The names of 412 residents of the catchment population of a district general hospital unit who died potentially self-inflicted deaths in the eight years 1974–81 were identified. They were classified as suicide (245), accidental death (126), and undetermined (41). In each group, over half had a lifetime history of psychiatric treatment and over a third were psychiatric patients at the time of their death. The relative risk of a violent death for those who died within a year of their last psychiatric contact was 27 times greater than that of residents with no recent psychiatric contact. The relative risk was highest for those aged 35–44 and lowest for those of 75 years and over.

A random community survey into psychiatric disorder among women in urban and rural New Zealand found urban women to be more often at age extremes, not married, better educated, in more paid employment, and to have better household and child-care facilities. There were no overall urban–rural differences in the GHQ-28 score, total PSE score or PSE case rates. A multiple regression found the same three factors accounted for most of the explained variance in both the urban and the rural total PSE scores: these were the quality of social networks, difficulties with alcohol, and the past experience of childhood sexual abuse. Low socioeconomic status, poor physical health, and adult experiences of sexual and physical abuse were also associated with increased psychiatric morbidity in both samples. Other individual sociodemographic items were correlated with psychiatric morbidity for the urban or rural sample only.

Using data from the WHO International Pilot Study of Schizophrenia and from our own previously reported series of 120 patients receiving treatment for schizophrenia, we ascertained the degree of agreement between 13 different systems for diagnosing schizophrenia. We identified a triad of symptoms similar to that from the International Pilot Study: auditory hallucinations, passivity feelings, and disturbances of affect. This triad correlated very strongly with the diagnosis of schizophrenia as determined by the 13 diagnostic systems, as well as with response to fluphenazine in our series. The triad should serve as a core set of symptoms in the study of schizophrenic illness. It represents the leading phenomena in a group of patients having what is generally considered to be schizophrenia, although it does not provide a definitive diagnosis. Evidence is needed on its specificity.

Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department. This group was then randomly allocated to hospital admission (38 cases) or discharge home (39 cases). One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms, and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. This lends support to recent government recommendations, but caution should be exercised before such a result is generalised.

It has been questioned whether Asperger's syndrome (AS) is in fact a specific (high-functioning) subgroup of autism, rather than a distinct entity. Thirteen AS patients were compared with 13 autistic patients and 13 developmentally disordered controls. While there was symptom overlap between AS and autism, patients could be separated into one or other group. However, current criteria are based on symptoms, and it is argued that studies of genetics and treatment response are needed to elucidate the relationship between these developmental disorders.

Recently, research into the connection between vitamins and psychiatric disorder, particularly affective changes, has been in the doldrums, with the exceptions perhaps of studies of folic acid and pyridoxine. The best way for research to proceed is first to establish that the association of a vitamin deficiency with a psychiatric disorder is beyond a chance finding. Then, questions should be asked about what mental symptoms it is linked with, and what the other associations (malnutrition, drugs, physical illness, etc) are. Lastly, queries should be raised about whether the association is causal or if the mental symptoms are merely secondary to the anorexia and poor diet so common in mental illness (or whether they are linked in a vicious circle as suggested by Reynolds et al (1971)). These questions became pertinent in the mid-1960s when reliable ways of assaying B vitamins such as folic acid became more generally available. In this review, I present evidence that deficiencies of folic acid, B12, thiamine, riboflavin, pyridoxine and ascorbic acid are not infrequently found in psychiatric practice. It should be remembered, however, that some ways of assaying vitamins are liable to give a larger proportion of spurious low results than other methods (false positives), although the adoption of more reliable ways of assaying vitamins should reduce this.

Resolution of presenting problems at three-month follow-up was studied in 228 parasuicides. ‘Non-resolvers' presented with less severe problems, but prodromes were longer, prior episodes more frequent, and they experienced more powerlessness and internally directed hostility than the resolvers. At follow-up resolvers had improved more on measures of depression, externally and internally directed hostility, locus of control, powerlessness, self-esteem, sensitivity to criticism, and social adjustment. Baseline problem severity, powerlessness (negatively), and ‘normlessness' ‘predicted’ degree of problem resolution, while baseline problem severity, the number of previous parasuicide episodes, and baseline internal hostility (the latter two variables negatively) were associated with problem resolution as a dichotomous variable. Resolvers improved more in social functioning during the follow-up than non-resolvers, but a similar proportion (16%) in each group reported repeat episodes of parasuicide at follow-up.

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14–20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.

