Of five patients with pervasive developmental disorders (PDDs), four developed psychotic illnesses in adult life. The other was treated with antipsychotic medication for many years following a mistaken diagnosis of schizophrenia.

Antipsychotic agents have been the mainstay in the management of schizophrenia for a number of years. Their therapeutic efficacy is primarily attributed to dopamine receptor antagonism (Creese et al, 1976), leading to a reduction in the positive symptoms of schizophrenia such as paranoia and hallucinations. Unfortunately, they have little effect on the negative symptoms (such as flattened affect, poverty of speech, anhedonia and social withdrawal) or cognitive deficits. The blockade of central dopamine receptors by classical antipsychotic agents also leads to the development of both acute and chronic motor disturbances (extrapyramidal side-effects) (EPS) (Meltzer, 1992).

In 1989 a crisis occurred in a West Country seaside town. Its psychiatric services had been regarded as a vanguard of community care, having been fully established some three years previously when the in-patient facilities which had been based in a mental hospital some 15 miles away were closed. The framework of the new-style service consisted of five mental health centres scattered throughout the residential area and a 60-bed in-patient unit, based in the grounds of the local district general hospital.

The official suicide rate for England and Wales has been higher than Scotland's (1) for at least 70 years. Since national differences in official suicide rates are quite frequently cited as an index of differences in social well-being, it is of some importance to know whether these differences are valid or whether they are merely artefacts caused by varying criteria for deciding what evidence is necessary to write 'suicide’ upon the death certificate.

While the demand for deinstitutionalisation, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of outpatient psychiatric treatment on length of stay in hospital and length of stay in the community. Outpatient care had a significant influence on read mission, but no effect on the length of inpatient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued inpatient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.

Background We evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis.

Method Individuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended.

Results The people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups.

Conclusions Involvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a ‘holding pattern’ in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.

Psychiatric symptoms among medical inpatients in an Indian hospital were assessed: the SRQ was used as a screening instrument, and those with probable psychiatric disorders were given the PSE and MSE, for further, detailed assessment. The prevalence of psychiatric disorders was 34%, with a further 15% reporting distressing psychiatric symptoms only. The most frequent complaints were delirium and adjustment disorders. They were largely associated with connective tissue, as well as cardiovascular and endocrine, disorders, and were characterised by depression, worrying and irritability. The reliability of the SRQ varied with the cut-off score, which gave optimal specificity and sensitivity when set at 9.

This is an attempt to describe a clinical syndrome which has hitherto received very little attention. It is widespread in Africa and has important medicolegal implications.

Significant differences in handedness patterns between groups of psychiatric patients and normal controls were identified in two recent British studies, with substantial disagreement in some important findings. Most of the discrepancies were attributable to the different application of a simple classification of handedness data, and the remainder to differences in sample size. Diagnosis, sex and age were then found to have a similar effect on handedness in both studies. Neurotic patients were similar to controls regardless of classification, whereas mixed handedness in personality disorder depended on it. There was no overall excess of left-handedness among schizophrenics, but trends towards excess sinistrality in men and full dextrality in women approached significance.

A survey of the literature on handicapped children reveals comparatively little on the subject of epilepsy.

Most of the articles dealing with cognitive functions have been concerned wholly or mainly with verbal intelligence as measured by tests of the “Binet” type. Those relating to behavioural or personality traits have been mainly impressionistic.

The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.

In trying to contribute to this symposium one can either comment, in the light of one's own experience, on what the principal speakers say about indications in general, or one can pick out a special problem which requires clarification. I have chosen the latter course. I propose to report on some observations on the effect of “intensive E.C.T.” By this I mean the administration of two to four shocks on successive days over a period of a week or two, which aims at producing a confusional state with deep clouding of consciousness. It is the method that has been advocated in this country by Milligan. Cerletti devotes a section of his report to this method. According to him, it was Bini who first employed it. He noted that it resulted in a temporary and almost complete annihilation of mental life. Cerletti calls it annihilation therapy, l'anéantissement. Nobody who has carried out or witnessed this treatment will deny the aptness of the term. American writers have called it regressive E.C.T. Bini and Milligan have reported very satisfactory and lasting results in chronic neurotics who had failed to respond to other therapies.

Recent sleep research has highlighted two specific anomalies in schizophrenia that have a proven impact on cognition. One is an abnormality of circadian rhythm, reported in this journal in two separate studies over the past year, and the other is the finding in electroencephalograms of reduced sleep spindles.

The experience and perception of effective sources of help of 101 schizophrenic patients were studied. A combination of professional help, social support, and self-coping efforts was listed as helpful. The more experiences patients had with the various sources of help, the better were their outcomes. Premorbid adjustment, exposure to the magnitude and nature of helpful sources, as well as the patients' own ability and motivation to make use of available helpful sources were thought to be important mediating variables for a better outcome. Apart from psychotropic medications, over half of the patients were not using any one of the sources of help mentioned. It remains an important research question whether or not schizophrenic patients may benefit from direct coaching in self-help skills in conjunction with making optimal use of professional and environmental supports.

The generally accepted (Waelsch and Weil-Malherbe, 1964) reduction in the rate of glucose utilization in cases of severe depression could not be confirmed with specifically determined blood glucose in patients given diets high in carbohydrate for three or four days before testing (Herzberg, Coppen and Marks, 1968; Hansen, 1969). Nevertheless, in numerical agreement with previous findings with older methods for blood sugar determination (Henneman, Altschule and Gonz, 1954; Balter and Efron, 1965), depression as a symptom in psychosis correlated highly with elevation of non-glucose carbohydrate concentrations as determined by the colorimetric anthrone method. It was found that elevated whole blood uridine diphosphate glucose (UDPG), enzymatically determined, correlated with depression in psychosis (Hansen, 1969).