Ten years ago, specific high-affinity binding sites for benzodiazepines (BDZs) were found in the brain (Mohler & Okada, 1977; Squires & Braestrup, 1977). These binding sites are believed to be the primary site of action of BDZs and are found on the same protein as GABA receptors. GABA is the main inhibitory neurotransmitter in the brain.

Depression in childhood and adolescence has become a topic of considerable research interest in the last decade. A number of studies ranging over the last half-century provide information about the prevalence of depressive symptoms and syndromes in non-referred populations. These studies are critically reviewed in the light of an analysis of the various meanings that the term ‘depression’ may carry, and a variety of methodological issues. The sparse evidence for the involvement of a number of potential risk factors for depressive disorders is then considered and suggestions for future work in this area are outlined.

The measure of expressed emotion (EE) of the relative has been found to be an important predictor of schizophrenic relapse. Electrodermal measures were recorded when the schizophrenic patient was talking to an experimenter, and when the patient was talking to a relative. Although there were no differences during the relative-absent period, patients with a high-EE relative present exhibited significantly higher frequencies of non-specific skin-conductance responses (NS-SCRs) than patients with a low-EE relative present. Patients show a significant decrease in NS-SCRs on the entry of low-EE, but not high-EE relatives. Patients with high-EE relatives show overall higher levels of skin-conductance levels (SCLs) than patients with low-EE relatives. Although patients with high-EE relatives rate themselves significantly more tense and anxious on self-rating scales, there are no significant correlations between self-ratings and electrodermal measures. The use of electrodermal reactivity as an assessment measure of relapse risk is discussed.

The frequency of schizophrenic first-rank symptoms (FRS) were investigated in 1698 patients with an organic mental disorder (OMD) according to Schneider's and DSM-III criteria: 7% of the patients with OMD had FRS, compared with 47% of schizophrenic patients. However, the frequency of FRS depends on the state of consciousness and on the aetiology of the OMD: 20% of the patients with clear consciousness had FRS, but only 1.5% of those with clouded consciousness. In cases of some aetiologically defined groups of OMD, such as post-ictal epileptic psychoses or alcoholic hallucinosis, the frequency of FRS is similar to that in cases of schizophrenia. FRS appear to be psychotic reaction patterns whose substrate-related basis extends across the whole spectrum of endogenous and exogenous psychoses.

In a study of 28 attenders of a sexual and marital clinic, the relationship between marital distress and both general and specific sexual dysfunctions was investigated. It was found that for men there was a much closer relationship between sexual and marital problems than for women. In particular, it was noted that the specific male sexual dysfunctions of impotence and premature ejaculation played a much larger part in marital discord than did the female dysfunctions of anorgasmia and vaginismus.

Unemployment became more common among females attempting suicide in Oxford between 1976 and 1985, although the rise was less than expected from the increased general-population female unemployment rate. Rates of attempted suicide among unemployed women between 1979 and 1982 were 7.5–10.9 times higher than those of employed women, and were particularly high in women unemployed for more than a year. Many more unemployed than employed women attempting suicide had a history of psychiatric difficulties, were suffering from alcoholism, and made repeat attempts. Two possible explanations are: firstly, the secondary consequences of unemployment increase the risk of suicidal behaviour; and, secondly, women already predisposed to psychiatric difficulties and hence attempted suicide are more likely to become unemployed.

On the basis of the records of subjects undergoing cross-gender hormonal treatment at the only gender treatment centre in the Netherlands, the prevalence of transsexualism was assessed over the years 1976–1986. In 1980, the prevalence was 1:45 000 for male-to-female and 1:200 000 for female-to-male transsexuals. In 1986 the prevalence for male-to-female transsexuals was 1:18 000, and for female-to-male transsexuals, 1:54 000. The increased prevalence is apparently due to a lower threshold for applying for medical treatment rather than to a true increase in the prevalence. Nevertheless, the calculated prevalence is higher than hitherto recorded. The ratio of male-to-female compared with female-to-male transsexuals was found to remain constant at 3:1.

Occurrence of cerebrovascular accidents has been associated with cocaine abuse. We investigated the relative distribution of cerebral blood flow (CBF) in groups of chronic cocaine users, and of normal controls. Relative CBF was measured using positron emission tomography and 15oxygen-labelled water. The cocaine users showed areas of deranged CBF as evidenced by patchy regions of defective isotope accumulation throughout their brain. The chronic cocaine users showed decreased relative CBF in the prefrontal cortex when compared with normal subjects. The repeated scans of some cocaine users, after 10 days of cocaine withdrawal, continued to show decreased relative CBF of the prefrontal cortex. We hypothesise that some of the widespread defects in CBF in the cocaine users could reflect the effects of vasospasm in cerebral arteries exposed chronically to the sympathomimetic actions of cocaine.

Patients with acquired immunodeficiency syndrome (AIDS), who present with or develop psychotic symptoms, almost invariably have evidence of cognitive impairment. Three psychotic patients, one with AIDS, and two with AIDS-related complex (ARC), who showed no evidence of cognitive impairment, are reported. It is suggested that the human immunodeficiency virus (HIV) may produce symptoms indistinguishable from those seen in the functional psychoses.