An investigation was carried out in 1986 of 41 patients, 39 female and 2 male, who had been treated for anorexia nervosa in a psychiatric ward at a general hospital between 1958 and 1980. A follow-up analysis was carried out, in which 30 subjects participated. Using the scores on the 40-item version of the EAT as outcome criteria, validated by the Morgan–Hayward outcome scales, the outcome distribution and rate of mortality was in agreement with previous findings. Further data concerning weight, menstruation, and nutritional, social and psychiatric status were based on a semistructured interview as well as on the scores on the EAT, the GHQ, and the MMPI. Prognostic variables were analysed, indicating that duration of illness, poor motivation for treatment, social withdrawal, and poor family relations were significant as predictors of poor outcome.

The prevalence of psychiatric disorder in 48 patients with chronic fatigue syndrome (CFS) was determined. Twenty-two had had a major depressive (non-endogenous) episode during the course of their illness, while seven had a current major (non-endogenous) depression. The pre-morbid prevalence of major depression (12.5%) and of total psychiatric disorder (24.5%) was no higher than general community estimates. The pattern of psychiatric symptoms in the CFS patients was significantly different to that of 48 patients with non-endogenous depression, but was comparable with that observed in other medical disorders. Patients with CFS were not excessively hypochrondriacal. We conclude that psychological disturbance is likely to be a consequence of, rather than an antecedent risk factor to the 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.

An unusual and rare variant of Capgras syndrome is reported in which a patient with depressive illness became preoccupied with doubles of inanimate objects. The patient responded to antidepressant therapy.

Based on data from the Danish Central Criminal Register, the total number of mentally retarded offenders serving statutory care orders on a census day decreased from 290 in 1973 to 91 in 1984. The reduction was caused by shorter sentences and a dramatic decrease in the number of sentenced borderline retarded offenders; the total number of sentences per year slightly decreased, and the number of first-time sentences was stable. Crimes of property are decreasing among this population, while violence, arson, and sexual offences are increasing. Behaviour disorder was found in 87.5% of 91 offenders serving care orders in 1984. Offensive behaviour was significantly predicted by early institutionalisation, having retarded or divorced parents of low socio-economic status, and behaviour disorder of social-aggressive type. Independent significant effects were attributed to behaviour disorder and low socioeconomic background. All predictors were closely correlated. Biological factors did not have any significant predictive value.

The 30-item version of the GHQ was administered to 102 adults with epilepsy, and four sets of variables (neurological, psychosocial, medication, demographic) were used to predict psychiatric distress. Psychopathology was found to be associated with increased perceived stigma, elevated number of stressful life events during the past year, poor adjustment to epilepsy, financial stress, vocational problems, external locus of control, and an earlier onset of epilepsy. Multiple regression procedures reduced this list to three independent predictors of psychopathology: an increased number of stressful life events in the past year, poor adjustment to epilepsy, and financial stress.

In a medium-sized Canadian city, 581 randomly selected households were contacted and responded to a survey on the impact of parental alcohol problems. Twenty-two per cent of the respondents indicated that at least one of their parents had a drinking problem. The biological father was affected in 81%. Compared with the rest of the sample, the adult children of problem drinkers were younger but they did not differ in income or education. Adult children of problem drinkers were more likely to have parents who were divorced or separated; to be divorced, separated, or remarried themselves; to be heavy drinkers and have indications of alcohol problems; and to use more sources of help for problems with stress and anxiety and problems with alcohol. They did not differ from those without parental drinking problems on measures of current positive and negative affect.

The clinical management of patients with personality disorders is seldom satisfactory. It is suggested that the bewilderment provoked and experienced by these patients can be reduced by a careful analysis of their shifting states of mind. The construction of diagrams tracing such shifts is helpful to both patients and clinicians. Illustrative case histories are presented.

Six patients who had delusional convictions that they were malodorous were followed up for between six months and four years. Difficulties encountered in clinical settings in differentiating overvalued ideas, delusions, and hallucinations arise from lack of clarity of psychopathological terminology. Schizophrenia and depression are closely related to the syndrome.

Seasonal affective disorder has not previously been linked with neuroanatomical abnormalities despite its relationship to biological rhythms. A 45–year-old woman is described with an arteriovenous abnormality in the right frontotemporal region who developed recurrent winter depression and summer hypomania.

Four elderly schizophrenic patients who had never been treated with neuroleptics, and a fifth patient who had received only the briefest exposure to such drugs, had retained their distinct clinical characteristics. Involuntary orofacial movements and cognitive dysfunction were found more uniformly than any particular pattern of symptoms.

Within the setting of a regional secure unit, all doses of medication given p.r.n. over three months were ascertained and the details of each administration determined from prescription charts and a semistructured interview with the nursing staff involved. Thirty-two patients were resident for all or part of the study, all compulsorily detained. Only 15 were given medication p.r.n.) compared with the other patients they were significantly younger and more likely to be detained under civil orders than under the criminal provisions of the Mental Health Act 1983. Rarely was the medication the sole intervention in a crisis. In terms of effects on the overall treatment programme of the patient, medication given p.r.n. seemed to have an impact in only one small subgroup.