The authors attempt to integrate several psychoanalytical and more recent neurobiological concepts regarding the development of the organism and emergence of psychopathology. They highlight the rough temporal correspondence of neurodevelopmental myelination cycles with stages of psychosocial development. They discuss concepts of critical periods and unique times of vulnerability to psychosocial insult and recurrence of critical stresses, gleaned from a multidisciplinary point of view, in relation to the occurrence of psychic aberrations. They suggest that it may be fruitful to explore further psychological constructs such as fixation and regression, as well as unconscious mental processes, in relation to their biochemical, physiological, and anatomical representations in the brain.

It is generally believed that anorexia nervosa is due to an abnormal attitude of mind which results in an insufficient intake of food. As the term anorexia nervosa implies, many patients experience a loss of appetite, but sometimes this is not so, and vomiting is an alternative or additional device adopted by the patient to ensure a reduction in effective food intake. As a rule the patient induces vomiting by tickling her throat with her fingers, but sooner or later she becomes so proficient at vomiting that mechanical stimulation is no longer necessary. Nevertheless one should not assume that vomiting in anorexia nervosa is always under the control of the patient's will. In the patient described below vomiting became intractable and was found to be due to a physical disorder—acute dilatation of the stomach. Such a complication occurring in a severely undernourished patient is highly dangerous unless recognized early and treated effectively. The opportunity was taken to measure water absorption and gastric motility.

Forty-five patients with acute schizophrenic illnesses (defined by PSE criteria) were assessed in clinical, cognitive and social terms before being entered in a four week study of the isomers of flupenthixol and placebo. At the end of one year they were re-assessed in the same terms. The clinical and psychological features of the acute illness and the drug treatment given did not predict outcome. Poor outcome in social terms was significantly related to severe social isolation in the initial assessment and to the presence of nuclear symptoms and negative schizophrenic features at follow-up.

Background Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis.

Method The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail.

Results There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis.

Conclusions Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.

This is the sixth and final paper of a series studying various symptomatic, physical and social aspects of a sample of 47 cases of infantile psychosis (I.P.) and 33 cases of late onset psychosis (L.O.P.). They were seen at the Park Hospital for Children, Oxford, and the Newcastle Child Psychiatry Unit.

This study questions the prevailing view that schizophrenic delusions, hallucinations and incoherence of speech (positive symptoms) reflect loss of cognitive control and that flattening of affect and poverty of speech (negative symptoms) reflect restriction of cognitive processing.

The prevailing view was examined by analysing the thematic organisation of speech produced by 18 patients describing pictures. Results showed that (a) positive and negative symptom schizophrenics did not differ in the control and restriction of thematic speech organisation; (b) speech disordered schizophrenics, positive as well as negative, showed cognitive restriction, by producing fewer inferential ideas than non-speech disordered schizophrenics.

The wider implications of these results are discussed, particularly the implications of (b) for the notion of concreteness in schizophrenia.

Four major categories of nonspecific or common factors are systematically analysed: relationship, expectancy, reorganising, and impact factors. The placebo control method should be discarded in psychotherapy research for two reasons: (a) sham treatment controls are unworkable because common factors in treatment are manifest only when real treatment is administered; and (b) the very events which were once thought of as ‘nonspecific’ noise are now recognised as active therapeutic factors common to many schools.

Of a random sample of new attenders at a dermatology out-patient clinic, 40% were classified as suffering from a psychiatric disorder. There was no correlation between psychiatric morbidity and the severity or site of skin disease. Self-report measures of the behavioural impact of skin disease and attitudes to appearance were related to psychological morbidity. Except in subjects without visible skin pathology (5%) there was no evidence that psychiatric illness was an aetiological factor in the development of skin disease. Self-report measures were used to distinguish between those patients in whom psychiatric morbidity was closely related to skin disease (75%), and those in whom it may be coincidental (20%). Psychological care for the former group is most appropriately provided by physicians, who should be encouraged to improve their detection and management of psychiatric morbidity.

