The background, methodology, and general results of a comprehensive survey of treated psychiatric illness in Lebanon have been described in an earlier report (4). The investigation consisted of obtaining biographical and diagnostic data on all patients seen by psychiatrists in Lebanon over a six-month period (15 February 1964 to 15 August 1964) and was carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside these institutions.

Until recently it was a widely held opinion that little could be done to alter the sexual orientation of homosexuals (Curran and Parr, 1957). Most therapists confined their efforts to helping the homosexual to adjust to his role. Now opinions are beginning to change. Bieber et al. (1962) with psychoanalysis and MacCulloch and Feldman (1967) with aversion therapy have reported a significant number of successes—where homosexual orientation has been lost and heterosexual orientation gained.

Results with relationship psychotherapy and with behaviour therapy in the treatment of homosexuality have not differed significantly as far as can be assessed, considering the different criteria used to measure response to treatment. Woodward (1956) reported that 36 per cent. and Bieber (1962) that 27 per cent. of their homosexual patients became exclusively heterosexual following psychotherapy; MacCulloch and Feldman (1967) reported a similar response in 33 per cent. of their patient group following behaviour therapy. The last authors also stated that 58 per cent. of their patients became heterosexual on the Kinsey scale (Kinsey et al., 1948). Mayerson and Lief (1965), using a similarly less rigorous definition of heterosexuality, concluded that 50 per cent. of their group achieved this state following psychotherapy. Freund (1960) considered that 18 per cent. of the group he treated showed a satisfactory response in that they had heterosexual intercourse regularly for several years after aversion therapy. He has been the only worker so far to utilize such a long follow-up period, and also the only one to report that some of his patients at later interviews admitted that they had lied about their degree of response at earlier interviews.

Although the value of phenothiazines is without question in the treatment of acute schizophrenia, their value in chronic schizophrenia is questionable. Cawley (1) states that social and environmental factors become more prominent for symptom relief and social adjustment with increasing chronicity. Both Ekblom and Lassenius (2) and Simon et al. (7), who did long-term follow-up studies on drug-treated schizophrenics, found only slight improvement when compared with control groups. Letemendia and Harris (4) found no significant improvement on phenothiazine treatment of previously untreated chronic schizophrenics when compared with a control group. On the other hand Kelly and Sargant (3) found a distinct improvement after two years in a group of phenothiazine-treated patients, who were compared with earlier admissions to the same hospital before the introduction of drugs. However, whilst Pritchard (6) found the short term prognosis was better for phenothiazine-treated schizophrenics when compared with patients admitted prior to introduction of these drugs, he found the three-year follow-up produced little difference.

A number of reports suggest that schizophrenia and coeliac disease (gluten enteropathy) occur in the same individual more often than expected by chance. The latter is an hereditary disease, with marked psychic and somatic symptoms which usually improve when wheat gluten and its analogues in other cereals are not eaten. This possible relationship, and the high correlation of the per cent. changes in wheat plus rye consumption with first admissions for schizophrenia during World War II (unrelated to availability of work, hospital beds and physicians or wartime status of the country), suggest that cereals may also be involved in the pathogenesis of schizophrenia (Dohan, 1, 2).

Disorders of body image are reported to be relatively common, and have been observed in some studies to occur in as many as 25 per cent. of psychiatric patients (Lukianowicz, 1967). Reduplication of the body image, however, is comparatively rare. Although classical literature is rich in descriptions of visual hallucinations of the self, it is only comparatively recently that this phenomenon has received medical attention. Coleman (1934) wrote at length on the possible psychological significance of the “double”, but it was left to Lhermitte (1951) to study such autoscopic experiences clinically and to draw attention to their medical importance.

Among a group of patients referred to the psychiatric out-patient departments of the Maudsley and King's College Hospitals primarily for emotional disorders, 40 patients who were at least 15 per cent above their ideal weight (Metropolitan Life Insurance Co., 1959, Statistical Bulletin, 40, 1) were selected for weight reduction. There were thirty-one women and nine men in the sample, and they were aged 25 to 54. The psychiatric diagnoses given were: anxiety (20), depression (17), and personality disorder (3).

Reports of serious complications arising from the administration of amitriptyline have been very few, particularly when account is taken of the widespread prescription of this drug in recent years for depressive illness. This is a report of three cases of jaundice, one mild, one fatal, and the third severe, but leading to a good recovery, occurring following the administration of amitriptyline, though in two cases other drugs were being given concurrendy. The makers of amitriptyline do include in their literature a caution about the very occasional link with jaundice, but only two cases have so far been reported (Cunningham, 1965; Biagi and Bapat, 1967). In a recent article (Sherlock, 1968), no specific mention was made of amitriptyline in particular, or of tricyclic antidepressant drugs in general, as liable to produce hepatic disorder.

