Investigation of the prevalence of eating disorders among a large sample of Japanese alcoholics admitted for hospital treatment revealed a strong association between eating disorders and alcohol abuse and alcohol dependence among young women. That association was not apparent in young men. The results of this study of the clinical courses of eating disorders and alcohol abuse and alcohol dependence suggest that women with eating disorders, especially bulimia nervosa, are at high risk of becoming alcoholic.

A conspicuous deficiency of practically all birth order studies is the absence of a general population control group. Instead, a number of statistical methods of estimating the expected number of subjects in each sibling position have been used. These are based upon the assumption that for any given size of sibship there should be equal numbers of subjects in each birth rank. As Price and Hare (1969) have pointed out, there are a number of reasons why such as assumption is incorrect, and therefore why the conclusions based upon it are unreliable. Because, in most studies, only relatively small numbers of patients are available various methods of combining sibships of different sizes are adopted and the sexes of the siblings are ignored. To consider a sibling position irrespective of the size and composition of the sibship in which it occurs is unjustifiable. As birth order effects are relatively slight, large numbers of subjects are required to detect them. Unless a patient sample of several thousand is used the numbers in any sibship size are too small to permit analysis by birth rank. As sibship size is itself a possible variable, and as within each sibship the sexes of the siblings can be distributed in a variety of ways, birth order studies should ideally consider one sibship size at a time and should investigate sibling position by sex of sibling. Unfortunately, in sibships of four or more the numbers of combinations become so great as to render this approach impracticable.

Many years ago Eugen Bleuler postulated a correlation between alcoholic hallucinosis and schizophrenia. In his textbook, he stated his belief that ‘alcholic hallucinosis could … be a mere syndrome of schizophrenia induced by alcohol (1)’.

The contribution of genetic differences to variation in ageing and the relationship of ageing to certain types of dementia are discussed. Neuropathological changes commonly found in the ageing brain are present in more severe form in Alzheimer-type dementia, Down's syndrome, multi-infarct dementia, and a substantial number of patients with Parkinson's disease. An increased frequency of ageing-associated changes outside the brain have been reported in Alzheimer-type dementia, Down's syndrome, and multi-infarct dementia, although the evidence is generally meagre and in many cases requires further corroboration. Genetic studies of Alzheimer-type dementia support the existence of heterogeneity on the basis of family history and age of onset; early onset is associated with greater genetic risk and severity of abnormality. The increasing evidence of an association between DNA damage, premature ageing, and neuronal cell loss may provide insights into the aetiology of these and other forms of dementia.

Psychoanalytic literature has a number of references to suicidal acts taking place on the anniversary of the death of a loved person. Anniversaries of significant bereavements have been seen as likely to reactivate a depressive syndrome and as possible precipitants of suicide. Zilboorg (7) suggested that suicides might take their lives on the anniversary of a parent's death as though to expiate the death which they unconsciously perceived as the result of their own wishes. Others have seen the meaning of the suicide's act as a fantasied rebirth or new beginning with a lost love object, and the supposed occurrence of suicides on the anniversary of a death has again been instanced as support (Jackson (3)).

Two cases of catatonic stupor are described due to presumed encephalitis lethargica. Catatonic and obsessional phenomena in the setting of a depressive psychosis associated with a movement disorder may constitute a post-encephalitic syndrome.

There have been reports that low doses of the dopamine-agonist apomorphine, which may inhibit dopamine neurotransmission, are of therapeutic benefit in schizophrenia. We conducted a placebo-controlled study of acute and chronic schizophrenics in which videotaped interviews were blindly rated. No specific therapeutic effect was demonstrated for apomorphine other than a reduction in anxiety in acute schizophrenics. Furthermore, there was no difference in the frequency of side-effects of apomorphine between schizophrenic patients and controls, and no specific effect of apomorphine on blink-rates. These findings emphasize the importance of placebo-controlled studies in schizophrenia research.

Studies of therapeutic contact following self-harm have had mixed results. We carried out a pilot randomised controlled trial comparing an intervention (information leaflet listing sources of help, two telephone calls soon after presentation and a series of letters over 12 months) to usual treatment alone in 66 adults presenting with self-harm to two hospitals. We found that our methodology was feasible, recruitment was challenging and repeat self-harm was more common in those who received the intervention (12-month repetition rate 34.4% v. 12.5%).

