Primary affective disorders, depressive or manic episodes in patients who have been psychiatrically well previously, or who have had episodes of mania or depression without other psychiatric illnesses (Robins and Guze, 1969), are associated with high suicide rates. The following data indicate that the suicide risk among these patients is over thirty times greater than that of the population without these disorders, and that the risk of suicide compared to other causes of death may be increased early in the course of the illness.

Published reports on sulthiame have been primarily concerned with its effects as an anticonvulsant. Some investigators have also examined behavioural changes brought about by its use. For example, Haran (1962) found that it reduced irritability and violent behaviour, and generally improved the sociability of epileptic patients. Ingram and Ratcliffe (1963) found that the hyperkinetic behaviour of 16 out of the 18 patients in their sample was either ‘abolished’ or improved. Working with a larger group, Liu (1966) noted ‘over-all clinical improvement’ in the behaviour of 32 out of 50 cases. Kneebone (1968) claimed that 12 out of a total of 18 hyperkinetic children had 'significantly improved behaviour’ with sulthiame.

Mandrax (Roussel, Ltd.) is a combination of methaqualone 250 mg. and diphenhydramine 25 mg. and there have been several reports on its efficacy, as an hypnotic, which are cited by Derbez and Grauer (1967) and Haider (1968). It has been found to have approximately the same potency as various commonly used hypnotics, and it has been particularly recommended because of indications that overdosage is not associated with severe respiratory depression, as is the case with barbiturates (Lawson and Brown, 1967), and also because it does not reduce REM sleep as barbiturates do (Davison et al., 1970). It is stated to be particularly suitable for elderly patients. There is however, only one published trial on its use with patients with a variety of psychiatric diagnoses (Burke and Mahadevan, 1966); it is not specified in that report whether the patients were acute or chronic.

The value of visiting by relatives and others to the well-being of elderly in-patients is widely recognized, but there appear to have been few attempts to collect systematic information about it from visitors. A preliminary study was therefore made of visiting in a psycho-geriatric admission ward.

Forty patients who requested treatment to reduce homosexual impulses were randomly allocated to receive apomorphine or aversion-relief therapy. Details have been published (McConaghy, 1969), concerning the subjects, the method of treatment and the changes observed two weeks after treatment in reported subjective feelings and in penile volume responses to pictures of nude males and females. A further analysis of the penile volume responses at this time has now been made, and the subjects have been followed up for at least a year.

Repertory grids can be applied to individuals in many different ways (Bannister and Mair, 1968). A grid is obtained whenever an observer rates or compares a set of objects, the elements, in terms of a set of logically applicable notions, or constructs, using a consistent scoring procedure throughout (Slater, 1964).

The concept of transference, as developed by Freud, arose within the context of the psychoanalytic treatment of neurotic patients. The extension of the techniques of psychoanalysis to a wider range of patients, including psychotics, has led to the introduction of a number of terms to describe special and additional forms of transference. This paper is concerned with aspects of the relationship between patient and doctor which are discussed in the literature under such headings as erotic transference (Saul, 1962), erotized transference (E. Rappaport, 1956; Greenson, 1967), transference psychosis (Rosenfeld, 1952, 1954, 1969; Searles, 1961, 1963; Wallerstein, 1967) and delusional transference (Little, 1958, 1960, 1966; Hammett, 1961).

Introduction Much has been written in the last ten years on the deleterious effects of high doses of amphetamine drugs on brain function. The majority of published cases of amphetamine psychosis have been cases of addiction or illicit drug taking, thereby making a good premorbid personality questionable and unlikely. Amphetamine psychoses and their association with delinquency was the subject of a paper by Scott and Willcox (1965).

Despite the views of many authors that migraine and epilepsy are unrelated phenomena, there is much evidence to the contrary. Davidenkov (1934) studied fifty parents with epilepsy, twenty-six of whose children had migraine. Barolin (1966) and Janzen (1969) also present evidence of a high incidence of migraine in epileptics. Owing to the success in treating migraine with anticholinesterases syntostigmin and nivalin (Ikonomoff, 1961, 1967, 1968), and the possible relationship between migraine and epilepsy, the same anticholinesterase drugs were administered to epileptics. Tentative and careful studies with syntostigmin and nivalin seemed to show that these anticholinesterases could be given with safety and apparent success. A study was therefore. undertaken of the effects of syntostigmin.