Findings on CT and demographical or clinical data in 80 patients with DSM–III schizophrenia and 45 medical controls were evaluated. Multiple-discriminant analysis showed that the enlargement of the third ventricle and frontal and parietal atrophy could significantly predict the diagnosis of schizophrenia. Widening of Sylvian fissures and parietal atrophy differentiated familial schizophrenics of both horizontal transmission (who had affected siblings) and vertical transmission (who had affected parents or/and offspring) from non-familial patients. Parietal atrophy and a history of birth complications differentiated horizontal from vertical transmission. The CT findings together with some clinical characteristics could differentiate the three subgroups classified by the hereditary form; thus each of these subgroup may belong to a different disease entity, of a different pathophysiology.

Fifty cases of attempted suicide were compared with 50 cases of completed suicide on variables reported to measure suicide risk: the seriousness of the attempt, and the circumstances in which the act occurred discriminated best. Depressive symptoms were more frequent in the suicide group and in the serious attempters' group than in the nonserious attempters' group.

Suicide is a rare phenomenon – in most countries, it explains between 0.5 and 1% of all deaths – no more than 15 per 100 000 population. Although rates increase with age, its impact on the total mortality of the young is greater than its impact on the elderly. Despite its rarity, the subject has attracted, and continues to attract, wide interest among academics and popular writers.

The unwanted effects of the phenothiazines can be divided into two categories; those effects which represent the pharmacodynamic actions of a particular drug and occur as a function of dosage and individual susceptibility; and the hyper-sensitivity reactions (Shepherd et al., 1968). This latter group of side-effects is relatively rare, and there is no suggestion in the literature that they occur more frequently with the injectable long-acting phenothiazines (LAP) than with the oral forms. With the first available long-acting phenothiazine (fluphenazine enanthate) motor side-effects were frequently observed, particularly during the first few days after injection (Millar and Daniel, 1967; Lowther, 1969; Malm, 1970). Initial studies have suggested that fluphenazine decanoate is less likely to produce these unwanted extrapyramidal effects (Neal and Imlah, 1968; Ayd, 1970). So far, however, no study has attempted to make a quantitative evaluation of the problem of side-effects in the clinical situation of longterm medication. Since both the therapeutic efficacy and the unwanted extra-pyramidal side-effects are dose-dependent, it is meaningless to measure the incidence of side-effects without also recording the therapeutic gain: a low incidence of side-effects might only reflect a non-therapeutic dose of medication. Further, any such study should be continued for at least two months after the last reduction in dosage, as it is well recognized that loss of clinical control may be postponed for many weeks after phenothiazines have been discontinued.

Eye-contact is a prominent Non-verbal cue in any Dyadic interaction and can be easily observed and measured. Argyle (1969) has postulated a relationship with Intimacy and Distance, Kendon (1967) described its expressive and regulatory function in conversation and Exline et al. (1965 and 1967) have related it to other variables, e.g. sex, dependency and affiliative needs.

The lumbar air encephalogram (L.A.E.G.) was introduced by Dandy in 1919, and in 1929 the first report of its use in schizophrenia was published by Jacobi and Winkler. Since then numerous papers have appeared, most of which have claimed to demonstrate cerebral atrophy in chronic schizophrenic patients. All these studies have suffered from the fact that no adequate series of normal controls has yet been collected. Most of the authors concerned made no attempt to use controls, nor did they consider the possibility of observer error or of the bias which may exist when the reporting radiologist knows the diagnosis and is looking for abnormalities.

During 1973 there were 169,362 abortions notified to the Chief Medical Officer at the Department of Health. In a leading article the British Medical Journal (1973) acknowledged that ‘bald statistics cannot help to answer the important question of the nature of the physical and emotional sequelae of termination of pregnancy’. The article called for careful prospective studies to assess such sequelae. This paper is a report of a short-term prospective study of the psychiatric sequelae.

The effects of physostigmine on patterns of rCBF in patients with pre-senile Alzheimer's disease were studied using 99mTc-labelled HMPAO SPECT. Regional CBF increased in the left cortex relative to right, with the most significant effect in left frontal and higher frontal regions. Measures of regional brain function, such as SPECT, are an important complement to psychological test batteries in understanding the effects in brain of putative antidementia drugs. SPECT brain imaging could extend our understanding of the action of psychotropic drugs in other major psychiatric illnesses.