Concurrent psychotropic medication has no negative influence on the outcome of electroconvulsive therapy

A consecutive cohort of 66 subjects receiving ECT in a period of a year were studied retrospectively in order to ascertain whether concurrent psychotropic medication affected negatively their response to ECT. No correlation was found between any drug variable and any outcome variable. It is concluded that a preliminary negative result of this nature suggests that there may not be such a negative effect, but that this must be confirmed by a prospective study; it is also cautioned that, to undertake such, current ethical and legal issues may need to be resolved.

Phenomenology and psychopathology: was there ever a relationship?

The philosophical doctrine known as phenomenology is believed by many to have provided during the early 20th century the conceptual basis of the new descriptive language of psychiatry, the very language that made possible the development of systems such as the DSM-III-R. To ascertain whether this is in fact the case is essential to the solution of technical problems affecting current psychopathological descriptions. This report argues against the above-mentioned belief, and suggests that the alliance between phenomenology and descriptive psychopathology was just a marriage of convenience, and that it was Karl Jaspers who made it appear as if his own views were based on Husserlian phenomenology. Indeed, a comparison of the clinical meaning and usage of mental symptoms before and after 1913 shows that Jaspers borrowed a great deal from 19th-century alienists, and that calling his views phenomenological added little to their meaning.

ABC of sleep disorders. "I don't get enough sleep, doctor"

Images

Cognitive function in the affective disorders: a prospective study

A prospective, controlled study of 50 subjects confirmed claims that major depression or mania may cause temporary disorders of attention, memory, visuo-spatial function, and choice reaction time, and cause-independently of medication-the appearance of glabellar tap, positive hand-face test, nuchocephalic reflex, and graphesthesia. On follow-up, all these phenomena either disappeared or markedly improved. Age and age of onset, but not pre-morbid intelligence or history of ECT, seemed to modulate the severity of the cognitive impairment. Presence of delusions predicted poor (but reversible) visuo-spatial function. Cognitive impairment accompanied by reversible soft neurological signs was more marked but patients thus affected surprisingly showed lower depressive scores; this was interpreted as representing a secondary, 'organic' form of affective disorder (i.e. a behavioural phenocopy of depression) characterised by a reduced capacity to experience depressive symptoms and by little improvement at follow-up.

European views on personality disorders: a conceptual history

A historical account is offered of the European origins of the DSM-III-R category, personality disorder, and a differentiation is made between the history of terms, patterns of behaviors, and concepts. The concept of "disorder of character (personality)" developed in the nineteenth century, and was possible after notions such as character, constitution, temperament, and self received a psychological definition, and after the insanities became transformed into "psychoses." Terms such as "type" and "trait" were in turn ushered into the nineteenth century by faculty psychology and the phrenological tradition. Until the end of that century, "personality" referred to the subjective aspects of the self, and "personality disorder" meant alteration of consciousness (e.g., hysterical dissociation); the behavioral patterns dealt with by DSM-III-R as personality disorders were then called disorders of character and explained as states of volitional failure, or loss of coherence between cognitive, emotional, and conative functions, or of "automatism," i.e., the manifestation of lower (more primitive or animal) forms of behavior escaping the control of higher (human) ones. Character types and disorders were first considered as forms of attenuated insanity, and later on were made into a separate group whose membership could be attained via the visitation of a degeneration taint, neurological disease (e.g., encephalitis), or plain ill-breeding. The relevance of the intellectual background of the nineteenth century to these diagnostic changes is also discussed.

The assessment of insight in clinical psychiatry: a new scale

Difficulties surrounding the meaning of insight in psychiatry have led to neglect of its assessment in clinical practice. A study is described in which an insight scale was constructed and tested in a sample of 43 patients suffering from schizophrenia or depression. The results showed that the insight instrument was able to provide a qualitative and quantitative assessment of insight. Qualitative features brought out by the scale included patients' perception of changes within themselves and within their environment, their recognition of being ill and their acknowledgment of needing help. Quantitative measurements showed that there was a significant improvement in the level of insight over the period of hospital admission. In addition, scores obtained on the insight scale were inversely correlated with the severity of the patients' disorder, though these correlations occurred at different times in relation to the different disorders. We thus postulate that other factors (such as intellect, past experience, personality etc.) must be involved in modulating the expression of insight. Although the insight instrument needs refining, we suggest that it may be a useful tool in the further exploration of insight in clinical practice.

