Forty-nine first episode schizophrenics were identified and considered to be representative of the parent schizophrenic population. Patients were rated before treatment with the Present State Examination. Findings are presented with regard to Catego classes, prevalence of first rank symptoms, conformity to ICD diagnoses, Feighner and Research Diagnostic Criteria and presence of a depressive syndrome. Physical examination revealed isolated neurological signs; in addition two neuroleptically naive patients had abnormal involuntary movements.

L-5HTP and tranylcypromine were compared in an open, but controlled and cross-over study, in patients suffering from major depression; all were non-responders to several reuptake inhibitors, including oxaprotiline and fluvoxamine. After four unsuccessful sleep-deprivations, L-5HTP or tranylcypromine were given during four weeks in a crossover design. Of 17 patients given L-5HTP during both treatment periods, none responded, whereas of 26 patients treated with tranylcypromine, 15 responded. Thus, L-5HTP is not a therapeutically effective alternative in depressed patients who have not responded to reuptake inhibitors.

This paper reports the results of measures taken during treatment in the study of imaginai flooding and exposure to real phobic situations previously described by Mathews, Johnston, Lancashire, Munby, Shaw and Gelder (1976). On weekly measures of change a similar reduction in phobic behaviour in all treatments was found, confirming the previous findings. Differences in therapist effectiveness were also confirmed. On measures of the immediate effects of treatment, exposure to the phobic situation had consistent positive effects, imaginai flooding had little or no detectable effect. It is proposed that the treatments studied differ in their immediate effects on phobic behaviour but also have the common effect of facilitating counterphobic behaviour outside the treatment situation, and that this is the main agent of therapeutic change.

There is a general view that the content of obsessions occurring in the course of depressive psychosis is frequently aggressive, homicidal or suicidal. Prichard (1835), Esquirol (1838), Marc (1840), Maudsley (1895), Heilbronner (1912), Gordon (1925 and 1950), Muncie and White (1937), Henderson (1937), Bowlby (1940), Lion (1942), Oltman and Friedman (1943), Stengel (1945), and Skoog (1959) all express this view on the basis of single anecdotal case reports or series of fewer than ten cases. The largest reported series is that of Vurpas and Corman (1933) who described 27 cases (2 organically based) of homicidal obsessions in depression. Only 3 cases (Nos. 10, 24 and 27) exhibited obsessions before the depression and this is too small a number to serve as a control group.

In most instances presenile dementia is based on well-defined organic diseases and it is not necessary to resort to cerebral biopsy to establish a diagnosis. These organic disorders cover a wide spectrum and include cerebro-vascular disease, tumours, trauma and well-defined degenerative states such as Huntington's chorea, vitamin deficiencies, endocrine disturbances, infections (bacterial and viral) and poisons such as alcohol, lead, barbiturates, bromides and carbon monoxide. The effects of liver and kidney failure as well as the hypercapnia of pulmonary insufficiency account for others.

The efficacy of antidepressants for panic disorders has had major effects on our understanding of the classification, pathophysiology, and treatment of anxiety disorders. Psychiatric practice has also been significantly affected, but important issues remain unresolved, such as the mechanisms of therapeutic effect, optimal duration of therapy to minimise relapse, and the interaction and sequencing of medication with cognitive behavioural treatments.

A case of a patient with monosymptomatic hypochondriasis exhibiting koro-like symptoms is reported. The patient did not respond to pimozide, but improved with a tricyclic antidepressant and has remained symptom-free for 1.5 years.

Among 18 patients receiving prophylactic, long-term lithium treatment for manic-depressive psychosis, a high incidence of increased thirst and frequency of micturition (60–70 per cent) was noted on direct questioning. Symptoms arose at varying times after the start of lithium therapy; in no patient did symptoms antedate the use of the drug.

Plasma levels of antidiuretic hormone were found, on average, to be higher than in normal control subjects for a given level of plasma osmolality, although the scatter of results was wide. It is suggested that elevation of antidiuretic hormone occurs as a compensatory mechanism for the polyuria which is a common feature of long-term lithium treatment. The more florid form of nephrogenic diabetes insipidus occasionally seen in lithium takers seems likely to be due to a different mechanism from the more common mild polyuria.

One-hundred female nurses at a psychiatric hospital were interviewed in an attempt to assess the overall frequency of having been the victim of indecent exposure and to describe it as experienced by the victim.

Forty-four of the subjects had been victims of indecent exposure, one-third of these on two or more occasions.

The attitudes of those who had been victims were no different from the attitudes of those who had not. One-third of all incidents had not been disclosed to anyone. In over one-fifth of the episodes the reaction of the family and friends in whom the victim confided had been more distressing to the victim than the episode itself.

Parkinsonism is generally considered to be essentially a disturbance of motor function, yet it is frequently accompanied, according to some writers (Hughes, 1961; Macdonald Critchley, 1955; Niehbuhr, 1961), by some degree of intellectual deterioration, especially in the later stages of the illness.

Nuclear magnetic resonance images of the non-dominant cerebral hemisphere were obtained in 20 unipolar depressed patients immediately before and 25 minutes after electroconvulsive therapy (ECT). T1 values rose about 1 %. Repeated scanning up to 24 hours after ECT was carried out in 13 of these patients. The greatest change in magnetic resonance images was two hours after ECT, and thereafter images gradually returned to baseline values. There was no correlation between magnetic resonance changes and the time taken to become re-orientated after ECT.

Cognitive functions were investigated in seven manic-depressive patients while on lithium, after two weeks off lithium, and after a subcutaneous injection of physostigmine while on lithium. Test performance was unaffected by lithium, but after physostigmine the I.Q. score of a shortened version of the WAIS was significantly increased.

Diminished sexual activity among individuals dependent upon the opiate drugs (heroin, morphine, methadone, etc.) has been noted by Freedman (1967) and by Jurgensen (1966). A study of four populations of male patients (controls, abstainers, heroin addicts and patients maintained on methadone), suggested that although factors other than the specific drug effects may be important determinants of sexual difficulties, that the drug itself may act as a specific determinant (Cushman, 1972). This was supported by the fact that all patients claimed to have been normal before narcotic use, that heroin reduced sexual performance and desire, and that a reversal to normal sexual function rapidly occurred during enforced withdrawal. Other observations by Ding (1972), and Scher (1967) support these findings. Berzins et al. (1971), and Mott (1972) have noted that drug-dependent subjects tend to have problems of sexual identity, and Hobi (1972) suggests that psychosexual immaturity is frequently seen in drug-dependent subjects.

In view of recent findings in Japan, and in England and Wales, data on schizophrenic births in the United States were reexamined to see if seasonal shifts had occurred. In Missouri a progressive shift from February to April and May was noted between 1921 and 1930 and between 1941 and 1950. In five New England states there was no shift over the same period. Data were then obtained to compare the Missouri shift with two hypotheses previously put forward to explain schizophrenic birth seasonality: (1) that it is related to the seasonality of general births, and (2) that it is related to seasonal temperature variation. Neither hypothesis was supported by the data.