In a previous study (Liss, Welner and Robins, 1973), the hospital records of 212 patients who received a diagnosis of personality disorder other than antisocial personality were studied. The clinical information about these patients was used to arrive at an established psychiatric diagnosis based upon the rigorous diagnostic criteria designed for research (Feighner, Robins, Guze, Woodruff, Winokur, and Munoz, 1972). In 118 cases (56 per cent) the clinical symptoms and the course of the disorder met the required diagnostic criteria for one or more of the established psychiatric diagnoses. The remaining 94 patients (44 per cent) had too few symptoms to meet these criteria.

The use of unilateral ECT as a method of exploring differences between the functions of the cerebral hemispheres has been suggested by Pratt et al. (1971). These authors found a greater impairment on a test of naming and a tendency to slower return to consciousness after left-sided than after right-sided treatments. Assuming that these effects depend on left hemisphere language specialization, they went on to use them as possible indicators of cerebral dominance for speech in left handers. The present enquiry was designed to explore these differences further by comparing patients immediately after right-sided and left-sided ECT for their ability to name objects and to make visual discriminations and for their time of recovery. Handedness was assessed through a measure of relative manual speed as well as by the usual questions of preference and family handedness. The speed differences give a continuous measure of degrees of right and left handedness which can be correlated with measures of differences between the effects of right-sided and left-sided ECT.

The token economy is an application of operant conditioning theory which is particularly relevant to the treatment of patients in institutions. The basic idea is to motivate the patient to behave more appropriately and constructively by giving him tokens whenever he behaves in such a way. The tokens have an incentive function, as the patient can cash them in for a number of different things, such as pleasant single room accommodation, cigarettes, magazines, TV viewing, drinks etc., depending upon what is programmed into the token economy. The theory of operant conditioning is that not only does the token motivate the patient to behave in certain ways, but ‘reinforces' his behaviour. Such reinforced behaviour should eventually become an integral part of the ‘way he is', continuing even when the token is removed.

The occurrence of psychiatric complications following the administration of ACTH and corticosteroids is well recognized. Psychiatric disturbances usually take the form of euphoria or elation in mood. Depression is less likely, and irritability or aggressiveness may occur. In about 5 per cent of cases the alteration in mood may be accompanied by clouding of consciousness, delusions, hallucinations and disorientation. This picture of an organic confusional state is said to result from high doses and prolonged therapy with corticosteroids and ACTH. The latter is recognized to cause psychiatric sequelae more often than the corticosteroids (Truelove and Witts, 1959). Disturbances may appear within six to seven hours of initial therapy (Goolker and Schein, 1953), after prolonged administration, or even after complete withdrawal of the hormone therapy.

Anorexia nervosa is a disorder characterized by loss of appetite, amenorrhoea, and weight loss in the absence of any primary psychiatric or physical illness (Dally and Sargant, 1966). Features which have recently been stated to be of value in distinguishing it from anorexia due to other causes are: denial of illness, bradycardia and lanugo hair (Wright et al., 1969). The weight losses in this condition are usually at least 20 per cent of ideal body weight, depending on the quality and promptness of treatment.

Opinions differ on the effectiveness and the risk involved in treating depressive illnesses with combinations of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants. Some authorities, including the Food and Drug Administration in the United States, the former Witts Committee in this country, and the pharmaceutical firms producing antidepressants, have given serious warnings against combining MAOIs with tricyclic antidepressants. These warnings have been repeated more recently by Beck (1967), Malitz (1966) and Shepherd et al. (1968).

It has not previously been suggested that prolactin may be involved in mental illness. Yet virtually every drug used in psychiatry either stimulates or suppresses prolactin secretion (Fluckiger, 1972). Prolactin causes renal sodium, potassium and water retention (Horrobin, 1973). It is bound to cerebral tissue and alters hypothalamic activity (Turkington and Frantz, 1972; Clemens, Gallo, Whitmoyer and Sawyer, 1971). Prolactin levels up to 100 ng./ml. potentiate the responses of smooth muscle cells to noradrenaline, while higher levels inhibit the responses: preliminary studies suggest that nerve cells behave in a similar way (Manku, Nassar and Horrobin, 1973). Emotional stress, surgery and drugs such as phenothiazines, reserpine and methyldopa can elevate human plasma prolactin levels into the 50–200 ng./ml. range (Frantz, Kleinberg and Noel, 1972; Friesen, Belanger, Guyda and Hwang, 1972).

This paper describes a double-blind drug trial to assess the effect of sulthiame on the behaviour of very disturbed mentally handicapped patients. Behaviour problems (especially hyperkinesis) are among the main causes of admission when parents or guardians cannot cope at home; and in hospital such patients constitute the main problems of management and reduce the time available for other patients. Moreover the present recognized treatments seem to have little effect on such behaviour if given within a dosage that avoids side-effects.

Good results with the use of lithium salts in the premenstrual tension syndrome have been reported (Sletten and Gershon, 1966); these observations await confirmation. The value of lithium is suggested by its known capacity to affect water and electrolyte balance implicated in the pathophysiology of the syndrome, and by its efficacy in psychiatric disorders characterized by periodicity. We therefore undertook a controlled study on the efficacy of lithium in the syndrome.

One of the earliest and best replicated findings resulting from the experimental investigation of animal learning is that conflict can produce disordered behaviour (Pavlov, 1927). These conflicts vary in kind, ranging from a conflict, as in the circle and ellipse discrimination experiments, between responding and not responding, to a conflict between approach and avoidance as in the pairing of electric shock with food. As Kimmel (1971) points out, whether or not a conflict produces disordered behaviour is a function of the animal's previous history. An ellipse has already to be clearly associated with ‘no food’ and a circle with food for disorder to be produced by presenting a circle and ellipse which are very similar to each other. Similarly, special conditions of training can be found which enable a dog to salivate and wag his tail in response to an injury severe enough to draw blood.

