At present the phenothiazine drugs constitute the medication of choice in the treatment of schizophrenia. While in most schizophrenics treatment with phenothiazines does ameliorate the symptoms of the disease there are a certain number of patients who remain resistant to therapy. In such patients the side effects caused by phenothiazines may also be less pronounced or completely absent.

The use of 1, 4 benzodiazepine drugs in the treatment of anxiety is well known and quite popular. The range of these drugs so far in clinical use includes chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serenid D) and nitrazepam (Mogadon). All have the advantages that effect is produced rapidly, side effects are of infrequent occurrence, and there is a very high safety factor.

Lorazepam is a psychotropic agent of the benzodiazepine class which has an action qualitatively similar to, but more potent than, chlordiazepoxide and diazepam. In animals lorazepam is about twenty times as potent as chlordiazepoxide as an anti-anxiety agent and 10–50 times as potent as an anticonvulsant. In addition it has been reported as having an effective amnesic effect in higher doses in animals.

The neuroleptics which are very effective in chronic schizophrenia, such as fluphenazine, thiothixene and haloperidol, have both central ‘inhibitory’ and 'stimulatory’ properties (Itil et al., 1969, 1970). When chronically administered in low dosages, these compounds decrease Stage 4 of the sleep process and produce insomnia, while in high dosages they produce deeper sleep stages. Based on these observations and the fact that extrapyramidal symptoms usually do not occur during deep sleep, we hypothesized that high oral doses of trifluoperazine given at night would produce fewer sleep disturbances and extrapyramidal symptoms than the same dosages of this compound administered during the morning.

Stutter, tic and the Gilles de la Tourette syndrome have many features in common. Haloperidol has been found of value in the treatment of the last-named syndrome (1) and also of tic (2). Our study was intended to evaluate its use, combined with orphenadrine, in stutterers. We used it both with and without speech therapy, as shown in Table I. The trial was controlled, and double blind. Our 36 patients, aged 15 to 60, were of both sexes and neither psychotic nor subnormal. They were not on other therapy. They were randomly divided by an independent third party equally into the following groups, and treated as indicated.

In a previous study hyperkinetic circulation was found in alcoholics in the abstinence phase. Normal conditions were restored by 40 mg. propranolol. Even tension symptoms decreased (Carlsson, 1971).

Many patients admitted to psychiatric hospitals give a history of recent drug treatment, and this may be important in the assessment of their clinical state. The aim of the present study was to survey the pattern of drug treatment in psychiatric patients at the time of admission, and to compare various accounts of this treatment.

There is a consensus of opinion among the staff of psychiatric hospitals that it is in the best interests of the patients to be occupied during their hospital stay. In most hospitals of this type workshops have been set up for the patients and these are variedly regarded as amenities and therapeutic tools. The workshops vary a great deal in their characteristics, but broadly fall into two categories: occupational therapy units and industrial units.

This is a report on 415 private patients who have been followed from four up to more than thirty years or until death. The operations were carried out before the end of twelve months of psychiatric hospitalization, not necessarily continuous. Many of the patients were operated upon more than once, especially in the earlier years before the importance of the orbitomedial quadrants of the brain was recognized.

The involvement of a number of psychiatric hospital staff members in group psychotherapy meetings constitutes multiple therapy. In such a situation one staff member is customarily assigned the role of ‘therapist’ and the rest are called ‘observers'. Observers are often passive, but they may participate in the group proceedings as co-therapists (MacLennan, 1965; Bloom and Dobie, 1969). Multiple therapy is said to enhance treatment (Mullan and Sanguiliano, 1960; Rubins, 1967), but this may be a rationalization to excuse its continued practice (MacLennan, 1965), particularly as it is so useful for training staff in group psychotherapy (Gans, 1962).

When a patient tells his therapist, directly or indirectly, that he is contemplating suicide, his communication is likely to evoke a strong reaction, although, like the patient's plea, it may, or may not be straightforward.

The treatment of phobic states by desensitization is tedious and not always completely successful (Marks, 1969). Recently newer methods claiming improvement in speed and efficacy have been introduced, such as flooding or implosion (for example, Boulougouris et al., 1971) and prolonged exposure (Watson et al., 1971). An approach based on respiratory control which seems to be as effective as other methods and even more rapid in action is described in this short paper.

