Seventeen fasting patients with anorexia nervosa and 15 who also binged were compared in terms of their psychosocial functioning and associated psychiatric symptomatology, using the Delusions Symptoms and States Inventory (Foulds & Bedford, 1975). Both groups scored very highly on the state of anxiety, depression, and elation sets of the DSSI, but less highly on the compulsive and ruminative symptoms sets and on the phobic dissociative and conversion symptom sets. The bingeing anorexic group was significantly older and heavier than the fasting group and experienced more feelings of self-harm and guilt. The bingeing group reported sexual interference during childhood, and currently experienced a desire to vomit during sexual activity to a significantly greater degree than the fasting group.

This paper describes the development of a standardized report intended for the assessment of the work behaviour of psychiatric patients in hospital workshops and clerical units. The report form was developed in the Rehabilitation Unit of the Maudsley Hospital, and primarily within the workshops and clerical section which are integral parts of the coordinated unit.

The treatment of severely disturbed patients is strengthened in an important way by listening closely to them and by attempting to understand their experience in the depth that is made possible by the use of psychoanalytic concepts. It follows that the practice of clinical psychiatry in the UK would be greatly improved by the introduction of a psychoanalytic and psychotherapeutic perspective into the acute ward. This paper reviews the work done on a ward at the Maudsley Hospital in which this approach was the practice.

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.

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.

El-Zar is one of the most popular traditional healing cults in Egypt, and it seems to have been introduced into the country from Sudan through Ethiopia. The word “Zar” means, in Amharic, the “devil” or “spirit”. Literally, the word is a derivative of the verb “to visit” and implies the intermittent visit of some wicked spirit. In practice, it generally connotes the gathering of some women, headed by a woman called “kodia”, with the purpose of exorcizing evil spirits.

A young male castrated himself in response to the biblical passage, Matthew 19:12. Although extremely rare, autocastration usually occurs in men with chronic paranoid schizophrenia, with a long history of delusions of sexual guilt which can only be relieved by castration. Management of these patients is long-term, involving both pharmacotherapy and individual and family therapy.

We report a case in which clozapine caused a marked and disabling exacerbation of obsessive–compulsive rituals in a patient with schizophrenia.

“Nature, in the production of diseases, is uniform and consistent; so much so, that for the same disease in different persons the symptoms are for the most part the same; and the self-same phenomena that you could observe in the sickness of a Socrates you would observe in the sickness of a simpleton. Just so the universal characters of a plant are extending to every individual of the species; and whoever (I speak in the way of illustration) should accurately describe the colour, the taste, the smell, the figure, etc. of the single violet would find that his description held good, there or thereabout, for all the violets of that particular species upon the face of the earth.”

In her sociological study of suicide Cavan (1928) commented that “up to date no adequate studies have been made of the relation of the habit of drinking to suicidal tendencies”. Ten years later, Merrill Moore (1939) makes a similar complaint: “What relation, if any, is there between alcoholism and suicide? This question has never been definitely answered and little has been written about it… In the entire literature of medicine hardly more than twenty acceptable articles on this subject are recorded.” Little has been written on the topic since then.

One of the main advantages of clozapine is that it rarely produces extrapyramidal syndromes and tardive dyskinesia. This advantage is linked to the atypical biochemical profile of clozapine, especially its combined and low blockade of D1 and D2 receptors. The level of D2 receptor blockade is too low to induce extrapyramidal side-effects, and D1 antagonists have a lower extrapyramidal side-effect potential than traditional D2 neuroleptics, especially with respect to dystonia. The combined and balanced D1/D2 receptor blockade may prevent the development of a dysbalance between D1/D2 receptor function (in favour of D1) which otherwise might lead to tardive dyskinesia.

Three separate studies were carried out to examine the patterns of mental health care in an Indian village. The first examined the conceptual frameworks of the various traditional and modern healers. The second was an attitude study inquiring about the type of healer favoured for psychiatric consultation. The third was a population survey in which every person with one or more symptoms was asked if he or she had consulted anyone for relief of distress.

Besides the modern doctors there were three types of traditional healers: Vaids, practising an empirical system of indigenous medicine; Mantarwadis, curing through astrology and charms; and Patris, who acted as mediums for spirits and demons.

It was found that a large majority (59 per cent) of those with symptoms had consulted someone. The consultation was determined more by the severity of illness than by socio-demographic factors. Modern doctors were more popular, but most people consulted both traditional and modern healers without regards to the latter's contradictory conceptual framework. Literacy and other sociodemographic factors had no influence on the type of consultation.

A conclusion was reached that any scheme for introducing modern psychiatry into rural areas should make use of the locally popular healers, both traditional or modern.

The association between the familial risk for schizophrenia and season of birth was studied in 88 schizophrenic patients. An increased risk for schizophrenia and ‘spectrum’ disorders was demonstrated among the first-degree relatives of winter and spring-born schizophrenic patients. However, patients with a family history of schizophrenia and ‘spectrum’ disorders did not differ from patients with no family history with respect to season of birth. Season of birth was unrelated to the sex of the patient, birth order, age at onset, or clinical subtypes (paranoid vs non-paranoid, as defined by the RDC, and ‘narrow’ vs ‘broad’, as defined by Taylor & Abrams' 1975 criteria). The morbid-risk data support a ‘stress-diathesis' hypothesis whereby environmental factors (in this case a seasonally varying viral insult may be implicated) interact with genetic vulnerability to increase the risk for schizophrenia.