Home Office records were used to trace the current status of a sample of 128 persons for whom heroin was prescribed in 1969 at Drug Dependence Clinics in London. In October 1975, after a mean time since self-reported first use of heroin of 11 · 25 years, 51 per cent were attending clinics, 40 per cent alive and not attending, and 9 per cent dead. One third of the sample were still receiving heroin on prescription, and 23 per cent appeared to have received heroin without interruption since 1969. The report points to the need for career studies of addicts' lives and the need for follow-up interviews, especially for the 40 per cent no longer attending clinics.

New psychiatric out-patients were offered immediate or delayed appointments (average delay 12 weeks) in random order. The two groups thus formed, comprising 234 patients, were shown to be comparable in some important respects. Immediate appointments were taken up significantly more frequently than delayed appointments, and 12 per cent of immediate and 22 per cent of delayed patients did not receive any psychiatric service. No evidence was found that delay increased other medical services supplied. Non-attenders were presumed to suffer from ‘neurosis’ and ‘personality problem’. Initial attenders used more services than those who failed to keep their first appointment but came later. A waiting list is proposed as a screening device to limit out-patient referrals.

Patients with idiopathic narcolepsy are seen by both neurologists and psychiatrists. The diagnosis has traditionally been made on the basis of a history of frequently falling asleep against the patient's wishes, attacks of cataplexy or loss of muscle tone upon sudden emotion, episodes of sleep paralysis, and an account of vivid, dream-like experiences during the periods of involuntary sleep.

Somatosensory potentials (SEPs) evoked by vibrotactile finger stimulation have been reported to be the same in both hemispheres in schizophrenics, whereas they are asymmetrical in normals, with the contralateral hemisphere leading the ipsilateral (Jones and Miller, 1981). These findings were taken to indicate that the corpus callosum is nonfunctional in schizophrenics. To attempt replication of these results, vibrotactile SEPs of 6 schizophrenics and 6 normal controls were recorded with both bipolar and monopolar derivations. Assymetrical bipolar SEPs were obtained in both schizophrenics and controls; previous observations of schizophrenic-control differences were not replicated. Acceptable evidence of ipsilateral early SEPs was not obtained; the test procedure seems inappropriate for measuring callosal conduction time.

Four elderly schizophrenic patients who had never been treated with neuroleptics, and a fifth patient who had received only the briefest exposure to such drugs, had retained their distinct clinical characteristics. Involuntary orofacial movements and cognitive dysfunction were found more uniformly than any particular pattern of symptoms.

Perhaps one of the most difficult investigations possible is the study of the mental characteristics of savage and semi-savage races, and, before formulating any theories regarding their psychic history, it is necessary that a careful study should be made of their mode of life, their normal mental state, and such folk lore as is accessible to us.

In previous communications (1951, 1952) we have shown that lysergic acid diethylamide (LSD-25), a drug which has a remarkable psychological effect in minute oral doses, also has an effect on carbohydrate metabolism resulting in an increased concentration of hexosemonophosphate in the blood. This observation has been confirmed by Cornforth and Long (1952). What was less clear from the experiments in mentally healthy subjects was the relation in time and severity between the psychological symptoms and biochemical changes.

The fact that electrical stimulation of the brain can produce unconsciousness in man and animals has been known since the eighteenth century, and from time to time this knowledge has been used in the production of anaesthesia for surgical purposes; Hobday, in 1932, performed castrations and herniotomies in small animals under electrical general anaesthesia, and in 1935 Hertz used electrical anaesthesia for laparotomies in dogs. To-day electrical stunning is used in bacon factories with the object of rendering pigs unconscious before slaughter. Electroconvulsant therapy (E.C.T.) is widely used in mental hospitals for the treatment of certain conditions, and recently Freeman (1948) has modified this technique to produce surgical anaesthesia for prefrontal leucotomy.

