An investigation was carried out in 1986 of 41 patients, 39 female and 2 male, who had been treated for anorexia nervosa in a psychiatric ward at a general hospital between 1958 and 1980. A follow-up analysis was carried out, in which 30 subjects participated. Using the scores on the 40-item version of the EAT as outcome criteria, validated by the Morgan–Hayward outcome scales, the outcome distribution and rate of mortality was in agreement with previous findings. Further data concerning weight, menstruation, and nutritional, social and psychiatric status were based on a semistructured interview as well as on the scores on the EAT, the GHQ, and the MMPI. Prognostic variables were analysed, indicating that duration of illness, poor motivation for treatment, social withdrawal, and poor family relations were significant as predictors of poor outcome.

The study to be reported was carried out within the framework of Personal Construct theory as proposed by Kelly (1955) and summarized in Bannister (1962).

In a sample of young mothers an association was found between a depressed mood and the recall of poor parental relationships during childhood. Women who had been depressed but had recovered by the time of questioning did not recall a poor relationship. A second retrospective measure of a childhood experience, based on more factual details, was unrelated to current mental state.

Dopamine receptors have been divided into two major types – D1 and D2 – based primarily on pharmacological and biochemical criteria. Recent advances in the molecular biology of the dopamine receptor system have allowed the identification and characterisation of at least five distinct neuronal dopamine receptor genes (D1 to D5). These genes encode dopamine receptors belonging to the D1 receptor family, termed D1 and D5, and three D2-like receptors, termed D2, D3 and D4. These receptors are distinguished on the basis of their primary structure, chromosomal location, mRNA size and tissue distribution, and biochemical and pharmacological differences. Although individually these receptor subtypes may not be directly and exclusively involved in the maintenance or expression of schizophrenia, alterations of any of the receptors may contribute to the perturbation or instability of dopaminergic homeostasis in the brain. What was once thought to be a simple two-receptor system seems to have emerged as an intricate and interactive entity. This review summarises what is currently understood about dopamine receptors, their role in antipsychotic drug action, and their association with psychosis.

An in-patient behavioural psychotherapy unit is described that emphasises self-treatment, teaching relatives to become cotherapists while resident in the unit, routine collection of outcome data, minimising use of medication, and absence of night nurses. Patients are referred from all over the UK, mostly with chronic disabling OCD. Treatment includes self-exposure and self-imposed response prevention. A year's cohort (52 patients) showed substantial improvement that consolidated during six-month follow-up (83% decrease in total ritual time per day, 58% fall in target ritual scores, better social adjustment), and families noted relief of burden; eight patients dropped out. Further such units are needed in the UK, perhaps on a regional basis; they could be run as specialist hostels.

The names of 412 residents of the catchment population of a district general hospital unit who died potentially self-inflicted deaths in the eight years 1974–81 were identified. They were classified as suicide (245), accidental death (126), and undetermined (41). In each group, over half had a lifetime history of psychiatric treatment and over a third were psychiatric patients at the time of their death. The relative risk of a violent death for those who died within a year of their last psychiatric contact was 27 times greater than that of residents with no recent psychiatric contact. The relative risk was highest for those aged 35–44 and lowest for those of 75 years and over.

Acutely ill patients presenting for admission in two district psychiatric services were randomly allocated to day-hospital or in-patient care. In both services a quarter of all admissions could not be allocated because they were too ill (half of these were compulsory admissions); these patients were predominantly manic and schizophrenic patients with pronounced psychotic symptoms and disturbed behaviour. In one service 80% (41/51) of patients randomly allocated to day-hospital treatment were successfully engaged in treatment compared with 54% (19/35) in the other service. This difference arose because only patients with mildly disturbed behaviour could be treated at the second day hospital. For patients who were successfully allocated, the outcome of treatment was similar in terms of psychiatric symptoms and social functioning. The results of a treatment trial for acutely ill patients in one district service cannot be generalised to other district services without due attention to the factors, such as staffing levels, which determine the degree of disturbed behaviour that can be tolerated in the day hospital.

All referrals made to the liaison psychiatric service for HIV and AIDS patients over one year were reviewed. ICD–9 and CDC diagnoses were applied to each case at presentation. Sixty HIV-positive patients were assessed, of whom 35 had affective disorder, which was significantly associated with CDC group IV disease (AIDS). Adjustment reaction was seen in nine patients, paranoid states in six, dementia in four, personality changes in four and paranoid schizophrenia in two. CT scans of the brain were performed on 23 of the patients: 17 of these showed abnormalities. The proportion of registered AIDS patients who were referred was five times the proportion of HIV patients.

A psychiatric investigation on 56 cases of male transsexuals in Singapore revealed a prevalence of 1 in 25,000. Eighty-two per cent were prostitutes and 83 per cent had completed secondary education. All were unmarried, and 35 per cent were co-habiting with men. Fifty-eight per cent had felt they were females before the age of 5, 65 per cent cross-dressed before the age of 10, and by the age of 20, 57 per cent were completely cross-dressed of whom 73 per cent were receiving female sex hormones. Their mean IQ was 105. Thirty-two (58 per cent) underwent sexual reassignment surgery. There was no report of psychiatric complications. It was concluded that transsexualism as described by different authors may not refer to the same condition. Aetiologically, these cases did not appear to be determined by early childhood experience.

Forty-six homosexual men and women who were twins took part in a study of their sexuality and that of their co-twin. Discordance for sexual orientation in the monozygotic pairs confirmed that genetic factors are insufficient explanation of the development of sexual orientation. There was a high level of shared knowledge of sexual orientation between members of twin pairs, and a relatively high likelihood of sexual relations occurring with same sex co-twins at some time, particularly in monozygotic pairs. The implications of these results for the study of the origins of sexual orientation and for twin research are discussed.

Peptidic neurones may be considered as multisignal integrators and transducers. When formation or release of peptide outstrips genetically determined breakdown capacity, overflow of peptides to the body fluids and urine may be expected. In this paper, pathological urinary chromatographic patterns of peptides are shown for genetic, functional and mixed disorders. Part symptoms of the disorders may be induced with the biologically isolated and purified peptides as well as with chemically synthesized peptides.

The place of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression remains unclear. In this sham-controlled study we determined the efficacy and acceptability of fast, left frontal rTMS given three times a week over 4–6 weeks to 29 patients with depression (79% treatment-resistant). The procedure was generally well tolerated and more effective than sham treatment (55 v. 7% responding, P<0.05), with improvement maintained to 12 weeks. This therapy could be a useful addition to available treatments but further research is needed to determine the optimum treatment parameters.

Of 15 patients with writer's cramp (4 females, 11 males, mean age 36, range 23–50, mean duration 3.6 years), 13 entered a behavioural treatment. Nine received a multimodal treatment, and four EMG feedback alone. Four patients dropped out during the treatment phase. Nine patients were considered as improved at a follow-up between 1 and 9 months. A stress-coping model is put forward to account for the therapeutic effectiveness, and to explain the drop-outs. Writer's cramp seems to be related to stressful situations at work. The existence of personality and biological factors remains to be demonstrated.

A Complex is a group of emotionally invested ideas that have unconscious activities. Contrary though it be to the popular and sentimental idea of an overriding mother love, it is common, especially in child psychiatry, to find a mother's lively hatred and even homicidal wishes towards her child. I consider that this should be called “The Medea Complex.”