Feelings of guilt in major depression. Conceptual and psychometric aspects

A new scale for the evaluation of feelings of guilt is described. Two types of guilt feeling were of potential interest: 'delusional' guilt or shame (experienced in relation to one's actions), and 'affective' guilt (a more general feeling of unworthiness). Reliability and validity analyses for the first (15-item) version of the scale were performed in three separate and contrasting clinical samples. The second and final (seven-item) version was tested in another sample of major depressives and in normal controls. The HRSD was used as a measure of severity throughout. The BDI and Widlöcher psychomotor retardation scale were also used as external criteria for the seven-item scale. Exploratory factor analysis of this sample yielded two factors--'cognitive/attitudinal' and 'mood/feeling'--of which only the first correlated with scores for psychomotor retardation. It is suggested that these two factors represent two forms of guilt, but that only the former is related to a putative dopaminergic disorder. Guilt scores and measures of severity were not correlated. It is suggested that feelings of guilt should be considered as a behavioural marker for a subtype of depression.

The meaning of insight in clinical psychiatry

Insight can be defined not only in terms of people's understanding of their illness, but also in terms of understanding how the illness affects individuals' interactions with the world. The term 'insight' encompasses a complex concept which should not be considered as an isolated symptom which is present or absent. Instead, it may be more appropriate to think of insight as a continuum of thinking and feeling, affected by numerous internal and external variables. Different psychiatric disorders involve different mechanisms in the process of impairment of insight; this may influence the ways in which insight should be assessed in clinical practice.

Factor structure of DSM-III-R personality disorders shown by self-report questionnaire: implications for classifying and assessing personality disorders

A modified version of the revised Personality Diagnostic Questionnaire (PDQ-R), based on DSM-III-R personality disorders (PD), was completed by 74 psychiatric patients. A factor analysis of the scores for each of the PD (i.e. of the number of positive DSM-III-R criteria for each of the PD) yielded 3 factors that defined 3 PD clusters. These were similar to the 3 DMS-III-R PD clusters for 7 of the 11 PD categories. The 3-group solution of a cluster analysis of the patients (using their scores of positive criteria for each of the PD) did not reflect these factors; the main discriminating variable between the 3 groups of patients was the total number of positive PD criteria. It is suggested that, for the routine assessment of patients, the most important derivative of the DSM-III-R classification of PD is the total score of positive PD criteria.

French views on positive and negative symptoms: a conceptual history

The history of the positive/negative terminology, as applied to psychiatric symptoms, can be divided into an early period of original meanings, a second one of French elaboration, and the current revival. This report addresses issues concerning the meaning, referent, and nature of the link between the positive and the negative as dealt with in French publications by Ribot, Janet, de Clérambault, Nayrac, Von Monakow and Mourgue, and Ey. It is shown how these authors modified the old Reynoldian terminology to meet ongoing epistemological needs, and in doing so exhausted the conceptual permutations through which the positive/negative dichotomy can be put. To render their views intelligible, the historical origin of concepts such as evolutionism, Jacksonian, inhibition, psychological automatism, and synchrony and diachrony is briefly mentioned. It is suggested that the French writers helped to bridge the gap between Reynolds and the present, but that the conceptual subtlety that characterized their work has not been matched by the leaders of the current revival.

Manic and depressive symptoms in the elderly: their relationships to treatment outcome, cognition and motor symptoms

70 subjects aged over 65 were evaluated within 48 h of admission in order to ascertain the correlation between manic and depressive symptoms and cognitive disorder, multi-infarct changes, abnormal movements, and extrapyramidal signs. Manic symptoms were found to be more often correlated with multi-infarct changes, lower cognitive scores, disordered behaviour, and bad outcome. The meaning of these findings is discussed.

Musical hallucinations: a statistical analysis of 46 cases

Musical hallucinations remain rare, are more common in women, and their onset is often related to ear pathology, particularly deafness. When brain disease is involved, pathology of the right or non-dominant hemisphere seems overrepresented. Psychosis and personality traits play a minimal role in their development. A discriminant function was constructed that correctly predicted the presence of brain disease (89%) and included the following clinical variables: being male, having acute onset musical hallucinations, and absence of deafness, psychiatric disease, and other forms of hallucination.

Extrapyramidal signs, primitive reflexes and frontal lobe function in senile dementia of the Alzheimer type

Of 146 elderly subjects suffering from Alzheimer-type dementia, 44% were found to have significant extrapyramidal signs. Although extrapyramidal signs were more common in those who had taken neuroleptic drugs in the preceding six months, 22 subjects (15%) who were drug free also had extrapyramidal signs. Scores for cognitive function and for 'frontal lobe' signs (verbal fluency, evidence of perseveration, and primitive reflexes) were found to correlate well with scores for extrapyramidal signs, suggesting that they reflect changes in a common substratum. It is tentatively suggested that this might be an abnormality in the dopamine system.

