In order to evaluate how many patients presenting at accident and emergency (A&E) departments show signs of psychiatric disturbance, 140 consecutive medical presentations to an A&E department were evaluated using a range of simple self-report and rater measures, then followed up a month later. High levels of reported psychological problems were detected at screening, and these persisted at follow-up. Correlates of psychological disturbance and repeated attendance at A&E were investigated, indicating the relevance and feasibility of psychiatric intervention related to simple predictors.

A case of depressive disorder in which treatment resistance was associated with the calcium-channel blocker nifedipine is described.

An investigation into the factors concerned in the etiology and pathogenesis of childhood schizophrenia is fraught with difficulties in numerous areas. Encountered are such problems as the diagnosis itself; doubt that psychoses exist in childhood; the existence of the duality organic or functional schools of thought, and of frequent contradictory findings reported by various groups of investigators in the field.

A schizophrenic patient whose severe level of auditory hallucinations had proved refractory to neuroleptic medication was given two treatment techniques derived from Green's theory that hallucinations represent verbal activity in the non-dominant hemisphere. Voice activity was markedly reduced in frequency and severity over a six-month period, and led to general improvements in interpersonal functioning. There was evidence for independent and additive effects of the two techniques.

In the psychiatric literature in English there is a tendency today to deprecate speculative neurophysiological theories of the “functional” psychiatric disorders, while little is done to halt the flood of far-fetched and untestable hypotheses of the “dynamic” psychopathologists. The present author believes that it is legitimate to postulate a neurophysiological basis for schizophrenia in the hope that those with a more adequate knowledge of neurophysiology will be obliged to re-examine the problem of schizophrenia more fruitfully. Conrad (1958, and Fish, 1960) has given a very interesting interpretation of acute schizophrenic symptoms, so that his approach to schizophrenia forms a very convenient starting point for further speculation. This worker's views will therefore now be presented in some detail before the present author's theories are discussed.

Sodium amytal has long been regarded as a physiologically inhibiting drug. It is widely used in clinical practice as a sedative and sleep-producing drug, although all of its precise pharmacological effects are not definitely established. It has also been suggested that sodium amytal produces an increase in extra-version, as manifest by an increase in communicativeness, etc. Thus Lindemann (1932) found that after receiving amytal, normal subjects report feeling of increased well-being, co-operativeness, serenity and friendship. Sodium amytal is also used for the reduction of manifest anxiety. Sargant and Slater (1954) cite many examples of its use for this purpose with neurotic subjects; they describe it as useful for “deconditioning to situations likely to produce anxiety”. Masserman (1938) reports that amytal apparently reduces the sympathetic activity in cats which normally results from faradic stimulation from the hypothalamus. It has also been shown to abolish conditioned fear responses in kittens (Bailey and Miller, 1952).

The literature related to conditioning is enormous. Hilgard and Marquis (1940) alone have a 973 item reference list at the end of their book. It has been established that anxiety neurotics or anxious subjects condition better than normals (e.g. Welch and Kubis, 1947a, 1947b; Taylor, 1951; Spence and Taylor, 1953; Spence and Farber, 1953). In the terminology of Eysenck (1952, 1953), in which introversion–extraversion and neuroticism are two orthogonal dimensions, anxiety neurotics are part of the groups known as Dysthymics, i.e. they have high scores on both the introversion end of the introversion–extraversion dimension and on the dimension of neuroticism. On the other hand hysterics and psychopaths have been shown to have high scores on the extraversion end of the introversion–extraversion dimension and on the dimension of neuroticism. Figure 1 will make this clear.

Haloperidol treatment for stuttering was examined in a double-blind cross-over study of 26 adult volunteers with long-standing stuttering. Most had had unsuccessful speech and drug therapy. During the three-month study, their speech and stuttering patterns were repeatedly evaluated from videotaped readings of a standard passage and during spontaneous speaking. Of the 18 patients completing the trial 11 were significantly more improved on haloperidol than on placebo, three benefited equally from both, and four were unchanged. Improvement over placebo was indicated by fewer dysfluencies, increased speed of speaking, and reduced secondary 'struggle’ phenomena. Side effects were common on a dosage of 3 mg haloperidol daily. Poor concentration, akathisia and dystonic movements caused 8 patients to discontinue the trial despite significant improvement in 5 of them. Although 'statistically significant’ improvement occurred in most patients on haloperidol, the ‘clinical significance’ of this form of therapy will be limited by the partial response, the need for continuous medication, the side effects of haloperidol and the attitude of stutterers to this type of therapy.

