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Long-stay psychiatric patients discharged to two group homes from Friern Hospital were studied 1 year and 5 years after discharge. A much greater cohesiveness of social relationships was noted in the smaller home at both time points, whereas in the larger home residents had failed to develop friendships and intimacy within their social group. A number of hypotheses were explored to explain this difference. None of the factors investigated provided an explanation, including the mental state of the patients prior to discharge, their problems of social behaviour, the size of the group homes, whether they were staffed or unstaffed, and the patients' age. However, the development of friendships and intimacy over a 5-year period was strongly determined by the quality of the patients' social networks while in hospital. Consequently, when selecting groups of patients to share homes in the community, it is deemed advisable to form groups that fully reflect the range and diversity of their social networks.

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Background Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder which often presents with neuropsychiatric symptoms. A large proportion of cases are associated with an identifiable tumor, most commonly ovarian teratoma. However, recent literature has also described an overlap of anti-NMDAR encephalitis and demyelinating syndromes. Cases have been reported of anti-NMDAR encephalitis in patients with ADEM, optic neuritis, myelitis and multiple sclerosis. This link is considered rare, however has important clinical implications as treatments and prognosis may differ. Case presentation A 33-year-old female with a history of multiple sclerosis presented with new-onset neuropsychiatric symptoms. After substance-induced psychosis was ruled out, she was admitted to the medical ward for work up of psychosis secondary to multiple sclerosis. However, the consultation-liaison psychiatry service noted atypical symptoms which were concerning for autoimmune encephalitis. Admission to a psychiatric inpatient ward was deferred. Anti-NMDAR encephalitis was diagnosed with CSF analysis demonstrating lymphocytic pleocytosis and anti-NMDAR antibodies. In addition to first-line treatment of encephalitis with steroids, second-line immunotherapies were also implemented given the patient’s underlining demyelinating syndrome. The patient’s neurologic and psychiatric symptoms began to improve. Conclusions There is literature to demonstrate a possible connection between anti-NMDAR encephalitis and demyelinating syndromes. As such, autoimmune encephalitis should be considered in patients with multiple sclerosis presenting with atypical symptoms. Determining the correct diagnosis is crucial to inform the appropriate treatment protocol, and to improve prognosis.

You see, but you do not observe," begins Sherlock Holmes in the 1891 short story A Scandal in Bohemia, by Arthur Conan Doyle. The passage that follows illustrates the idea of mindful observation, as Holmes makes a point to distinguish it from just seeing the steps that lead up to the room in which he and Watson stand (1). In fact, this concept of active observation is integral to the practice of medicine. As William Osler said, "the whole art of medicine is in observation" (2). Physicians perform evaluations based on the patient's communication of ailments. Oxford Dictionary defines communication as "the imparting or exchanging of information" (3). This exchange can take many forms when interacting with a patient. Most commonly what physicians conceptualize as communication is that which is spoken by the patient. However, literature continues to reveal the importance of nonverbal behaviors in communication. THE STUDY OF NONVERBAL COMMUNICATION All forms of communication other than words can be considered nonverbal communication (4), including vocal tone, facial expressions, posturing, and bodily movements. In his 1882 book, The Expression of the Emotions in Man and Animals, Charles Darwin put forth the idea of bodily movements representing internal emotional states as a result of evolution and inheritance. He argued that these movements we see accompany certain emotional states are universal to our species and that they serve a purpose while in that emotional state (5). This was demonstrated by his understanding of the function of these