Andre G. Ombredane and the psychiatry of multiple sclerosis: a conceptual and statistical history

By means of conceptual history and statistical analysis of historical data, this report shows that studies into the psychiatry of multiple sclerosis (MS) underwent a qualitative improvement between the Great War and the publication of A.G. Ombredane's great work. Analysis of his database, collected 60 years ago, shows that some of his conclusions (later to be influential) were unwarranted, but that, on the other hand, it enshrined hidden information showing a relative independence between euphoria (and other affective changes) and chronicity and illness duration. An earlier knowledge of this point might have had a corrective effect on later claims about the neuropsychiatry of MS.

Wilson's disease: a longitudinal study of psychiatric symptoms

One hundred and twenty-nine cases of Wilson's disease (WD) were assessed at index admission and two follow-ups (F1 and F2) on a range of clinical and biochemical variables. The commonest psychiatric symptoms throughout were incongruous behavior, irritability, depression, and cognitive impairment. Among psychiatric cases, most improvements occurred in the interval index-F1, with subsequent leveling off. Significant improvement occurred only with incongruous behavior and cognitive impairment. Psychiatric cases whose psychiatric symptoms persisted to F2 differed from those who responded, in particular showing more dysarthria, incongruous behavior, and hepatic symptoms. Neuropsychiatric cases displayed more dysarthria and incongruous behavior than patients with neurological symptoms alone. Further evidence for associations between dysarthria and abnormal behavior emerged from this study.

Feelings of fatigue and psychopathology: a conceptual history

Since the 19th century, fatigue has received far more attention in the medical literature than feeling of fatigue. The latter is defined as a primary, sui generis feeling, which can be studied (and is experienced) independently of physical phenomena such as tiredness, and cognitive concomitants such as "not wanting to continue or initiate a task." The unexplained feeling of fatigue is a common medical complaint, and accompanies various medical and psychiatric conditions. Several meaning systems can be identified in relation to feeling of fatigue and provide material for construction of a measuring instrument. Such a scale will allow us to answer four questions: Is the feeling of fatigue a unitary and primary experience or sensation? Is it the same regardless of the clinical or social context in which it occurs? Are the somatic and cognitive accompaniments of feeling of fatigue an essential part of its definition? Does feeling of fatigue have a neurobiological basis?

Musical hallucinations. A historical and clinical study

A sample of 46 subjects experiencing musical hallucinations was analysed - 10 new cases in addition to 36 culled from the literature. When compared with controls, it was found that musical hallucinations are far more common in females, and that age, deafness, and brain disease affecting the non-dominant hemisphere play an important role in their development. Psychiatric illness and personality factors were found to be unimportant.

Durkheim and French psychiatric views on suicide during the 19th century. A conceptual history

One of the targets of Durkheim's criticism, in his masterly book Le Suicide (1897), is the view upheld (according to him) by all 19th-century French alienists that suicide was, in all cases, a form of madness (henceforth, the ‘absolutist’ or ‘psychiatric’ hypothesis). Durkheim's view is important, particularly among sociologists, and lest they, and other readers, are led uncritically to accept his version of 19th-century French psychiatric views on suicide, it would seem important to put the historical record straight. The relevant literature is vast, and only representative writers are included in this paper. It is not the purpose of this paper to deal, in any way, with Durkheim's sociological views. (This is being done by Mohanna & Berrios (1990)).

Biological and quantitative issues in neuropsychiatry

During the recent resurgence of interest in neuropsychiatry, rapid technological advances have outpaced developments in the underlying theoretical framework. Neurophilosophy has tended to overlook clinical problems. This paper aims to redress the balance by examining a number of conceptual issues. Two groups of problems are considered: those related to brain functioning and psychiatric symptoms, and those related to the measurement of symptoms and their statistical analysis. It is emphasized that psychiatric symptoms appear to reflect the modular organization of the brain; and the particular psychiatric symptomatology associated with individual neurological diseases may be more distinct than is generally assumed, both cross-sectionally and over time.

Depressive illness in multiple sclerosis. Clinical and theoretical aspects of the association

The present state of knowledge of the possible relationship between depressive illness and multiple sclerosis is described. Problems of the research methodology are identified and suggestions made for useful areas of inquiry.

