Several surveys (Carstairs and Bruhn, 1962; Shepherd et al., 1966; and Johnson, 1973a) have demonstrated that the treatment of psychiatric disorders in general practice consists principally of prescribing drugs, with relatively little use of social agencies and psychotherapy. Although Shepherd et al. (1966) comment that the treatment is often haphazard and inadequate, the published surveys of general practice give little specific information about the prescribing habits of doctors. The present author surveyed the prescribing habits of general practitioners in the treatment of depression in the belief that it is necessary to have this information in order to evaluate the need for education in this clinical expertise, and also to act as a comparison for other surveys which will undoubtedly be carried out in the future to test the effectiveness of the current expansion of undergraduate teaching in psychiatry.

Since the beginning of the century, group methods have played an increasingly important role in the treatment of patients suffering from psychological or physical disorders.

Postgraduate teaching in psychiatry has always been a function of the provincial mental hospitals, but nothing before has equalled the expansion of theoretical teaching which has taken place over the past ten years. At the heart of the training of a psychiatrist, however, there is the National Health Service job with its own demands, where the practical clinical skills are acquired. The job has not changed much, even though the arrangements for theoretical instruction have improved. Yet changes may be possible which will make the registrar's job more efficient as an educational experience by removing the unsystematic and random elements.

Reports have been accumulating in the literature attesting to the failure of patients, particularly out-patients, to take medication as prescribed (Stewart and Cluff, 1972; Moulding et al., 1970). The incidence of these failures, which may include anything from missing occasional doses to taking no medication at all, has been reported to range from 25–59 Per cent. In addition, it has not been possible to identify those patients who will have the highest failure rates (Blackwell, 1972). While most of the studies have involved medical patients, it is probably legitimate to assume that schizophrenic patients are at least as unreliable in taking medication as the medical patients. Thus, in one study of 125 psychiatric patients, Willcox et al. (1965) found that 48 per cent took no medication at all.

Drugs have been used to control deviant sexual behaviour in recidivist sexual offenders for over 20 years. Oestrogens have been most widely used (Golla and Hodge, 1949; Whittaker, 1959; Scott, 1964) and generally have been considered to be effective though limited by their side effects, in particular nausea, vomiting and feminization. A further uncommon but grave complication has been carcinoma of the breast (Symmers, 1968). Recently, oestradiol implants have been used (Field and Williams, 1970). A similar libido-reducing effect has been claimed with some tranquillizers, notably thioridazine (Litkey and Feniczy, 1967; Bartholomew, 1964), fluphenazine enanthate (Bartholomew, 1964) and a new butyrophenone, benperidol (Sterkmans and Geerts, 1966; Field, 1973). Progestogens have been recognized for some time as having libido reducing qualities in both males and females (Heller et al., 1958; Kupperman, 1963; Money, 1970). The use of medroxyprogesterone in treating sexual deviants has recently been reported (Money, 1970); it was found not only to be effective in controlling behaviour but also to produce marked reduction in circulating androgen. Currently, much interest is being shown in the use of an anti-androgen, cyproterone acetate, for this purpose (Laschet and Laschet, 1969; Briggs and Briggs, 1971; Cooper et al., 1972).

The Tunbridge Report on Rehabilitation (1972, para 71) comments on ‘the paucity of research on the requirements of rehabilitation and the evaluation of rehabilitative treatment and techniques.’ An unusual way of evaluating the effectiveness of rehabilitation is to study its cost.

Although there have been reports of psychotic reactions to benzhexol hydrochloride in adults we have not found any reports of adverse reactions in children. Recently, at the in-patient psychiatric unit of the Hospital for Sick Children, Great Ormond Street, London, we have seen two children who developed acute psychotic reactions when treated with benzhexol hydrochloride given to prevent extra-pyramidal side effects. In both cases, complete recovery occurred rapidly when benzhexol was discontinued.