It is known that different mental symptoms may occur as early symptoms of acute viral meningoencephalitides. In herpes virus (HSV) infections of the central nervous system (CNS) the appearance of these symptoms is well documented (Juel-Jensen and MacCallum, 1972). The recurrence of psychotic symptoms in cases of recurrent HSV infections has also been described (Shearer and Finch, 1964; Drachman and Adams, 1962). In recent years serological observations of the prevalence of HSV antibodies in patients with psychiatric disorders have suggested a possible association of HSV infections with aggressive behaviour (Cleobury et al., 1971), as well as with psychotic depressions (Rimon and Halonen, 1969).

Although some reservations have been expressed about the value of sustained release phenothiazines (Hicks and Ovenstone, 1966; West, 1970), the majority reaction has been favourable. Many authors have emphasized the usefulness of an approach which by-passes a patient's impaired insight as to the need for regular medication (e.g. Capstick, 1968; Lehmann, 1970).

Almost all sleep-promoting drugs distort the natural pattern of sleep by suppressing rapid eye movement (REM) sleep, and cause a rebound to above-normal values on withdrawal which typically lasts about six weeks (Oswald, 1968, 1969). Furthermore, barbiturates reduce the number of eye movements per unit time in REM sleep (Oswald et al., 1963; Baekeland, 1967; Lester et al., 1968; Feinberg et al., 1969), with a rebound in eye movement (EM) profusion on withdrawal (Oswald, 1970). Non-barbiturate hypnotics do likewise, also with a rebound in EM profusion on withdrawal (Allen et al., 1968; Lewis, 1968).

Although phenothiazines have gained acceptance as the standard treatment for the acute episode of schizophrenia (Rathod and Rees, 1953; Cole, 1964), there is much more doubt about their effectiveness as maintenance therapy. Several American studies have reported on the results of maintenance therapy with chlorpromazine compared with placebo, and found phenothiazine treatment to be superior in preventing relapse (Scarpitti et al., 1964; Pasamanick et al., 1957; Ravaris et al., 1967). However, these studies suffer from methodological problems which impair their clarity. First, as emphasized by Leff and Wing (1971), diagnostic criteria are rarely stipulated. This is clearly important if American work is to be compared with British, since Kendell et al. (1971) have shown the wider concept of schizophrenia used in the U.S.A. Secondly, the likelihood of bias occurring in the population meeting trial selection criteria, resulting in a trial population which is unrepresentative of the group as a whole, is not usually defined. Every trial worker knows this ‘shrinking sample’ phenomenon, which appears to result in a sudden scarcity of patients as soon as a trial is contemplated. The trial of maintenance therapy conducted by Leff and Wing (1971) meets this objection by following the progress of patients who met the trial criteria but could not be included for various other reasons.

Despite controversy about whether cerebral arteriosclerosis is a valid clinical entity and independent of senile dementia and/or ‘functional’ senile psychoses (Post, 1971), there is a good reason for differentiating it in clinical practice, and its incidence is increasing (Registrar General, 1960).

The investigation had three major aims. We attempted to repeat and extend the findings of the Gelder, Marks and Wolff (1967) study of the comparative efficacy of desensitization and psychotherapy in the treatment of phobic patients. Our second aim was to isolate the effects of various components of desensitization treatment, in the manner employed in laboratory studies of fear-reduction (e.g. Davison, 1968; Rachman, 1965; Rachman, 1968). The third aim was to collect data on the relationships between psychophysiological changes and clinical outcome.

The purpose of this short paper is to draw attention to the higher scores on neurotic scales found by the authors in Irish female subjects in three separate comparative studies of different categories of Irish and British hospital patients, using three different instruments for enquiry.

Determinations of acid monoamine metabolites, such as homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), in cerebrospinal fluid (CSF) give valid information on the metabolism of the corresponding amines in the brain tissue (Moir et al., 1970; Roos, 1970). The monoamine metabolites in the CSF are related to age. The concentrations of HVA and 5-HIAA increase with age (Gottfries et al., 1971). Probenecid blocks the elimination of HVA and 5-HIAA from brain tissue to blood (Neff et al., 1964, 1967; Werdinius, 1966) and from CSF to blood (Guldberg et al., 1966; Olsson and Roos, 1968). Probenecid thus normally induces an increase in the concentrations of the acid monoamine metabolites in the CSF, which is related to the turnover of monoamines in the brain tissue.

The therapeutic effect of lithium in mania was first described by Cade (1949), but the possibility that lithium could have a prophylactic action in recurrent affective disorders was not suggested until some years later (Hartigan, 1963; Baastrup, 1964). The early studies of the prophylactic action of lithium were open trials, in which both investigator and patient knew that the patient was receiving the drug. More recently, controlled double-blind studies have confirmed these early reports (Melia, 1970; Coppen et al., 1971; Cundall et al., 19712).

Feelings that life is not worth living and thoughts of suicide are common in psychiatric patients, particularly in depressives (Beck, 1967). Very little information is available, however, regarding the occurrence of suicidal feelings in the general population. In contrast, the epidemiology of completed suicide has received extensive study (Dublin, 1963), and there have been some epidemiological studies of attempted suicide (Shneidman and Farberow, 1961; Mintz, 1964; Parkin and Stengel, 1965). However, this information cannot automatically be generalized to suicidal feelings. It has been emphasized in recent years that suicidal phenomena are diverse, and that completed suicide, suicidal attempts, and suicidal feelings should not be equated (Stengel and Cook, 1958; Neuringer, 1962).