This is a preliminary report on a clinical trial designed to evaluate the effect of intravenous infusions of chlorimipramine as a possible alternative to ECT in the treatment of severe depression.

We have previously reported the use of repertory grid testing to extend the understanding of psychopathology in neurotic patients and to test predictions about the effects of therapy (Ryle, 1967; Ryle and Lunghi, 1969). In these tests the elements were people known to the subject, and the constructs were elicited from him. Repertory grid testing can supplement the data obtained from clinical interviews, notably in the following ways:

Introduction Obsessional neurosis is considered to be resistant to behaviour therapy; the literature is reviewed by Marks et al. (1969). Wolpe and Lazarus (1966) described a ‘thought-stopping’ technique for this condition, but subsequent workers have largely ignored this method. In the case to be described, it was used experimentally with apparent success, and in view of the therapeutic nihilism felt about obsessional neurosis it was thought worthwhile to report this long-standing and previously resistant case.

We have previously suggested that a number of psychoanalytic concepts have undergone changes of meaning when extended to wider settings both within psychoanalysis and outside it (Sandler, Dare, and Holder, 1970a, b; Sandler, Holder and Dare, 1970a, b, c). This has led to situations in which the same term can have a variety of meanings attached to it, with consequent confusion and loss of precision. A clear example of this is the concept of transference, which is now given a wide range of meanings, including that of being simply a synonym for ‘relationship'—a usage substantially different from its original meaning (Sandler, Dare and Holder, 1970b).

A recent note by Karon and VandenBos (1) on psychotherapy of schizophrenic patients claims to have demonstrated that additional psychotherapy produced significantly better results than the usual hospital treatment; and that outcome depended strikingly on an interaction between the use of drugs and the experience of the therapist. In presenting their findings as a challenge to a report by May and Tuma, they fail to point out that their results run contrary also to the general trend in other studies of psychotherapy and schizophrenia. These indicate that, even when given by experienced therapists, psychotherapy for hospitalized schizophrenic patients is, in general, relatively ineffective, while drug therapy enhances results regardless of the therapist's experience.

A number of publications have appeared in the last few years advocating the use of diazepam in the treatment of status epilepticus (Boyer, 1966; Gordon, 1966; Lombroso, 1966; Parsonage and Norris, 1967). The long term therapeutic value of diazepam in epilepsy is not yet so widely reported. However, Lehmann and Ban (1968) showed that the excitement and hostility so commonly encountered in epileptic patients can be successfully and selectively controlled by diazepam. It was also revealed in this study that diazepam had definite anti-convulsant effects in a certain number of epileptic patients; one third (7 patients) also improved psychiatrically.

While the treatment alliance (Sandler, Holder and Dare, 1970a) and some aspects of transference (Sandler, Dare and Holder, 1970b) relate to tendencies within the patient which act to maintain the treatment relationship, the concept of resistance is concerned with elements and forces in the patient which oppose the treatment process. Although resistance is a clinical rather than a psychological concept (Sandler, Dare and Holder, 1970a), originally described in connection with psychoanalytic treatment, it is one which can readily be extended, without substantial revision, to other clinical situations.

Riemer (1955) has argued that gaze is an ‘expression of affect’ between individuals. Kendon (1967) writes that the direction of gaze has a regulatory and expressive function, and ‘fluctuations in the amount of eye-contact during the course of one conversation showed that it was inversely related to the amount of emotionality displayed by the participants'. Also that it has a regulatory function which governs the pattern of social interaction. Argyle and Dean (1965) made similar observations in their concept of intimacy. They postulate that there is an Intimacy Equilibrium; Intimacy is a function of eye-contact, physical proximity, intimacy of topic, amount of smiling etc. They have shown that an alteration in one variable produces a change in the others until an equilibrium is reached. Exline et al. (1965, 1966, 1967) have described other aspects of eye-contact in relation to sex, dependency, social reinforcement, affiliative needs and affective relations. These findings support those of Kendon and Argyle.