Daily measurement of mood, and the occurrence of specific eating behaviours, were assessed concurrently over an eight-week period in a sample of 50 patients meeting diagnostic criteria for bulimia nervosa. Results of observer-rated scales of mood showed a significant reduction of scores, whereas self-assessment of mood showed no change over the study period. Negative mood states, although not severe, were more marked when the specific behavioural symptoms of binge-eating, vomiting, or purging occurred, and they increased as abnormal eating behaviours accumulated. It is suggested that the accompanying dysphoric mood states of bulimia nervosa are likely to be a secondary manifestation related to the presence of abnormal eating symptoms, and that they do no constitute a primary depressive illness.

Four mentally defective patients who were suffering from short-cycle manic-depressive psychosis were each studied under metabolic ward conditions for about six months. Weekly estimations of erythrocyte Na-K ATPase activity, ouabain sensitive potassium influx, sodium concentration, whole blood cell ATP concentration and blood haematocrit were made. The findings in each patient differed, but the erythrocyte Na-K ATPase activity, sodium and ATP concentration appeared to show cyclic changes related to, though out of phase with, the clinical state.

Temporal stability of symptom patterns was examined in 33 depressives studied initially at the height of illness and again some months later in a relapse following earlier recovery. Relapse symptoms were significantly less severe at the time of rating, and initial and relapse severity were not significantly related. Nevertheless there were significant correlations between initial and relapse scores on two factors orthogonal to severity. One of these reflected symptom patterns important to the endogenous-neurotic distinction, the other a contrast between depression and anxiety. These findings indicate some consistency in symptom patterns in successive episodes of depression, and thereby support the value of clinical classifications depending on symptom patterns.

Patients were treated with three different types of electroconvulsive therapy in random order in the first three sessions of their courses. Anaesthetic and muscle relaxants were administered in standard doses, and treatment applied a set time after bolus injection. Electroencephalographic recordings were undertaken before, during, and after treatment, and hormonal measures before and after. The responses to treatment differed between the three types of current in both EEG and prolactin measures. It is suggested that the quality of the convulsive response varies with different currents.

Prescription-event monitoring (PEM) is one of two national systems of drug safety monitoring practised in Britain. The objective of this PEM study was to assess the safety of fluvoxamine and to monitor the occurrence of untoward and other events during treatment. A total of 10 401 patients treated with the drug in general practices throughout England were studied and data were analysed in the Drug Safety Research Unit, Southampton. The main outcome measures were the overall incidence of events per 1000 patients; the incidence during the first month of treatment; the mean incidence for months 2–6 of treatment; and the ratio of these rates as a signal that an event could be drug related. The most commonly reported category of events was neuropsychiatric while the most commonly reported individual events were nausea and vomiting. Fluvoxamine was shown to be a safe drug and no unexpected or previously undetected drug-related events were encountered. There was a relatively high incidence of gastro-intestinal symptoms, but other adverse reactions often encountered during treatment with tricyclic antidepressants were not frequently reported.

A psychosocial intervention is described geared to the needs of carers of the long-term mentally ill, which is feasible for a busy clinical team to implement: relatives were not selected for the group by patient diagnosis or motivation and little extra staff input was required. An interactive education session at home was followed by a monthly relatives group which aimed to reduce components of expressed emotion (EE) and to alleviate burden. The group facilitators adopted a directive but non-judgemental style, and constructive coping efforts were encouraged. The intervention was effective at reducing EE and improving family relationships. The study offers a realistic model of how to offer support to people providing long-term care for the severely mentally ill.

Psychiatrists have an essential role to play in promoting human rights in mental healthcare. The World Health Organization's QualityRights initiative, in partnership with different stakeholders, is improving the quality of psychiatric care in different countries.

Few studies have assessed psychopathic traits in community samples of young people. We investigated the predictive utility of callous and unemotional traits in a representative sample of 5770 young people from Great Britain. Teachers provided information on the presence of callous and unemotional traits and parents completed the Strengths and Difficulties Questionnaire to determine the level and impact of psychiatric problems at baseline, 12 and 24 months later. Baseline callous and unemotional trait scores independently predicted the number and intensity of conduct, emotional and hyperactivity symptoms at follow-up. Callous and unemotional traits are longitudinally associated with the level and impact of childhood psychiatric problems.

Of all known schizophrenics living in Nithsdale, south-west Scotland, 146 (88%) were examined for the presence of the three principal movement disorders secondary to antipsychotic medication, namely akathisia, tardive dyskinesia and Parkinsonism. Of these, 18% had akathisia, 5% pseudoakathisia, 29% tardive dyskinesia, 8% persistent tardive dyskinesia, and 27% Parkinsonism. No movement disorder was seen in 44%, 36% had one and 20% had more than one movement disorder. Plasma neuroleptic levels at the time of clinical assessment were measured by the radioreceptor technique. Correlations between dose and plasma level were low; the ratio of mean plasma concentration to mean dose was greatest with fluphenazine decanoate and lowest for sulpiride. The concentration:dose ratio was higher in the elderly. There was no relationship between neuroleptic levels and akathisia, Parkinsonism or tardive dyskinesia. Additional psychotropic medication influenced neuroleptic levels. In 9% of patients receiving oral antipsychotic medication, no drug was detected in plasma.

The level of expressed emotion (EE) in 32 relationships between relatives and schizophrenic patients was assessed on three separate occasions over five years. EE was high on all three occasions in 25% of relatives, low on all three in 38%, and fluctuating in 38%; that is, in the majority of relatives (63%) the level of EE was stable over time. Three relatives who had previously shown high EE had evidence of dementia at the time of the third assessment, and showed low EE. Fourteen patients relapsed at least once over five years; patients who relapsed were evenly spread throughout those living in a home in which EE was consistently high, consistently low, or fluctuating. However, patients living in low-EE homes who did relapse did so significantly less often than those who relapsed and were living in homes in which EE was high or fluctuating. At the time of relapse, EE was not consistently high, and some patients in consistently high-EE homes did not relapse at all over five years.

Many experimental findings suggest that disturbances of noradrenergic neurons in the CNS are involved in the pathogenesis of depressive disorders. Moreover, evidence indicates that adaptive changes of central noradrenergic neurons contribute to the biochemical mechanism of action of most anti-depressive treatments (Goodwin, 1984; Johnstone, 1982). Accordingly, assessing the activity of central noradrenergic neurons in depressive patients has become important in psychiatric research.

Forty-nine first episode schizophrenics were identified and considered to be representative of the parent schizophrenic population. Patients were rated before treatment with the Present State Examination. Findings are presented with regard to Catego classes, prevalence of first rank symptoms, conformity to ICD diagnoses, Feighner and Research Diagnostic Criteria and presence of a depressive syndrome. Physical examination revealed isolated neurological signs; in addition two neuroleptically naive patients had abnormal involuntary movements.

L-5HTP and tranylcypromine were compared in an open, but controlled and cross-over study, in patients suffering from major depression; all were non-responders to several reuptake inhibitors, including oxaprotiline and fluvoxamine. After four unsuccessful sleep-deprivations, L-5HTP or tranylcypromine were given during four weeks in a crossover design. Of 17 patients given L-5HTP during both treatment periods, none responded, whereas of 26 patients treated with tranylcypromine, 15 responded. Thus, L-5HTP is not a therapeutically effective alternative in depressed patients who have not responded to reuptake inhibitors.