Wilson's disease: clinical groups in 400 cases

Existence of clinical subgroups among cases of Wilson's disease has long been postulated and various classifications suggested but none statistically tested. This study analyses, by means of pattern recognition techniques, 400 cases from 4 series including our own (n = 195). Factor analysis (to summarise variables) and cluster analysis (to derive groups of patients) were performed. From each series 4 clusters were derived, each containing a "hepatic" and at least one "neurological" cluster, other clusters being "mixed hepatic & neurological" (3 series) and "asymptomatic" (3 series). Two series contained 2 "neurological" clusters; one dividing in terms of age and the other in terms of presence or absence of psychopathology. At least 2 factors, "hepatic" and "neurological", emerged from each series. Reasons for differences are discussed. In conclusion, Wilson's disease is not homogenous: clinical groupings are supported by statistical classification.

Wilson's disease. Psychiatric symptoms in 195 cases

A series of 195 cases of Wilson's disease were assessed retrospectively on a range of variables, including psychiatric, neurologic, and hepatic symptoms, and biochemical data as recorded at first admission to a specialist clinic. Ninety-nine patients (51%) were rated as displaying some evidence of psychopathologic features, and 39 (20%) had seen a psychiatrist before the diagnosis of Wilson's disease. The most common psychiatric features were abnormal behavior and personality change, although depression and cognitive impairment were also rated frequently. Schizophrenialike psychoses were rare, apparently occurring at no more than chance frequency. Psychiatric symptoms were related to neurologic rather than hepatic symptoms, and certain symptoms (incongruous behavior, irritability, and personality change) had a particularly significant relationship with bulbar and dystonic disorders but not with tremor. Psychiatric manifestations are important in Wilson's disease, and many of the psychopathologic features seem to have an organic basis.

Wilson's disease: a prospective study of psychopathology in 31 cases

A prospective neuropsychiatric study of 31 consecutive subjects with Wilson's disease is reported. Exploratory factor analysis yielded four factors: neurological, cognitive, hepatic/depressive and psychiatric. Significant associations were found between a 'psychopathic' personality factor and neurological and dysarthria scores. The d' and beta coefficients of a signal-detection memory task dissociated: the former correlated only with Mini-Mental State and Benton visuospatial task; and the latter with depressive symptoms. Using discriminant function analysis, there was efficient classification of 'psychopathic' personality by dysarthria, and of individual depressive symptoms by disturbance of gait. Biochemical markers of hepatic dysfunction were significantly associated with certain depressive symptoms. No evidence emerged to support the putative association with schizophrenia-like psychosis.

Obsessive-compulsive disorder: its conceptual history in France during the 19th century

Until the 1850s, obsessive-compulsive phenomena were considered to be a variant of the old notion of insanity. Around this time they became a separate disease: first, as a member of the old class of the neuroses; then, briefly, as a variant of the newly formed notion of psychosis; and finally, as a neurosis proper (in the post-1880s sense). These changes reflected theoretical shifts in the definition of the grand psychiatric categories. After 1860, organic causal hypotheses for OCD included dysfunctions of the autonomic nervous system and cortical blood supply. Psychological hypotheses suggested the OCD might result from volitional, intellectual, or emotional impairment, the last of which predominated after 1890. Issues relating OCD to personality types and hereditability were dealt with in terms of the degeneration theory. By the late 1880s, OCD achieved full clinical and nosological definition.

The early development of Kraepelin's ideas on classification: a conceptual history

Psychiatry still lives in a Kraepelinian world and scholarship on the work of Kraepelin has consequently been unhistorical. Selective exegesis of the various editions of his textbook has led to a rigid view of his contribution. However, Kraepelin lived and wrote during an important period of European intellectual history and his work can only be understood against this background. This paper analyses the development of his views in terms of the 'Research Programme' he planned early in his life and whose objective was the creation of a stable description and classification of the psychoses. This Kraepelin eventually achieved by longitudinally studying patient cohorts in terms of methodological criteria such as illness course and incurability. In the event, this methodology allowed him to identify by correlation 'clinical pictures' that both represented the 'essence' of the disease and provided a taxonomic criterion. Although avowedly atheoretical, Kraepelin thus managed to construct (influenced by Kahlbaum and Wundt) an empirical support for his Kantian categorization of the psychoses. A discussion of the cultural variables that moulded these ideas is included.

