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.

The trial was a double-blind cross-over study in which patients presenting in general practice with anxiety received haloperidol (Serenace) 0·5 mg. twice daily for two weeks and a placebo of identical appearance for two weeks in random order. Forty-three patients entered the trial. Of these, six failed to attend for follow-up and one proved impossible to assess. A further eight completed the first two-week period of assessment only (5 active drug, 3 placebo) but are included in the analysis. There were equal numbers of men and women, aged 24 to 71 years.

For the purposes of this paper the term ‘precipitant’ is defined as a new circumstance associated in time with the onset of the addiction. If the precipitant is merely the ‘final staw’ in a long chain of causal circumstances, no particular value can be attached to its identification. If, on the other hand, the precipitant brings into operation the background causal factors leading to addiction, it has important practical and therapeutic implications. It could be expected that this type of precipitant might persist during the addiction and its disappearance might be associated with remission of the addiction.

The literature on the treatment of sexual frigidity indicates that some success can be obtained by a variety of methods, including psychoanalytic interviews (Abrahams, 1956), insight therapy with physical self-examination (Dawkins and Taylor, 1961; Ellison, 1968), group therapy (Stone and Levine, 1950), desensitization (Lazarus, 1963), and directive advice and counselling (Hastings, 1967; Masters and Johnson, 1970). This investigation aims to look at the different kinds of frigid women and to see if this is related to outcome in treatment.

Cohen (1960) defined risk-taking as ‘embarking on a task without being certain of success', and he agreed with Stengel (1958) that it is possible to gain a better understanding of attempted suicide if we regard it as conveying a degree of uncertainty that the attempt will succeed or fail. Investigation after a suicide attempt usually reveals that the patient was at the time uncertain about the toxic effects and lethality of the overdose, and uncertain of whether others would intervene before the poison could take effect. Taking the widely held view that in most cases of so-called attempted suicide the prevailing motives are directed towards survival with all the advantages of having risked self-destruction, it might be argued that the attempt succeeds by avoiding rather than causing death. The alternative term ‘parasuicide’ suggested by Kreitman et al. (1969) is less paradoxical.

The Public Enquiry into William Frederick Windham's ‘alleged lunacy’ is well documented and the evidence of 140 witnesses provides a uniquely full history. The case is of interest as a diagnostic problem, a study in mid-nineteenth century psychiatric thinking and methodology, and in the then prevailing attitudes to mental illness. It was a significant event in psychiatric history, as the scale and expense of the trial brought the method of public enquiry into bad repute. Thus the case represented one of the steps away from legal management in psychiatric illness and towards medical management.

A review of studies relating suicide to the menstrual cycle (Wetzel et al., in preparation) showed that an increased proportion of female suicides and attempted suicides probably occur during the luteal (from ovulation to onset of menses) and menstrual phases of the cycle. Mandell and Mandell (1967), in a study of women calling the Los Angeles Suicide Prevention Center, found an increased number calling in the late luteal and menstrual phase of their cycle. This study assessed the relationship between phase of the cycle at the time of call and self-judged lethality.

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.

The care of the mentally subnormal in Britain has quite suddenly become a live and prominent issue, but public indignation fades quickly and political interest is soon transferred to other issues that are constantly arising. The time seems ripe to re-think the overall philosophy of provision for the mentally subnormal in a developed industrial society, and in particular, the place of the large institution (Craft, 1970; and McKeown, 1970). These institutions resulted from conditions which no longer exist, and they now attempt to carry out a variety of functions, which many think ought to be separated. However, the subject remains a very controversial one (Shapiro, 1969, 1970; Freeman, 1969a).

Two studies have been made of the relationship between premenstrual tension and phase of the menstrual cycle at the time of suicide attempt. Tonks et al. (1968) reported a negative relationship. Women without premenstrual symptoms accounted for the premenstrual increase in suicide attempts. Zacco et al. (1960) reported a significant positive relationship, women with the premenstrual syndrome being more likely to attempt premenstrually.

A previous double-blind controlled evaluation of lithium and chlorpromazine in both manic and schizo-affective individuals carried out in this unit (Johnson et al., 1968) indicated that 85 per cent of the schizo-affectives showed a worsening of thought disorder when treated with lithium carbonate, the majority developing symptoms of an acute brain syndrome. The possibility of experimental design accounting for such treatment outcome must be considered.

In a survey of 612 young people remanded in the London area during 1964, positive urine tests were found for amphetamine for 18 per cent of the 558 boys and 16 per cent of the 54 girls examined (Scott and Willcox, 1965). This paper presents the findings of a similar type of survey carried out in the same remand homes five years later.

As part of a study of the predictive value of a picture-story test in relation to verbal behaviour in group therapy, a positive relationship was recently found between the number of participations patients made in the first session of a new therapy group and the number of times they described human figures on a projective story test as making active, observable ‘approach’ movements toward another person or place (Aston, 1970). It was hoped that this finding might prove helpful in selecting patients for group therapy.

This investigation is an extension of a study carried out recently (Lowe, 1966) with educationally subnormal school children.

Jellinek describes periodic or Epsilon alcoholism as the ‘least known species of alcoholism’ (1). Åmark (2), comparing them to the general population, found periodic drinkers to be older at time of study, to show increased heritability in offspring and to have a higher incidence of cycloid and cyclothymic personalities. His determination of cyclothymic personality traits reinforces the hypothesis of Dobnigg et al. (3) of a correlative between periodic drinking patterns and affective symptoms. This paper examines the usefulness of the diagnosis of ‘bender’ alcoholism.

The aetiology of those movement disorders characterized by localized, involuntary intermittent, and repetitive muscular spasm remains obscure. They include spasmodic torticollis, writer's and other occupational cramps, and facial spasms. The obscurity is reflected in psychiatric and neurological classification. Some, or all, are frequently regarded as conversion symptoms, although they differ profoundly from those typical of that group, particularly in terms of prognosis. Secondly, some, or all, have been regarded as variants of dystonia musculorum deformans. Otherwise, they occupy an indeterminate or ‘miscellaneous' place in classification. If it could be shown that a substantial number of clinical characteristics are shared by those who exhibit localized spasmodic conditions, they could justifiably be regarded as a distinct nosological entity. This might reasonably be regarded as a step towards clarifying their aetiology.

This investigation is a direct sequel to the work on evaluation of group psychotherapy already published in this journal (Sethna and Harrington, 1971). The method, setting and aims of the main investigation were described in the original paper and will not be repeated here. The need for the present study became evident when it was found that of the 94 patients considered for the evaluation study as many as 37 (41 per cent) lapsed or discharged themselves without completing their treatment, and against medical advice.

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 premenstrual occurrence or exacerbation of affective symptoms has been noted (Dalton, 1964). This symptom exacerbation may be sufficient to require hospitalization (Dalton, 1959; Janowsky et al., 1966). Data presented by Coppen (1965) indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual symptoms. However, we are aware of no previous report that would suggest any relationship between premenstrual symptoms and bipolar affective disorder.