In a previous paper (Seager, 1958) I described a retrospective examination of the records of patients who had been suffering from depressive illness and who had received electroplexy, with or without an anaesthetic or relaxant drug. The results of that survey suggested that patients who received unmodified E.C.T. were in hospital for a shorter period, received fewer treatments and were more likely to remain well than those treated with modified E.C.T. Recognizing that the method of retrospective evaluation could give rise to many errors which would affect the results, I have now carried out a controlled trial of these treatments. The aim of the trial was to ascertain any difference between the results of modified and unmodified electroplexy, and if so, to find out which factor or factors were responsible for the difference.

The depressive syndrome is very distressing and incapacitating for any patient who suffers from it, and wherever it occurs psychiatrists are faced with a serious problem more particularly because of the consequent risk of suicide. The incidence of depressive illnesses has in my experience certainly not decreased during recent years, on the contrary it has probably increased and there is still an urgent need for more effective therapy to counteract the dire suffering and suicidal rate involved.

The period of adolescence includes within its span the shorter phase of puberty, and may extend from prepuberty as early as ten years (1) to adult maturity attained perhaps in the early twenties. A study of psychosis in adolescence must therefore take cognizance both of the psychoses of later childhood and of early adult life.

Reports have appeared in the literature suggesting an association between physical illness and the later development of anorexia nervosa. The histories of 326 patients with anorexia nervosa were examined for physical illness. A higher rate of severe physical illness was found in this group when compared with controls suggesting that it should be regarded as a risk factor for anorexia nervosa. No statistically significant differences were found when illness was examined by time in relation to onset of anorexia, system involved, or when subjects were stratified by age. Possible explanations for the observed association are discussed.

Common observation indicates that phobic patients tend to avoid the stimuli which are related to their phobia. This characteristic has suggested the analysis of traffic phobia in terms of avoidance learning theory. According to this theory, stimuli which have been associated with a noxious event (accidents in the case of traffic phobia) may acquire aversive properties (fear arousal) and responses which appear in an attempt to avoid these stimuli (accident situation) are reinforced by fear reduction (Skinner and Estes, 1941; Wynne and Solomon, 1955; Keehn, 1961). If the analysis of traffic phobia in terms of avoidance learning is correct, however, accidents would be expected to be a major source of such phobic reactions. The present study gives a clear illustration of a traffic phobia acquired through conditioning in accident situations and its satisfactory treatment by application of learning theory.

One hundred and sixty-four 16–35-year-old offspring of parents with drinking problems, recruited from a variety of clinical and community sources, were compared with 80 respondents of similar ages from similar sources who did not have parents with drinking problems. Each was interviewed using a semistructured interview. Adult adjustment was similar in the two groups, but the offspring of parents with drinking problems did report considerably more disharmony in their families of origin, and many more childhood difficulties. Factor analysis of the adult adjustment data for the samples combined showed four factors which accounted for 41% of the variance; these factors differed little in their effect in the two groups. The groups' reports of the drinking problems of their siblings, however, suggests that this sample might be unrepresentative of the true risk to the children of parents with drinking problems for the development of alcohol-related (although not other) difficulties in adulthood: 16% of this group reported a sibling with a drink problem and a further 9% were unsure, but only one member of the comparison group reported a sibling with a drink problem, and one was unsure. Path analysis showed that both parental problem drinking and family disharmony are related in complex ways to adjustment difficulties in adulthood. ‘Demoralisation’, the largest of the four factors, was particularly related to disharmony in the family of origin: in the absence of disharmony, offspring versus comparison status was negatively correlated to demoralisation in adulthood, suggesting that having a parent with a drinking problem might sometimes be a strengthening experience.

The prevalence of emotional disorder in a total of 72 patients suffering from myasthenia gravis or from peripheral neuromuscular disorders was assessed, using the General Health Questionnaire and Present State Examination.

Approximately half the patients were being treated with an alternate day regime of prednisone, receiving high dosage one day and low the next. Emotional disorder was found to be less prevalent among these patients than among patients not on steroids. The significance of the finding is discussed.

