Electronarcosis was introduced as a new treatment of schizophrenia by Tietz and co-workers in 1946. They reported favourable results in a group of 47 schizophrenics and claimed that it was as effective as deep insulin therapy, in the treatment of schizophrenia.

This study is based upon data derived from reported cases of suicide in Afghanistan.

More than ten years have elapsed since insulin therapy was first introduced in this country as a treatment for schizophrenia. This should gradually enable us to form a more accurate opinion as to its value. An enormous literature has accumulated on the subject. Only some samples of it, representing the different views expressed, can therefore be mentioned. It is here attempted to apply some common criteria which are indispensable for the assessment of the effects of treatment, which it is hoped may lead to a clarification of the present position of insulin therapy.

That there are wide regional differences in the demand for psychiatric beds is common knowledge, and is frequently commented upon. There is no generally accepted interpretation, and it is difficult to draw conclusions from a comparison between different areas when the crucial treatment facilities—in-patient and out-patient services, admission policies, after-care in the community—are far from uniform. It has been argued that much of the variability in admission rates is independent of mental disorder incidence and reflects other forces at work, such as the organization of the services available to the mentally ill.

The purpose of this paper is to present the results of treatment by prefrontal leucotomy in 30 cases of mental disorder. In view of the fact that this procedure is not only comparatively new, and uncertain in its ultimate effects, but is also after all a destructive operation, its trial was only felt to be justified, in the first instance at any rate, in a selected number of chronic patients with an apparently hopeless or very poor prognosis.

Practising psychiatrists' views about the treatment of schizophrenia were investigated as part of a Quality Assurance Project. A questionnaire which asked for treatment recommendations for each of four case descriptions of patients with schizophrenia was mailed to a one-in-six random sample of Australian psychiatrists; 90% responded. Psychiatrists almost uniformly advocated the use of antipsychotic drugs and usually recommended concurrent supportive psychotherapy or family/social intervention procedures. The recommendations varied systematically, according to the initial history obtained and to the initial response to treatment.

There is only a small literature on the psychiatric complications of acromegaly. Manfred Bleuler (1954) reported an acromegalic man who had blunted affect and apathy and suggested that this clinical picture represented a special variation of the endocrine psychosyndrome. Avery (1973) reported a further case of depression and anxiety in association with the illness. There are relevant reviews by Michael and Gibbons (1963), Beumont (1972), Labhart (1974) and Lishman (1978).

455 male and 120 female opiate addicts were treated at two London drug dependence clinics between 1968 and 1975. The delinquency pattern of 117 female addicts and of a systematic sample of 119 male addicts was analysed in relation to stages of their addiction career and outcome. Treatment had no effect on overall crime rate but there was a significant increase in the proportion of drug offences during the treatment stage. Comparisons between the sexes showed that the outcome of treatment was worse in women. In male addicts a history of delinquency had no prognostic significance, but in females convictions for non-drug offences before entering treatment might predict poor response to treatment of drug dependence.

Thirty-five people labelled as baa (crazy or insane) were studied in Laos—a country without psychiatrists or psychiatric institutions. Informant information was obtained for violence prior to becoming baa, violence during the course of their baa condition, and violence during the seven days prior to interview. Observation for violence was made for a one day period at the time of the interview. Use of restraints was also assessed.

Subjects were significantly more apt to have assaulted others, posed a risk to themselves, and been restrained (although not incarcerated) during their baa condition as compared to their previous state. Those in early stages of their condition (two years or less) manifested more violence than those later in their condition. ‘Folk’ use of restraints was applied only after dangerous or violent behaviour had occurred. Restraints were released as soon as practicable, but there was an ‘ascending’ use of certain restraint measures if violence persisted.

The prevalence of Schneiderian first-rank symptoms in 75 schizophrenic in-patients was found to be 67%. The commonest were somatic passivity, thought broadcast, and thought insertion. This suggests a considerable variation in the prevalence of first-rank symptoms and their individual frequencies in different cultures. First-rank symptoms thus have inherent weaknesses.

This paper is concerned with the occurrence in three cases of a major psychosis of more or less circumscribed and apparently psychogenic episodes similar to those described by Ganser (1897), and which form a characteristic syndrome, since called after him. Two of the cases here described were endogenous depressions, the third was a schizophrenia. All three showed depersonalization.