Despite controversy about whether cerebral arteriosclerosis is a valid clinical entity and independent of senile dementia and/or ‘functional’ senile psychoses (Post, 1971), there is a good reason for differentiating it in clinical practice, and its incidence is increasing (Registrar General, 1960).

Five consecutive patients referred to a psychosexual clinic are described to illustrate the diversity of aetiology and pathology, and the need for a range of treatment techniques. Three patients responded to a cognitive-behavioural therapy which is described, and one to antidepressive drug treatment.

In an authoritative paper, Sandler and Hazari (1960) examined the responses of 100 neurotic patients to a personality questionnaire. The latter was in fact the Tavistock Self-Assessment Inventory, which consists of 867 statements each of which the subject is required to mark as “True” or “False” in regard to himself. Sandler and Hazari extracted responses to forty of these statements which were regarded as having reference to obsessive/compulsive character traits and symptoms, and subjected the data to factor analysis. Two factors were identified, and the original items were then classified according to their projection on two reference vectors, A and B, obtained through rotation of the Centroid factor axes through 45°. The two groups of items represented “two tendencies which, in their appearance in this group of patients, appear to be more or less unrelated”.

A treatment for male genital exposure (exhibitionism) has been given successfully to 15 persons who have previously been resistant to change. The procedure involves the subject undressing before a mixed sex audience, followed by video-taping and subsequent replay to the patient. During the period of nakedness the subject describes in detail the events, his expectations and attitudes, and those attributed to his victim during exposure.

The success of the treatment appears to depend on the profound anxiety induced. During the phase of greatly increased anxiety, cognitive changes previously resisted seem to be made possible.

Pace Mr. Punch, we know that there are plenty of takers, and anyone who uses convulsion therapy soon becomes convinced that much good is achieved in one way or another. Moreover, it has become evident that the treatment is not applicable to schizophrenia only; some striking results are seen in depressive states and in atypical paranoid and obsessional cases. This matter is dealt with at length in Dr. Cook's paper. These results, together with the comparative ease of application of the treatment, suggest that it will inevitably be tried out on a very large scale indeed.

There has recently been a plethora of new methods of psychosurgery. This has, we believe, created considerable bewilderment in the minds both of the clinical psychiatrists who have to decide which of the methods to choose and of the neurosurgeons who have to practise them. The aim of the present paper is to clarify and disentangle the situation as far as this can be done from the anatomical angle.

There does not appear in the literature any method of treatment to which the term “prolonged narcosis” can be applied prior to the year 1897, when Macleod (47, 48) published his first article on the bromide sleep treatment. The Hippocratic “Aphorisms” (126) mention that immoderate sleep is bad for the patient, but Celsus (129) quotes Asclepiades as being in favour of procuring sleep, and remarks that some insane patients recover if sleep is obtained, and Paulus Aegineta (128) observes that sleep produces oblivion of mental suffering and rectifies the distracted powers of reason. Aretaeus (127) in discussing satyriasis mentions “very protracted sleep” as the proper cure for the condition”.

It is now several years since acetylcholine was first administered intramuscularly in the symptomatic treatment of anxiety, on the theory that anxiety was sympathicotonic in nature and could be counteracted by the vagotonic action of acetylcholine. Unfortunately decomposition of acetylcholine is so rapid that there is little time for this action to be effective, and the majority of investigators believe that it has no effect, or at least a momentary one, when given either subcutaneously or intramuscularly. Maxwell Jones (1936) used carbachol, a drug with a similar but more prolonged action than acetylcholine to treat six patients with anxiety neurosis. He was able to report relief from the psychic and somatic symptoms of anxiety in all cases but unfortunately, following withdrawal of the drug, they tended to relapse. An entirely different rationale led Tomasson (1936) to claim both alleviation and shortening of the duration of attacks of mania in manic depressive psychotics using a combined ephedrine and acetylcholine treatment.

The nitrogen retention, and especially the periodically changing excretion of urea, seems to be a characteristic symptom in periodic catatonia (1). We therefore made it our aim to investigate the amino acids in the urine, and later also in the blood and cerebro-spinal fluid (C.S.F.), throughout the lucid interval and the catatonic phase.

