Since the introduction of the WAIS many short forms have been proposed, but specific problems associated with the assessment of the aged have not been factors influencing their development. The measurement of cognitive functioning in persons over 65 presents the clinician with many difficulties, not least of which is a consideration of time.

Patients who do not comply with therapeutic procedures have been of longstanding concern to the clinician and have presented knotty methodological problems to those involved in evaluating the effectiveness of different treatments and treatment modalities (1, 2, 4, 6, 10, 11, 12, 13).

Previous reports (1 and 2) have shown that very simple questions to a mother about her own childhood, particularly whether she was ever separated from one or both parents, can identify a group of women who are likely to experience difficulty in managing their baby.

Much early research on attempted suicide looked upon this phenomenon as failed, frustrated or bungled suicide, an attitude which still persists among the general population. Conceptually, attempted suicide was viewed as a special case of suicide, and theories about the latter were used to explain the former, without much success. Stengel's influential monograph (Stengel and Cook, 1958) made an important contribution to the study of suicidal behaviour by contending that attempted suicide presented issues peculiar to itself as well as sharing problems with suicide. The definition of attempted suicide offered by Stengel (1964) is as follows, ‘A suicidal attempt is any act of self-damage inflicted with self-destructive intention, however vague and ambiguous. Sometimes this intention has to be inferred from the patient's behaviour.’ Suicidal attempts as thus defined are frequently insufficient to cause death, and must be related to the social setting of the patient. In situations which might be called crises of despair some people injure themselves in order to appeal for help, to spite others or to submit themselves to trial by ordeal. Stengel's definition has found general favour, although Kessel (1966) tried to promote the term self-poisoning, arguing that this term aroused fewer preconceived notions in the minds of the uninitiated.

In a controlled trial of alprazolam and exposure in 154 patients with panic disorder with agoraphobia, relations between panic, anticipatory anxiety, and phobic avoidance were examined. The three symptoms were independent of one another at baseline and improved largely independently during treatment; only early improvement in avoidance predicted global improvement after treatment. Global improvement was more related to reduction of avoidance than a decrease in panics. Panic was not a valuable outcome measure in panic disorder with agoraphobia.

The addition of lithium to the tricyclic antidepressant medication of 23 patients with major depression resulted in an increase in the prolactin response to intravenous l-tryptophan after both four days and four weeks of treatment. The extent of this increase did not distinguish the ten patients who were classified as clinical responders (> 50% reduction in score on the HRSD). Among the responders there was a modestly significant correlation between the decrease in score on the HRSD and the enhancement of tryptophan-induced prolactin release. Some responders, however, showed very little change in this endocrine response over the four weeks of lithium treatment. Lithium may increase brain 5-HT function in tricyclic-resistant depression but there is only limited support for the hypothesis that changes in brain 5-HT function are involved in the antidepressant effect of this treatment combination.

The analysis of patterns of co-occurrence and cotransmission of affective disorders and alcoholism in families may provide clues for understanding the excess comorbidity between these conditions in clinical settings and in the general population. This paper reports the results of a family study of the relatives of patients with bipolar disorder, unipolar depression and alcoholism, and combinations thereof. Excess comorbidity between affective disorders and alcoholism was observed in all groups of relatives. However, the sharing of familial aetiological components was not a major contributor to the excess comorbidity between affective disorders and alcoholism. Unipolar depression and alcoholism segregated independently in families, whereas a modest correlation between familial components of alcoholism and bipolar disorder was observed.

Depressive illness is known to be associated with low self-evaluation, but it has been suggested that there may be a reciprocal connection as well, such that low self-appraisal (in the absence of illness) makes the subsequent onset of depression more likely. A prospective study, using a community sample of 376 women, provided data about clinical state over a period of 18 months, and self-appraisal questionnaire scores were determined on two occasions separated by 6 months. There was no evidence that low self-evaluation predicted future episodes of depressive illness, except in women who reported previous psychological episodes for which they had sought medical help, and, even for those with previous episodes, much of the predictive power of low self-esteem was accounted for by individuals who were subsequently recognised to have been in the early stages of illness. Conversely, there was little evidence that prior episodes predicted future illness in people with high self-esteem. One explanation of the findings is that recurrent episodes of illness cause progressive impairment of self-appraisal, but other possibilities are also considered. Women who had recovered from illnesses detected at the first interview still had significantly less self-confidence 6 months later than those who were well throughout.

Standardised personality assessments were administered to 50 consecutive referrals to an Eating Disorders Clinic. A history of childhood sexual abuse was identified in 30% of patients using a modified version of the SLEI. This rate is comparable with those from other studies. Overall, 52% of the patients were rated as having a personality disorder but a significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse compared with those without a personality disorder (13/26 v. 2/24, Fisher P < 0.001). Although in patients with eating disorders no clear causal link between CSA and personality disorder was demonstrated, our findings emphasise the need to inquire sensitively into the sexual history of such patients.

Attempted suicide has been described as the prime emergency of general practice. Although this may represent a slightly exaggerated claim, the present writers have certainly found attempted suicide to be a frequent reason for the referral of patients to the psychiatric department of a general hospital. The expression “attempted suicide” is usually taken to refer to an unsuccessful attempt to kill oneself: yet such a description is often somewhat inappropriate to describe a dramatic episode of behaviour, during which an assault upon the self occurs as the result of a mood of despair or rage. Death may not be consciously sought and it is more satisfactory to define attempted suicide as a non-fatal act of self-damage.

In a survey of authoritative psychiatric texts, inconsistent, sometimes contradictory use can be found of the terms ‘affect’, ‘mood’, and ‘emotion’. There is some consensus that these terms deal with subsets of the larger domain of feelings, but many authorities, explicitly or implicitly, treat them as at least partially interchangeable. Others see the terms as referring to different phenomena, but disagree on how they differ. In lay usage, feelings are primarily subjective experiences, but the term is used here in a more encompassing, generic sense. In the psychiatric texts, some attributes are frequently used to distinguish among feelings. These include the duration of the phenomena; whether they are subjective, objective or both; the relative involvement of cognition; and whether they are clinically observable or rather reflect the patient's potential for response. Some examples of current usage will be considered before alternative formulations are suggested.

An unselected sample of 204 epileptic patients attending a neurological out-patient clinic in Abeokuta, Nigeria, was evaluated for psychiatric morbidity using the CIS. Thirty-seven per cent emerged as psychiatric cases, almost a third of these being cases of psychosis. Patients with partial seizure of temporal lobe origin were the most psychiatrically impaired, while those with partial seizure of non-temporal lobe origin the least. These findings are broadly similar to those reported for epileptic populations in other studies. However, in spite of the relatively high prevalence of major psychiatric disorders among these patients, their impairments were more likely to remain ‘hidden’ and untreated than those in similar patients in developed countries.

The relationship between child and adult psychiatric illness, though of fundamental importance, has received scant attention, perhaps because of the split which exists between the study and treatment of children and of adults.

Psychopathy is not included in either of the main classification systems (ICD-10 or DSM-IV). Research has now extended the concept of psychopathy to childhood and has produced evidence that it is meaningfully distinct from antisocial behaviour. It is proposed that psychopathy should be accepted as a meaningful diagnosis in childhood.