Memory impairments are handicapping to those who suffer them, and a number of ways of trying to help those afflicted have been devised. Effective psychological approaches are likely to be based on methods designed either to make the most efficient use of remaining memory capacity, or to alter the environment so as to reduce the demands placed on memory. At present the success of such approaches is limited.

The major assumption underlying all X-linkage studies of bipolar disorder has been that a subgroup of manic–depressive illness follows an X-linked dominant mode of inheritance. An evaluation of the segregation patterns in the pedigrees that have been analysed for X-linkage over the past 20 years does not support this assumption, because the formal genetic criteria for an X-linked dominant mode of inheritance are virtually absent. Not a single pedigree has been ascertained in which the segregation pattern is suggestive of the assumed mode of inheritance. This is mainly because segregation ratios characteristic for X-linked dominant inheritance cannot be observed among the offspring of affected males.

Most measurable aspects of normal personality appear to be at least moderately heritable, with direct evidence coming from family, twin and adoption studies and indirect support deriving from psychophysiological research and breeding experiments on animals. Interestingly, genetic studies also shed light on the environmental sources of variation in personality and suggest that shared family environment rarely, if ever, has any positive effect on similarity between relatives. Despite problems of classification, and variations in the use of terms, a survey of the literature provides reasonably consistent evidence of a genetic contribution to several categories of abnormal personality, which we here divide into three groups, antisocial, anxious/avoidant, and schizoid–schizotypal personalities. However, personality disorders are complex traits that do not show simple mendelian patterns of inheritance and so far molecular genetics has been of no help in understanding their aetiology. Fortunately, techniques are now becoming available that enable the detection and potential localisation of genes of small effect and which may help elucidate the molecular basis even of (probably) polygenic traits such as abnormal personality.

The fragile-X syndrome accounts for up to 10% of individuals with mental handicap, and 50% of cases of X-linked mental retardation. Knowledge of the genetic basis of mental functioning, psychopathology, and neuropsychology is being furthered by this recently recognised condition. The disorder has considerable significance for psychiatrists, particularly, but by no means exclusively, those working in the field of mental handicap and with children. This review outlines the slow clarification of this complex and important behavioural phenotype and the implications of these advances for identification, diagnosis, genetic counselling and a wide range of management interventions.

This paper concerns certain questions which arose during the analysis of a trial showing positive effects of tacrine in Alzheimer's disease. Cognitive improvement occurred during the first two weeks, reached a maximum at one month and was maintained during the rest of the three-month treatment period. Rebound effects were not detected in any of the key outcome variables, but were suggested by one of the supporting cognitive tests and other measures. Practice effects occurred on tests which were repeated at short intervals or too frequently. The paper discusses the significance of these findings for the interpretation of other trials and for practical management.

The treatment of severely disturbed patients is strengthened in an important way by listening closely to them and by attempting to understand their experience in the depth that is made possible by the use of psychoanalytic concepts. It follows that the practice of clinical psychiatry in the UK would be greatly improved by the introduction of a psychoanalytic and psychotherapeutic perspective into the acute ward. This paper reviews the work done on a ward at the Maudsley Hospital in which this approach was the practice.

Sixty agoraphobics were treated by behavioural therapy (self-exposure in vivo) either with their partner involved in all aspects of treatment or without their partner. The two treatment formats were about equally effective. Behavioural treatment directed at the agoraphobia resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner. Avoidance behaviour, intropunitivity and overprotection were found to predict treatment response. The partners of agoraphobics were not found to have psychological problems themselves.

The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM–III–R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and ‘going crazy’/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.

The risk for schizophrenia among first-degree relatives of schizophrenic probands obtained from an epidemiological sample using family history methods was examined to determine whether month of birth of the proband was associated with familial risk. The results of this study of the first-degree relatives of 106 female schizophrenics and 275 male schizophrenics suggested that the relatives of probands born in the months February to May had the highest risk, although the association between month of birth and familial risk among the male probands was present only for those relatives who had onset of schizophrenia before the age of 30.

The hypothesis that mothers of winter–spring-born schizophrenics have an unusual pattern of conception which results in an excess of winter–spring births was tested by studying the distribution of birth-dates of 401 siblings of 120 winter–spring-born schizophrenics and 157 siblings of 59 winter–spring-born controls. All analyses were gender-specific. The results suggest there is no association between the probability of a winter–spring date of birth and being a sibling of a winter–spring–born schizophrenic or control.

