Two cases of Gilles de la Tourette's syndrome occurring in Sri Lanka are reported. Both patients had the characteristics of the syndrome as described by Fernando (1967): (1) Childhood onset (below 16 years of age); (2) Multiple motor tics; (3) Unprovoked vocal utterances which may progress to coprolalia. Both responded to haloperidol, withdrawal of medication being followed by relapse, and reintroduction by remission.

The literature on the aetiology of the condition has been reviewed. The weight of evidence favours an organic cause, although psychological precipitation cannot be ruled out.

Early reports on enhancing occipital alpha through feedback noted that subjects reported the experience as being pleasant and relaxing. This paper reports the subjective experiences of 140 subjects who participated in four studies which examined the alpha enhancement phenomenon. Under both eyes-open and eyes-closed conditions, approximately 50 per cent of the subjects reported that alpha enhancement was ‘pleasant’ and 50 per cent ‘unpleasant/neutral’. With eyes-open training conditions, about half the subjects stated that the experience was ‘relaxing’ and the other half ‘not relaxing’. During eyes-closed training, 63 per cent of the subjects noted that enhancing alpha was ‘relaxing’, while 37 per cent reported that the experience was ‘not relaxing’. However, in the last case the circular relationship between increased alpha and deep relaxation may obtain.

A survey was made of all female admissions to the State Hospital, Carstairs, between the time of the first female admissions in 1959, and 31 December 1973. There were 66 female admissions, constituting 7·1 per cent of the total admissions over the same period. The females fall into two separate sub-groups. The first consists of persistently violent patients transferred from other hospitals, suffering from mental subnormality or personality disorder; they have a poorer prognosis than the second group, who are sent from Courts or prison because of single serious acts of violence often directed at a member of the family, and who suffer from a personality disorder or from schizophrenia. Some features of the two groups are compared and contrasted. There may be an increase in the proportion of patients in the first group being admitted to the State Hospital, and some implications of this trend are discussed.

A battery of psychological tests was administered on three occasions over a three-month period to 75 patients admitted to a geriatric hospital and 75 patients admitted to psychiatric hospitals serving the same catchment area. The test results, used as an independent criterion, provided evidence that the criteria of psychiatric diagnosis were applied with constancy and accuracy in the two types of hospital, and supported the psychiatrists' findings that there were no strong grounds to believe that elderly patients were being ‘misplaced’ in one or other type of hospital facility.

In a controlled trial, ‘reality orientation’ for elderly patients diagnosed as suffering from dementia is shown to be effective only where therapists actively participate. Exposure to change in a more stimulating environment than their own wards is not enough to produce sustained improvement.

This paper describes a controlled study of 22 non-psychotic female habitual self-cutters. In this study an habitual self-cutter is defined as a patient who has cut herself with a sharp object on at least two separate occasions.

The physiological response to stress falls mainly on the cardiovascular system, adrenergic stimulation resulting in peripheral vasoconstriction and an increase in systemic blood pressure. The analogous effects that occur in anxiety-provoking situations immediately suggest an association, whether causal or effectual, between raised blood pressure and anxiety. It has also been suggested that hypertensive individuals exhibit more aggressive traits than others and that these may be hidden or suppressed, becoming manifest by abnormal elevation of the blood pressure (Smirk, 1957).

Personality profiles of 79 non-psychotic male offenders admitted to a security hospital were subjected to a cluster analysis. Four profile types were generated, classifying four-fifths of the sample, and differences were found between the types in previous antisocial behaviour. Two of the types were identifiable as primary and secondary psychopaths, while the remaining two showed little resemblance to the concept of the psychopathic personality. The primary psychopaths were extraverted but not neurotic, while the secondary psychopaths were neurotic, but not extraverted. Both were highly impulsive but distinguished by a dimension of sociability-withdrawal.

This study attempted to assess the applicability of the Clinical Interview Schedule (Goldberg et al., 1970) to mentally handicapped patients in a hospital. Twenty-seven patients were rated simultaneously by three raters. Of the 31 items assessed for reliability, 11 were completely satisfactory, 8 were satisfactory, 6 unsatisfactory and 6 ‘not proven’. Ratings made by all raters for overall severity of psychiatric illness correlated significantly with similar ratings made by the consultants responsible for the patients.

A replication study of the effects of single-night sleep deprivation therapy was carried out as a preliminary to a controlled comparison with orthodox antidepressant measures. The results show that sleep deprivation therapy was acceptable to a majority of the patients studied, and was followed by an improvement in over half those who completed treatment. Adverse effects were minimal. The authors feel that further clinical and physiological study is warranted.

A coroner concludes an open verdict if there is insufficient evidence to record any of the other verdicts, namely, suicide, accident, homicide and natural causes (Purchase and Wollaston, 1957). In practice, open verdicts are most often used when the coroner cannot decide between suicide and accident. They are therefore of interest to doctors, especially family doctors and psychiatrists, and to social scientists, because suicides may be so classified for want of evidence of intent to die. Thus the study of open verdicts may increase knowledge about suicide itself and the accuracy of suicide statistics. To further these aims we describe, for the first time, a consecutive series of such deaths which occurred in a London coroner's district. The psychiatric aspects have been given special emphasis.

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations, Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.

In a double-blind trial 600 μg. of thyrotrophin-releasing hormone (TRH) was compared with placebo given daily for four days to two groups of ten patients. There was no significant difference between the antidepressant effects of TRH and placebo.

In a minority of persons interviewed for the purposes of a court report it will be found impossible to determine retrospectively their intention at the material time with any exactness. This in itself is an indication of an abnormal mental state when the alleged crime was committed, irrespective of Bow the accused may appear when interviewed later. As well as issues arising under the McNaughton Rules or Diminished Responsibility to which intention is relevant, many offences require a specific intention to be proved so that the reporting psychiatrist should enquire into the accused's intention when preparing a court report.

A study of familial and social factors among Jewish and Protestant depressives and non-psychiatric controls revealed the following positive findings:

Depressives compared to normals as a whole had: (a) a higher rate of psychiatric illness in their families; (b) lower scores on maternal overprotection; and (c) a higher rate of marriage in both ethnic groups and both sexes, except in the case of Jewish men. Religiousness was associated with depression among Jews but not among Protestants. Jewish fathers compared to Protestant fathers were: (a) less strict in the normal group; and (b) less strict, less ‘dominant’ and more ‘inadequate’ in the depressed group. Ethnic links among depressed Jews were probably weaker than those among depressed Protestants.

The findings suggest that: (a) depression among Jews may be related to mental stress arising from ‘marginality’; and (b) single Jewish men may be particularly vulnerable to depression.

Definitions of mental handicap are imprecise in practice, and a wide spectrum of patients are provided for under this heading. There can be no question of specific treatment for ‘mental handicap’ as such. Many situations arising in institutions for the mentally handicapped derive from the nature of the institution and the regime. Drugs may be used ‘faute de mieux’ when environmental manipulation would be more appropriate. There is much overprescribing, and the choice of drugs is not always logical; monitoring of dose is seldom employed. A major source of behaviour disturbance in the mentally handicapped is lack of suitable occupation. Apart from a few specific indications, use of sedatives and tranquillizers for the mentally handicapped should be seen as a holding device, to enable a different system of management to be adopted or to disrupt an undesirable behaviour pattern.

Cannabis is easily available in Nepal, large numbers of persons using it regularly. I have studied its effects on 226 persons who had been using it for a long time and in considerable amount. As a control group I used an equal number of men of matching age and education.

Compared with the controls, the cannabis users had a poor work record, poor social and family relationships, a lack of interest in sex and a general loss of initiative and efficiency. However, there was no difference in crime rate between the groups.

Previous reviews of hysteria have emphasized the most severe and disabling forms and ignored evidence from a wide variety of sources. It is argued that hysteria is more prevalent in medical settings than is usually recognized, that the same psychological mechanisms are of wide occurrence, often being accepted as normal for the culture. Discussion of the social factors affecting prevalence suggests that there is a universal potential for the hysterical reaction, with individual variation in susceptibility in appropriate circumstances.

Eighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content.

The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder.

The potential difference across the rectal mucosa (rectal p.d.) is generated by the active transport of sodium across the mucosa, and it is sensitive to the action of aldosterone. The rectal p.d. values of depressive patients on no treatment, tested whilst depressed or after recovery, were found to be similar to those of control subjects, indicating that sodium transport across the rectal mucosa and the activity of aldosterone were normal in these patients. This contrasts with previous reports of abnormalities of sodium transport and of aldosterone levels in manic-depressive patients. Manic-depressive patients taking lithium carbonate as a prophylactic agent were found to have significantly elevated rectal p.d. values when normothymic. Patients who had become depressed whilst taking lithium, and in whom prophylaxis had therefore failed, were found to have normal rectal p.d. values. Lack of elevation of rectal p.d. in response to lithium administration may be a characteristic of patients who fail to respond to lithium prophylaxis.