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The content of grandiose delusions—inaccurate beliefs that one has special powers, wealth, mission, or identity—is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning.

Individuals belonging to ethnic minority groups are less likely to experience symptoms of psychosis, such as paranoia, if they live in areas with high proportions of people from the same ethnic background. This effect may be due to processes associated with group belonging (social identification). We examined whether the relationship between perceived discrimination and paranoia was moderated by explicit and implicit Pakistani/English identification among students of Pakistani heritage (N= 119). Participants completed measures of explicit and implicit Pakistani and English identity, a measure of perceived discrimination, and a measure of paranoia. Perceived discrimination was the strongest predictor of paranoia (0.31). Implicit identities moderated the relationship between perceived discrimination and paranoia (−0.17). The findings suggest that higher levels of implicit Pakistani identity were most protective against high levels of paranoia (0.26, with low implicit English identity; 0.78, with medium English identity; 1.46, with high English identity). Overall, a complex relationship between identity and paranoia was apparent.

Voice notes, spoken messages recorded and sent via smartphones, have become a widespread means of communication. A likely consequence of this situation is that voice note users become more frequently exposed to recordings of their own voices (self-voices). This correlational study examined if frequent exposure to recordings of the self-voice via voice note replay was associated with improved self-voice recognition (accuracy and response latency) and self-voice liking. Participants (N = 128), regular voice note users, reported voice note replay frequency. They also reported self-voice satisfaction/liking. Finally, participants completed a novel self-voice recognition task, where, across 20 trials, they identified whether a recording was them (self-voice) or not (non-self-voice). The tendency to frequently replay voice notes was positively correlated with self-voice liking and recognition accuracy. These findings may have implications for the treatment of social anxiety disorder and auditory verbal hallucinations.

Research has demonstrated that situational factors such as perceived threats to the social order activate latent authoritarianism. The deadly COVID-19 pandemic presents a rare opportunity to test whether existential threat stemming from an indiscriminate virus moderates the relationship between authoritarianism and political attitudes toward the nation and out-groups. Using data from two large nationally representative samples of adults in the United Kingdom (N= 2,025) and Republic of Ireland (N= 1,041) collected during the initial phases of strict lockdown measures in both countries, we find that the associations between right-wing authoritarianism (RWA) and (1) nationalism and (2) anti-immigrant attitudes are conditional on levels of perceived threat. As anxiety about the COVID-19 pandemic increases, so too does the effect of RWA on those political outcomes. Thus, it appears that existential threats to humanity from the COVID-19 pandemic moderate expressions of authoritarianism in society.

From 'A Proposal to Classify Happiness as a Psychiatric Disorder,' by Richard P. Bentall, in the June 1992 issue of the Journal of Medical Ethics, published in London. Bentall is [...]

Different aspects of the neighborhood social environment have been linked with mental ill health; however, the mechanisms underlying these associations remain poorly understood because of the number and complexity of the components involved. We used a novel statistical approach, network analysis, to explore the complex associations between neighborhood social cohesion, social disorder, and mental-health symptoms in a sample of 3,670 adults from an economically deprived region of the United Kingdom (mean age = 49.34 years, SD= 18.87; 57% female). Elasso regularized networks were estimated, and network comparisons were conducted by level of deprivation. Mental-health symptoms and neighborhood components formed relatively distinct clusters of items. These domains were linked primarily by paranoia, although only in the most deprived group. Drunken/rowdy behavior was particularly influential within the neighborhood cluster; therefore, policies aimed at reducing such disruptive behavior could have positive knock-on effects for social cohesion and mental health.

Trial has too many shortcomings EDITOR--Powell et al's controlled trial of graded physical exercise in chronic fatigue syndrome has several shortcomings.[1] Firstly, the only tool that was used to assess [...]

