SynopsisTwenty-six patients with RDC bipolar disorder were compared with a previously reported group of 48 RDC schizophrenics and 34 healthy controls, using volumetric MRI measurements of cerebral, cortical and sulcal volumes. The bipolar group appeared no different from the controls, and both of these groups had significantly larger cerebral and cortical volumes than the schizophrenics. Our previous report of a significantly reduced cortical volume in the schizophrenic group, with a corresponding increase in the volume of sulcal fluid is, therefore, not a generalized feature of psychotic illness but may be more specific to schizophrenia.

Cholesteatoma is a non-neoplastic, keratinising lesion which has two forms: congenital and acquired. Congenital cholesteatoma develops behind a normal, intact tympanic membrane, whilst acquired cholesteatoma is associated with a defect in the tympanic membrane. The pathological substrate of cholesteatoma is keratinising stratified squamous epithelium, but the origin of this epidermal tissue in the middle ear is controversial. Here, we review the most relevant and recent evidence for the principal aetiopathogenic theories of both forms of cholesteatoma, in the light of recent otopathological findings. Congenital cholesteatoma is most plausibly explained by the persistence of fetal epidermoid formation. Conclusive 'proof' awaits the unambiguous demonstration of the metamorphosis of an epidermoid nidus into a lesion in vivo. Acquired cholesteatoma may develop by various mechanisms: immigration, basal hyperplasia, retraction pocket and/or trauma (iatrogenic or non-iatrogenic). However, squamous metaplasia of the normal cuboidal epithelium of the middle ear is a highly unlikely explanation. Chronic inflammation seems to play a fundamental role in multiple aetiopathogenic mechanisms of acquired cholesteatoma. Therefore early treatment of inflammatory conditions might reduce their sequelae, perhaps by preventing the development of hyperplastic papillary protrusions. Continued otopathological, cellular and molecular research would enhance our limited understanding of cholesteatoma and may lead to new therapeutic strategies for this erosive disease, which often defies surgical treatment.

Keratosis obturans and external ear canal cholesteatomas have been considered as separate entities for the last 20 years, after being regarded as variations of the same disease for at least 87 years. While both disorders are distinct, they do have some overlapping characteristics which may make it difficult to reach a definite diagnosis. This review explores the diagnostic dilemmas which may arise, and discusses the classification, aetiology, pathogenesis and management of these conditions. We concur that external ear canal cholesteatoma and keratosis obturans are different conditions and conclude that the presence of osteonecrosis and focal overlying epithelial loss are the most reliable features favouring the diagnosis of external ear canal cholesteatoma over keratosis obturans. Furthermore, whilst keratosis obturans can be managed successfully by regular aural toilet, external ear canal cholesteatoma may require surgical intervention depending on the extent of the disease.

Botulinum toxin (Botox) is an exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions. This article reviews the current evidence pertaining to Botox use in the head and neck. A literature review was conducted using The Cochrane Controlled Trials Register, Medline and EMBASE databases limited to English Language articles published from 1980 to 2012. The findings suggest that there is level 1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhoea, temporomandibular joint disorders, bruxism, blepharospasm, hemifacial spasm and rhinitis. For chronic neck pain there is level 1 evidence to show that Botox is ineffective. Level 2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy oesophageal speech. For stuttering, ‘first bite syndrome’, facial nerve paresis, Frey's syndrome, oromandibular dystonia and palatal/stapedial myoclonus the evidence is level 4. Thus, the literature highlights a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck (mainly level 1 evidence). With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Botox appears to justify its title as ‘the poison that heals’.

SynopsisThis paper reports development of a computerized (‘box-counting’) method for estimation of fractal dimension (FD) of the magnetic resonance image (MRI) boundary between cerebral cortex and white matter; and the application of this method to MRIs of 39 schizophrenics (SZs), 23 manic-depressives (MDs) and 31 controls (CONs). Mean FD across all diagnostic groups was 1·402; 95% confidence interval (CI) 1·399 to 1·406. Mean FD was greater in boundaries extracted from manic-depressive patients than in boundaries extracted from controls (difference between MD and CON mean FDs = 0·008; 95% CI −0·002 to +0·018); and less in schizophrenics than in controls (difference between SZ and CON mean FDs = −0·003; 95% CI −0·011 to +0·005). Mean FD was positively correlated with subcortical volume and anterior cerebral volume, and negatively correlated with sulcal cerebrospinal fluid volume. Significant differences in mean FD between diagnostic groups were demonstrated by analysis of covariance (ANCOVA; P < 0·01), with age and volumetric measures of brain size as covariates; and manic-depressive boundaries were shown to have significantly greater values for residual FD (after controlling for effects of brain size) than boundaries extracted from controls (t test; P < 0·05). It is proposed that FD is a useful measure of clinically relevant differences in the complexity of MRI boundaries.

This paper analyses a number of possible reasons why modern psychiatry has neglected the therapeutic effects of religious beliefs. The gap which exists between psychiatry and religion is a relatively recent phenomenon and is partly related to psychiatry's progress in elucidating the biological and psychological causes of mental illness, rendering religious explanations superfluous. In addition, it is often assumed that religious attitudes are inevitably linked with phenomena such as dependence and guilt which are frequently seen as undesirable. Psychiatrists and psychologists tend to be less religiously orientated than their patients, which may further increase the professional's idea that religious beliefs are associated with disturbance. However, it has long been suspected that a positive relation exists between religion and mental health, and recently, the psychology of religion has provided empirical support for this idea. Psychiatry faces the challenge to accommodate this evidence into theory and practice.

The present study examined the general public's ability to recognise mental health disorders and this ability's association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors. A total of 477 members of the British general public completed an overclaiming scale, in which they were asked to rate the degree to which they believed 20 mental health disorders (of which five were foils designed to resemble real disorders) were real or fake. Participants also completed a novel scale measuring psychiatric scepticism, a single-item measure of knowledge of psychiatry, and a measure of the Big Five personality factors. Results showed that participants were significantly more likely to rate foils as fake disorders than real disorders. In addition, the difference between real and foil ratings was significantly predicted by knowledge of psychiatry, psychiatric scepticism, and the Big Five personality factors of agreeableness and openness to experience. These results are discussed in relation to the overclaiming technique as a novel method to study mental health literacy.

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