Linguistics, human communication and psychiatry.

Background: Psycholinguistics and sociolinguistics have extended our understanding of the abnormal communication seen in psychosis, as well as that of people with autism and Asperger's syndrome. Psycholinguistics has the potential to increase the explanatory power of cognitive and neuropsychological approaches to psychosis and new methods of assessment and therapy are now being developed, based on linguistic theory.

Method: A MEDLINE literature search was used.

Propofol anaesthesia in electroconvulsive therapy. Reduced seizure duration may not be relevant.

Background: The induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.

Koro: culture-bound disorder or universal symptom?

A case report is presented of koro associated with a depressive illness in a 31-year-old male Briton. The specificity or otherwise of koro as culture bound and a distinct nosological entity is discussed.

Patient satisfaction: a valid concept?

Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of 'satisfaction'.

Shiftwork, helplessness and depression.

Forty-three student nurses undertaking shiftwork for the first time participated in a study which tracked their perceptions of altered neurovegetative function, perceived criticism from others, sense of purpose and control and psychosomatic complaints. It was found that this first ever episode of shiftwork produced marked changes in all of the above. These findings have implications for circadian rhythm hypotheses of depression as well as for the methodology of future studies on cognitive or psychosocial variables in depression.

5-HT and physical illness.

The discovery and clinical evolution of 5-HT re-uptake inhibiting drugs are reviewed. From the widespread distribution of 5-HT in bodily systems and the range of effects and side effects reported, it is concluded that these and other drugs active on the 5-HT system are likely to have beneficial effects on a range of other physical conditions coincident and co-morbid with the affective disorders. Clinical vigilance may therefore be repaid with serendipitous discoveries.

Psychopharmacology and the ethics of resource allocation.

The introduction of clozapine to current psychiatric practice is considered against a background of potential problems of resource allocation posed by the development of a number of 'budget-busting' drugs. It would appear that clinicians may increasingly have to operate within a climate in which the rights of individual patients to expensive treatments will seem to be pitted against the abilities of their communities to afford such treatments. Both clinicians and pharmaceutical companies have roles in the development of such conflicts.

Patient advocacy: psychiatrists' perspectives.

This paper describes the responses of senior psychiatrists in Wales to a questionnaire exploring their knowledge and beliefs about patient advocacy. The results suggest mainly pro-advocacy attitudes; respondents who had not met advocacy groups involving their own patients holding attitudes almost as positive as those who had. However, despite these findings, further research is required to define the specific benefits of advocacy before further resources are diverted to the development of such services.

Altered states of consciousness: phenomenology and pharmacology.

In recent years a conjunction of factors have brought questions surrounding the phenomenology and pharmacology of altered states of consciousness back onto the scientific agenda. These factors primarily involve the re-classification of psychiatric disorders that took place in 1980 with the publication of DSM III, which contained a number of syndromes that could be characterized in terms of altered states of consciousness, and also the recognition of the phenomenon of awareness under anaesthesia. These issues are outlined against a historical background, in which there had been at the end of the last century a primary psychopathological focus on the question of consciousness that was, however, increasingly neglected during the course of this century until its recent return to prominence.

Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders.

Meta-analysis of 19 double-blind placebo-controlled trials of antidepressants (N = 13) and benzodiazepines (N = 6) for patients with panic disorders showed that active treatment had 25% greater success rate than placebo over a mean duration of 14 weeks. There were no statistically significant differences observed between treatment sub-groups (antidepressants--mean duration 16 weeks; and benzodiazepines--mean duration 7 weeks). On this basis antidepressants and benzodiazepines prescribed in clinical settings are likely to be equally effective in the short-term treatment of people with panic disorders.

Alpha-1-acid glycoprotein in major depressive and eating disorders.

Plasma alpha 1-acid glycoprotein (AGP) levels were measured in 49 subjects with major depressive disorder, 15 subjects with anorexia nervosa and 18 subjects with bulimia nervosa, together with age- and sex-matched controls. AGP levels were elevated in depression and bulimia compared to controls. They were particularly elevated in depressed subjects who proved unresponsive to treatment with a standard course of antidepressants.

Tourette-like disorder in Asperger's syndrome.

An eight-year-old boy with Asperger's syndrome was given haloperidol to control agitation and aggressive outbursts. Withdrawal of the drug after two years was followed by Tourette-like symptoms. Subsequently neither haloperidol nor a second antipsychotic drug altered the core features of Asperger's syndrome, despite suppressing the movement disorder.

The psychopharmacological era: notes toward a history.

Cultural and economic influences on the psychopharmacological era are reviewed, in an attempt to bring into focus what has been happening in psychopharmacology for the past thirty years. It is argued that the belief that clinical advances are made through the heroic achievements of disinterested scientists is a simplistic view that may militate against future significant discoveries. Such discoveries, it is argued, still come about for the most part serendipitously, despite a widespread belief that psychopharmacology has become a rational science.