Thiothixene and thioridazine, established anti-psychotic agents (5), have been reported to possess antidepressant (4, 7, 8, 9, 17) and anxiolytic (3, 15, 16) properties. The present study is primarily concerned with the latter claim. It was initiated to assess the role of both these major tranquillizers—thiothixene, a thioxanthene derivative, and thioridazine, a phenothiazine derivative—in the symptomatic treatment of anxious neurotic out-patients.

A girl is briefly described who had typical bipolar manic-depressive psychosis starting unusually early at 14 years of age. Symptoms at the time of onset included severe anorexia, school phobia and attempted suicide, about the time of onset. She required unusually high doses of lithium carbonate to obtain adequate plasma levels, and there was a tendency for the administration of antidepressant medication to cause her to switch rapidly from depression to hypomania. The last two findings were shared by her father who also had bipolar manic-depressive psychosis.

Previous studies have shown that in-patients in psychiatric hospitals may not always take prescribed drugs reliably (Hare and Wilcox, 1967; Wilson and Enoch, 1967; Irwin et al., 1971).

Anxiety is perhaps one of the commonest and most disabling symptoms in medicine, yet its satisfactory alleviation has been elusive.

Work by Kluver and Bucy (1939) suggested that the amygdala generated anxiety, the function of the hippocampus being to decrease it. The hypothalamus appears to organize the level of arousal through the amygdala.

A previous paper (Malcolm and Madden, 1973) has described the use of disulfiram implantation as a method of treatment for some alcoholics. The results obtained were satisfactory, measured in terms of duration of abstinence and social improvements made in the post-implant period. However, it was suggested that the success of the implant might be due to psychological rather than pharmacological factors. In an effort to clarify the nature of any deterrent effect of the implant, further clinical and biochemical evidence has been collected.

These studies were carried out in Park Prewett Hospital (1,400 beds) which serves most of northern Hampshire, a population of just over 300,000 people. Our aim was to describe in some detail the gross features of this hospital population. Three descriptive techniques were employed.

The memory loss that follows a series of electroconvulsive therapy (ECT) treatments has been well documented. The amnesia appears to involve an impairment in the ability to acquire new memories, an impairment of memory for events that occurred shortly before ECT (Dornbush, 1972; Williams, 1966), and an impairment in the ability to recall material from remote memory (Janis, 1950; Squire, 1974a). Several characteristics of the anterograde amnesia produced by ECT have been the subject of contradictory reports. For example, it has been reported that memory functions can improve markedly or even return to pre-ECT levels within hours after the last of a short series of treatments (Brengelmann, 1959; Zinkin and Birtchnell, 1968; Zirkle, 1956). Yet, it has also been found that amnesic effects of a short series of treatments can be detected for weeks (Cronin, Bodley, Mather, Gardner and Tobin, 1970; Halliday, Davison, Browne and Krieger, 1968). Moreover, some reports suggest that memory recovers at the same rate following each of the first few treatments in a series (Brengelmann, 1959; Zinkin and Birtchnell, 1968), whereas other reports demonstrate that the effects of the first few treatments on memory can be cumulative (Bidder, Strain and Brunschwig, 1970). One explanation for such variant findings is that different memory tests have been employed in these studies. To obtain accurate estimates of the effects of ECT on memory, tests used to assess memory should be as sensitive as they can be to memory impairment. This point is particularly relevant, of course, to the evaluation of long-term effects of ECT on memory. Patients who had sustained partial temporal lobectomy could perform normally in tests of immediate reproduction from memory, but were markedly impaired in tests that imposed long delays between learning and retention (Milner, 1958). Apparently tests involving delayed reproduction from memory are a more sensitive index of organic memory dysfunction than tests that involve immediate reproduction. The present study assessed the ability of patients receiving ECT to retain newly learned material for 30 minutes and 24 hours. The results of these delayed retention tests demonstrate that recovery from anterograde amnesia is quite gradual and that the effects of the first few ECT treatments on memory are cumulative; and underscore the value of such tests as sensitive indicators of possible long-term effects of ECT on memory.