Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114.

Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation.

Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

In a retrospective study of 67 elderly bipolar patients the first manic attack occurred at about age 60, often after a long period from the time of the first affective episode, after which further depressive episodes occurred. This calls into question Perris’ criteria for unipolar diagnosis. Among the men, a preponderance of cerebral-organic disorders was found. The evidence for sub-classification of bipolar disorders into secondary or symptomatic manias is discussed. The recurrent nature of the illness in old age stresses the need for further evaluation of lithium prophylaxis.

Fifty-seven cognitively impaired elderly had significantly elevated serum IgG (P $0.005) and IgA (P $0.01) levels and similar IgM levels, compared to a population of 65 elderly matched for age and sex, who did not manifest cognitive impairment. These findings are compatible with a current hypothesis that immunological factors may be important in the cognitive disorders observed with increasing frequency among the aged.

In 42 patients with cognitive dysfunction (senile dementia) significant correlations between immunoglobulins and various tests of intelligence were observed. Serum IgG emerged as the single best predictor of behavioural status. There is need for further research in this field.

Two samples of newly admitted psychiatric patients were examined. Of 558 patients admitted during one year, 76 (13.7 per cent) came in from transitory accommodation or no fixed abode; of 456 patients discharged 131 (28.7 per cent) either changed address during their stay in hospital or left without known accommodation. Of 102 patients in the wards and day hospital on one day, 29 (28.4 per cent) came in from transitory accommodation or no fixed abode, 66 (64.7 per cent) were unemployed, 51 (50 per cent) were living alone. Of the 74 inpatients 30 (40.5 per cent) were homeless and 27 (36.5 per cent) had no visitors. These results indicate that many patients have lost their community supports by the time they reach hospital.

Ten chronic schizophrenic in-patients and ten matched normal controls were tested on a cross-hemispheric stereognostic task, using both meaningful objects and non-meaningful shapes of wood, under four different retention intervals. The main finding was that the schizophrenic group but not the control group displayed deficits in intermanual transfer of tactual material, as compared to the same task performed within hands.

The implications of this result are discussed in relation to the possibility that some basic neurological disorder may accompany schizophrenia.

Peptidic neurones may be considered as multisignal integrators and transducers. When formation or release of peptide outstrips genetically determined breakdown capacity, overflow of peptides to the body fluids and urine may be expected. In this paper, pathological urinary chromatographic patterns of peptides are shown for genetic, functional and mixed disorders. Part symptoms of the disorders may be induced with the biologically isolated and purified peptides as well as with chemically synthesized peptides.

Among 231 cases of manic-depressive illness parental loss before 17 years was high but was not associated with earlier onset of illness.

The effects of hypothyroidism are protean, involving many systems. Electrocardiographic changes are almost invariable, and include bradycardia, low QRS voltage and flattened T waves: these are usually reversible with replacement therapy (McDonald, 1978). Psychiatric disturbances are also well known, although they are seldom the presenting feature and are notorious for mistakes in diagnosis (Lishman, 1978; Whybrow and Ferrell, 1974). Most such disturbances comprise apathy and depression, some an organic reaction and a few manifest as an acute schizophrenia-like psychosis. Phenothiazines, the most generally used neuroleptic medication, may interfere with cardiac conduction. When hypothyroidism presents as acute psychosis and the patient is hypersensitive to phenothiazines a dangerous situation can arise.

Twenty-six patients with proven myasthenia gravis were interviewed to assess the length of time between onset of symptoms, presentation to the general practitioner and diagnosis. In one third the initial diagnosis was psychiatric and the average time between presentation and correct diagnosis was 2.8 years for men, 1.2 years for premenopausal women and three weeks for postmenopausal women. Diagnosis could have been made much earlier if doctors had been familiar with early symptoms in this relatively rare disease. Symptoms and signs fluctuated and were at times absent, especially in the mornings.