Objective: The major cognitive theories of persecutory delusion formation and maintenance are critically examined in this article. Method: The authors present a comprehensive review of the literature, citing results of relevant functional neuroimaging and neural network studies. Results: People with persecutory delusions selectively attend to threatening information, jump to conclusions on the basis of insufficient information, attribute negative events to external personal causes, and have difficulty in envisaging others' intentions, motivations, or states of mind. Presence of the 'reality distortion' cluster of psychotic symptoms correlates with cerebral blood flow in the left lateral prefrontal cortex, ventral striatum, superior temporal gyrus, and parahippocampal region. Social cognitive processing (selective attention to threat, attribution of causation or mental states) in normal subjects involves similar areas. Neural network models of persecutory delusions highlight the importance of disordered neuromodulation in their formation and of disordered neuroplasticity in their maintenance. Conclusions: Further studies examining the interaction of these cognitive processes, cross-sectionally and longitudinally, at cognitive psychological, neural network, and functional neuroanatomical levels are warranted to establish a comprehensive cognitive neuropsychiatric model of the persecutory delusion. (Am J Psychiatry 2001; 158:527-539)

Abstract Objective To assess the efficacy of an educational intervention explaining symptoms to encourage graded exercise in patients with chronic fatigue syndrome Design Randomised controlled trial. Setting Chronic fatigue clinic [...]

An influential psychological model of persecutory delusions proposed that they are caused by a bias towards holding others responsible for negative events (an externalising attributional bias), preventing the individual from becoming aware of underlying low self-esteem. An early version of the model predicted self-esteem would, therefore, be preserved in people with these delusions, but a later version suggested it would be unstable, and that there would be a discrepancy between explicit and implicit self-esteem, with the latter being lower. We did a comprehensive meta-analytical test of the key predictions of this model and assessed the quality of evidence.

There is a need to develop novel interventions for psychosis, targeted at specific psychological mechanisms. We used a classical conditioning paradigm to a) modify implicit self-esteem and b) examine subsequent effects on subclinical psychotic symptoms measured by the Experience Sampling Methodology. This study is a proof-of-concept pilot investigation conducted with 28 students with high paranoia levels, assessing variations in their self-esteem, paranoid beliefs, and subclinical psychotic symptoms daily. After 2 days, participants were randomized to receive either a positive conditioning task (repeatedly pairing self-relevant words with an image of a smiling face) or a neutral conditioning task (repeatedly pairing self-relevant words with random smiling, angry, or neutral faces). After the intervention, the positive conditioning participants showed significantly higher levels of implicit self-esteem and lower subclinical psychotic symptoms than the control condition participants. This study demonstrated that implicit self-esteem can be increased by using a classical conditioning task.

Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.

Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.

Epidemiological studies have suggested that there may be associations between specific adversities and specific psychotic symptoms. There is also evidence that beliefs about justice may play a role in paranoid symptoms. In this study, we determined whether these associations could be replicated in a patient sample and whether beliefs about a just world played a specific role in the relationship between adversity and paranoia. We examined associations between childhood trauma, belief in justice, and paranoia and hallucinatory experiences in 144 individuals: 72 individuals with a diagnosis of schizophrenia spectrum disorders and 72 comparison controls. There was a dose-response relationship between cumulative trauma and psychosis. When controlling for comorbidity between symptoms, childhood sexual abuse predicted hallucinatory experiences, and experiences of childhood emotional neglect predicted paranoia. The relationship between neglect and paranoia was mediated by a perception of personal injustice. The findings replicate in a patient sample previous observations from epidemiological research.

