Any particular system which is being conditioned is likely to maintain a certain level of background activity throughout the experimental procedure; either of a discontinuous nature, as, for example, with eyeblink, heart rate and respiratory cycle, or continuously, as in the case of basal skin resistance and muscle tonus. This background activity or level of arousal does not remain constant but usually varies in time, presumably as a result of underlying neural excitation or inhibition. It may increase throughout an experiment if the subject becomes highly motivated, as with the gradients of muscle action potentials observed by Bartoshuk (1955), or decrease, if the subject becomes more relaxed and familiar with the set-up, as Duffy and Lacey (1946) found with level of skin conductance.

Five patients suffering with delusional depression, and who were resistant to tricyclic antidepressants, were successfully treated with lithium carbonate. Delusional depression does not usually respond to tricyclic antidepressants, and ECT has been considered the treatment of choice. Such patients often refuse to acknowledge that they are ill. They, therefore, understandably often refuse to accept ECT. In order to treat, the Mental Health Act 1983 must be invoked. Treatment with lithium carbonate is more acceptable to most patients, and in the cases described, patients agreed to take this drug whereas they had refused to accept ECT.

The efficacy of intramuscular pipothiazine palmitate (PP) in the management of aggressive mentally handicapped patients was examined in a double-blind, placebo-controlled, cross-over study, in which 30 patients received each treatment for 13 weeks. A target symptom scale of aggressiveness (TSA) and a clinical global impression scale of efficacy were rated at monthly intervals, and an extra-pyramidal side-effects scale weekly. The patients showed marked improvement during treatment with PP, which was assessed as superior to placebo. Individual and total TSA scores were also reduced compared to placebo.

A middle-aged woman with a recurrent depressive illness showed worsening of her tardive dyskinesia during the depressive phases, with improvement on remission.

In a recent survey of the psychiatric outpatient services at three Manchester Hospitals (Johnson, 1973), the diagnoses, treatments and disposals of new patients were discussed. The survey concentrated on the psychiatrist's role in the out-patient department, whereas in fact two other important viewpoints are involved, that of the referring doctor (usually the general practitioner), and the patient. Despite the importance of these viewpoints they have been largely neglected in the psychiatric literature. Only the study of Kaeser and Cooper (1971) attempts to investigate the out-patient department from all points of view, and their findings are likely to be atypical in certain respects since 60 per cent of their patients sample were referred to an emergency clinic, and dealt with by non-consultant medical staff. The present study attempts to answer the following questions about patients referred to the psychiatric outpatient department of a provincial teaching hospital.

“The incidence of schizophrenia is regarded as being similar between different cultures and times. However, several studies, mostly based on first-admission rates, have suggested that the incidence has declined over the past 10–15 years. Data from England and Wales for 1952–86 have been examined: there has been a substantial decrease, beginning in the mid-1960s, in the incidence of schizophrenia.”

Forty-four psychiatric patients were separated into four groups on the basis of presence/absence of hallucinations and reactive/process status. Reactive hallucinators were found to be singularly impaired in two aspects of cognitive processing: (1) tolerance of ambiguity; and (2) availability of alternative meanings. The perceptual errors produced by premature judgment and limited consideration of alternative meanings for misperceptions are discussed as factors predisposing to auditory hallucination.

It has been recognized for at least 150 years that the organization of wards in public institutions often “results in a lack of adequate attention, provides an unnatural environment and promotes neglect, abuse, injuries and confusion”, Noyes (1953). The atmosphere of the mental hospital back-ward, so different from that existing in the patient's home, creates a social, psychological and physiological “vacuum” and is particularly unfavourable to the long staying schizophrenic patient, who, as a result shows a progressive deterioration in habits and social relationships.

An early remedy practised at the York Retreat (Samuel Tuke, 1813) was that the nurses, having gained the patients' confidence, should attempt “to arrest their attention, and fix it on objects opposite to their illusions; to call into action as much as possible, every remaining power and principle of the mind; and to remember that, in the wreck of the intellect, the affections not unfrequently survive.”

In the present investigation verbal statements of certainty, or confidence in the performance of immediate recall and recognition, were related to the neurotic/schizophrenic dichotomy and, within the neurotic group, to personality questionnaires of rigidity, extreme response set, extraversion and neuroticism. The aim was to find pointers to conditions favourable for the investigation of individual differences in certainty and to assess the relative validity of a number of independent personality criteria. Statements of certainty analysed are derived from an immediate recall experiment, the results of which have already been reported (6). An analysis of the interaction between certainty and other measures derived from the same experiment is to be presented at a later date.

Correlations have been noted between certain persistent personality traits on the one hand and certain patterns within the normal range of variation of the EEG on the other. Some of these correlations had been based on impressionistic assessments of personality, and the following paper contains the results of part of an investigation which was undertaken in order to check these assessments by a more objective method, and to define more precisely some of the qualities reported.

Amitriptyline is a widely used antidepressant and its effectiveness has been shown, e.g. in comparison with imipramine in double blind trial (Burt et al., 1962; Hordern et al., 1963, 1964). A disadvantage of currently prescribed tricyclic antidepressants is the necessity for administering the drug three times a day. It has been shown that general medical and in particular psychiatric patients fail to take their medication either in the prescribed dose or at all (Benstead and Theobald, 1952; Haler, 1952; Park and Lipman, 1964; Parkes et al., 1962; Porter, 1969). This failure rate may be as high as 50 per cent (Dixon et al., 1957; Willcox et al., 1965). Even in psychiatric in-patient studies there was still a high failure rate in taking prescribed psychiatric drugs (Hare and Willcox, 1967). A regimen consisting of a single daily dose is more reliably taken than one consisting of thrice daily dosage (Coppen et al., 1969; General Practitioner Clinical Trial 1970).

The life expectation of even the most severely subnormal patients in hospital with IQs below 25, has risen dramatically since the beginning of the century. This paper reports the results of a survey carried out by the author into the expectation of life of patients with IQs up to 50 in the Stoke Park Hospital Group, Bristol.

Fifty female schizophrenic patients on the same locked ward were randomly assigned to experimental and control groups. Experimental group subjects were given as much autonomy and freedom as possible (they were permitted to leave the ward at will) and were encouraged to take part in collective activities. The control group were not permitted to leave the ward and did not take part in these activities. All patients were evaluated at enrolment and after six months – using Chinese versions of the Scale for Assessment of Negative Symptoms and the Brief Psychiatric Rating Scale – by psychiatrists who were blind to patients' treatment status. After the six-month intervention the severity of all types of both negative and positive symptoms and the mean dosage of medication in the experimental group were significantly less than in the control group.

In his survey of drug-induced extrapyramidal reactions, Ayd (1961) found that they occurred in 38·9 per cent, of 3,775 patients treated with phenothiazines. La Verne (1961) reported the occurrence of dyskinesia in 48 per cent. of 270 cases treated with haloperidol. It is therefore standard practice in many units to administer anti-Parkinson drugs concurrently with tranquillizers.

In a prospective study the criteria and characteristics associated with the admission of acutely ill psychiatric patients to in-patient or day hospital care were examined. Over a four-month period, 54 patients were admitted to hospital and 43 to a day hospital. There were significantly more schizophrenics in the hospital. Day hospital patients were significantly younger, had shorter psychiatric histories, were considered less severely ill and had more insight into their illness. Hospital patients had poorer employment histories, and perceived their families as less supportive; admission had more often been requested by them or their families.