Thirty-eight patients suffering from severe depression were given a course of ECT (Electroconvulsive therapy) in one of three waveforms. These were high-energy sine wave (HS), high-energy pulse (HP), and low-energy pulse (LP). Patients were assigned to one of these treatments on a double-blind basis. The patients were given a battery of memory tests before ECT commenced, after three treatments, at the termination of treatment, and two weeks after the last treatment. The marked improvement in both verbal and nonverbal memory scores was attributed to the lifting of depression. No significant differences were found between the memory scores of the three treatment groups at any point during the treatment period.

The human brain has a remarkable capacity for plasticity, but does it have the capacity for repair and/or regeneration? On the basis of controversial new evidence we speculate that the answer may be ‘yes', and suggest that clinicians should therefore approach cognitive impairment and dementia with a new, cautious optimism.

Although abnormalities in physique in mental patients have been reported many times (see review by Rees, 1960) their cause and significance are obscure. Rey and Coppen (1959) reported the results of an investigation into the physique of mental patients using a measure of sexual maturation known as the androgyny score (Tanner, 1951, 1962).

This is the first of a series of papers reporting studies of various cognitive disorders in schizophrenia. The present paper deals with the validity of certain tests as measures of thought-process disorder: subsequent papers will relate type of disorder to various sub-categories of schizophrenia, as diagnosed clinically and by the Symptom-Sign Inventory (Foulds, 1965).

The observations recorded in this paper were made on 72 patients referred to a neurological clinic on account of headache who proved to have no evidence of organic disease and whose symptoms were not migrainous in nature. They were, therefore, suffering from the type of headache described as psychogenic headache, tension headache, stress headache, or common headache.

One of the hypotheses advanced to explain the processes underlying severe depression postulates a change in brain function due to an alteration in the distribution of cations across the neuronal membranes (Shaw and Coppen, 1966; Shaw, 1966). Electrophysiological evidence of abnormal function of pathways in the nervous system in depression has been obtained by the study of evoked cortical potentials (Shagass and Schwartz, 1966), but evidence of derangement in the distribution of cations between the cells and extracellular space has come only from “whole body” studies (Coppen and Shaw, 1963; Coppen, Shaw, Malleson and Costain, 1966; Shaw and Coppen, 1966).

Amongst 100 chronic paranoid schizophrenics depression occurred in 30 per cent over a mean 6 years and was significantly associated with parental loss before 17 years.

In an in-patient population in Sri Lanka, only those receiving a diagnosis of schizophrenia had Schneider's First Rank Symptoms. Among 65 males and 104 females, the prevalence of FRS was 25.4 per cent. Those patients with FRS in the first episode are likely to develop more during subsequent episodes. An attempt is made to explain the findings on a cultural basis.

This is a study of the results of screening tests on all new psychiatric in-patients over a period of one year. Although none of the results indicated definite physical causes for the psychiatric illness, 10 per cent of the tests revealed abnormalities resulting from or co-incidental with the psychiatric illness. Of these abnormal results 61 per cent led to no further investigation or treatment, and the significance of this is discussed.

In a prospective screening of emergency admissions of patients suffering from neurosis, personality disorder or adjustment reaction, 100 were assessed as suitable for early transfer to day hospital treatment, 101 as unsuitable, and 39 as not requiring further intervention. Of the unsuitable patients, 39 were grossly disturbed; the remainder did not differ in severity from those thought suitable, but there was a specific reason against day treatment in all but 13 of the 62—most commonly alcohol abuse, physical problems, social problems or aggression. Patients' attitudes were also important. Recruitment of patients had to be active, with regular visits to the wards by day hospital staff.

This paper attempts to show something of the interaction between social factors and the response to treatment in patients with chronic renal failure who embark on a programme of recurrent dialysis. The social work involved was carried out on the series of patients reported by Professor Cramond and his colleagues in the three articles preceding this one.

Testing hypotheses on classification could be made more precise by using only clinical symptoms and signs as its basis. Analyses based on a mixture of clinical, aetiological and background variables give ambiguous results since they incorporate the assumption that aetiological and symptomatological patterns are related in a one-to-one manner. A set of simplified models of possible relationships between aetiology and symptomatology is used to discuss these problems of interpretation. The clinical variables to be used for discriminant analyses may be chosen by testing for the existence of lower-order and higher-order differences between groups.