The authors undertook to investigate the effects of two new phenothiazine derivatives on schizophrenic patients. Over a period of two years a series of clinical trials have been carried out on approximately 260 patients, some controlled, some uncontrolled. These drugs, known as Melleril (TP21) and KS75 are chemically related. Although Melleril was ultimately selected as the drug of choice we have, for statistical reasons, included some of the findings with KS75.

As Bleuler (1925) pointed out, all our relationships with our human environment are regulated through language. For this, auditory perception is essential, this can only take place if the peripheral auditory mechanism (viz., the tympanic membrane, ossicles, spiral ganglion of Corti and VIIIth nerve) is not diseased. When a person becomes deaf through disease of any of the latter, it does not matter which one of the peripheral mechanisms is involved, the result is always the same. Often not knowing what his fellow men are saying he becomes doubtful about them: losing auditory contact with them he has to rely on an inner world of auditory memories and images; he misinterprets auditory sense impressions which have been distorted by disease, and incorporates tinnitus caused by such disease into his world of inner phantasy. He projects his inner feelings of inferiority caused by his deafness on to his environment and develops ideas of reference. Systematization soon follows, with active delusions of persecution. If the personality is sufficiently unstable a psychotic illness results.

HLA antigens were typed among 136 Japanese schizophrenics. Increased frequencies were seen in A9 (Aw24), A10 (A26) and Bw54, and decreased frequency in B40 antigens when compared to 187 Japanese controls. It is suggested that there may be an association between A9 (Aw24) and schizophrenia with a chronic-progressive course and also an association between A10 (A26) and hebephrenia.

Levi-Strauss (1977) describes what happened to a child, in a primitive tribe, accused of sorcery–a crime punishable by death. The child invented more and more complex stories by way of self-justification. In the end his accusers believed his outlandish explanation because “the choice is not between this system and another but between this system and no system at all-chaos.” The child's plight can represent the close affinity between magic and hysteria; his accusers might represent those contemporary psychiatrists who would prefer any system of classification of hysteria, however absurd, to no system at all (Sheehan & Sheehan, 1982a, b; DSM-III, 1980).

Among the numerous reports on toxic side effects of antidepressant drugs, the monoamine oxidase inhibitors appear prominent in causing such a variety of serious complications (4) that many physicians prefer to avoid their use altogether, and prefer other drugs (such as the Iminodibenzyl group) that produce their euphoriant effects more slowly but also more safely.

Rampton is a Special Hospital catering mainly for subnormal and psychopathic patients with histories of dangerous and violent behaviour. Earlier work (McKerracher, Street, Segal, 1966) had shown that female patients were significantly more prone than males to mutilate their own bodies and smash hospital property. Such acts are usually regarded in this hospital as hysterical outbursts in which there is often an insensitivity to pain. Gross lacerations are often inflicted without the patient appearing to experience any suffering. Some kind of hysterical anaesthesia may be involved. It is known that this kind of behaviour is found in long-term patients suffering from (a) schizophrenia and (b) severe character disorder (Offer and Barglow, 1960).

Serum antibody titres to eight neurotropic viruses were measured by enzyme immunoassay in 450 psychiatric in-patients and 143 controls. A seasonal variation in schizophrenic births was observed, with a peak incidence between March and April. Both herpes simplex virus and cytomegalovirus antibody titres correlated with age and, when this was controlled for, no significant differences emerged between any patient group and the controls. Mumps antibody titres were significantly lower in patients with mental subnormal and neurosis or personality disorder; measles and rubella antibody titres were lower in male but not female mentally handicapped patients; males had lower antibody titres to mumps, cytomegalovirus and Epstein-Barr virus than females in all groups. A decrease in mumps antibody titres was also found in schizophrenics if the medication factor was excluded. These low antibody titres may indicate an impaired immune response. Thus perinatal or childhood subclinical viral infections of the central nervous system, particularly of mumps, might lead to a range of possible psychiatric outcomes in later life.

The available evidence suggests that adolescent drug addicts are likely to have an underlying personality disorder, to come from broken homes, and to have parents who are alcoholic, antisocial or mentally ill (Nylander, 1964; Chein, 1965; Rosenberg, 1969a and b). Assuming that a background of family instability is related to deviant behaviour—including the abuse of drugs—it seems probable that some of the siblings of young addicts, who grew up in similar circumstances, would also become the subjects of psychiatric disorder.