In a study of the dexamethasone suppression test (DST) in patients with bulimia nervosa, a non-suppression rate of about 50% was found. The only clinical correlates of DST non-suppression were a previous history of weight loss and/or of anorexia nervosa. These results suggest that DST non-suppression in these subjects may be a trait rather than a state marker of anorexia nervosa.

A dexamethasone suppression test (DST) was carried out in a heterogeneous sample of 174 depressed patients. In a subsample of 130 patients in whom biological antidepressive treatment had been commenced either because of an initial clinical judgement of ‘endogenicity’ or because of subsequent evidence of DST non-suppression, the response to treatment was globally assessed. The results showed no significant differences between the two groups in the numbers of patients responding favourably to treatment. The positive predictive value of DST non-suppression for a favourable response was no higher than that of clinical judgement, and there was little difference between the sensitivity and specificity of the two predictors.

The reliability and validity of the Chinese version of the 17-item Hamilton Depression Rating Scale (CHDS) was assessed. Interrater reliability was excellent, the item total-score correlations were good, and the internal reliability was satisfactory. The concurrent validity was tested by correlating the CHDS score with the Global Assessment Scale score; the strong negative correlation found indicated that the CHDS reflects the overall level of disability. Five distinct factors were generated by principle-component analysis; these factors account for 52.4% of the total variance. Rigorous evaluation of the numerous translated scales being used in clinical and research settings of non-Western countries is important.

Beta-adrenergic-mediated cyclic AMP accumulation was reduced in lymphocytes obtained from depressed patients from that observed in an age- and sex-matched group of control subjects. Among the depressed patients, those not responding to treatment showed significantly lower pretreatment responses to isoproterenol compared with patients who exhibited significant clinical improvement during antidepressant treatment. Late-night (terminal) insomnia was significantly associated with the blunted response to beta-adrenergic stimulation. In depressed patients with the lowest isoproterenol response, the effect of forskolin (which acts distal to the receptor and directly stimulates the catalytic subunit) on cyclic AMP accumulation was also significantly decreased. This suggests that post-receptor modulations of signal amplification also play a role in the reduced response to beta-adrenergic stimulation in depression.

In the present study, two raters, a psychologist and a nurse, each made five independent ratings of 30 different video-recorded patient-examinations. Having thus excluded patient fluctuation, individual-rater consistency and between-rater agreement over the 6 weeks of the study are examined. While between-rater agreement was apparently being maintained, mean AIMS scores steadily increased. In the hands of these raters, AIMS items 2 and 4 emerged as very reliable, while items 1, 6, and 7 showed high variability. Some patients appeared to be hard to rate. Differences between the study raters and the author JB highlight the issue: how reproducible is an AIMS rating?

Five chronically disabled dysmorphophobic patients with disturbed bodily perception improved with systematic exposure to avoided situations that evoked dysmorphophobic discomfort, and refraining from behaviours which reduced that discomfort. As avoidance and anxiety improved with exposure, so did associated bodily delusions. Four of the patients had additional problems, for which three cases had drugs at some time. The encouraging pilot results warrant a controlled study of exposure for dysmorphophobic avoidance and anxiety.

Flash and pattern-reversal visual evoked potentials (VEP) were recorded in 35 elderly patients with dementia, and 19 controls of equivalent age. Dementia produced a slowing of the major positive (P2) component of the flash VEP but did not affect the latency of the flash P1 component or the P100 pattern-reversal component. This unusual type of abnormality was found in both primary and multi-infarct types of dementia, and has previously been found in primary presenile dementia. The results show that the VEP can be used for the diagnosis of multi-infarct, and primary presenile and senile dementias.

A retrospective study of 65 consecutive referrals for behavioural disorder of mentally handicapped patients living in the community revealed that 31 of these were associated with life events sustained in the 12 months prior to the referral. These patients were usually mildly handicapped, while those who presented with behaviour disorder without a history of recent life events were usually more severely retarded. The differences between the two groups are discussed and the need for further research emphasised.

The aspirations, mores, and family structure in Cypriot immigrants, which are illustrated in four cases of hysterical behaviour, have many similarities to nineteenth century Viennese society. Such behaviour may mask more sinister diagnoses; one of the cases remains diagnostically uncertain and another passed through a transient hysterical psychosis with Ganser-like symptoms. The cultural, dynamic, and nosological issues are discussed.

A paper referred to me for statistical review has drawn my attention to the issue of appropriate evaluation of the effectiveness of treatments used in psychiatry. It has been suggested that the classical randomised controlled trial (RCT) is inappropriate to many aspects of psychiatry. I feel it is important that this issue should be looked into closely. I believe that the principle that treatment evaluation should be by RCT wherever this is feasible is certainly no less important in psychiatry than in other medical specialties. Discussion of this issue is needed, so that guidelines can be set out which will both be acceptable to researchers in psychiatry and meet scientific standards accepted in other areas of medicine.

The prevalence of psychiatric disorder (by DSM–III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.