We have investigated cation transport in vivo in patients being treated with lithium for bipolar affective illness by studying the disposition of rubidium after an oral load of rubidium chloride. The rate of erythrocyte cation transport was increased in the patients when compared with matched healthy volunteers. However, the rate of in-vivo erythrocyte rubidium accumulation in the euthymic treated patients was significantly lower than in a matched group of unmedicated manic patients. The regulation of specific pathways for cation transport may be altered in individuals predisposed to affective illness.

Considerable evidence has accumulated that alterations in the direct current fields of the brain can produce alterations in function (O'Leary and Goldring, 1964). In view of this a group of investigators instituted a clinical trial of the possible usefulness of transcranial polarization (Lippold and Redfearn, 1964; Redfearn et al., 1964; Costain et al., 1964). In the approach used a current was passed between electrodes attached just superior to the eyebrows and an electrode on the leg. The principal changes reported consisted of an elevation of mood and an increase in involvement with the environment when the head was positive relatively to the leg and a withdrawal and quietness when the head was negative relatively to the leg. The current level reported as effective was generally of the order of 250 microamperes. Among Lippold and Redfearn's subjects were seven schizophrenics, in six of whom brief D.C. polarization produced the expected effects. Among the subjects of Redfearn et al. were four schizophrenics, in all of whom some favourable effect from D.C. head positive polarization was reported. This study was uncontrolled. In a blind controlled trial, Costain et al. found head-positive polarization to be of therapeutic efficacy in a group of 24 depressed patients. Their interpretation of results was challenged by Dawson and Montagu (1965). In view of these reports, we decided that a pilot study of the possible efficacy of transcranial polarization in altering the non-responsive state of chronic schizophrenic patients was warranted. It was decided that a more longitudinal study would be of greater value in determining possible therapeutic usefulness than a shorter trial on a larger number of patients. The experiment was conducted on one of the research wards of Rockland State Hospital.

Most people suffer from so-called ‘nervous symptoms' sometime during life, and their activity is influenced in varying degrees by these symptoms. There are a number of works reporting high prevalence of so-called neurotic symptoms: Rennie and his collaborators studied a sample of the population in the age range 20–59 of the central residential area of New York City and found that 75 per cent manifested significant symptoms of anxiety and that only 11 per cent of the lower class and 29 per cent of the upper class were psychiatrically symptom-free respondents (Rennie, Srole, Opler and Langner, 1957). Leighton found the life-time prevalence (after the age of 18) of psychoneurotic symptoms in a small town (population about 3,000) to be 67 per cent (Leighton, 1956). Winter interviewed 200 apparently healthy workers (mean age 36·6 years, 141 males and 59 females) of various social strata of Berlin, and found only 18 per cent free from so-called neurotic symptoms, i.e. anxiety, phobia, insomnia, headache and other psychosomatic symptoms (Winter, 1959). Agras, Sylvester and Oliveau found the prevalence of fear of storms, enclosures and journeying alone in females of Burlington to be 31 per cent, 14 per cent and 10 per cent respectively, and noted that psychiatrists saw only a small percentage of the phobic population (Agras, Sylvester and Oliveau, 1969). In all of these surveys, the authors noted that the majority of those with symptoms appeared to function well in the society. In Japan, a comparable survey is lacking, but Kasahara and Sakamoto investigated by questionnaire 2,481 students who entered Kyoto University in 1967 and found 24·1 per cent suffering from headache and 18 · 5 per cent from difficulty in falling asleep (Kasahara and Sakamoto, 1970). On 30 August 1970, N.H.K. (Japanese Broadcasting Corporation) invited to the studio 100 males who had graduated in 1945 from a single metropolitan all-male middle school for a programme entided ‘Age Forty’, in which health, economical and social status of this age group was enquired into. Among these, 26 ‘often suffered from palpitation and shortness of breath without significant exertion’, and 34 often awoke in the middle of the night or too early in the morning and could not get back to sleep again.

DSM–III has largely been based upon essentialist notions of increasingly accurate and ‘valid’ definitions of diseases. A nominalist approach would facilitate study of aetiological factors and variables in the natural history of diseases.