Objective: To examine hand preference, hand skill and hand strength in university undergraduates in order to determine the most reliable index of handedness.

Method: The Edinburgh Inventory, a group test of handedness by marking dots in circles, and a standard dynamometer were used with 248 (148 female, 100 male) subjects.

Results: No statistically significant correlations were found between hand skill and strength, or between hand preference and strength. A significant correlation between skill and preference was found in the male right-handed group of 93 students.

Conclusion: It is not possible to demonstrate whether preference or skill is the better index of handedness; a standardised method for assessment of hemispheric dominance for handedness is required; in the meantime the criterion used in a specific study should be explicitly stated in any citation of that study.

Objective: Eighty one patients admitted following deliberate self-harm were assessed using a semi-structured interview. The aim of the study was to compare clinical and social profiles of the 42 patients who had committed self harm for the first time with those of the 39 who had committed self harm in the past.

Method: The patients were assessed jointly by a psychiatrist and either a community psychiatric nurse or a social worker. A description of past suicidal behaviour, socio demographic information, medical and psychiatric history were recorded. Suicide intent was assessed both from the clinical interview and rated objectively using Pierce's suicide intent scale. Psychiatric diagnoses were made using the ICD 9 classification.

Results: The entire group had experienced difficulties in sustaining relationships. This problem was significantly more widespread in repeaters with increased use of physical violence in their relationship. More patients with a previous history claimed to have death wishes at the time of self harm, and asserted that they would harm themselves again compared with patients without a previous history. Clinical predictions regarding future self harming behaviour were in line with the patient's stated intentions.

Conclusion: The persistent desire to commit self harm and more widespread relational difficulties amongst the patients with a previous history suggests a need for different treatment strategies and outcome measures for the two groups.

This study describes the uncontrolled treatment of six patients who developed an agoraphobia-like syndrome following physical illness. They all revealed danger-related cognitions associated with possible sequelae of their physical illness. Cognitive therapy based on realistic assessment of risks and a strategy to minimise them was associated with improvements that were maintained at six-month follow up. The study identifies the specificity of the danger-related cognitions and points to the need for further studies to assess the size of the problem, and the need for controlled trials to assess the outcome of the treatment.

Objective: The aim of this study was to investigate the characteristics of patients whose identities are unknown at presentation to psychiatric services.

Method: We retrospectively reviewed 12 years of presentations to an emergency psychiatric unit and identified 37 anonymous presentations in that period. Cases were assessed with regard to demographic data, legal status, reasons for presentation, putative diagnosis at presentation, eventual documented (ICD-9) diagnosis, previous history, duration of anonymity, method of identification and re-occurrence.

Results: 0.6% of all patients who presented during the study period were unidentified for at least 24 hours. Patients were young (mean age 33.6 years). Over half were of foreign nationality (53%). The majority were suffering from major psychotic illnesses (86%). When compared with all admissions during the study period, schizophrenia and drug-induced psychoses were significantly more common in the group unidentified at presentation. Malingering, organic psychiatric disorders and dissociative states were not commonly encountered underlying diagnoses. All of our patients were subsequently identified. Successful identification methods included self admission, careful examination of personal belongings, careful history taking, liaison with police and recognition by staff. Patients frequently had a previous psychiatric history (91%). Recurrence was uncommon.

Conclusion: The anonymous presentation represents a unique challenge to the investigative skills of the psychiatrist. The application of basic strategies enables the successful identification of the majority of cases.

This report describes the case of a 62 year old man with late onset bipolar affective disorder whose mood swings were associated with episodes of thrombocytopenia. The inter-relationships between affective symptoms, the immune system and the hypothalamic pituitary axis are discussed.

A case of acromegaly presenting as psychotic depression is described. The relationship between psychiatric symptoms and acromegaly is reviewed and the importance of considering an organic diagnosis in a psychiatric syndrome arising de novo in later life is highlighted.

Self-enucleation is a rare and disturbing form of self-mutilation. A case is reported in which a schizophrenic patient simultaneously attempted the three main forms of major self-mutilation, that is self-enucleation, amputation of the penis and of the right hand. The historical background, underlying psychiatric factors and possible complications are discussed.

Two cases of school refusal are presented. From the experience of these two cases, and support from the literature, early assessment of parental control in cases of school refusal is advocated. When parental control, even with professional therapeutic support, is not sufficient to effect an early return to school, intervention in the wider systems which are organised around the problem is recommended.

A case of post traumatic rapid cycling unipolar mania is described in an individual with no apparent genetic predisposition to an affective disorder. A head injury is proposed as being causative. It is suggested that head injury should be included as a cause of rapid cycling affective disorder.