The range of interventions available for the treatment of erectile failure has increased in the past ten years. A significant development is intracavernosal injection of vasoactive drugs, but this treatment is far from ideal. Other, less invasive, pharmacological interventions are being investigated; as yet, none of these appear effective enough to have any significant clinical impact. External vacuum devices are a viable option for some patients, and penile prostheses have become increasingly sophisticated, although research examining their benefits has not. The range of available treatment methods and the growing complexity of the assessment for erectile problems demands an eclecticism of approach which can best be provided by multidisciplinary clinics specialising in sexual dysfunctions.

Comparatively high intelligence level has recently been reported as an exception in patients with the chromosome constitution XYY (Borgaonkar et al. (1968), Forssman et al. (1968), and Leff and Scott (1968)). We found, however, normal or high intelligence level in all nine patients with the XYY syndrome diagnosed in our laboratory and found in psychiatric institutions (full scale IQ, by WAIS 99, 90, 93, 100, 120, 93, 96, 98, and IQ low in the normal range).

The patient who develops the delusional conviction that he/she is infested with small organisms, such as mites or insects, has been recognised in the medical literature for over a century. A wide range of descriptive terms — ‘dermatophobia’ ‘acarophobia’, ‘parasitophobia’ and ‘entomophobia’ (Table 1) have been applied to this symptom. Such terminology is now inappropriate but it has continued to be used until relatively recently: Pope (1970), for example, defined parasitophobia as “a delusional state in which there are sensations of infestation of the skin by insects”.

Higher CSF 5-HIAA concentrations and lower CSF HVA concentrations have been associated with various measures of slowed motor behaviour and communication in schizophrenic patients. To derive a single, reliable measure of deficit characteristics in schizophrenic patients, we entered four items of the BPRS reflecting negative symptoms, a work history measure derived from the Strauss-Carpenter scale, and three subscale scores of the WAIS-R into a principal-components analysis to derive a single factor score. The CSF 5-HIAA concentrations were within the normal range of values, and correlated directly with this factor score, but CSF HVA concentrations were not associated with the deficit factor score. These findings add support to the hypothesis that brain serotonin function is associated with deficit schizophrenic characteristics.

An improvement in tardive dystonia in a patient who had received ECT for a schizophrenic psychosis is reported. The improvement suggests that the pathophysiology of tardive dystonia may involve neurotransmitter receptor changes similar to those seen in schizophrenia.

Early intervention in psychosis has significantly improved outcomes compared with standard treatment but it is considered as a luxury for low- and middle-income (LAMI) countries. However, a public health approach that is based on the principles of supplying all essential medication free of charge for at least the first 2 years of illness, medication being taken under supervision of a caregiver and treatment following a standardised treatment algorithm can prove a cost-effective early intervention model for LAMI countries.

Psychotic symptoms are not included under accepted definitions of premenstrual syndrome (PMS). We present a 14-year-old girl with PMS, who developed a late luteal cyclic psychosis during two consecutive premenstrual periods, which resolved completely after the onset of menses. She was treated with dehydroxyprogesterone for two cycles, and later with placebo for the next three consecutive cycles. Psychotic symptoms did not reappear following two psychotic cycles, and the PMS resolved within the next menstrual cycle. We suggest that cyclic psychoses associated with the menstrual cycle may be a specific benign entity, not included under the recognised functional psychoses. In some cases these psychoses could be classified as a subgroup of PMS.

To summarise then, in 1962 RET displayed important features still current. These include the inter-relatedness of cognitive, emotive and behavioural processes, the important role that cognition plays in psychological problems, its humanistic view of the self, and the futility and dangers of self-rating. The emphasis on perpetuation rather than acquisition processes of emotional disturbance holds good now as it did then, and the core view of therapeutic change is essentially the same now as it was in 1962, despite further, more recent elaborations.

Significant change has occurred in RET since 1962 that updates several of Ellis' original ideas. These include the distinction between interpretations (or inferences) and evaluations, the primary of musts in accounting for psychological disturbance, the clear distinction between healthy and unhealthy negative emotions and the greater role according to force and energy in the change process. In addition, a greater emphasis is placed on biological aspects of emotional disturbance now than 30 years ago. Finally, a greater range of cognitive, imaginal, emotive and behavioural methods are found in current RET literature than in Reason and Emotion in Psychotherapy, where Ellis restricts himself to illustrating a few cognitive and behavioural techniques.

RET, then, has grown and developed over the past 30 years. In large part, this reflects the theory's flexibility and the competent people who have worked to make RET one of the most viable and widely used cognitive-behaviour therapies.

The literature contains only a few reports on plasma 17-hydroxycorticosteroids (17-OHCS) in mental patients (Bliss, Migeon, Branch and Samuels, 1955; Freeman, Steed, Hoegemeier, Wheeler, Savage and Wadeson, 1956; Board, Wadeson and Persky, 1957; Hoagland and Freeman, 1959). According to these investigators the mean values in schizophrenic patients do not differ significantly from values found in normal subjects.

Unilateral E.C.T. applied to the non-dominant hemisphere has been tried by several workers in cases of depressive illness. Although Levy (1968) has pointed out that the evidence is not sufficient to recommend unilateral E.C.T. as a routine procedure, its main advantages over bilateral E.C.T. have been demonstrated as reduction of post-E.C.T. memory disturbances (Zinkin and Birtchnell 1968 and Valentine et al., 1968), and diminution of post-E.C.T. confusion (Halliday et al., 1968). The present investigation studies the effect of unilateral E.C.T. on schizophrenic delusions and hallucinations with a view to testing the hypothesis that the apparent superiority represented by the diminished side-effects with the unilateral technique might be therapeutically disadvantageous where treatment of patients with delusions and hallucinations is concerned. According to this hypothesis memory impairment may be part of the therapeutic mechanism responsible for the disruption of delusions and hallucinations and their ultimate amelioration or disappearance. If this hypothesis is correct patients treated with bilateral E.C.T. should do better than those treated with the unilateral technique.

People with intellectual disabilities are at risk of premature death due to failings in healthcare provision. To prevent this, it is important for healthcare services to identify and flag not only vulnerable conditions (including intellectual disability, dementia and mental health problems), but also the specific adjustments needed by individual patients.

The classification of mood disorders lacks precision and consequently there has been no recent meaningful advance in their treatment. By virtue of its therapeutic specificity, lithium responsivity offers an opportunity to diagnose a definitive subtype of mood disorders that may provide a platform for the development of targeted therapy.

Transcranial direct current stimulation is coming of age with the large treatment study published in this issue. We review transcranial stimulation methods, their efficacy and the likely impact on National Health Service (NHS) practice. Their use in individuals who do not respond to or cannot tolerate medication should now be explored in large controlled naturalistic studies in the NHS.