Psychological treatment approaches to the negative symptoms of schizophrenia (e.g., blunted emotions, poverty of speech and loss of drive) are described. Token economies which involve behavior modification and operant conditioning were extensively utilized in the 1950s. When patients behaved well, they were given tokens, which could later be exchanged for positive reinforcers such as cigarettes, candy or extra television time. Still used, this method does improve some negative symptoms in long-term patients, but the rewarding social interactions between staff and patients rather than the token rewards are now thought to be the strongest treatment factor. Social skills training programs, developed in the early 1980s, have been tried, but have only reported short-term benefits. Life skills training approaches, which focus on money management, interpersonal skills, nutrition, hygiene, community resources and social networks, have also demonstrated significant favorable short-term effects, although long-term effects have not been assessed. Cognitive behavior modification techniques involve self-instructional training (SIT). SIT teaches patients to first instruct themselves out loud, then quietly on how to plan and control their own behavior. SIT has been shown to improve the cognitive performance of patients with negative symptoms. Interpersonal problem-solving approaches are more recent. A study which trained patients to identify social problems, define goals, generate solutions, evaluate alternatives and pick the best solution produced positive effects at one- and four-month follow-up periods. It is concluded that designing therapeutic regimens for specific symptoms and specific patient populations would enhance the efficacy of existing treatment approaches. (Consumer Summary produced by Reliance Medical Information, Inc.)

Algunas teorías psicológicas sobre los delirios persecutorios enfatizan la importancia del concepto de selfy otros (Bentall, Corcoran, Howard, Blackwood y Kinderman, 2001). Sin embargo, los resultados son inconsistentes, en parte por el uso casi exclusivo de medidas explícitas centradas en la autoestima. Freeman (2007)propone que las creencias evaluativas sobre el selfy los otros son el indicador más estable y mejor predictor que la autoestima, por lo que este estudio exploró las diferencias en el concepto explícito e implícito del selfy de los otros entre pacientes con paranoia (n= 79), con depresión (n= 38) y un grupo control sano (n= 52). Los resultados mostraron que a nivel explícitolos grupos clínicos tenían más creencias negativas del selfque los controles, pero no hubo diferencias entre los grupos en las creencias negativas sobre los otros. Sólo el grupo con depresión mostró un selfsignificativamente más negativo que el de los otros. A nivel implícito, aunque los pacientes presentaban un selfmás negativo que los controles, estas diferencias no fueron significativas. Tampoco se observaron diferencias entre grupos en las asociaciones negativas implícitas sobre los otros. Sin embargo, el grupo control presentó un patrón implícito opuesto al explícito en el que el índice de los otros fue significativamente más negativo que el del self. Este estudio señala la importancia de explorar el selfen comparación con el concepto de los otros en diferentes dimensiones del procesamiento cognitivo.

AbstractAimsCurrent information about the prevalence of various mental health disorders in the general adult population of the Republic of Ireland is lacking. In this study, we examined the prevalence of 12 common mental disorders, the proportion of adults who screened positive for any disorder, the sociodemographic factors associated with meeting criteria for a disorder and the associations between each disorder and history of attempted suicide.MethodsA non-probability nationally representative sample (N= 1110) of adults living in Ireland completed self-report measures of 12 mental health disorders. Effect sizes were calculated using odds ratios from logistic regression models, and population attributable risk fractions (PAFs) were estimated to quantify the associations between each disorder and attempted suicide.ResultsPrevalence rates ranged from 15.0% (insomnia disorder) to 1.7% (histrionic personality disorder). Overall, 42.5% of the sample met criteria for a mental health disorder, and 11.1% had a lifetime history of attempted suicide. Younger age, being a shift worker and trauma exposure were independently associated with a higher likelihood of having a mental health disorder, while being in university was associated with a lower likelihood of having a disorder. ICD-11 complex posttraumatic stress disorder, borderline personality disorder and insomnia disorder had the highest PAFs for attempted suicide.ConclusionsMental health disorder prevalence in Ireland is relatively high compared to international estimates. The findings are discussed in relation to important mental health policy implications.

Between 7% and 40% of people with Alzheimer disease (AD) experience persecutory delusions (PDs) during the course of their dementia. Although attributional style and theory of mind processes have been linked with PDs in people with psychosis, they have not yet been examined in those with AD and PDs. The objective of this study was, hence, to explore the role of these cognitive processes in groups of participants with AD with and without PDs, as well as a nonclinical comparison group.

The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved (“poor me”; PM), b) individuals who believed that persecution is justified (“bad me”; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.

