Four schizophrenic patients are reported in whom the acute development of dystonic muscle spasms, usually involving gaze deviation, was accompanied by the exacerbation or appearance of psychotic symptoms. In all cases the relationship between the neurological and psychiatric phenomena was close, and sometimes the presentation was bizarre or dramatic. The similarity of these states to the complex neuropsychiatric disturbances seen in post-encephalitic Parkinsonism is emphasised.

The pain thresholds of patients with schizophrenia often seem to differ from those of healthy subjects. In the present study we assessed the pain thresholds of ten patients with schizophrenia, and of ten controls, by measuring the leg flexion nociceptive reflex threshold: the stimulation threshold at which this reflex is triggered, is known to be correlated with the pain threshold. Our conclusion is that, in most cases, the increase in pain threshold is the result of ‘attitude’ and not of alterations in brain function.

Seven years ago the authors examined 64 consecutive female out-patients with macrocytosis (erythrocyte mean cell volume ⩾ 100 fl). The cause remained undetermined in 23 (35.9%). Their patient histories were evaluated in 1992, and the new highly specific alcohol marker, serum carbohydrate-deficient transferrin, from the frozen sera taken during the initial study was examined. It was elevated in 6 of the 23 women. Furthermore, four of these six had visited the health centre after 1985 and they all had clinical records indicative of alcohol problems. Because early intervention has proved to be effective, information about the risks of alcohol abuse (intervention) should be given to women with suspect alcohol-induced symptoms or signs.

We report a case of neuroleptic malignant syndrome where the catatonia clearly followed the administration of neuroleptics and where the neurovegetative disturbance was remarkably severe, including episodes of tracheal spasm, apnoea and episodes of bradycardia, and sinus arrest requiring insertion of a temporary external pacing wire. To our knowledge, such severe disturbance has not previously been reported.

A 14-year-old boy with obsessive–compulsive disorder (OCD) developed, under fluvoxamine treatment, acute symptoms of Tourette's syndrome (TS) with aggravation of the OCD. The TS symptoms did not respond to dopamine blockers and disappeared only after withdrawal of fluvoxamine. Readministration of fluvoxamine caused a re-emergence of the same symptoms.

In recent years, the use of hospital care in Finland has decreased, while out-patient care has expanded; a psychotherapeutic approach and rehabilitative measures have been widely adopted. For schizophrenic patients, these changes may also have improved outcome, which is better than 30 years ago. However, their need for treatment and care has not been reduced to the extent that was hoped; in line with the decrease in use of hospital services, the need for alternative services for the socially disabled has increased. There is an urgent need to develop crisis-intervention. Male schizophrenic patients require special attention from the community care system and possibly a new kind of service which would meet their needs better. The need for care, support and education of patients' families is also increasing.

Four children presented to child psychiatric clinics with a variety of symptoms. They were all later recognised as having Crohn's disease. There was a significant delay between the onset of symptoms and diagnosis, compared with a control group of patients with Crohn's disease whose presentation was with predominantly gastrointestinal symptoms, which was associated with evidence of increased morbidity. Children with abdominal and psychiatric symptoms occurring in combination need serial assessments of physical status, including height and weight, and measurements of inflammatory and nutritional status.

We describe a patient with marked elevations of creatine kinase following institution of clozapine treatment. The enzyme levels promptly subsided with discontinuation of clozapine. The clinical features did not meet any of the published criteria for neuroleptic malignant syndrome.

Earlier studies have failed to differentiate the unipolar manic subtype from bipolar patients with both manic and depressive episodes. This retrospective cohort study of 50 elderly manic in-patients identified six patients (12%) who met strict criteria for a course of unipolar mania. Significant differences emerged in age at onset, with a mean of 41.2 years for unipolar mania compared with 64.7 years for the others. Consequently, clinical course was significantly longer, 27.7 v. 7.4 years. Elderly patients pursuing a unipolar manic course are among the very few elderly ‘bipolars’ whose illness begins early in life. Recent neuroradiological investigations and data from geriatric studies suggest that the concept of unipolar mania is worthy of further investigation.

A man suffering from persecutory delusions attempted to commit suicide by holding the head of a three-inch masonry nail against a wall and head-butting its point until he had driven it fully into his forehead.

Two cases of dysthymia in mentally handicapped patients are described. The absence of publications on dysthymia in the mentally handicapped is noted. The importance of early diagnosis and treatment with advanced antidepressants and psychotherapy is emphasised.

A case of homosexual erotomania is described in a patient with AIDS-related complex. Direct involvement of the central nervous system was thought an unlikely cause, as specific stressors appeared to have precipitated a reactive psychosis. A psychodynamic understanding of these factors and their interaction with the patient's masochism, fetishism, and personality disorder provided an alternative explanation for the onset of the paranoid illness and its symptom content. The psychodynamic aspects of acute psychotic disorders without evidence of cognitive impairment in patients with HIV infection is a neglected area of study.

We report an unusual and unsuspected cause of maternal neglect in a patient with Tourette's syndrome. An important cause of the behaviour appears to have been a form of dyscalculia characterised by a complete inability to appreciate the passage of time. To our knowledge this is the first case of its kind to be reported.

Vigilance is required in order to detect the cardinal signs of neuroleptic malignant syndrome (NMS), especially after prolonged exposure to neuroleptics. In this case, NMS was diagnosed in a 29-year-old man, who had been on fluphenazine decanoate for over one year, coinciding with a cessation of his neuroleptic medication. Vigorous treatment, including assisted ventilation, was necessary, extending over three months. On recovery, his mental state and social functioning had undergone a sustained improvement sufficient for his release from hospital.

Three cases of a misidentification syndrome are presented. In this syndrome, which may be Capgras' or a new syndrome that we refer to as delusional gross replacement of inanimate objects, patients believe that their new possessions are replaced by inferior copies of the original objects by identified individuals. The patients believe that these individuals want to enhance themselves at the patients' expense, and feel persecuted by them.