Increasing numbers of cystic fibrosis (CF) patients are surviving into adulthood. An understanding of the psychiatric and psychosocial aspects of CF in adults and adolescents is therefore more important than ever. There is a large body of evidence indicating that the psychological and psychosocial functioning of people with CF is similar to that of well people, until the disease becomes severe. However, there is also evidence that patients do suffer an increased likelihood of psychiatric problems, such as depression, and of scoring poorly on physical functioning measures of quality of life. Studies have found conflicting evidence as to any association between degree of respiratory impairment and psychological functioning. Coping styles seem to have a large effect upon the quality of life of CF patients. People with cystic fibrosis can have problems with sexuality, platonic relationships and independence. Families of patients also suffer problems, which can affect the patients themselves. Non-compliance is a complicated problem with many patients. New treatments for people with CF are emerging, such as lobe transplants from live donors and gene therapy, with possible new psychosocial problems resulting. Furthermore, older studies are becoming increasingly inapplicable as treatment and prognosis changes. Therefore, more research is needed in this field.

Nine patients who habitually ruminated after meals underwent clinical tests and psychological questioning.

Eighty-two house-physicians filled in a questionnaire concerning the care of self-poisoning patients with special emphasis on training and attitudes. These recently qualified doctors dealt with large numbers of such patients and expressed dissatisfaction with their training in this respect. Hostile attitudes towards these patients developed most clearly at those district hospitals where psychiatrists are rarely available. During their 6 months as a house-physician, doctors at the teaching hospital became more interested in making a full assessment of these patients whereas those at other hospitals became less so. Better training at both undergraduate and pre-registration level is needed to make house-physicians more able and more willing to fully assess these patients.

Our study was designed to test the hypothesis that psychoneurosis in irritable bowel syndrome (IBS) may be the secondary effects of the unsatisfactory nature of the medical transactions (diagnosis, explanation, prognosis, and therapy) in IBS rather than a primary cause of the syndrome. We carried out psychometric assessments on three groups of subjects: 10 healthy volunteers, 12 patients diagnosed as suffering from benign gastrointestinal disease, and 18 patients with IBS. We found a significantly raised incidence of psychoneurosis in IBS, but the components of this were predominantly anxiety and obsession; the incidence of depression in all 3 groups was similar. We argue that the data support our hypothesis that the psychoneurotic manifestations are secondary components of IBS; the data do not support the hypothesis that IBS is a manifestation of depression.

It is over a quarter of a century since Henry Miller's classical paper on accident neurosis appeared in which he stressed the importance of compensation proceedings in perpetuating symptoms following accidents or trauma when there was no organic basis for them. Since then, his views have held sway with the medical and legal professions, despite a large body of research which has disputed his findings. In addition to a consideration of the aetiology and diagnosis of this condition, psychiatric management of such cases is critically reviewed, emphasizing the possible influence of iatrogenic factors on outcome and prognosis.