The effect of single intravenous doses of metoclopramide (10 mg, 20 mg and 40 mg) and haloperidol (5 mg and 10 mg) have been compared to placebo (saline) in a double blind randomised study in 8 patients with tardive dyskinesia secondary to neuroleptic therapy. Tardive dyskinesia rating scores were improved significantly (P <0.01) 6 hours after dosing by metoclopramide 40 mg, and haloperidol 5 mg and 10 mg, when compared to placebo. Single doses of dopamine receptor blocking agents improve tardive dyskinesia. The dose of metoclopramide required to show a beneficial effect was high, and this therefore suggests that it is unlikely to be of therapeutic value as the incidence of adverse reactions would be greatly increased. By monitoring the effects of single doses of dopamine receptor blocking drugs in patients with tardive dyskinesia it is possible to compare the relative potencies of these drugs on dopaminergic systems in vivo in man.

Between 1982 and 1987, 42 patients were selected who had been admitted three times in one week to the Regional Poisoning Treatment Centre in Edinburgh for the treatment of deliberate self-harm. Most (87%) of these admissions related to drug overdose. Most of the patients were young, unemployed, lacking a partner and from the low social classes. Three-quarters of the sample had at least one known conviction and more than a third were known to have served a prison sentence. There was only one patient in whom mental illness was thought to be relevant to the episode of self-harm, although five patients were mildly mentally handicapped. Case notes were reviewed to assess the outcome one year after the index admission. None of the patients had committed suicide, although 36 repeated self-harm during the follow-up year.

Writer's cramp, crampe des écrivains, scrivener's palsy, graphospasm or mogigraphia may be defined as a condition of inco-ordination of the small muscles of the hand which appears only when attempting to write. The various names given to this condition emphasize that cramp or spasm is the predominant feature, and Osler thought that it was an early symptom. As the principal nerves and muscles are often intact and movements of a wider range can be carried out efficiently, the condition appears to be a functional disturbance of co-ordination.

We preface this short communication by emphasizing that it originates as a by-product from some work that is still in progress at the Burden Institute on the balance of electrolytes in various normal psychological and neurotic conditions. This research is chiefly being conducted by McLeod, Morrison and Fosbrooke, in the Biochemical Department, and Grey Walter in the electrophysiological laboratory.

The Eysenck Personality Inventory (EPI) was designed by Eysenck and Eysenck (1964) to measure two dimensions of personality—extraversion (E) and neuroticism (N). A high N score on the EPI has been found to dis criminate neurotic patients from normals (Knowles and Krietman, 1965; Eysenck and Eysenck, 1964).

In recent years the recognition of autoimmune processes has led to important advances in our understanding of certain diseases of hitherto uncertain causation (Mackay and Burnet, 1963). In psychiatry, schizophrenia has been the main focus of studies of auto-immunity, with Heath and Krupp (1967) reporting positive results of tests for antibodies to brain cell nuclei and Whittingham et al. (1968) reporting negative results. Studies have been described (McAlpine et al., 1965) in which antibodies were detected to whole brain homogen- ates, mostly by complement-fixation, in various disease states that included multiple sclerosis. Wilkinson and Zeromski (1965) found, by immunofluorescence, serum antibodies to cytoplasm of neurones in four of eight patients with carcinomatous neuropathy.

A young man aged 23 made contact and asked to talk about an adverse drug reaction. He had been puzzled and frightened by what had happened to him and although he was a very experienced drug-user he had not fully realized that a drug could cause such consequences—he had feared that he was going mad. He came along not as ‘a patient’ but because he believed that he had something to tell which might add to medical insights.

A questionnaire was sent to 274 doctors and nurses. The first section was to see if certain symptoms and signs elicited the description of patients as ‘confused’, and the second to discover the respondents' definitions. The results showed a marked discordance in health workers' understanding of this word ‘confused’ in reference to patients, and it is suggested that it should only be used if it is clearly defined.