This paper is an attempt to fill the void in objective investigation into the personality factors of lesbians. Although the subject of male homosexuality has been investigated exhaustively, it was not until relatively recently that studies concerned with lesbianism have been published, beginning with Armon (1960), then Bene (1965), Kaye et al. (1967) and Kenyon's series of articles in 1968. These papers have all attempted to take the subject out of the myth and psychoanalytic theory stages and bring it into the light, to determine whether the many theories, which at times have been based upon knowledge gleaned from male homosexual studies, have any objective, quantifiable basis. For example, one view stated by Caprio (1957) ‘that the vast majority of lesbians are emotionally unstable and neurotic …’ is a view commonly held as true almost by definition in psychiatric circles. It might be that this type of observation has been too subjectively made, on the basis of psychiatric interviews of otherwise neurotic women, who also may have been homosexually inclined.

In conjunction with a longitudinal study of ageing twins (Jarvik, 1967) the opportunity arose to examine the postulated relationship between increasing aneuploidy and age (Jacobs et al., 1961, Hamerton et al. 1965, Court Brown et al., 1966). Chromosome analyses have been completed for 59 subjects, ranging in age from 77 to 93 years with a mean age of 84.5 years for the 23 men and 84.6 years for the 36 women.

This paper describes a study of the sources and content of ideas concerning sex and reproduction held by adolescent girls in an approved school. The inquiry arose as the result of a question asked in a discussion group of psychiatrists as to how boys and girls normally acquired information about sex.

The therapeutic optimism which accompanied widespread introduction of milieu therapy has now been tempered, but there is still little doubt that it makes a substantial contribution to the treatment of the chronic schizophrenic. Much the same has been said about drug treatment. However, Hordern and Hamilton (1963) suggested that the results obtained with phenothiazines were no better than the findings of those pioneers who introduced moral therapy over a century ago. They further claimed that reports of a beneficial drug effect came from those places where resources were most meagre. If their view is correct it may mean that drugs and certain environmental factors have a therapeutic action in common on chronic mental hospital patients. These chronic patients, who are in large part schizophrenics, usually show the symptom of volitional defect more prominently than any other single symptom. It is possible therefore that both moral therapy and drugs may be acting primarily on this symptom. The present experiments aimed at examining this proposition.

Makerere University College is the oldest institution of higher education in East Africa. Situated in Kampala, Uganda, it lies not far from the northern shore of Lake Victoria, and draws its student population from those countries around the lake shores—Kenya and Tanzania, as well as Uganda itself. Eighty-five per cent of the enrolled students are of African origin, the remainder being Asians.

Research relating brain stem stimulation and cortical selectivity by Lindsley (1957) led Venables (1963) to utilize a score from a perceptual discrimination task (two-flash fusion threshold, T.F.T.) to examine hypotheses relating arousal level to perceptual dysfunction and schizophrenic symptoms. Other work failed to confirm the results (Hume and Claridge, 1965), possibly due to the unsuitable method of determining T.F.T., a method of constant stimuli. The following experiments were based on the proposition that perceptual functioning is related to arousal level, and also attempted to resolve confusions arising from earlier studies by control of possible sources of error in the experimental situation.

Bi-temporal electrical convulsive therapy has been used extensively in psychiatric practice since its introduction by Cerletti and Bini in 1938. There are undesirable side effects, principally memory disturbance and confusion. The organic changes in the brain following E.C.T. are not yet understood, although some E.E.G. work has been carried out on this aspect (Martin et al., 1965).

Comparatively high intelligence level has recently been reported as an exception in patients with the chromosome constitution XYY (Borgaonkar et al. (1968), Forssman et al. (1968), and Leff and Scott (1968)). We found, however, normal or high intelligence level in all nine patients with the XYY syndrome diagnosed in our laboratory and found in psychiatric institutions (full scale IQ, by WAIS 99, 90, 93, 100, 120, 93, 96, 98, and IQ low in the normal range).

Diagnosis of adolescent psychiatric patients is complicated by the absence of history of function in an adult role and by the assumed presence of psychological turmoil, thought to be normal at this age. Information about prognosis, always a useful part of clinical management, is especially important in counselling adolescent patients and their families about the prospects for education, vocation, and marriage.

†Patients came from both rural and urban areas of several neighbouring states. Parents or guardians of approximately one-third were teachers, salesmen, or shopkeepers and of another third, skilled labourers or farmers. The remainder were approximately equally divided between the well-to-do at one extreme and unskilled labourers at the other. That this sample provided a wider distribution among social strata than most private hospitals or most public hospitals is borne out by the fact that some patients who were subsequently hospitalized again were treated in private hospitals while others were admitted to public facilities (state hospitals).

Recently there has been interest in the nocturnal sleep of the elderly. The studies by McGhie and Russel (1962), Weiss et al. (1962), Kales et al. (1967) demonstrated that, compared with young adults, elderly people have a reduced total sleep time, more awakenings following sleep onset and a moderate reduction in REM (rapid eye movement) sleep. In other words, elderly people have a more disturbed sleep. While this group have a shortened night's sleep, they are given to taking afternoon naps, and it may be that through these they can compensate for their insomnia at night.