A prospective study of 47 married women who met RDC for major depressive disorder investigated the relationship between the social support provided by the husbands and the post-hospital symptom course of the women. Separate taped semistructured interviews were held with the patient and husband at the time of admission. Six months later, symptom course was rated using the LIFE psychiatric status schedule. Only 51 % of the sample recovered in the six months. Few demographic or clinical factors were related to symptom course. Recovery was predicted by the depressed woman's ratings of the current marital relationship and by the husband's rating of the pre-morbid relationship but not by the husband's level of expressed criticism or his ratings of the current relationship.

A total of 89 depressed out-patients were randomly allocated to one of three groups: group A received one dose of antidepressant medication at night; group B received three doses of medication during the day; group C were allowed to choose either A or B above. Compliance with medication was assessed at three, six, nine and 12 weeks by interrogation and pill count; at the same time, depression and side-effects were rated. No overall significant difference was found between doctor-prescribed and patient-chosen regime, or between once-a-day and three-times-a-day dosage. However, compliance was significantly better in those patients who were allowed to choose, when they selected the three-times-a-day regime. There was a significant decline in compliance for all regimes over the 12 weeks. There was no evidence that better compliance produced a better therapeutic result, and possible reasons are given for this finding.

A field survey was conducted in two villages – Gambhirgachi and Paharpur – in 1972. The survey was repeated after 10 years in the former village and after 15 years in the latter one. The second survey showed very little change in the rate of total mental morbidity. The rate of prevalence of hysteria declined significantly in both villages. In Gambhirgachi the rate of hysteria dropped from 16.9 to 4.6 per 1000 in 10 years, and in Paharpur it dropped from 32.3 to 2.05 per 1000 in 15 years.

A systematic search was made in the Hebrew Bible for expressions of emotional distress. A wide range of somatic and psychological vocabulary was found, especially in the Psalms and other poetic literature. Somatic expressions most frequently involved the heart, bowels, belly, bones, and eyes. Head symptoms were rare. Metaphors referring to the heart were common; other somatic expressions appeared to be descriptions of actual physical sensations. Usually somatic and psychological expressions were paired together, utilising the ‘parallelism’ of Hebrew verse form. Biblical Hebrew thus incorporated a powerful and sophisticated language of emotional expression.

Recent advances in molecular genetics have radically altered the prospects for determining the role of heredity in the transmission of major psychiatric disorders. Identification of the actual gene(s) involved, elucidation of their structure, and determination of their products are the steps which theoretically follow successful demonstration of linkage (Gurling, 1985; Baron & Rainer, 1988). Consideration of the ethical issues raised by genetic linkage studies is therefore now of paramount importance. This article focuses on the problems raised by the research process, and not on the ethical implications of the results eventually obtained.

“The philosophy of Community Care has resulted in the closure of several mental hospitals in this country. The ethos of the Worcester Development Project saw the closure of St Wulstan's and Powick Hospitals, and their replacement by a community-based service. This paper briefly describes the outcome of a three-year retrospective study completed in 1988 following the closure of both hospitals. The findings provide a comparison of the two hospitals, including details of the destination of all the patients. It is suggested that the term ‘hospital replacement’ might be preferable to ‘hospital closure’.”

“The Worcester Development Project began in 1968 when the Department of Health and Social Security brought together the Worcester and Kidderminster Hospital Management Committee and the County Council in a co-ordinated joint planning venture. Powick Hospital was chosen as the location for testing the hypothesis that closing a mental hospital and replacing it with general hospital psychiatric units, supported by a variety of community facilities, would provide a more economical and better service. This paper describes the outcome of this unique opportunity to study the problems involved in closing a mental hospital and its replacement with other facilities.”

The brains of 41 late paraphrenics, 16 of whom had first-rank symptoms, were examined by CT. Late paraphrenics with first-rank symptoms had significantly less cortical atrophy than those without them.

Of 113 patients in long-stay wards of a psychiatric hospital, 43 had TD. Twenty-six of the 39 patients who consented to take part in the study were unaware of abnormal involuntary movements. These patients scored significantly lower on a short test of cognitive function than patients who were aware of such movements. The diagnosis of schizophrenia, perticularly the ‘defect’ state with cognitive deficit and negative symptoms, was found to be associated with lack of awareness of TD.

Three males with factor-IX deficiency (Christmas disease) in one pedigree all had severe affective disorder. This apparent cosegregation, if true, would support the hypothesis that in some pedigrees, a gene for major affective disorder is located on the X chromosome.

This is the first report of a case of anorexia nervosa in a woman with XY gonadal dysgenesis. Anorexia nervosa is a potential complication of gonadal dysgenesis, stemming not only from the disorder itself but from its investigation and treatment.