics of different populations - was overcome by using logistic regression. Three out-patient psychiatric referral groups (chronic pain, disability applicants and competency to stand trial) provided subjects; adjustments were made for age, race, sex and education. The groups were significantly different in the adjusted prevalence of DSM-III personality disorder clusters. Clinical association between personality disorder and drug or alcohol abuse was again confirmed.

A group of depressed patients and a group of normal subjects were assessed on two occasions. On each they were required to recall past real life experiences associated with a series of stimulus words. Subjects were subsequently required to rate each experience for happiness and pleasantness. The depressives showed an increased probability of recalling sad memories; within this group there was a significant relationship between severity of depressed mood and the percentage of sad memories recalled. The extent of reduction in depressed mood from occasion 1 to occasion 2 was significantly related to the increase in accessibility of happy memories and the decrease in recall of sad memories. For those patients who improved between the two occasions there was a significant reduction in the probability of recall of a very unhappy memory. The results extend the previous findings on the effect of mood state on the accessibility of memories of differing affective tone. The findings are discussed in terms of context specific encoding and retrieval.

In the second half of the fourteenth century, the whole problem of poverty became in England for the first time a matter of government concern. The contractual relationship between landlord and villein which had prevailed during the Middle Ages, was breaking down, and the Black Death hastened this process. Statutes dealing with vagrancy and poverty were promulgated in 1349, 1351 and 1388: the able-bodied beggar was punished in the stocks and generally repression was the keynote, but despite harsh laws vagrancy increased. In a series of statutes from 1531–1601 the Tudor sovereigns initiated a system of local relief based on the Parish unit. In 1576, Houses of Correction were established: