The literature on the purely psychiatric aspects of mental handicap is remarkably limited. In the third edition of Mayer-Gross, Slater and Roth's Clinical Psychiatry, apart from one or two brief incidental mentions elsewhere in the text, the main references consist of just one paragraph on psychoses and two short paragraphs on neuroses included in the section on ‘The Association of Mental Subnormality with Other Syndromes’! Similarly the only reference to mental illness in mental handicap in the eighth edition of Henderson and Gillespie's Text-Book of Psychiatry was a mere four lines on psychosis; by the ninth edition, this had grown to seven lines covering both neuroses and psychoses, but with two of those lines devoted to an admission by the authors of their own lack of knowledge.

Parasuicide admissions to the Regional Poisoning Treatment Centre in Edinburgh are reviewed over the seven year period 1968–74. Special emphasis is given to trends in parasuicide rates for Edinburgh City, but social and clinical data are also described. Though the mean annual increase for admissions is 10 · 6 per cent, recent years have shown a fall in the rates for men and a levelling off for women. There have been increases in the rates for the young, for men in social classes 4 and 5 and for divorced women, and in poisonings with psychotropic drugs and alcohol consumption among women. At the same time it is important to note variables which have not changed: the relative risks by age and sex, repetition rates, the diagnostic picture, poisoning with non-prescribed drugs, and the rank order of municipal ward rates: and variables which have diminished: the rates for divorced men, overcrowding, domestic gas and barbiturate poisoning, and drug misuse. A comprehensive explanation of parasuicide in the contemporary scene would have to explain both the consistencies and the changing trends. The answer to the central question of why parasuicide is changing remains elusive.

Esrath Nashim was the name of the women's forecourt of the Second Temple in Jerusalem. The words can also be interpreted as ‘women's aid’ and were adopted as its title by a ladies' benevolent organization. This body, in 1895, established in the Old City of Jerusalem a one-room asylum where two patients were cared for. In 1905 the Esrath Nashim Hospital was opened in the Jaffa Road in the New City, and after the founding of the State of Israel in 1948 it remained as the only psychiatric hospital in the new State, though others were soon established. The old hospital was a Turkish-style stone building which was impressive of its kind, but the difficulties under which it operated may be illustrated by recalling that when the present chairman of the Hospital Board took office in 1948 and obtained the first grant from the newly-established Ministry of Health it was decided that the most pressing need was to install a hot-water system. In the late 1950s the chairman persuaded the Board that they should build a new hospital, and in August 1968 this was finally opened, the first purpose-built psychiatric hospital in the country. At that time three pavilions, each with 50 beds, were complete.

A validated objective measure of the state of psychological function was used to determine the incidence and course of psychological dysfunction in a group of evacuees from Darwin following disaster caused by a cyclone (Cyclone Tracy). While psychological dysfunction was increased initially (58 per cent) and at ten weeks (41 per cent), it had returned to an Australian general population control level (22 per cent) at 14 months.

Factors influencing psychological dysfunction were examined, and it is suggested that the sample faced two different stressors at differing times. Initial psychiatric morbidity was most clearly associated with the experience of thinking that one might die or be seriously injured and therefore conceptualized as a ‘mortality stressor’. Psychiatric morbidity at ten weeks appeared to be most closely associated with what has been conceptualized as a ‘relocation stressor’.

Reasons why psychiatric morbidity decreased to a general population control level are discussed.

In eleven patients with the syndrome of Capgras, the clinical data and the results of electroencephalographic, echoencephalographic, air-encephalographic, psychological and brain-scanning investigations are presented and discussed. All patients were psychotic: six were schizophrenic, four were depressive and one suffered from an organic psychosis. A paranoid element was marked in all cases.

The present evidence supports the view that organic factors are important in the pathogenesis of Capgras' syndrome.

Home Office records were used to trace the current status of a sample of 128 persons for whom heroin was prescribed in 1969 at Drug Dependence Clinics in London. In October 1975, after a mean time since self-reported first use of heroin of 11 · 25 years, 51 per cent were attending clinics, 40 per cent alive and not attending, and 9 per cent dead. One third of the sample were still receiving heroin on prescription, and 23 per cent appeared to have received heroin without interruption since 1969. The report points to the need for career studies of addicts' lives and the need for follow-up interviews, especially for the 40 per cent no longer attending clinics.

We report for the first time the case of a male patient with the Noonan syndrome (Turner phenotype with a normal karyotype) who also had a psychiatric disorder which satisfied research criteria for schizophrenia.

All new female indigenous Zambian patients (180) admitted to Chainama Hills Hospital from 1 June 1974 to 31 May 1975 were seen by the authors and given a firm diagnosis before they were started on treatment. The diagnostic classification of these patients was compared to that of a similar group of patients (163) admitted to the same hospital from 1 June 1973 to 31 May 1974. Forty-two per cent of the patients in 1974/75 were given a diagnosis of depression as compared to 26 per cent in 1973/74; 14 per cent of those in 1974/75 had a diagnosis of schizophrenia as compared to 21 per cent in 1973/74, and 3 per cent of the patients in 1974/75 fell into the group of ‘not yet diagnosed’ as opposed to 27 per cent in 1973/74. The ‘acute transient psychoses' were noted for their relative rarity in the two groups. A plea is made for all psychiatrists working in Africa to give diagnosis the importance it deserves.

A double-blind, cross-over trial of the effectiveness of piribedil, procyclidine and placebo in the control of parkinsonism induced by fluphenazine decanoate was conducted in sixteen cases of chronic schizophrenia. Procyclidine was shown to be more effective and piribedil less effective than the placebo. Piribedil produced a number of unpleasant effects, including headache, vomiting and malaise.

A behavioural technique is described suitable for the treatment of patients with high levels of guilt who attempt to relieve their depression by risk-taking activities which reflect their individual wishes and fears, or who suffer anxiety due to unacceptable past behaviour. It is recommended as an alternative brief method of treatment to psychoanalysis and is based on the application of behaviour therapy to a patient's psychopathology. Three case histories are described to illustrate the principles of the technique.

A young man was followed-up over three years who had severe obsessive-compulsive rituals and ruminations, interpersonal deficits, complicating depression and a history of childhood autism. Intensive behavioural treatment was given in an operant framework, with exposure in vivo, modelling, response prevention and social skills training. Compulsive rituals improved markedly and lastingly, but ruminations and social defects persisted. When intercurrent depression occurred dothiepin facilitated behavioural treatment. Adjustment remained fragile. Minimum maintenance treatment in the community could not be adequately arranged, so that gains made in hospital were partly lost at follow-up, despite continuing improvement in rituals.

Forty depressives and 40 matched controls were compared in terms of a number of self-report variables and in terms of their descriptions and evaluations of both real-life and hypothetical social relationships. Clear differences between the two groups reveal poorer self-ratings in the depressive sample, together with a tendency to describe and to evaluate both real and imaginary relationships more negatively. A retest of the depressed patients at the time of discharge from hospital showed improvement only in the two depression measures and not in any of the other self-rating and perceptual measures used. The possibility is discussed that the perceptual variables are predisposing to depression rather than concomitant with it.

Elderly psychiatric patients who were in contact with the hospital one year after in-patient admission were retested on a number of clinical and psychometric measures first done soon after admission. In general, changes were small; and for several measures very high correlations existed between the scores gained on the two occasions. When those patients with uncomplicated chronic brain syndromes were considered separately, increasing impairment was demonstrable.