Most patients with endogenous depression who receive electroconvulsive treatment (E.C.T.) recover completely or improve considerably. However, it is evident that the effect of E.C.T. varies in different individuals. In some cases more treatments are necessary than in others and sometimes the final result is unsatisfactory even after a great number of treatments. Many attempts have been made to explain these variations.

Eighty patients admitted to hospital with major depression were randomly allocated to six weeks of treatment with tranylcypromine, amitriptyline, or tranylcypromine and amitriptyline in combination, in a double-blind study. Scores on the HRSD improved significantly in all three groups, but there were no differences between the three groups. Patients on tranylcypromine and amitriptyline combined improved more according to their self-ratings after six weeks, and response was earlier as measured by a clinical global improvement scale. Those with endogenous depression improved more than those with neurotic depression, irrespective of treatment group. Combined treatment was less well tolerated than single treatments and gave rise to more side-effects, although there was no serious toxicity. Orthostatic hypotension was observed more frequently in patients on combined treatment. This group also experienced a significant increase in weight and prolongation of the P-R interval on ECG.

Sociopathy, alcoholism, and drug dependence have been shown to be the only psychiatric disorders more frequent among convicted male felons than in the general population (4, 5). In these studies, sociopathy, regardless of other disorders, was found in nearly 80 per cent. An increased prevalence of sociopathy, alcoholism, drug dependence, and hysteria, or Briquet's Syndrome (3), was found among the first-degree relatives of these felons; hysteria (Briquet's Syndrome) among the female relatives and the other disorders predominantly among the male relatives. Overall, 44 per cent of the male felons' first-degree relatives received a psychiatric diagnosis (6).

The inability in a woman to tolerate intercourse is a factor which causes tremendous strain in marriage and leads rapidly to dissension between husband and wife and often the eventual break-up of the union. It is therefore a condition which it is vital to treat quickly and successfully if the partnership is to be saved.

The purpose of this paper is to report on ten cases of this uncommon syndrome admitted to Woodbridge Hospital, Singapore, and studied by the author in a systematic way. No attempt will be made to review the literature, as this has already been done recently by Goldin and MacDonald (1955), Enoch and Irving (1962), Enoch et al. (1967) and Whitlock (1967). The Ganser syndrome appears to be getting rarer in the West, as reports in recent literature have usually covered a few cases only: May et al. (1960) reported three cases and Whitlock (1967), six cases.

Recent workers investigating psychological dysfunction in schizophrenic patients have stressed the fact that such patients appear to have some specific difficulty in speech perception. It has been claimed that schizophrenics require more cues in order to reproduce verbal material accurately. This disability has been analysed by methods inspired by the work of communication engineers.

Two patients with erotomania (de CIérambault's syndrome) associated with epilepsy and head trauma are presented. The delusion appeared during periods of mania or hypomania and partially remitted during depression or euthymia. Erotomania may be seen in a wide variety of psychotic conditions, including those that are organically based.

We tested the hypothesis that the increased incidence of schizophrenia among Surinamese immigrants to The Netherlands could be explained by a similarly high incidence in Surinam. We conducted a 1-year first-contact incidence study in Surinam and compared the findings with data from a similar study conducted in The Netherlands using the same inclusion criteria and instruments. The risk of developing a schizophrenic disorder was 2.4 times higher (95% CI 1.3–4.2) in Surinamese immigrants than in residents of Surinam. The increased risk is probably due to environmental factors in The Netherlands.

Social anxiety was found to be the most common complaint in a sample of psychiatric patients reporting social interaction difficulties. High social anxiety was shown to be associated with impairments to social behaviour in socially anxious psychiatric patients and non-psychiatric volunteers. A comparison was made of systematic desensitization and a form of social skills training in the treatment of social interaction difficulties associated with high social anxiety. This indicated that while both therapies were effective in the reduction of social anxiety, the training programme was the more effective in reducing problem behaviour, but desensitization appeared to lead to a wider generalization of improvement as indicated by increases in social participation.