Wilson's disease and epilepsy

The relationship between Wilson's disease and epilepsy is explored, both in the literature and in a series of 200 cases of Wilson's disease. Details of 44 literature and 14 personal cases of both disorders are presented. The prevalence on December 1, 1986 of epilepsy in the Cambridge series was 6.2%, ten times higher than that of epilepsy in the general population. Seizures in Wilson's disease occur at any stage of the disease, but often begin shortly after the start of treatment. Prognosis of seizures was comparable with the best quoted figures for idiopathic epilepsy: at 7 years 60% of cases had been seizure-free for at least 5 years, and 75% for at least 2 years. Possible mechanisms of seizures are discussed. Penicillamine-induced pyridoxine deficiency is probably not involved in more than a minority of cases. It is more likely that a direct effect of copper deposition is responsible for most of the seizures.

Melancholia and depression during the 19th century: a conceptual history

The meaning of ‘melancholia’ in classical antiquity is opaque and has little in common with 20th-century psychiatric usage (Drabkin, 1955; Heiberg, 1927). At that time, melancholia and mania were not polar opposites (i.e. one was not defined as having opposite features to the other). Melancholia was defined in terms of overt behavioural features such as decreased motility, and morosity (Roccatagliata, 1973; Simon, 1978). Hence, in medical usage, ‘melancholia’ referred to a subtype of mania and named, in general, states of reduced behavioural output. These included disorders that might “exhibit depressed, agitated, hallucinatory, paranoid and even demented states … the ancient diagnosis of melancholy has no correct analogue in modern psychiatric practice …” (Siegel, 1973, p. 274).

Psychiatric morbidity in subjects with inner ear disease

A prospective assessment of psychiatric morbidity in a sample of 207 patients with inner ear disorders, attending an ENT clinic, was carried out. As a group, they were found to have higher psychiatric morbidity on the general health questionnaire (GHQ) than either normal samples or samples affected by other forms of physical disease. Within the sample tinnitus patients scored the highest, and presbyacusis patients the lowest. High GHQ scores predicted an exaggerated self-rating of symptom severity in a visual analogue scale. Past psychiatric history did not play a role in the development of psychiatric morbidity. Elderly subjects complained more often of fear of collapsing in the street but this was not related, as has been suggested, to the subsequent development of agoraphobic symptoms. Factor analysis of GHQ items for the 'cases' yielded 'depression', 'anxiety' and 'personality' factors. No correlation was found between these factors and the rest of the clinical variables. It is concluded that tinnitus shows the clearest association with psychiatric morbidity and hence merits detailed psychological analysis. Such a study has been started at Addenbrooke's Hospital.

Dementia during the seventeenth and eighteenth centuries: a conceptual history

An historical analysis is made of the word and of the concept of 'dementia' before the nineteenth century. With regard to the word, it is shown that it had legal and medical meanings and that, while the former developed during the seventeenth century, the latter did so only during the eighteenth century (earlier than psychiatric historians have suggested). As evidence for the latter point, rare historical material on 'Démence' from the first edition of the Encyclopédie Française is presented for the first time in English. It is also shown that the legal meaning was finally enshrined in the 'Code Napoléon'. With regards to the concept of dementia, it is shown that it took final shape in the work of Willis, Hartley and Cullen in whose view it was made to include terminal states of behavioural incompetence due to severe failure of almost any mental function. During this period, dementia was not yet associated with a particular age group nor was specifically defined in terms of cognitive deficit. The origins of the 'cognitive' paradigm of dementia and of the clinical boundaries of the future concept of dementia are briefly outlined.

The adverse effect of benzhexol on memory in Parkinson's disease

Seventy-eight subjects suffering from idiopathic Parkinson's disease were studied in 2 separate groups to test the hypothesis that benzhexol affects memory. In study A, 54 subjects were tested by means of a free recall technique; in study B, 24 subjects were given a signal detection memory task. Both studies yielded significant correlations between memory impairment and dosage levels of benzhexol. No correlation was found between memory status and dosage of levodopa, duration of illness or Hamilton depression scores. The implications of these findings are discussed.

Post psychotic depression: the Fulbourn cohort

A comparison is reported, based on a 10 year follow-up, between an index sample of 29 subjects suffering from schizophrenia and post psychotic depression and a control sample of 41 subjects suffering from schizophrenia alone, all having had their first admission to the same hospital in 1974. The index subjects were significantly older on onset of schizophrenia and exhibited more auditory hallucinations. Follow-up patients with post psychotic depression were admitted more often, but their admissions were shorter. No difference was found between the two groups in the frequency of family history of affective disorder, in the duration of treatment with depot neuroleptics or in the dose level of the depot injection received immediately prior to readmission.

