This is an account of a model psychosis (6) produced by eating the seed of a tropical American plant which is known in Mexico as ololiuqui. It is only quite recently that Schultes (16) has made order from chaos in the matter of the identity of a climbing vine called Rivea corymbosa. I was introduced to ololiuqui by Mr. Leslie LeCron during a visit to Los Angeles in which he showed me Taylor's (22) article where he compares it with the peyote. Mr. LeCron discovered that seeds of Rivea corymbosa could be obtained from Dr. I. D. Clement, Director of the Atkins Gardens and Research Laboratory of Harvard University. I am indebted to Dr. Clement for sending me a supply of the seeds which would otherwise have been very difficult to obtain. It is reassuring for the investigator to know that the substances with which he is experimenting have been collected by skilled scientists who exercise meticulous care, for medical and pharmacological investigators have very often suffered from improper or imperfect botanical determination.

Although family intervention programmes to instruct relatives in management and coping skills are often effective in reducing schizophrenic relapse, many families either fail to be engaged or withdraw from treatment at an early stage. Some possible reasons for this are described and some suggestions for increasing adherence are made. Adherence with interventions may be viewed as a complex behaviour pattern, and factors increasing or decreasing the probability of such behaviour occurring and being maintained can and should be investigated to maximise the clinical potential of family intervention programmes.

Vicente and his colleagues present admirably concise findings from a large epidemiological survey of non-psychotic psychiatric morbidity in four different geographical locations in Chile (Vicente et al, 2004, this issue). Without gainsaying the importance of psychiatric morbidity in that country, many readers, including local decision-makers, may find it difficult to assimilate these results.

In four studies homosexual patients were randomly allocated to receive either different forms of aversive therapy; or aversive therapy or a positive conditioning procedure. Before and after therapy the patients' sexual orientation was determined by measuring their penile volume responses to moving pictures of nude men and women.

The aversive therapies produced reduction in homosexual feelings and behaviour. In the fourth study the reduction was significantly greater following the aversive compared with the positive conditioning procedure. No significant change in measured sexual orientation occurred in the patients who received aversive therapy compared with those who received positive conditioning. The measured sexual orientation of the homosexual patients after treatment differed significantly from that of heterosexual patients who received aversive therapy for sexual anomalies.

The prevalence of psychiatric illness was studied in 150 epileptic mentally handicapped people (both hospital in-patients and living in the community) and a matched group of 150 non-epileptic controls. The Profile of Abilities and Adjustment (PAA) scale was used for the initial screening of psychiatric illness. Mildly to moderately handicapped individuals who had good communication skills and scored positively on the PAA schedule for psychiatric illness were interviewed using the PSE interview schedule. Severely mentally handicapped individuals who scored positively on the PAA's psychiatric illness subscale were observed and information was gathered from their medical notes and carers. A psychiatric diagnosis was made using DSM–III–R criteria. The non-epileptic group showed significantly more psychiatric illness than the epileptic group. Psychiatric illness was diagnosed in 25% of the cohort.

It is known that official suicide statistics underestimate the incidence of suicide, but it is not clear whether the extent of under-reporting remains constant. An examination of coroners' records in Dublin from 1900 to 1904 and comparison with a similar series in 1964–68 suggests that the underestimation was of similar proportions in both series. It is suggested, therefore, that official suicide statistics are likely to reflect valid temporal changes in suicide and are therefore of value for the study of socio-economic influences on trends in suicide frequency.

Only Scandinavian investigators have reported on demographic aspects of reactive psychoses. Data from the National Health Service, Denmark, for age at first admission, sex, and length of stay in hospital in reactive, manic-depressive and schizophrenic psychoses are analysed. Differences in sex incidence ratios, age at first admission and length of stay are evident between the three psychoses. The differences noted are considered to provide indirect evidence supporting the separate diagnostic categories.

Fluoxetine, a selective serotonin uptake inhibitor (mean dose 73 mg each morning) was compared with amitriptyline (mean dose 122 mg at night) in a double-blind study of 64 depressed out-patients. Fifty patients completed the 6-week trial. The drugs did not differ with respect to psychiatrists' ratings, but amitriptyline was slightly superior with respect to patients' ratings. The amitriptyline-treated group had complaints of dry mouth and dizziness on standing; the fluoxetine-treated group of sleep disturbances, nausea, and headaches.

