Two cases are described where auditory hallucinations persisted, in spite of medication, in two schizophrenic patients, one with acute onset and one with a severe chronic illness. The hallucinations were treated successfully by methods derived from Green's theory that auditory hallucinations are represented in the non-dominant hemisphere.

Background. In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs.

Method. Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients.

Results. Although clinical diagnosis was not a useful predictor of either service utilisation or costs, more than a third of the variation in community care costs could be explained by symptoms, behaviour and personal characteristics at least one year earlier.

Despite the fact that environmental factors have been demonstrated to be important in the genesis of seizures in people with epilepsy, such factors have received scant attention in the education of clinicians or in the provision of services for managing patients with epilepsy. This paper reviews the history of, and literature about, reflex epilepsy, with particular reference to seizures which occur in response to psychological states or stimuli, and discusses the possible implications for management, and the rationale for the use of psychological interventions which may complement drug treatments in the management of epilepsy.

Esketamine has been licensed for ‘treatment-resistant depression’ in the USA, UK and Europe. Licensing trials did not establish efficacy: two trials were negative, one showed a statistically significant but clinically uncertain effect, and a flawed discontinuation trial was included, against Food and Drug Administration precedent. Safety signals – deaths, including suicides, and bladder damage – were minimised.

Childbirth and lactation entail a severe stress on the female sex, and, under certain circumstances, are liable to cause insanity, during the course of which attempts at infanticide and suicide are common. For this reason the insanities connected with child-bearing and lactation have a definite medico-legal aspect. In the past very little has been written on this subject, though infanticide is by no means uncommon, and cases of child murder account for a large percentage of the population of the female division of the State Criminal Lunatic Asylum at Broadmoor. Possibly a study of some of these cases may not be lacking in interest.

A recent court case (16) exposed many of the problems that confront the psychiatrist called upon to perform electroplexy.

In particular it revealed that in 1957, nearly 20 years after E.C.T. had first been used for the treatment of mental disorder, no uniform technique had yet been evolved. The medical witnesses were unable to agree on the use of muscle relaxants or mechanical restraint, but were agreed that there were certain risks attendant upon the use of electroplexy, especially the risk of fractures and the risk to life. It was argued that had the plaintiff received a relaxant drug he might not have sustained bilateral acetabular fractures, but might have suffered an even worse disaster, namely death.

We investigated the effects of zuclopenthixol on aggressive behaviour in patients with intellectual disabilities by randomly withdrawing it after a 6-week period of open treatment. Of the 49 patients responding to the treatment, 39 took part in a randomised withdrawal trial. The placebo subgroup (n=20) showed more aggressive behaviour as indicated by outcomes observed by external raters on the Modified Overt Aggression Scale than did the continuing subgroup (n=19). The results indicate that discontinuation of zuclopenthixol in this population leads to an increase in aggressive behaviour.

It is now ten years since the Drug Clinics were set up. In the early 1960's a long established equilibrium broke down, and the number of narcotic addicts known to the Home Office began to rise steeply. The new addicts were predominantly in their early 20's, and drugs were being obtained either from the over-generous prescribing of a handful of doctors or from the spill-over of this prescribing to the black market (Bewley, 1965 (1), 1966 (2)). Heroin was the essential agent of this epidemic, with cocaine as the major ancillary.

These documents were prepared by Dr J. A. Baldwin, Dr J. Leff and Professor J. K. Wing at the request of the Executive Committee of the Social and Community Psychiatry Group of the College. After extensive consultation they were approved by the Executive and Finance Committee as representing the policy of the Royal College of Psychiatrists.

Copies of the Code of Practice (Annex B), and of the unpublished Annex C, Technical Arrangements for Ensuring Confidentiality and Annex D, General Features of Medical Information Systems, are obtainable from Professor J. K. Wing, M.R.C. Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.

A 14–year-old youth sustained an Injury to the left frontoparietal area, which was followed by evident change in personality and subsequently by an early-onset schizophrenia-like psychosis. Magnetic resonance imaging revealed ventricular dilatation, slightly more marked in the left hemisphere, and cortical atrophy. Some implications of this case for research on schizophrenia itself are discussed.

This investigation has provided evidence against the hypothesis that heterozygous carriers of a schizophrenic gene have a reproductive advantage through enhanced fertility. An advantage arising from lower mortality between birth and the end of the reproductive period was not investigated, but should be examined before we search for other explanations of the apparently stable polymorphism of schizophrenia.

Buspirone is an anxiolytic drug from the azapirone family of molecules. It differs chemically and pharmacologically from the benzodiazepines. Although its profile of efficacy is comparable with that of benzodiazepines, it produces less drowsiness, less psychomotor impairment, less alcohol potentiation, and has less potential for addiction or abuse. Buspirone also appears to have efficacy in major depressive disorders, in comparison with placebo, but its activity in panic disorders is less impressive. It may diminish alcohol dependence both in animals and in chronic alcoholics. Clinical studies in the elderly show no important difference from younger patients in safety and efficacy profile, pharmacokinetics, and dosage requirement. The drug appears to be well tolerated in primary care settings and to be free of adverse clinical interactions with many drugs that might be used concomitantly. However, because its pharmacology differs from that of conventional anxiolytics, patients need to be informed about both its gradual onset of action and absence of euphoria and immediate sedation.

Of 146 elderly subjects suffering from Alzheimer-type dementia, 44% were found to have significant extrapyramidal signs. Although extrapyramidal signs were more common in those who had taken neuroleptic drugs in the preceding six months, 22 subjects (15%) who were drug free also had extrapyramidal signs. Scores for cognitive function and for ‘frontal lobe’ signs (verbal fluency, evidence of perseveration, and primitive reflexes) were found to correlate well with scores for extrapyramidal signs, suggesting that they reflect changes in a common substratum. It is tentatively suggested that this might be an abnormality in the dopamine system.

There have been two surveys of the patient population of Glenside Hospital, Bristol, in recent years—Cooper and Early (1961), and Early and Magnus (1966). Since the 1961 review, a considerable number of patients admitted have become “chronic”, i.e. have remained continuously in hospital for over one year. An attempt to enquire into this problem has been made.

Systematic psychiatric studies of tattooed men are rare. Lander and Kohn (1943) noted that they had a higher rate of rejection for military service on psychiatric grounds than non-tattooed men. Yamamoto et al. (1963) studied the male population of a Veterans Hospital. They compared the 65 (15 per cent) men who were tattooed with the 368 who were not. They found that the percentage of tattooed men on the psychiatric wards was not significantly higher than that on the general medical or surgical wards; the tattooed men, however, exhibited significantly more evidence of personality deviation than the non-tattooed men.

For a long time, monoamine oxidase inhibitors (MAOIs) have been the Cinderella drugs of psycho-pharmacy. Although they were introduced just before the tricyclic antidepressants (TCAs), they rapidly became second-line treatments. Several factors contributed to this, in particular the dietary restrictions, the scattered reports of death from overdose and/or toxic interactions, and the unfavourable reports on the efficacy of phenelzine in depression from, among others, the Medical Research Council trial (1965). For a number of years afterwards, prescription of these drugs was limited to a few enthusiasts. More recently, however, their popularity has increased owing firstly to a re-evaluation of their effectiveness in tricyclic-resistant depression and in anxiety disorders, and secondly to growing awareness of the exaggerated claims made about their dangerousness (Pare, 1985).