Affective disorder in the neurological patient

An index sample of neurological patients diagnosed as clinically depressed (83) was compared with a "major depression" sample (43) and a "neurological sample" (44) who were free from psychiatric disorder. There was no difference in global Hamilton Scores between the index and the major depression sample. The latter, however, more often exhibited family and personal history of psychiatric illness, early awakening, guilt, suicidal ideas, shorter index episodes of depression, and better response to treatment. The three samples were followed up for a period of up to 5 years. The index sample did worse on follow-up than did the depressed and the neurological samples. The disease profiles of both the index and neurological samples were similar, but there were more cases of epilepsy in the former. The index sample responded badly to conventional antidepressant treatment. It is concluded that the presence of chronic affective disorder in the neurological patient has an adverse effect on prognosis.

Patients who break their fast before ECT

Of 81 patients receiving ECT during a period of 24 months, 21 ate or drank something, against medical advice, shortly before ECT was due. Compared with controls, the fast-breakers were less often married; were more likely to be detained under a section of the Mental Health Act; had an unfavourable view of ECT; and had often not given consent for ECT. Fast-breaking was more likely to occur after four or more ECTs. Amongst the fast-breakers there was a significant correlation between age and number of previous ECTs; treatment at which the fast-break occurred. The more drugs the patient was taking the more likely it was that the fast would be broken early in the course of ECT.

Significant rise in plasma insulin after electroconvulsive therapy

The effect of ECT on insulin plasma levels was studied in 10 single treatments in five patients suffering from DSM III-diagnosed schizophrenia. The treatments were chosen from early, middle and late ordinal positions. A significant rise was found 10, 20 and 30 min after an effective electrical stimulus. Values returned to normal in all cases at 60 min. The rise at 10 min occurred in all treatments, irrespective of ordinal position, but an incidental finding was that the higher the ordinal position of a given treatment, the higher the peak of insulin.

Temporary urinary incontinence in the acute psychiatric patient without delirium or dementia

In a prospective study of the 295 admissions in one year to an acute psychiatric ward, 14 subjects without delirium or dementia were found to have developed temporary urinary incontinence. When compared with matched controls (n = 56) the incontinent patients were found to be suffering from psychosis (P less than 0.0002) and to have a history of childhood enuresis (P less than 0.01). Compared with psychotic controls (n = 22), the incontinent patients were older (P less than 0.05), they had been exposed to a greater variety of treatments (P less than 0.01), and they had received more thioridazine (P less than 0.04).

Presbyophrenia: the rise and fall of a concept

The history of the concept of presbyophrenia is traced from its inception in 1863 to the present day. Early in the twentieth century it was used to refer to a subtype of dementia characterized by confabulations, marked memory impairment, hyperactivity, disorientation, elevated mood and preserved social graces. At the time it was considered to be either a form of Korsakoff's psychosis or a subtype of senile dementia. The decline of the concept started in the 1920s and was precipitated by the redefinition of dementia in terms of impaired cognition, cortical symptomatology and specific neuropathological changes. Three explanations for the curious combination of symptoms characterizing presbyophrenia were then suggested: toxic-delirious states, manic illness in late life, or a combination of cerebrovascular disease and senile dementia. It is suggested that the dismissal of presbyophrenia could have been premature as it may capture a behavioural phenocopy of relevance to clinical practice.

Urinary incontinence and the psychopathology of the elderly with cognitive failure

Thirty-five percent of a sample of 100 elderly patients suffering from a degree of cognitive impairment were found to have urinary incontinence. They were significantly older, had lower memory and information scores and were more disorientated, hyperactive, aphasic, apraxic and socially incompetent than their continent counterparts. Their diagnosis was more likely to be a combination of senile and arteriosclerotic dementia (ICD-9); they suffered less often from concomitant functional psychiatric disease and showed a higher mortality rate (at 18 months' follow-up) than the patients without incontinence.

Pseudodementia: facts and figures

The historical and conceptual aspects of the pseudodementia state are briefly touched upon. A "collective sample", composed of 61 cases culled from the literature, is analysed and compared with the "Fulbourn sample" consisting of 22 cases reported for the first time. Two sub-types of pseudodementia emerge, one associated with depressive illness and the other with delirium. A follow-up of the Fulbourn sample (1-4 years after discharge) showed 14 patients to be alive and 8 to show no signs of dementia. No variable except the diagnosis "non-specific psychosis" correlated with death during the follow-up period.