Lipopigment, identifiable in the fluorescence microscope, is thought to be cellular debris partly derived from free-radical-induced peroxidation of cellular constituents. The volume of neuronal lipopigment has been positively correlated with advancing age, Alzheimer dementia, and the neuronal ceroidoses, while various changes in neuronal lipopigment have been reported in association with the chronic administration of dihydroergotoxine, ethanol, phenytoin, centrophenoxine, and chlorpromazine. An increase in the volume of neuronal lipopigment may indicate increased functional activity of the cell, impaired removal of pigment or anoxia. Chronic administration of agents which can be correlated with decreased neuronal lipopigment in animal models might protect neuronal function against any adverse effects associated with (but not necessarily resulting from) lipopigment accumulation in normal ageing, anoxia, or certain degenerative diseases. Long-term studies of the prophylactic use of such agents, or of drugs which neutralise free radicals, may be indicated. Other clinical applications of such drugs may include protection against the effects of free radicals formed during periods of oxygen deprivation.

The pineal gland, Descartes' seat of the soul, was variously considered until recently as a somewhat mysterious vestigial organ, or simply a good neuroradiological marker. The former point of view arose partly out of ignorance and the curious mythical associations related to its function as a ‘third eye’ in some lower vertebrates. The latter is due to the calcification which is present in most adult human pineal glands.

In a recent article in the British Medical Journal Maurice-Williams & Dunwoody (1988) reported two patients with frontal meningiomas who presented initially to psychiatrists. The correct diagnosis was made in one of them after prolonged, perhaps unnecessary, psychiatric treatment. In the other the diagnosis was made at autopsy. In this case psychiatrists were only briefly involved and neurosurgical referral had been made promptly. The authors, who treat these reports as a cautionary tale, conclude by warning psychiatrists to pay special attention to a number of features in the history and examination of psychiatric patients. In particular we are told that suspicion should arise in the presence of gradual non-remitting symptoms such as irritability, memory loss, self-neglect, dysphasia or incontinence in patients without a previous history of psychiatric disease or clear precipitating factors. They also suggest that we pay attention to the views of relatives when they feel the patient suffers from a physical rather than a psychiatric illness, and emphasise that early diagnosis leads to easier surgical removal and better outcome.

“The history of man for the nine months preceeding his birth would, probably, be far more interesting and contain events of greater moment than for all the three score and ten years that follow it.” Samuel Taylor Coleridge (1885)

It is 13 years since Kendell (1976) reviewed the ‘contemporary confusion’ surrounding the classification of depression. Reconsideration of this issue is now timely, especially in light of the development of the new classifications of affective disorder included in DSM–III (American Psychiatric Association, 1980), the revised version, DSM–III–R (American Psychiatric Association, 1987), and the forthcoming ICD–10 (World Health Organization, 1988). Recent activities in neurobiological, genetic and social research also bear importantly on our concepts of the aetiology of depression.

Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age.

Findings on CT and demographical or clinical data in 80 patients with DSM–III schizophrenia and 45 medical controls were evaluated. Multiple-discriminant analysis showed that the enlargement of the third ventricle and frontal and parietal atrophy could significantly predict the diagnosis of schizophrenia. Widening of Sylvian fissures and parietal atrophy differentiated familial schizophrenics of both horizontal transmission (who had affected siblings) and vertical transmission (who had affected parents or/and offspring) from non-familial patients. Parietal atrophy and a history of birth complications differentiated horizontal from vertical transmission. The CT findings together with some clinical characteristics could differentiate the three subgroups classified by the hereditary form; thus each of these subgroup may belong to a different disease entity, of a different pathophysiology.

The necessary components of a comprehensive service of local non-institutional forms of care for the seriously mentally ill have been researched separately in pilot trials, but not within integrated programmes for defined populations. Reported outcomes are at least as favourable as for traditional long-term hospital care, but alternative provisions are no less costly. A case manager system may allow co-ordinated formal and informal services to meet the individual needs of chronically ill patients. Poorly integrated programmes will expose discharged patients to disadvantages.

Areas of need exist where people with a mental handicap experience problems greater than, or differing from, the rest of the population. For example, there is a greater than average incidence of psychiatric disorder in mentally handicapped adults (Heaton-Ward, 1977) and children (Rutter et al, 1970; Gath & Gumley, 1986). Also, their families experience greater psychological distress and require support in their own right (Dupont, 1986; Shulman, 1988).

At the end of the 19th century, when the current psychiatric diagnostic concepts used in most countries were being elaborated, in Germany particularly by Kraepelin, French-speaking psychiatrists, who until then had dominated European psychiatry, continued to develop their own system. This difference in classification is most apparent in the non-organic, non-affective psychoses. Although some of the French names used may be unfamiliar to anglophones, when the new ‘consensus' criteria developed by Professors Pull and Pichot are compared with the DSM-III-R criteria it becomes apparent that the French and American concepts are converging.

It is now over 30 years since Gaddum & Picarelli (1957) described and characterised tryptamine receptors in the periphery. The setting in which they were working was what to us now is an antique department of pharmacology whose most sophisticated equipment was a smoked drum to record the response of a variety of smooth muscle preparations to the extracts of tissue containing the sought after transmitters. Gaddum the Professor of Pharmacology was the ideas man, Crawford a brilliant though highly obsessional methodologist, and Amin an indefatigable Indian PhD student. That group (Amin et al, 1954) described the presence of 5-HT in brain. They had been looking for substance P but the contractile response of the preparations to the extracts of brain did not resemble that peptide but serotonin. In many ways that was an initiator of psychopharmacology which has progressed exponentially to the present day.

Depressive disorders are more common in the relatives of depressed probands than in the population at large, and there is compelling evidence that the familial aggregation of bipolar disorder and severe unipolar depression is at least partly due to genetic factors. However, the evidence concerning ‘non-endogenous' depression is less clear, and family environment probably plays a stronger role. Much current research is focused on two areas: firstly, the mode of inheritance of manic-depressive illness, with the use of molecular biological techniques to detect and localise major genes; and secondly, the ways in which familial predisposition and environmental insults combine to produce depressive disorder.

While the demand for deinstitutionalisation, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of outpatient psychiatric treatment on length of stay in hospital and length of stay in the community. Outpatient care had a significant influence on read mission, but no effect on the length of inpatient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued inpatient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.