Although day care for the mentally ill has been used for almost forty years the potential of the service has not been fully utilised and the movement lacks any sense of overall direction. Day hospitals, the major provider of day care places, have expanded because of practical and financial pressures rather than by their own merit. Meanwhile, day centres have failed to make any significant impact on the psychiatric system, due to a lack of funding to local authorities and their consequent lack of commitment. The result has been a rather ad hoc development of services and a failure to rationalise their activities.

Wrist motor activity was continuously recorded by a solid-state monitor in 12 patients with major depression throughout their stay in hospital; their clinical state was evaluated using three scales. During the day, activity troughs and immobility peaks occurred before noon and around 1500 hrs. Activity level progressively increased, while the duration of immobility decreased, with clinical improvement. The immobility measurement appeared to be a valuable index of depression and is more sensitive than the activity level, mainly for agitated depressed patients. Immobility episodes during the day could suggest the release of an ultradian sleep-wake rhythm in depression.

This study investigates sex differences in patterns of drug taking and related injecting and sexual behaviour among 355 patients attending a London community drug team. The majority of cases attending the service presented with heroin problems. Men were more likely to use heroin by injection and women were more likely to use heroin by inhaling/smoking (‘chasing the dragon’); there was no sex difference in the overall incidence of needle sharing. The delay between first use of the problem drug and first presentation to services was the same for both men and women. Women were more likely to have a sexual partner who was a drug user and to be living with another user than men. This closer social attachment to other drug users was seen as presenting a high risk factor for women with regard to prognosis and treatment.

The older monoamine oxidase inhibitors (MAOIs) are mechanism-based, irreversible inhibitors of MAO; most inhibit both the A and B forms of MAO. Several of the drugs are hydrazine derivatives which have non-specific effects other than MAO inhibition. These properties convey disadvantages, which may be seen as serious, though infrequent, adverse events — the ‘cheese effect’, hepatotoxicity, amphetamine-like activity, orthostatic hypotension and anticholinergic effects. New, reversible MAOIs stem from a variety of chemical classes and are more specific in their effects, with relatively rapid onset of action, direct relationship between plasma concentration and pharmacological effect, and no prolonged carry-over phenomena.

A depression-screening instrument (DSI) was administered to all 25–34-year-old, British-born, married women registered with a health centre on a south-east London housing estate. A disproportionate number of high scorers lived in those dwellings with the highest disadvantagement score. The dwelling interiors of the high DSI scorers were significantly poorer in appearance compared with those of the low scorers. Significantly more of the high scorers (and of their husbands) described the estate as unpleasant, and bad for their children. They raised significantly more objections to other residents' (including children's) behaviour. Their complaints were only partly explicable in terms of their less favourable accommodation.

In a recent edition of the Schizophrenia Bulletin devoted to negative symptoms, the editor suggested at the beginning of his preface that what he called the “positive–negative symptom distinction” had been introduced into psychiatry only a decade previously (Levine, 1985). Many authors in the same volume seemed to agree with him; at least they did not emphasise any continuity with earlier work. There were a few notable exceptions. Since, for more than 30 years, I have seen the relationship between psychological deficit (cognitive defect, negative syndrome) and the productive (florid, positive) symptoms as lying at the heart of the mystery of schizophrenia, it seemed possible that some account of how that interest arose and developed might still be timely. This is part of the history of the Social Psychiatry Research Unit of the Medical Research Council.

Contingency management is highly efficacious in improving outcomes in substance misuse. Whereas a great deal of research has evaluated these interventions empirically, few treatment providers integrate this approach in practice. The rationale for contingency management is described, with a call for expansion of this technique outside the USA.

Mortality rates in psychiatric patients have been reported as higher than those of the general population in Scandinavia (Odegaard, 1952), the United States (Gorwitz et al., 1966; Babigian and Odoroff, 1968), and Scotland (Innes and Millar, 1970). These findings may be related both to a greater prevalence of physical disease amongst psychiatric patients (Kay and Roth, 1955; Culpan et al., 1960; Shepherd et al., 1964; Kay and Bergman, 1966; Eastwood and Trevelyan, 1972) and to a greater frequency of suicide (Stenstedt, 1952; Stenstedt, 1959; Pokorny, 1964).

There have been a few studies of the nature and frequency of mental disorder in the offspring of marriages in which both parents were known to have been mentally ill (Schulz, 1940; 1941, Elsaesser, 1952; Lewis, 1957). A number of psychoses affecting both husband and wife have also been described as examples of folie à deux. Gralnick (1942) reviewed the literature, and found altogether 118 cases of folie à deux, but Ascher (1949) has concluded that such cases are commoner than would appear. The majority of those reported have involved blood relatives, in whom the implications of a “psychosis of association” are questionable, because of similarities in their genetic endowment (Kallmann and Mickey, 1946). However, Gralnick recorded 26 cases of folie à deux involving husband and wife.

Truant is an old French word meaning “vagrant”, and the term “truancy” means “unlawful absence”. The study of truancy in children is chiefly concerned with wandering, staying out from home, and staying away from, and refusing to go to school.

The survey of 140 children under 16 in two subnormality hospitals showed that 3 per cent of the children had definitely been rendered mentally handicapped as a consequence of violent abuse, and that a possible maximum total of 11 per cent might have been thus rendered mentally handicapped. In 24 per cent of the children, neglect was considered to be a contributory factor in reducing intellectual potential.

Impairment of intellect from abuse and neglect, especially in those with ‘vulnerable’ brains due to pre-existing abnormality, may be much commoner in children than is generally realized.

Thirty-six patients who had had infectious mononucleosis (IM) were followed up a year later and assessed by the Middlesex Hospital Questionnaire and by interview or (in five cases) by postal questionnaire. The results support the view that IM leads to depression in a considerable number of cases, but in this series only women were so affected.

There have been reports of a high prevalence of bulimic episodes and the syndromes of bulimia nervosa and DSM-III bulimia in community samples. A group of American authors recently compared the findings of a contemporary survey with those of a survey they had conducted previously and reported a three-fold increase in the prevalence of DSM-III bulimia. The present study replicates a community survey conducted four years ago in Britain. The prevalence of bulimic episodes, self-induced vomiting and bulimia nervosa found in the present survey was very similar to that found in the earlier study.