The author discusses Richard Bentall's views about his career as clinical psychologist in Great Britain. The author mentions Bentall's interest and fascination in psychology during his younger days and cites his decision to take up the same field during his collegiate years. The author notes Bentall's career development in clinical psychologist and became a professor in various institutions in the country. The author also states Bentall's efforts in studying various psychological illnesses.

Both schizotypy and at-risk mental states (ARMS: prodromal states) define individuals at risk for psychotic symptoms. However, the relationship between the 2 is unclear. ARMS individuals are, by definition, help-seeking and therefore at greater risk. We tested whether high schizotypes and ARMS exist along the same continuum by examining maladaptive metacognitions and distress. About 95 healthy volunteers (39% male; mean age, 22.8 years) completed the Schizotypal Personality Questionnaire, the Launay-Slade Hallucinations Scale, Metacognitions Questionnaire (MCQ), and the General Health Questionnaire, and 58 help seeking individuals with ARMS status (41% male; mean age, 22.2 years) completed the Metacognitions Questionnaire and General Health Questionnaire. With increasing expression of schizotypy and hallucinatory proneness healthy volunteers became difficult to differentiate from ARMS patients and showed similarities in distress and metacognitive abnormalities. Results suggest healthy volunteers who express both schizotypal trait and proneness to hallucinations have cognitive processes in common with ARMS patients.

Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N17) and low (N15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.

We aimed to identify transdiagnostic psychological processes associated with persecutory delusions. Sixty-eight schizophrenia patients, 47 depressed patients, and 33 controls were assessed for paranoia, positive and negative self-esteem, estimations of the frequency of negative, neutral, and positive events occurring to the self in the past and in the future and similar estimates for events affecting others in the future. Negative self-esteem and expectations of negative events were strongly associated with paranoia in all groups. Currently deluded patients were asked to rate whether their persecution was deserved on an analogue scale. Mean deservedness scores were higher in deluded-depressed patients than deluded-schizophrenia patients, but patients in both groups used the full range of scores. The findings indicate that negative self-esteem and negative expectations independently contribute to paranoia, but do not support a simple categorical distinction between poor-me (persecution undeserved) and bad-me (persecution deserved) patients.

Early interventions for psychosis have recently received a great deal of interest. This is because research findings have indicated the importance of duration of untreated psychosis (DUP) in influencing future prognosis. Most interventions have so far centered around the early identification of first episode cases in an attempt to minimize the DUP. A further development of the early intervention strategy aims to identify high-risk cases prior to the onset of psychosis. Treatment of this at risk group could potentially prevent the onset of psychosis. In this paper we describe three cases from a randomized controlled trial designed to test the feasibility of a cognitive therapy intervention, to prevent the onset of psychosis. These are presented with formulations based on a recent cognitive model conceptualizing the onset of psychosis. Implications of this approach for future research and clinical practice are also discussed.

In order to study brain activation during the formation of equivalence relations, 12 subjects underwent fMRI during matching-to-sample (MTS) tests of (1) previously trained arbitrary relationships between iconic stimuli and the untrained, emergent relations of (2) symmetry, (3) transitivity, and (4) symmetry with transitivity, plus a test of verbal fluency (VF). Brain activation was similar in all MTS tasks and in the VF task. In particular, both types of task activated dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex bilaterally. However VF, but not the MTS tasks, activated Broca's area. In three of the four MTS tasks, behavioural accuracy was significantly correlated with left lateralisation of DLPFC activity. Brain activation patterns during equivalence thus resembled those involved in semantic processing underlying language, without involving regions concerned with the simple sub-vocal articulation of stimulus names.

