Psychosurgery has always been, and is likely to remain, a controversial subject. Blind operations lack precision and can lead to adverse personality changes or other serious side-effects. Open surgery is becoming less acceptable because of the difficulties of accurately assessing the extent of a lesion and its exact location. The introduction of stereotactic techniques enables far smaller lesions to be placed with a high degree of accuracy, and increased knowledge of the limbic system has contributed to advances in this field.

The neurophysiological aspects and operative technique of stereotactic limbic leucotomy have been described in a previous paper (Kelly, Richardson and Mitchell-Heggs, 1973). The present investigation is a prospective study designed to assess the results of such surgery in a group of 40 severely ill psychiatric patients, who had failed to respond satisfactorily to every other type of treatment. The results have been assessed clinically, psychologically and physiologically, in a very detailed way, at six weeks; a similar follow-up at one year is in progress. A comparison is made between the results of the present series and those of a previous: study (Kelly et al., 1972), in which more extensive leucotomy operations were carried out, and similar means of assessment were employed.

The investigation which is reported here was designed as a pilot project for a possible later research programme into the prevention of emotional disturbance in mothers and young children. The idea came through the clinical experience gained by one of us (E.A.F.) during eight years' work in a Day Unit for disturbed children under five and their families at St. Thomas' Hospital, London (Frommer, 1967). It had become clear over the years that many of the mothers of such children had themselves experienced a disrupted childhood, with separations from their parents or siblings, mental and physical ill-health of family members, and even cruelty and physical violence to themselves or a parent or sibling.

Previous reports (1 and 2) have shown that very simple questions to a mother about her own childhood, particularly whether she was ever separated from one or both parents, can identify a group of women who are likely to experience difficulty in managing their baby.

During the past fifteen years, attention has been drawn to the difficulties experienced by the families of mentally-handicapped children. Early studies showed that a mentally handicapped child in the home constituted a severe burden for other members of the family, particularly the mother (Tizard and Grad, 1961; Holt, 1957; Schonell and Watts, 1957).

We present here some findings from a survey carried out in one (former) London borough, of the information known to one or more of a number of agencies such as courts, clergy, employers, doctors, etc. (we term these sources ‘reporting agencies', see Methodology Section 4), concerning those individuals who might have a drinking problem. The results will be interpreted in the light of a house-to-house sample survey which was conducted at the same time, and in part of that same area (Edwards et al., 1972a, b, c, d, 1973): the extent of overlap in case identification will be closely considered. The literature on epidemiology applied to alcoholism has been reviewed by one of us elsewhere (Edwards, 1973), and the relevance of epidemiology to planning the community's response to its drinking problems was discussed. In the present paper the application of those general arguments to the realities of a particular set of data will be tentatively explored.

In a recent survey of the psychiatric outpatient services at three Manchester Hospitals (Johnson, 1973), the diagnoses, treatments and disposals of new patients were discussed. The survey concentrated on the psychiatrist's role in the out-patient department, whereas in fact two other important viewpoints are involved, that of the referring doctor (usually the general practitioner), and the patient. Despite the importance of these viewpoints they have been largely neglected in the psychiatric literature. Only the study of Kaeser and Cooper (1971) attempts to investigate the out-patient department from all points of view, and their findings are likely to be atypical in certain respects since 60 per cent of their patients sample were referred to an emergency clinic, and dealt with by non-consultant medical staff. The present study attempts to answer the following questions about patients referred to the psychiatric outpatient department of a provincial teaching hospital.

During the last decade, social psychologists and ethologists have become increasingly interested in the non-verbal elements of social interaction, as recent reviews testify (Argyle, 1969; Vine, 1970; Hinde, 1972). Research into facial expression, visual interaction, posture, gesture, non-verbal aspects of speech, etc., has considerable clinical implications, but carefully conducted investigations of non-verbal social interaction in psychiatric patients have been rare (Grant, 1972). The purpose of this paper is to review the evidence concerned with one aspect of social behaviour in psychiatric patients, namely visual interaction, in an attempt to summarize the current state of knowledge and to suggest ways in which research in this area might develop.

Tasks involving verbal learning and memory are widely used in the differential diagnosis of depressive and dementing conditions. That dements suffer widespread impairments of these functions is self-evident, yet depressives also evince some degree of deficit. For elderly patients suffering from affective illnesses Bolton, Savage and Roth (1967) found 29 per cent to gain organic scores on the Modified New Word Learning Test; of elderly depressives, 16 per cent gained scores in the organic range on the Synonym Learning Test (Kendrick, Parboo-singh and Post, 1965), and this figure increased to over three-quarters when a group was selected to contain a large proportion of patients clinically judged as suffering from ‘pseudo-dementia’ (Kendrick, 1967).

Bannister (1960, 1962) found that thought-disordered schizophrenics had significantly lower scores on a repertory grid test of the intensity of the relationships between their constructs than did non-thought disordered schizophrenics, normals, neurotics and (in the 1962 study only) depressives. This finding has been confirmed, sometimes in slightly different ways, by a number of subsequent studies (vide infra). On the basis of his results, Bannister put forward the theory that schizophrenic thought disorder is characterized by ‘loosened construing’, which can account for all its clinical signs, and which stems from repeated invalidations of construing. This theory has been followed up in a number of subsequent investigations (Bannister, 1963, 1965; Bannister and Salmon, 1966).

The present study is the psychological part of a comprehensive study of male patients with the XYY syndrome from the Cytogenetic Laboratory, Risskov (Nielsen, 1968, 1969, 1971; Nielsen et al., 1969a, b; and Nielsen and Henriksen, 1972).

The use of feedback techniques as therapeutic tools has increased quite considerably during the last decade (Berger, 1970). Techniques such as videotape and tape recorder playback have been used with a wide rage of patients, and to secure effects such as ‘overcoming resistance’, ‘evoking insight’, ‘increasing motivation for psychotherapy’ and ‘shocking alcoholics back to reality’. The general strategy has involved making a recording of the patient's behaviour, or a sample of therapeutic interaction; the recording is then played back to the participants and often used as a basis for discussion and further treatment. In spite of the enthusiasm about the value of these techniques, empirical and scientific evidence for their efficacy is almost entirely absent (Bailey and Sowder, 1970).

The abuse of cannabis and its consequences to mental health have been a subject of much debate in recent years. While the literature is replete with reports of mental disturbances following acute intoxications (1, 4, 7, 15), the mental health implications of long-term abuse of cannabis remain speculative (9, 13). Since the drug possesses psychotomimetic and hallucinogenic (8) properties, prolonged experimentation with cannabis on human subjects is undesirable. The clinical manifestations of disturbed mental functioning due to chronic abuse of cannabis can therefore be best observed in societies where the drug is taken as a pastime, generally to enjoy pleasant euphoria. Such a situation is found in India where the use of cannabis has become woven into the general philosophy of life over the years. The drug is particularly used at religious ceremonies, and sweets and non-alcoholic beverages containing varying quantities of cannabis are traditionally offered and consumed during the colour-throwing festival of Holi.

Several years have passed since the last study of the psychiatric abnormalities shown by epileptic patients in an English mental hospital (2), during which time detailed information has become available about the development of schizophreniform states in some chronic epileptics (3). This study was undertaken to examine the mental state of patients with epilepsy resident in Bexley Hospital, using a semi-structured psychiatric interview technique (6). The criteria used for the definition of epilepsy were those of Gunn and Fenton (1)—a history of at least three epileptic attacks in a two-year-period, and continuation of anti-convulsant therapy if the period did not immediately precede the time of examination.