Over the past thirty years the emphasis on low intelligence as a major causal factor in criminality has decreased considerably. When intelligence tests were less refined, early in this century, authors considered a depressed intelligence score as an important determinant in delinquency. Improved psychometrics, with their culturally non-biased test items, have since proved that individuals from deprived upbringing and adverse social learning situations do relatively poorly on verbal items. Woodward (1955) pointed out that both in this country and in the United States the delinquent is only 8 I.Q. points behind the normal population. Opinions amongst psychologists have gradually but radically changed, and it is for this reason that research workers now look elsewhere for causal factors in the subnormal offender rather than attributing his delinquencies to low intelligence.

This paper presents some of the more important results of a factor analysis of the mental state ratings made as part of the United States–United Kingdom Diagnostic Project's cross-national study. The project was organized in order to help account for the large differences between the two countries in the admission rates for schizophrenia and for the affective disorders (see Kramer, 1969, and Zubin, 1969). The major results of the study have been reported by Cooper, Kendell et al. (1969), Gurland et al. (1969), Cooper (1970), and Cooper, Kendell, Gurland et al. (1972).

Studies of birth order of male alcoholics, reviewed by Chen and Cobb (1960), Sampson (1965), and Barry, Barry, and Blane (1969), generally showed more last-born than first-born cases. This difference was found in samples of more than 500 cases hospitalized in Denmark (Martensen-Larsen, 1957); Austria (Navratil, 1959); Canada (de Lint, 1964b), and Norway (Steén, 1966). Most samples in the United States have shown the same trend but with smaller numbers of cases, so that the difference was short of statistical significance. Ambiguous results have been obtained from the few studies of birth order of female alcoholics, generally based on small samples. The present paper reports on the birth-order distributions of a relatively large sample of male and female out-patient alcoholics in the United States.

Alcoholism is associated with a high family incidence of both alcoholism and affective disorder (1). First degree male relatives of alcoholic probands have a 50 per cent lifetime expectancy for alcoholism, while first degree female relatives have a 50 per cent lifetime expectancy for affective disorder (1). Children of alcoholic parents raised with that parent show no higher, and perhaps less, alcoholism than children of alcoholic parents raised separately (2). This paper looks at the influence of parental alcoholism or affective disorder on the characteristics of alcoholism in probands, their progeny and siblings.

In a recent series of investigations significant but conflicting relationships have been claimed between the two personality dimensions extraversion (E) and neuroticism (N) and certain spontaneous and induced features of the normal EEG. Savage (1964), using alpha abundance data from automatic frequency analysis, demonstrated a significant positive correlation between extraversion and high alpha amplitude. Extraversion has been similarly related to the amplitude of the averaged evoked potential waveform (Shagass and Schwartz, 1965). However, in an investigation by Broadhurst and Glass (1969) both alpha amplitude and prevalence bore an inverse relationship to E scores; extraversion was significantly associated with the rate of change of potential of the EEG, as was neuroticism with the alpha frequency. More recently, Winter et al. (1971) could find no direct relationship between extraversion and EEG amplitude, though there was a tendency for low amplitude activity to be associated with high neuroticism scores. The findings were interpreted as showing a significant interaction between the variables measured, the relationship of extraversion and amplitude varying according to the neuroticism score.

Pain in organic disease has anatomical, physiological and psychological components which are inseparably linked, but there does not appear to be a strict relationship between the nature and apparent severity of noxious stimulation and the point at which different individuals experience pain. Moreover, in any group of patients at the same stage of an illness known to be associated with pain, some complain whereas others do not. Many factors are known to influence pain and complaint behaviour. The elderly experience less pain than younger patients with similar disorders (Exton-Smith, 1961). Pain thresholds tend to be lower in women than men, and racial differences are significant when considering both thresholds and complaint behaviour (Merskey and Spear, 1967). Pain may not be immediately associated with wounding in the physical and emotional struggles of battle, and the later intensity of suffering has been shown to be related to the significance of the wound to the patient (Beecher, 1956). There is an increase in pain in the presence of anxiety (Kennard, 1952; Masson, 1966) and Cole (1965) reported that factors associated with persistent pain include a disagreeable environment, a long history of pain, anxiety, depression, poor general health, resentment and lack of confidence in the doctor. Complaint behaviour is regarded by some as a learned response developed in childhood (Schilder, 1935; Russell, 1962; Sarbin, 1962; Simpson and others 1965). Bond and Pilowsky (1966) have demonstrated that in a clinical setting differences in complaint behaviour between the sexes depend in part upon the attitudes of nursing staff towards pain.

The diagnostic index is a most valuable tool when using a hospital's records for research purposes. This paper describes an attempt to produce such an index suitable for use in a busy psychiatric hospital. It was felt that priority should be given to simplicity and ease of use, as otherwise few of those concerned would have been able to spare the time needed for its preparation. Later an attempt was made to assess its reliability in use at two hospitals.