The effect of loss of parents during childhood has been the subject of many studies. Although most reports agree that some emotional disturbance occurs in the child, it is not yet clear what are the late effects of such separations in adult psychiatric health and behaviour. Brown (1961) and Munro (1965) pointed out that childhood bereavement before the age of 15 is not a rare experience: both studies report an incidence of over 19 per cent, in non-psychiatric populations. While some studies (e.g. Brown, 1961) reported an increased frequency of bereavement in childhood in depressed patients, other studies (e.g. Hopkinson and Reed, 1966) failed to confirm this. Furthermore, as Ainsworth (1962) pointed out, the term “parental deprivation” requires careful definition. It can refer to insufficiency of parent-child interaction (which cannot be assumed to follow automatically in every separation, because of the presence of parent substitutes), to grief reactions which may be supposed to follow parental loss and predispose to depression (Bowlby, 1961) and to distortions of parent-child relationships. The psychological consequences of parental loss could be expected to differ according to the degree of pre-separation distortions of relationships.

Seventeen patients with schizophrenic symptoms were assessed before and after ECT to elicit possible factors predictive of outcome. The strongest associations with good outcome were shown by short duration of illness and paucity of premorbid schizoid personality traits; significant associations were also shown by short duration of current episode, paucity of paranoid premorbid personality traits, and the presence of perplexity. The diagnosis of schizoaffective disorder was not related to outcome. Questionnaires completed by 16 patients after ECT showed their attitudes to be generally favourable to the procedure.

Background Early detection and intervention in schizophrenic disorders is an important challenge for psychiatry.

Method Review of literature on effective biomedical and psychosocial intervention strategies.

Results Comprehensive programmes of drug and psychosocial interventions with adults who show early signs and symptoms of schizophrenic disorders may contribute to a lower incidence and prevalence of major episodes of schizophrenia. These programmes combine early detection of psychotic features by primary care services, with close liaison with mental health professionals. Long-term monitoring of signs of recurrence, with further intervention, appears essential to maintain these benefits.

Conclusions Field trials demonstrate that effective early treatment strategies can be routinely applied in clinical practice.

All hitherto applied antidepressant drugs, both the tricyclic compounds and the MAO inhibitors, present serious disadvantages, not only some more or less grave undesirable side-effects, but also a rather long latency time before the antidepressant effect itself strikes through.

Significantly more of 300 patients with non-endogenous depression compared with 300 matched controls were unemployed and had a poor marriage before the onset of depression, had a first-degree relative who had been treated for depression, had experienced separation for one year or more from a parent before 17 years of age and had three or more children under 14 years of age at home. However, significantly more of 44 patients with endogenous depression, than their 46 controls, also had a poor marriage before the onset of depression and 43% of them had a first-degree relative who had been treated for depression. Thus a family history of depression and a poor marriage before the onset of depression are associated with both non-endogenous and endogenous depression but unemployment, separation for one year or more from a parent before 17 years of age, and having three or more young children at home may be risk factors for non-endogenous depression.

A recent alert from the UK Committee on Safety of Medicines stated that the dangers of treatment of depression with paroxetine outweigh the benefits in those under 18. Such a warning should focus our minds on the evidence on which clinical practice is based. Antidepressant treatment of depression in the under-18s has been thought to be justified because clinical trials show that it works so well in over-18s. But is that a reasonable assessment of the evidence? Kirsch et al (2002) use the analogy of ‘The Emperor's New Clothes' to describe the findings from their meta-analysis of randomised placebo-controlled trials of antidepressants. They conclude that antidepressant medication appears to have only a small effect on outcome over and above placebo. In this analogy psychiatry is the emperor, drug trials are the fraudsters and the deception is being revealed by a growing body of critical opinion proposing that, once methodological problems with clinical trials are taken into account, antidepressants either do not work at all or have an effect that is so small as to be clinically unimportant (Andrews, 2001; Moncrieff, 2002). A large number of randomised placebo-controlled trials of antidepressants have been carried out over the past decades, mostly funded by the pharmaceutical industry, and it is now recognised that about 50% of negative trials go unpublished (Thase, 1999). Meanwhile, unipolar depression has jumped into the top five of the world's total burden of disease, and there is an imperative need for effective and safe treatments. Do we need more randomised controlled trials (RCTs) of antidepressant medications, or has that research paradigm outlived its usefulness? In this month's debate, Professor Gordon Parker, University of New South Wales and Black Dog Institute, Australia, and Drs Ian Anderson and Peter Haddad from the University of Manchester discuss whether clinical trials for antidepressant medication produce meaningless results.

