We asked 24 patients with anorexia nervosa and 30 normal controls to estimate their body-size several times, each time using different instructions. The degree of over-estimation was found to vary predictably with the wording of the instructions. Informing the subject that she had made an error without specifying the direction of the error resulted in reduced over-estimation on a subsequent trial, for both anorexics and controls. ‘Internally directed’ instructions were associated with a greater degree of over-estimation than ‘external’ instructions in both groups, but particularly in anorexic subjects. Our results indicate the necessity of controlling the ‘demand characteristics' of such experiments.

There is a commonly held conviction among physicians and the lay public that oral contraceptive agents are associated with a high incidence of adverse psychological effects, particularly depressive symptoms. This belief is enhanced by a body of literature which includes case reports, studies of small samples, and overall side effect incidence rates (1–22). Careful, adequately controlled, objective studies of emotional reactions are, however, lacking, and this can be ascribed to the serious problems inherent in the design of such studies. For example, adequate control groups are difficult to establish, and contraceptives cannot easily be randomly assigned. Studies using a placebo must also introduce other contraceptives; nonrandom processes operate in the selection of women for study. Suggestibility secondary to use of medication requires placebo double-blind studies in order to differentiate the psychological from the pharmacological effects.

The purpose of the study was to clarify the attitude of patients with schizophrenia and paranoid psychoses towards hospital personnel and treatment procedures during the two pre-suicidal months. The study was carried out on subjects from south Finland who had committed suicide during a three-year period and had been treated under these diagnoses. The controls included suicides who had received psychiatric treatment for other reasons. A questionnaire was issued to ascertain the opinions of the doctor last in charge of the patient and other personnel. Both groups answered independently, and the opinions given were almost the same. Both groups stated that during the last pre-suicidal months the patients with schizophrenia and paranoid psychoses had shown a more negative or indifferent attitude towards personnel than the controls, and their attitude towards medication had been clearly more negative. Among them there were considerably more patients who had ceased to request support or attention. Thus these patients had developed a degree of despair which manifested itself in a negative attitude towards personnel and treatment.

In discussing current trends in mental hospital statistics, it is convenient to make a distinction between patients who have been resident for more than two years (the longstay group) and short or medium stay patients. The chances of discharge, once an individual has been resident for two years, are low and become progressively lower the longer he stays. In mental hospitals in England and Wales from 70 to 80 per cent. of patients are longstay; and the majority of these are diagnosed as schizophrenic (75 per cent. in 1954), although no more than one-third of newly admitted patients are given this diagnosis. There has been a consistent tendency over the past 30 years for a decreasing proportion of schizophrenic patients to be retained continuously for two years after admission—for example, about 60 per cent. of schizophrenics admitted in 1930 were retained in this way, compared with 30 per cent. in 1950 (Brown, 1960). Since then there have been important changes in social treatments and administrative policies, and the major tranquillizers have been introduced. The proportion of schizophrenics retained for two years or more has now approached 10 per cent. at many hospitals (Brown, 1959; Wing et al., 1959). However, very little is known in numerical terms about the extent to which the patients have to be readmitted to hospital once they have been discharged. The only satisfactory studies of the readmission of schizophrenic patients were made before the introduction of the recent changes in discharge policy, and dealt with admission cohorts in which the proportion retained for two years ranged from 60 to 30 per cent. (e.g. Freyhan, 1958; Shepherd, 1957). Reduction within this range did not appear to lead to an increased risk of readmission. However, the possibility cannot be dismissed that a further reduction would lead to the discharge of patients with a special liability to relapse and readmission.

It was in 1923 that J. Capgras (1) first described the syndrome of non-recognition which has since come to be associated with his name.

In this editorial we argue for the need for better research evidence on the prevalence of child mental health problems in minority ethnic groups, service utilisation among these groups and whether some service barriers are specific for certain groups. Without such evidence it is not possible to influence policy and practice so that evidence-based and appropriate services can be designed and offered to these populations. The terms ethnicity, race and migration are often imprecisely defined, and mental health needs and outcomes vary between immigrants from different generations. There is also a complex interplay between minority status and social class, with terms such as ethnicity being a proxy for multifaceted sociocultural and economic variables. However, we need to start collecting better data on children from minority ethnic groups so that these relationships can be understood, services tailored on the available evidence and ultimately better care delivered to this group of children.

We assessed whether adult Black and minority ethnic (BME) patients detained for involuntary psychiatric treatment experienced more coercion than similar White patients. We found no evidence of this from patient interviews or from hospital records. The area (mental health trust) where people were treated was strongly associated with both the experience of coercion and the recording of a coercive measure in their records. Regarding charges of institutional racism in psychiatry, this study highlights the importance of investigating the role of area characteristics when assessing the relationship between ethnicity and patient management.

The authors were sent to Mwinilunga from Ndola to investigate what was reported to the local press as ‘mysterious madness'. The condition was actually an outbreak of epidemic hysteria which was triggerred off by a group of girls who were having educational and emotional problems prior to the epidemic.

A change in the administrative policy of rigidly segregating the sexes apparently prepared an emotionally charged background for the rapid spread of the illness. The salient features and management of the epidemic are discussed.

The development of antipsychotic drugs has followed two complementary approaches, either towards highly specific actions (e.g. on the dopamine receptor) or targeting a broad range of receptors. The properties of ‘atypical’ agents challenge the original dopamine hypothesis and suggest roles for a variety of dopamine receptors and for other pathways, such as serotonin. Older drugs, despite their proven efficacy in relieving many schizophrenic symptoms, have several drawbacks, being ineffective in some patients, relatively ineffective against negative symptoms, and causing adverse neurological effects which may, in turn, be associated with poor compliance. Among newer agents, currently available ones, such as clozapine and risperidone, offer the possibility of more effective control of negative symptoms and an improved side-effect profile, while others are in earlier stages of development. However, much still remains to be understood about their mechanisms of action.

In spite of a decrease in the number of electroconvulsive treatments (ECT) administered during the decade 1966–1975, ECT is still commonly used in Sweden. About 4 per cent of all patients admitted for psychiatric treatment during 1975 received ECT. Affective disorders and confusional states appear to be the main indications. Treatment is usually unilateral, with general anaesthesia and muscle relaxants, generally using the same type of ECT machine.

Recent clinical studies have identified significant olfactory deficits in several neuropsychiatric disorders, notably Alzheimer's disease and Parkinson's disease. These have correlated with neurochemical and neuropathological studies of the olfactory system. The presence of a specific sensory deficit may be related to the localisation of pathology within the brain. There is a need for incorporation of olfactory testing into routine clinical examination.

In a pilot study, SPECT was used to explore differences in rCBF between a group of patients with schizophrenia-like psychoses of epilepsy (SLPE) and a matched group of epileptic controls. Five patients in each group were investigated and those with SLPE showed significant reductions in the index of rCBF in the left medial temporal region. These differences are being investigated further.

A 46-year-old mother with a history of chronic headaches and other symptoms, and a clinical diagnosis (in Western terms) of depression, ascribed her condition to non-observance of Chinese postpartum ritual. The characteristic features of ‘wind illness' are described. Western medicine proved useless but acupuncture was beneficial. The case underlines the importance of understanding the patient's own view of his/her illness and its causes in arriving at a correct diagnosis and intervening effectively: this is particularly true when the gap between the doctor's and the patient's cultures is wide. The value of the distinction between the disease (the pathological process, which may be universal) and an episode of illness (the personal and cultural construction of disease) is emphasized.