In some instances electrical anaesthesia has proved satisfactory, but there have been reports of “distorted consciousness” after E.C.T. in human subjects (Morgan, 1950), and of electrical curarization after industrial accidents (Hume, 1935); in these conditions the subject is conscious of sensation but unable to make voluntary movements. Such a condition is only appreciated when the subject is questioned after regaining full consciousness, and hence, if it occurred in animals, it would not be readily recognized.

The object of the work described in this paper was to determine the effect of the many variables of electric stimulation, and to investigate the state of consciousness of human subjects and animals after electric stunning. It was hoped thus to provide a basis for future work on electrical anacsthesia and to acquire a better understanding of the action of E.C.T.

The terms “macrocosm” and “microcosm” have been taken by Jung from the traditions of the alchemists and the philosophy of Leibnitz for expressing his theories, but they are not often used elsewhere in psychiatry or psychology so it may be as well to define them when introducing them here.

The birth of a mentally handicapped child to a couple is a traumatic event. It has even been compared with a bereavement. In the crisis of family handicap, however, there is also anxiety, fright, guilt and shame. Some of these reactions have been denied by families but it has to be borne in mind that mothers of abnormal babies, although they are not aware of it consciously, may be protective and dominant (Prechtl, 1963). The reactions of parents of mentally handicapped may swing from extremes of over-protection to complete rejection. On the other hand, there is stress both emotional and physical in looking after the handicapped day in, day out. The amount of the emotional stress has not been quantified, but of the many forms of interactions between parent and offspring, over-involvement, criticism, hostility, and warmth can be evaluated using the Expressed Emotional scales.

For a foreign observer who has been trained in German and French psychopathology, British psychiatry is very attractive at first glance for a number of reasons. Its eclectic and principally non-theoretical approach (Cooper, 1975), characterized by an open acceptance of foreign concepts and by the tendency to question traditional structures and hypotheses and to test them by means of statistical methods, appears most impressive. The substantial contribution British authors have made toward the development of structured tools in psychopathology, like for instance the Present State Examination or the Hamilton Rating Scale in order to facilitate such a statistical evaluation, which reflects clearly the inheritance of Sir Francis Galton, is also a cause of sincere admiration. The European observer realizes furthermore that the British approach is rooted mainly in continental, especially in German, clinical psychiatry, and is not as heavily influenced by psychodynamic theories as, for instance, the American schools were, at least until recently. This provides him with a comfortable feeling of familiarity and he is not inclined to question certain British tenets until his involvement progresses and he becomes aware of the comparative lack of attention paid by British schools to some of the fundamentals of continental psychopathology.

The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic drugs, made up of hyperthermia, muscular rigidity, disturbance of level of consciousness and autonomic dysfunction. It is potentially lethal and should be kept in mind whilst using anti-psychotic drugs; as most patients treated by them require further anti-psychotic treatment, the clinician faces the problem of treating those patients after a NMS episode, yet reports in the literature have generally neglected the problem of late management. A patient suffering from a psychosis and NMS is presented, and a rationale for management offered.

A patient with obsessive–compulsive neurosis arising six months after minor head injury is described. The theoretical implications of this case are discussed. A neuropsychological model to explain the onset of the disorder in this and previously reported cases is suggested.

Background The HOMES (Home-Oriented Management of Early Psychosis) programme is a new home-based management programme for people presenting for the firsttime with psychotic illnesses. The present paper aims to present preliminary data as to the efficacy of this programme and factors identified as being associated with successful prevention of hospital admission.

Method The programme applied to all the people presenting to the Dandenong Hospital Department of Psychiatry with first-episode psychosis who are considered suitable at first assessment for home-based management. A programme description is included in the paper. Prospective evaluation data on the first 31 people managed within the programme is presented.

Results Twenty-two out of 31 people were managed without the necessity for hospital admission. Illness severity was not related to the ability to manage this group of people outside of hospital. The level of social support and duration of untreated psychosis prior to treatment, may be most closely related to home-based treatment success.

Conclusions Home-based management of people with first-episode psychosis is feasible and offers a viable alternative to admission for this group. Home-based treatment is dependent on the degree of social support but is independent of the degree of illness severity.