This single case history is reported because scant information is available in textbooks of psychiatry and medicine on depression in acromegaly and gigantism. Attention is drawn to relevant recent articles.

It is generally accepted that psychological factors are of importance in determining the effects of drugs—beneficial or adverse (Green, 1964; Wilson, 1966; Boszormenyi, 1969). Placebo studies have suggested that one such psychological factor may be prior knowledge of side-effects (Wolf, 1950; M.R.C., 1950; Coleman, 1969). In a controlled trial of amitriptyline in general practice (Blashki et al., 1971) the patients were asked to record their experience of side-effects on a prepared list, and it was thought that this might have ‘involved the risk of suggesting side-effects to the patients'. In a controlled trial of Imipramine in general practice (Porter, 1970) the data suggested that side-effects were an important cause for patients abandoning treatment. Doctors may be chary of detailing side-effects, thinking that imparting such knowledge to patients may in a proportion of them induce the side-effects to appear and lead to discontinuance of therapy.

The effect of emotional stress in myasthenia gravis is well known, and moreover Meyer (7) has shown that psychiatric problems make a considerable contribution to the mortality of the disease. It has been estimated that there are at least 1,100 diagnosed myasthenics in England and Wales with many more undiagnosed (5). Considering the close medical supervision myasthenics receive it is striking that in 677 cases of myasthenia subjected to psychiatric scrutiny only 2 schizophrenia-like reactions were observed, despite the similar age of onset of the two conditions.

In 1954 a large survey showed that exhibitionists accounted for about a third of recidivist sexual offenders in England and Wales (Radzinowicz, 1957). As less than 2 per cent of convicted sex offenders fall into the recidivist category, the numbers concerned are small: a matter of a few hundred only. However, their frequent reappearances in the Courts and psychiatric clinics result in their constituting a problem out of all proportion to their numbers.

The frequency and intensity of various alcohol post-intoxication symptoms and their regression was studied during a three week double-blind treatment period. During the first two weeks daily doses of 60–120 mg. chlorprothixen and 120–240 mg. oxazepam respectively were given. During the third week a dose reduction was generally made, and during the fourth week placebo treatment was given. As an alternative treatment placebo alone was given during four weeks. No other medication than the coded substance was allowed during the observation period. The dose-response technique was used for ethical and practical reasons. The results have been registered by means of psychometric tests as well as assessments made by the patients, the personnel and the psychiatrist (the author) (Fig.). Some of these results have already been accounted for (Bliding, 1970) and will consequently not be mentioned here.

Manic-depressive illness is believed to comprise two different clinical entities: Bipolar and Monopolar. This paper aims to study any differences there may be between monopolar and bipolar depressions in respect of three factors: occurrence of affective disorder (including suicide) in first degree relatives; parental death before the patients' twelfth birthday and the extent of ‘jointness' (Khatri, 1970) of the patients' family.

Complementarity of roles is chiefly responsible for the degree of harmony and stability obtaining in interpersonal relationships (Spiegel, 1957). Collins et al. (1971) compared decision-making in the marriages of a group of male neurotics and in a control group. They found that patient marriages were more often categorized as ‘segregated’ (where distinct areas of responsibility were demarcated for each spouse) or ‘husband-dominated’ (where most of the decisions were made by the husband). Conflict over decision-making was also commoner in the patient marriages. By contrast, the control marriages were more often co-operative (both partners collaborated equally in a co-operative manner). The authors suggested that the severity of the husband's neurosis led to the adoption of certain patterns of decision-making which in turn led to conflict. They proposed that these patterns of behaviour might partly explain the development of psychiatric symptoms in the patient's spouse. In a series of normal families in Australia, Herbst (1954) noted that as the percentage of separate decisions increased tension rose. The ‘syncratic’ family structure (comparable to the co-operative pattern) was below average in tension, while the ‘autocratic’ (comparable to the segregated pattern) carried the highest tension.

Durkheim directed attention to the suicide rate seen not merely as the sum of individual acts of suicide but as the product of factors which affect the group or society as a whole. The study of suicide rates of different societies thus involves the study of their social structures and leads to inferences about the effects of differences in their cultural, social, psychological and religious composition. Such inferences are based on the assumption that differences in suicide rates are valid and not merely artefacts resulting from differing ascertainment procedures.

In an open clinical trial of clomipramine (chlorimipramine, Anafranil, Geigy), the phenomenological aspects and the response to treatment of twenty-five patients suffering from obsessional disorders were studied. The criterion for admission was the presence of distressing obsessional symptoms. Thirteen of the patients were diagnosed as suffering from a true obsessional state, six from depression, four from schizophrenia; one was an epileptic, and one was of uncertain classification. The drug technique has been described (Capstick, 1971a).

A recent examination paper for the Membership of the Royal College of Psychiatrists contained a compulsory question on pseudo-hallucinations. As is proper in a higher examination, the question was difficult, and at least one examiner (the present writer) had no idea what the answer should have been. While it is probably true that an examiner does not need to know a great deal about a question in order to assess a candidate's worth, yet if he is conscientious he will feel that he ought to know something about it. A rapid search through several textbooks proved curiously unhelpful; so this particular examiner awarded marks as best he could, and as soon as time permitted set out to discover what he should have known about pseudo-hallucinations. The present communication reports his findings and reflections. The findings are in no sense an exhaustive enquiry into the subject; they are the outcome of a search through those current textbooks and journals which may be taken to constitute as broad and as authoritative a background of study as can reasonably be expected of an examination candidate faced with a compulsory question.

Hare, Price and Slater (1971) plotted the age distribution of first admissions to hospital of patients suffering from schizophrenia and neurosis. (I.C.D. 7th Revision, Nos. 300, 303, 310–318). They found a close correspondence between the curves, and contrasted this with the deviation shown by similar age distribution curves plotted for mania, depression and personality disorder (I.C.D. 7th Revision, Nos. 301.0, 301.1, 301.2, 302, 320 and 321). Hare et al. argued from these curves that the environmental factors precipitating an attack are the same for schizophrenia as for neurosis.

The absence of a motor-perceptual learning measure which has a control or partialled out effect for age and general intellectual level has become obvious and the need for such a measure has been seen to be urgent in relation to the assessment of cognitive functioning in the elderly. Work by Savage and his colleagues (1971) has highlighted the fact that the measurement of intellectual levels and intellectual learning ability for both verbal and performance or motor-perceptual aspects of cognitive functioning is essential if the normal and abnormal structure and changes in cognitive functioning at any age is to be more fully understood. This paper reports on the development of the Block Design subtest of the WAIS as such a performance learning test. To our knowledge, there has so far been no measure of motor-perceptual or performance learning which has built into it an acceptable level or process of automatic control for general or performance intelligence and for age.