So far the attempts to relate measurements of perseveration empirically to types of personality, whether in the normal or the psycho-pathological field, have not given rise to such coherent results as might lead to any comprehensive general hypothesis.

The major psychoses remain an enigma. Affective and schizophrenic psychoses are apparently present (probably at about the same lifetime prevalence of approximately 2%) in all human societies. Yet their aetiology is obscure. While a genetic contribution is acknowledged by most authorities, few accept that genes are a sufficient explanation of causation because: onset is in adult life; psychosis – particularly schizophrenia – is associated with a substantial fertility disadvantage; and most cases lack a family history of illness. But genetic determination has to be considered because onset is determined by chronological age rather than environmental insult (Crow & Done, 1986), adoption away from a family with schizophrenia does not reduce risk of illness, and no plausible environmental precipitant of psychosis has been identified. The fact that psychosis occurs across widely differing climatic, industrial, and social environments without obvious variations in incidence suggests that the disease is relatively independent of the external milieu. The suggestion that birth injury is relevant has been tested in a prospective study (the National Child Development Study) and found wanting (Done et al, 1991).

The uses of chlormethiazole (Heminevrin) are briefly mentioned. Differing views of its potential for producing dependence are discussed. The consensus opinion is taken to be that a risk of psychological dependence does exist, but only one case has appeared in the medical literature to date of physiological dependence on chlormethiazole, with withdrawal symptoms. This case is re-examined. A second case is described in which the features of increasing dosage and withdrawal were followed by confusion, disorientation, delusions, hallucinations and muscular spasm and coarse jerking. This is taken as confirmation of the potential of chlormethiazole to produce physiological dependence. Some personal opinions of the author regarding indications for use and incidence of abuse are briefly mentioned.

Depressed, schizophrenic and normal subjects were tested for incidental recall and recognition of lists of positive and negative personal attributes. It was hypothesised that depressives would show a deficit in recall and recognition of words of which they had been asked a self-referential encoding question, but would show equivalent performance to controls on words of which they had been asked an other-referential, semantic or structural encoding question. The experiment was designed to enable a decision to be made between two possible explanations of the expected deficit: Davis's (1979) suggestion that it is due to disorganisation of the self-schema in depression, and the hypothesis of Beck at al (1979) that depression is characterised by the predominance of a negative self-schema. The expected deficit was observed on the recall but not on the recognition task. However, the precise pattern of the results raises problems for both of the above interpretations, and alternative explanations are considered.

The anticonvulsants now in general use have made epilepsy among the mentally subnormal no longer the problem it was. However, the treatment of long standing epilepsy associated with behaviour problems or personality disorders in the so-called temporal lobe syndrome still remains a challenge. Surgical intervention seldom has a place in cases with severe and diffuse brain damage complicated by subnormal intellectual functioning, frequent seizures and personality changes.

This enquiry was prompted by a discussion on training in psychotherapy which took place at the Troon Conference on the Teaching of Psychiatry (Ingram, 1963). We felt that more precise information was required about what is meant by the term psychotherapy, which methods are in use and what opinions are held by psychotherapists in training. This information could be of value in assessing the workload of psychiatrists and in deciding what training might be given to psychiatrists and medical students. It was therefore decided to seek the opinions of Scottish psychiatrists on some aspects of their current practice in psychotherapy.

Recent work has revealed that autistic children's predominating tendency to avoid social interactions is actually enhanced by the ‘friendly’ approaches of others. In this study it was recorded on video-tape how eight autistic children reacted to four styles of adult behaviour. The adult reacted to the child's looks at her by (i) smiling, (ii) gaze averting, (iii) gaze averting plus other ‘timid’ behaviours and (iv) doing nothing except continuing to look back. For this last condition—when the adult did not react—it was found that autistic children showed less avoidance behaviour after eye contact and spent more time within one metre of the adult. The implications for treatment are contrary to much modern practice and to what seems to be adults' ‘natural’ response. Reactivity by others appears to enhance the child's avoidance, and it is suggested that adults should be circumspect in the degree of sociability with which they respond to autistic children.