The self‐concept and causal attributions are both centrally implicated in psychological disorders including depression and paranoia. In two investigations of the dynamic relationships between causal attributions and self‐representations, non‐patient participants completed questionnaires derived from Higgins (1987) Self‐Discrepancy Theory before and after completing a measure of causal attribution. In Study 1, consistent with cognitive models of depression, external attributions for negative events were associated with reductions in self‐actual: self‐ideal discrepancies. Study 2 revealed significantly different effects on self‐discrepancies of three types of causal attributions. Internal attributions led to increased self‐actual: self‐ideal discrepancies as well as increased discrepancies between selfperceptions and the believed views of others about the self (self‐actual: other‐actual discrepancies). External situational attributions led to no changes in either self‐actual: self‐ideal or self‐actual: other‐actual discrepancies. External personal attributions led to no changes in self‐actual: self‐ideal discrepancies but increased self‐actual: other‐actual discrepancies. These findings point to the value of distinguishing between different kinds of external attributions. They show that self‐representations and causal attributions are closely coupled cognitive domains. The results also suggest that paranoid ideation might be specifically associated with external‐personal attributions for negative events.

The COVID-19 public health emergency has led to changes in people's attitudes towards minority groups, increasing prejudice and discriminatory behaviors, especially towards migrants. These prejudicial attitudes and discrimination negatively influence migrants’ mental health increasing anxiety and depression and loneliness. However, the sense of belonging can be beneficial in mitigating these mental health issues especially in adverse social situations. Within this context, the aim of the study was to examine to what extent overall social connectedness plays a role in immigrant mental health during the COVID-19 crisis, hypothesizing that reduced sense of belonging to the social world will be part of the pathway from the negative effects of perceived discrimination on mental health during the pandemic. We recruited 104 immigrants from Greece who completed online self-report measures of perceived discrimination, social connectedness, depression, anxiety, paranoia, and loneliness, and conducted mediation analyses to test our predictions. Mediation models indicated that perceived discrimination has a negative impact on sense of belonging, which in turn increases anxiety and paranoia symptoms. Findings suggest that while perceived discrimination has a negative impact on mental health, this effect is less severe if participants remain socially connected. Results are discussed with regard to the need for social inclusion practices.

Objectives. It was hypothesized that people with persecutory delusions, such as depressed people, would experience difficulty when attempting to generate specific autobiographical memories. Design. 20 deluded participants, 20 depressed patients and 20 normal controls were compared on an autobiographical memory test.

The self-serving attributional bias was studied in matched groups of patients with persecutory delusions, patients with major affective disorder, and normal controls, (N14 in each group). On a preprogrammed computer task, subjects mainly won points in one condition and mainly lost points in the other. Subjects were asked to estimate the degree of control they thought they had over winning or losing in the two conditions. In comparison with the normal subjects and the psychiatric controls, the deluded subjects showed a greater selfserving bias, as evidenced by their perceived greater control over outcomes in the win condition. These findings are interpreted as consistent with the hypothesis that persecutory delusions function as a defense against low self-esteem.

Current research on the role of cognitive processes in psychiatric disorders, particularly schizophrenic disorders, depression and anxiety, is reviewed. An important distinction is made between research which focuses on information processing deficits and research which focuses on cognitive biases. Traditionally, research into schizophrenic disorders has focused on deficits, whereas research on the neurotic disorders has tended to focus on biases. These trends have continued, although there is emerging evidence that biases may be fruitfully explored in psychotic disorders and that deficits may be implicated in depression.

Two groups of patients suffering from persecutory delusions, one consisting of patients also suffering from depression and a non‐depressed group, together with clinically depressed and normal controls matched with the deluded patients for age and intelligence, were asked to rate the frequency with which selected positive, negative and neutral events had happened to themselves and to an average other person in the past, and the frequency with which these events were likely to happen to themselves and to an average other person in the future. Results were similar for both past and expected future events. Non‐depressed‐deluded, depressed‐deluded and depressed patients rated negative events as occurring relatively more frequently in comparison to the normal controls. Depressed participants rated positive events as occurring more frequently to others, whereas the normal participants rated negative events as occurring more often to others. Correlational analyses indicated that depression scores were associated with low estimates of the frequency with which positive events happen to self and high estimates of the frequency with which negative events happen to self. Magical ideation scores, an index of psychosis, were associated with high estimates of the frequency of negative events for both self and others. These findings are interpreted in the context of previous evidence on cognitive biases in deluded patients.

