An association between seasonal affective disorder (SAD) diagnosed according to DSM–III–R criteria and ‘environmental hypersensitivity’, Candida hypersensitivity, and food allergies is reported in two patients. It is suggested that patients with somatisation disorder may present with symptoms of SAD and other media-popularised diagnoses in a form reminiscent of the cases of multiple media-popularised diagnoses.

The hypothesis that geomagnetic storms may partly account for the seasonal variation in the incidence of depression, by acting as a precipitant of depressive illness in susceptible individuals, is supported by a statistically significant 36.2% increase in male hospital admissions with a diagnosis of depressed phase, manic-depressive illness in the second week following such storms compared with geomagnetically quiet control periods. There is a smaller but not statistically significant increase in female psychotic depression and non-psychotic depression admissions following storms. There was no correlation between geomagnetic storm levels and number of male admissions with psychotic depression, which is consistent with a threshold event affecting predisposed individuals. Phase advance in pineal circadian rhythms of melatonin synthesis may be a possible mechanism of causation or be present as a consequence of 5-hydroxytryptamine and adrenergic system dysfunction associated with geomagnetic disturbance. Effects on cell membrane permeability, calcium channel activity and retinal magneto-receptors are suggested as possible underlying biochemical mechanisms.

It is usually assumed that psychiatric disturbance cannot be caused by SLE alone. We report two cases of ANA-negative SLE presenting with psychiatric features.

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5–10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect.

Of 38 adult patients admitted for first-episode psychosis, 20 reported childhood abuse, with equal prevalence in men and women. Patients with histories of childhood abuse had significantly more dissociative symptoms, but not more severe psychiatric symptoms. Childhood abuse was not related to rate of recovery and was only marginally related to longer stays in hospital. Although childhood abuse did not affect recovery during first-episode psychosis, it may contribute to a chronic course in some patients.

The aim of this study was to establish the prevalence of epilepsy in persons with Down's syndrome aged 19 years and over. A total of 191 adults with Down's syndrome were identified, giving a prevalence of 0.76/1000 (95% CI 0.75 to 0.77). Of these, 18 had epilepsy, giving a prevalence of 9.4% (95% CI 5.3% to 13.5%). The prevalence of epilepsy increased with age, reaching 46% in those over 50. The neurophysiological (EEG) findings of the epilepsy group were compared with those of a control group of Down's syndrome adults without epilepsy. Paroxysmal abnormalities consistent with a diagnosis of epilepsy were found in 80% of the epilepsy group, compared with only 13% of controls (P < 0.001). Epilepsy of late onset was associated with diffuse EEG abnormalities and clinical evidence of dementia. The age distribution and EEG findings suggest two independent processes in the causation of epilepsy: late-onset epilepsy associated with clinical evidence of dementia, and early-onset epilepsy in the absence of dementia.

In two adults, both schizophrenia and hydrocephalus were associated with aqueduct stenosis. The prevalence is argued to be above chance, and may contribute to the neurodevelopmental hypothesis of the causality of schizophrenia.

We report cases of several side-effects from the antidepressant fluoxetine. We suggest that, at therapeutic doses, fluoxetine may have a beneficial effect on sexual function in some men with erectile failure and premature ejaculation.

A novel approach is described for the treatment of post-traumatic stress disorder (PTSD). Eye-movement desensitisation (EMD) requires the patient to generate images of the trauma in the mind and define physiological and emotional arousal states. While concentrating on these states, lateral multisaccardic eye movements are induced. Ten consecutive cases are reported who presented with symptoms originating from a range of traumas. The effectiveness of EMD in reducing symptoms outlined by DSM–III–R is described. An independent rater indicated that eight of the ten cases showed considerable improvement in PTSD symptoms following EMD, which was maintained at follow-up. Particular reference is given to the ‘specificity’ of EMD in treating symptoms and the changing pattern of effect at follow-up.

Patients developing neuroleptic-induced akathisia have been reported to show higher levels of psychopathology. We sought to replicate this finding and determine its symptom specificity. We confirmed a significant relationship between ratings of akathisia and total score on the Brief Psychiatric Rating Scale (BPRS) during both acute and maintenance neuroleptic treatment. Using stepwise regression models, BPRS anxious-depressive subscale scores were the strongest predictors of akathisia during both treatment conditions. Paranoid subscale scores predicted akathisia only during maintenance treatment. These results suggest that neuroleptic-induced dysphoria largely explains the relationship between akathisia and residual psychopathology during both acute and maintenance neuroleptic treatment.

“Objective - To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. Design - Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. Subjects and setting - 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. Main outcome measures - Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. Results - Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantage of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. Conclusions - The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.”

Two depressive patients with systemic lupus erythematosus (SLE) and cerebral infarction, while being treated with corticosteroid, are described. In both cases, lithium was remarkably effective and no severe side-effects occurred. These findings suggest that lithium can be a useful antidepressant agent in the treatment of depressive SLE patients.

In the mental health field, the attention given to the subjective side of a person's experience is grossly inadequate. The best way to reflect the subjectivity of a person may be by means of the subjectivity of another. To take account of both subjective experience and objective measures in the course of mental disorders, a new concept is needed. This may be the person's story.

A significant difference of plasma interleukin (IL)-1α concentration was found between schizophrenic patients taking neuroleptic drugs (n = 38) and those not taking them (n = 14; P < 0.02); Kruskal-Wallis analysis revealed a significant difference of plasma IL-6 concentration among the patients taking neuroleptic drugs, those not taking them, and healthy control subjects (H = 7.1, d.f. = 2, P < 0.05); also, there was a significant difference of plasma IL-6 concentration between the patients taking neuroleptic drugs (n = 32) and those not taking them (n = 13; P < 0.01). No significant differences were found between the three groups in the concentrations of IL-1β, IL-2 and tumour necrosis factor(TNF)-α. The present results suggest that neuroleptic treatment may change IL-1α and IL-6 production in schizophrenic patients.

We present the first report of the use of cyproheptadine to treat fluvoxamine-induced anorgasmia, in a 63-year-old man suffering from recurrent severe unipolar depression.

Schizophrenia constitutes a lifelong vulnerability in relation to life stresses and the maintenance of social networks. Satisfactory quality of life – understood as subjective well-being in a lifetime perspective – is the ultimate treatment objective. This paper draws on research and clinical experience from Lofoten – the catchment area of a psychiatric out-patient clinic in Northern Norway. This work stresses the quality of life for the social network around the psychiatric patient as a consideration in its own right. The patient's coping resources and social network are regarded as a continuous professional concern.

In a study of 100 institutionalised patients with psychosis and an equal number of age- and sex-matched healthy controls from the same regional background, the prevalence of Australia antigen (HBsAg) was 11 and 2, respectively. Institutionalised psychotic patients are a high-risk group for hepatitis B virus infection.

This study is a descriptive survey of financial difficulties in a consecutive series of patients who deliberately poisoned themselves. Over three months 160 such patients presented to the liaison psychiatry service at Leeds General Infirmary. Information was available on 147 of these patients, of whom 54 (37%) had problem debts. Patients in debt were more likely to harm themselves with greater suicidal intent and, after the episode, to report more symptoms of depression and hopelessness. Psychiatrists were more likely to diagnose mental illness in those in debt.

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