Very few cases of thyrotoxic psychoses have been reported during the last twenty years. Recent authoritative reviews on the management of thyrotoxicosis and its complications (Ingbar, 1966; Trotter, 1967) scarcely mention psychotic reactions. It seems that such conditions have become increasingly rare since the advent of modern anti-thyroid treatment. The present report attempts to summarize what is known about these disorders, and describes the clinical features, treatment and subsequent course of a schizophrenia-like psychosis which developed during thyroid crisis.

During the past ten years varying degrees of prognostic value have been claimed, directly or indirectly, for a number of specific factors in connection with the treatment of depressive illnesses by E.C.T. These have included the blood pressure responses to adrenaline and methacholine (Funkenstein et al., 1948, 1950); the “sedation threshold” to intravenous sodium amylobarbitone (Shagass, 1954; Shagass and Jones, 1958); EEG changes under thiopentone following electroshock (Roth, 1951; Roth et al., 1957); and psychological tests based on items derived from the Minnesota Multiphasic Personality Inventory (Pearson, 1950; Feldman, 1957, 1958; Welsh, 1952). Other studies have been made on the prognostic value of adrenocortical activity (Faure et al., 1957); serum calcium levels (Gour and Chaudhry, 1957); the “amytal test” (Kahn et al., 1956); and the administration of methylamphetamine (“methedrine”) (Rudolf, 1956). Some of the techniques employed appear too complicated or unreliable in their interpretation to be of any practical clinical value, although a few are of great theoretical value in the contributions to further knowledge of the rationale of E.C.T.

Asian and non-Asian referrals to the department of child psychiatry at the London Hospital in 1987 were analysed. Asian referrals were under-represented with respect to the local population but, contrary to our expectations, there were no significant differences between the groups with regard to demographic data, the nature of the presenting problem, and attrition rates.

There is evidence that the superior temporal gyrus and Heschl's gyrus within it are implicated in schizophrenia. We investigated neuronal and glial cell density and cortical thickness within Heschl's gyrus, using the optical disector to estimate cell density within cortical layers 3 and 5 in tissue derived postmortem from people with diagnoses of major depressive disorder, schizophrenia and bipolar disorder, compared with normal controls (n=15 per group). No significant difference in neuronal or glial cell density or in cortical thickness was observed between the groups; our findings therefore provide no support for the presence of cellular pathology within Heschl's gyrus in schizophrenia.

A cross-sectional survey of the drinking habits of 877 mentally handicapped in-patients revealed 31 patients (prevalence 3.5%) who, in the opinion of nurses, drank five litres or more daily. Low urine specific gravity was a less useful indicator of polydipsia. Polydipsia appeared to be significantly associated with a borderline level of handicap and with a diagnosis of schizophrenia, autism or severe personality/behaviour disorder. Of five cases of water intoxication associated with polydipsia, one was fatal. In two cases excess drinking improved with increased neuroleptic medication. Lithium and demeclocycline were used in two cases to prevent hyponatraemic episodes.

The number of alcoholics admitted to mental hospitals in the United Kingdom has recently shown a sharp rise. In Scotland the admissions have risen from 732 in 1956 to 1,347 in 1961 (General Board of Control for Scotland) and in England and Wales from 1,285 in 1956 to 2,479 in 1960 (Registrar General). Figures for admission to general hospital units are not as yet available but they may well show a similar rise. Admission rates for alcoholism to Scottish mental hospitals are about four times higher than in England and Wales, and one-third of first admissions of middle-aged men to Scottish mental hospitals are suffering from alcoholism or alcoholic psychosis (Morrison, 1964). The rise in admission rates cannot be taken as indicative of a rise in prevalence; it may be that they reflect other changes, such as the attitude of the patients towards the acceptance of treatment, the attitude of the family doctor towards referral, and the availability of hospital beds.

The official suicide rate in Ireland increased markedly between 1970 and 1985. This is a genuine increase in suicide and not an apparent one due to previous deficiencies in recording practices. Possible reasons for this change include an increase in ‘anomie’ shown by a rise in the rates of crime, illegitimacy and admissions to hospital for alcoholism, a decline in social cohesion revealed by a fall in the marriage rate and a rise in the number of separated couples, and an increase in unemployment.