The extent to which individuals suffering from persecutory delusions, as compared to matched controls, were prepared to change their attributional judgments following additional information, was investigated. Participants were required to decide whether the actor or target individual had caused an action before and after information, which was either high or low in terms of distinctiveness, consistency and consensus. There were no differences between the three participant groups which all made decisions, and changed their decisions, in the directions predicted by attribution theory.

The ability of two models to predict the outcome of inpatient detoxification was tested. The first model related to motivation and self-efficacy for undergoing the withdrawal, and was found to be weakly predictive of premature discharges. The second model related to the stability of subjects' lifestyles prior to admission, and strongly predicted whether or not subjects would still be in receipt of withdrawal medication at the time of their discharge. It was concluded that further research was required as to the relative usefulness of cognitive/affective versus behavioral indicators of motivation for withdrawal.

The Family Assessment Device (F.A.D.) was administered to a sample of 57 opiate misusers at admission for inpatient detoxification. Logistic regression analyses showed that the odds of a premature discharge against medical advice from the Unit were increased by progressively poorer ratings of family functioning in the areas of problem solving and roles, while progressively poorer ratings of functioning in the areas of communication and behavioral control were associated with decreasing odds of a premature discharge. It was concluded that further research was required to better understand and utilize the potentially supportive role of families in this phase of treatment.

In an attempt to distinguish between associative network and verbal mediation accounts of equivalence formation, three experiments were carried out in which conditional stimulus relations were established and response latencies assessed during tests for emergent relations. In Experiment 1, three groups of adults were trained with six three-member classes of visual stimuli, using different kinds of stimuli for each group: readily nameable pictograms, which were “preassociated” (Group 1); equally nameable but “non-associated” pictograms (Group 2); or non-associated “abstract” stimuli, designed to discourage the use of verbal mediators (Group 3). For those trained with pictograms, equal response latencies were observed on all tested relations, viz. trained associations, symmetry, transitivity, and transitivity with symmetry, but for subjects given abstract stimuli response latencies were greater on tests requiring transitivity. In Experiment 2 this result was replicated with methodological refinements, using only groups trained with preassociated pictograms or abstract stimuli. In Experiment 3 subjects were pretrained to label abstract stimuli with either individual names or class names. Latencies were longer for tests involving transitivity in the case of those subjects using individual names, but equal response latencies were observed on all four types of test for those using class names. The results suggest that equivalence classes May be supported by either an associative network or by verbal mediation, depending on stimulus conditions and the subsequent strategies employed by subjects.

The article examines research studies on hallucinations and delusions. Some findings from the studies are the role of the normal phenomenon of inner speech as a clue to the mechanisms involved in auditory-verbal hallucinations, the dysfunctional metacognitive beliefs of hallucinating patients and the role of deficits in theory-of-mind skills in persecutory delusions.

This is a preliminary report of the use of a device to apply small pulses of radio-frequency energy to surgical wounds in order to improve wound healing. The device was applied to one eye in 21 patients who underwent bilateral blepharoplasty. There were no devicerelated complications. In 11 patients, edema and ecchymosis were noticeably less on the treated side within 24 hours of surgery. In 6 patients, ecchymosis and swelling were so slight that no difference between treated and untreated sides was visible. Two patients were noticeably worse on the treated side. Further studies will be conducted.

This paper describes the design for a microsurgical stainless steel atraumatic needle for primary suture of small peripheral nerves in which the epineurium is friable.The needle (manufactured by Dixey Instruments, U.K.) is curved with a spearshaped point and a small cutting edge on the concave surface. The rest of the body of the needle is round.We have found with histological evidence that there is an improvement in accuracy of suture placement on previously used needles in experimental and clinical microsurgery of peripheral nerves.

The article discusses a perspective on psychological medicine. The author is a respected critic of diagnosed madness. He is among the people who advocates for radical approaches in understanding and treating schizophrenia and bipolar disorder. Psychiatric researches are well under way for development and advancement towards better understanding of these conditions.

Several letters to the editor are presented related to the Division of Clinical Psychology (DCP) on psychiatric classification in a previous issue.