A 43-year-old man presented with an 18-month history of acute-onset cyclical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness which lasted 24 hours. On examination, there was some evidence of visual memory and frontal lobe deficits. A brain CT scan showed bilateral thalamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported case of thalamic infarction associated with acute-onset cyclical affective psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamo-frontal circuits in the pathogenesis of the Kleine-Levin syndrome.

SynopsisThe aim of this study was to determine whether HIV infection is associated with increased psychosocial distress in the asymptomatic and early symptomatic stages of disease and to determine the factors associated with reporting health symptoms. Subjects included 61 gay men (41 HIV −, 20 HIV +) who were assessed at the time of requesting their first HIV test and again 12 months later. Measures included a detailed standardized psychiatric interview (Present State Examination, PSE), a range of psychosocial self-report measures and a physical symptom checklist. There were no differences between the HIV + and HIV − groups in terms of self-reported symptoms. Multiple regression analysis showed that the symptom reporting was not associated with clinical or immunological markers of disease progression but was associated with measures of psychosocial distress. Although both groups showed elevated levels of psychosocial distress at the time of HIV testing, there were no differences between serostatus groups at follow-up. Multiple regression analysis indicated that the best predictors of PSE scores at follow-up were baseline PSE score and a history of psychiatric illness. Early HIV disease is not associated with increased psychosocial distress and symptom reporting is more closely related to psychological measures than to clinical or immunological markers of disease.

A General Health Questionnaire (GHQ) was completed by 55 women attending a clinic for vulval problems in central London. The GHQ-caseness rate was 40% from which the psychiatric morbidity in the sample was estimated to be 32%. The level of psychiatric morbidity in 10 women with a diagnosis of vulvodynia was similar to that of 41 women with other vulval diagnoses.

Aims and MethodThe aim of the study was to determine whether diagnostic case-mix influenced the distribution of clinical activity within the community mental health team (CMHT). Information concerning every patient involved with the CMHT and every episode of clinical activity was collected over a 2-week period.ResultsData were obtained concerning 417 patients and 1744 corresponding episodes of clinical activity. Diagnostic case-mix significantly differed between the professions. The duration of episodes of clinical activity varied significantly according to the type of patients involved and whether or not direct face to face contact occurred.Clinical ImplicationsDiagnostic case-mix, in addition to absolute numbers, should be considered when estimating the actual work generated by the different professions' case-loads. Patients with psychosis may place an increased time burden upon CMHT members.