It is well recognized that bouts of uncontrolled and excessive eating (binges) occur in both a small proportion of patients who are overweight and in about 50 per cent of patients with anorexia nervosa. However, it has only recently been appreciated that many people who fall into neither category also have an eating disorder which is principally characterized by episodes of binge-eating. These people experience a profound and distressing loss of control over eating which results in a grossly disturbed eating pattern. Despite this, their body weight tends to lie within the normal range. The disorder has attracted various names including ‘the dietary chaos syndrome’ (Palmer, 1979), ‘the abnormal normal weight control syndrome’ (Crisp, 1979), ‘bulimia nervosa’ (Russell, 1979), and simply ‘bulimia’ (DSM III, 1980). The term bulimia nervosa is probably the most satisfactory since it conveys the links with anorexia nervosa and emphasises the central role of binge-eating. Russell (1979) proposed the following diagnostic criteria for this syndrome:

To discover why parasuicides who resolved their difficulties repeated self-harm within three-month follow-up at the same rate as those who had not resolved problems, a group of 30 repeaters was compared with 156 non-repeaters. The repeaters had a history of more frequent episodes, beginning younger. Their problems were more severe, the acts of self-harm potentially less lethal. They experienced greater feelings of externally directed hostility, powerlessness, and ‘normlessness'. A constellation of nine variables correctly predicted 81.5% of the repeaters and 77.5% of the non-repeaters. At follow-up the non-repeaters had improved on several parameters but the repeaters were essentially unchanged. The resolvers among the subgroup of repeaters were more like repeaters in the overall sample than the resolvers, which may explain why some parasuicides repeat in spite of resolving their problems.

Clozapine's clinical profile is unique among antipsychotic drugs. What makes it different? For almost two decades researchers have been attempting to answer this question. Based on various data, many hypotheses have been proposed. Using electrophysiological techniques we have found that clozapine, like typical antipsychotic drugs, inactivates most midbrain dopamine cells secondary to the induction of depolarisation block. However, unlike classical antipsychotic drugs, clozapine does not inactivate the nigrostriatal dopamine system. Based on these and other findings the hypothesis of ‘depolarisation block‘ is reviewed and presented as an explanation for clozapine's unique clinical profile. Research data both for and against the hypothesis are then discussed.

The different classifications of homicide used make comparative studies difficult. For our purposes we will sub-divide homicide as follows: (i) ‘Abnormal homicide’, comprising (a) ‘murder-suicide’ in which the murder suspect commits suicide, and (b) ‘abnormal murder’, comprising cases where (i) the murder suspect is mentally ill, or (ii) the court returns a verdict of manslaughter by reason of diminished responsibility. (2) ‘Normal homicide’, a term we will use synonymously with ‘normal murder’, i.e. murder committed by the mentally normal.

The cheese reaction following use of the irreversible monoamine oxidase inhibitors (MAOIs) began to be reported in the UK with increasing frequency from about 1961. By 1965, the underlying mechanism (tyramine-provoked hypertension) had been essentially elucidated. Thereafter, this potentially severe side-effect could have been largely avoided by the use of fairly simple dietary precautions. Unfortunately, suspicion and fear burgeoned, and both the seriousness and the frequency of risk were dramatically inflated. This was a major factor in the subsequent general disuse of the irreversible MAOIs. Second-generation MAOIs which are selective for monoamine oxidase-A and B are now being synthesised and may eliminate the eventuality of hypertension without special dietary precautions.

The sedative effects of single doses of hypnotic drugs in normals are still detectable on behavioural tests 13 hours after administration, and on the electroencephalogram (EEG) at 18 hours (Malpas et al., 1970), and similar results have been noted by other workers (Lader and Walters, 1971). Using measures of driving skill, Betts et al. (1972) have also found that normal subjects may be impaired after five doses of amylobarbitone sodium taken over the preceding 36 hours. However, the relevance of all these results to the prediction of effects in patients for whom the drugs are prescribed is uncertain, as our preliminary report indicated (Legg et al., 1973). Here we present the more detailed results of a study carried out on anxious out-patients, using behavioural and EEG measures to determine whether or not persistent effects were present following a course of 7 days treatment with hypnotic drugs.