In a previous study, Shapiro, Post, Lofving and Inglis (10) found that a modified version of the Bender Visual-Motor Gestalt Test differentiated, at a high level of confidence, three groups of elderly psychiatric patients: brain-damaged patients, functionals and a group of doubtful diagnosis. This level of confidence was far higher than that of any of the other 24 tests used. Furthermore, a number of recent studies have shown that the Bender test differentiated Organic from non-Organic subjects (2, 4, 6, 7, 8). In our own Department Yates (13) found significant differences on measures of the reproductions of other designs between Organics and Functionals. In view of these findings we decided to investigate our own results further. Our general purpose was to measure and control some of the variables appearing relevant in the performance of the task and in this way make possible testable explanations for the results.

In previous papers in this series we have discussed two concepts which have been used in connection with aspects of the relationship between the patient and his doctor. These were the treatment alliance (Sandler, Holder and Dare, 1970) and transference (Sandler, Dare and Holder, 1970). Although these two clinical concepts originated within the psychoanalytic treatment situation they are capable of extension outside it. Both relate to and emphasize processes occurring within the patient and tend to stress one side of the relationship only. Even the concept of treatment alliance, although nominally appearing to include the roles of both patient and doctor, has tended to be regarded from the point of view of processes and attitudes in the patient; the aspect of the therapist's attitudes, feelings and professional stance have to a large extent been omitted. However, in recent years more attention has been paid in psychoanalytic and other writings to the relation of the doctor towards his patient. Just as the term ‘transference’ is often used loosely as a synonym for the totality of the patient's relation to his therapist, so is the term ‘counter-transference’ often used in a general sense (both within psychoanalysis and outside it) to describe the whole of the therapist's feelings and attitudes towards his patient, and even to describe facets of normal, non-therapeutic relationships (Kemper, 1966). Such a usage is very different from what was originally intended, and as a consequence confusion has arisen about the precise meaning of the term. It is the purpose of this paper to examine the concept in the light of its origins and development within psychoanalysis and to comment briefly on some possibilities of its extension outside the psychoanalytic treatment setting.

The effect of drug-induced Parkinsonism and of the topography of the dyskinetic movements on the psychological consequences of tardive dyskinesia was assessed in 20 schizophrenic subjects and 20 non-dyskinetic schizophrenic controls matched for age, sex, the presence of anticholinergic medication, and the presence and severity of drug-induced Parkinsonism. Limb–truncal subscale scores but not orofacial scores had a significant correlation with cognitive impairment and with negative symptoms. Drug-induced Parkinsonism was found to be a powerful confounding variable.

Over a six month period, 142 consecutive referrals of patients over 65 to a community-orientated psycho-geriatric service in North London were studied. The psycho-social factors determining referral were quantified and their relationship to diagnosis analysed. Therapeutic strategies are described, devised to deal with the presenting psycho-social problems. It is suggested that a family-centred approach is of some value in the management of the elderly mentally ill.

Several researchers, among them Penrose (1944), Slater and Woodside (1951), Pond et al. (1963), Kreitman (1962, 1968) and others, have found that psychiatric disturbance occurs in both members of marital pairs more often than can be expected by chance. It appears that symptoms in the spouse are more evident when it is the husband who is the patient, and that neurosis rather than psychosis is associated with higher levels of disturbance in the spouse (Kreitman, 1962, 1964).

In the past, psychiatry has paid little attention to the relatives of the mentally ill, but this attitude has changed gradually since the 1950s, when increasing numbers of patients began to be discharged from psychiatric hospitals through the introduction of neuroleptics and other changes. Especially for schizophrenic patients, with the low age of onset of the disorder, this development has meant that in many cases, the burden of care fell on their families, and as a consequence of this development, relatives have gradually become an important factor in care (Katschnig & Konieczna, 1987a). This field of involvement of relatives continues to expand, but is becoming increasingly confusing and complex. Our task here is an attempt to offer a structure within which to understand the manifold relative-centred activities that exist today.

Wing (1963) has recently reviewed the literature, mainly of the last five years, that has contributed much to our knowledge of the rehabilitation process, especially in long hospitalized schizophrenics. Over the same period there has been an increased discharge rate among this group of patients, and the continuation of this trend appears to be one of the expectations upon which plans for future mental hospital bed requirements have been based (Tooth and Brooke, 1961).

The Gilles de la Tourette syndrome is a puzzling disorder, usually beginning in childhood. It is characterized by (1) facial and bodily tics progressive in involvement and frequency, (2) grunting and barking noises and, (3) coprolalia (i.e. compulsive obscenities). Although this pattern of behaviour has been described with striking uniformity over the past century (Gilles de la Tourette, 1885; Fernando, 1967; Kelman, 1965; Lucas, 1967; Prabhakaran, 1970), no specific neurological or psychological aetiology has been found.

As yet, there is no satisfactory model with which to understand steroid-induced mental disorder. It is suggested that a case of prednisone-induced psychosis in an adolescent female with Chrohn's disease can be best understood in terms of behavioural sensitisation to steroid therapy.

Evidences suggest that the predisposed individual can develop dependence to various tranquillizers even to the extent of physical dependence similar to that seen with the barbiturates. Dependence can develop to benzodiazepine derivatives, and cases have been reported mainly for chlordiazepoxide, diazepam and oxazepam. These drugs can also produce withdrawal reactions (Hollister et al., 1963; Barten, 1965; Krypsin-Exner, 1966; Bakewell and Wikler, 1966; Essing, 1966; Gordon, 1967; Ewing and Bakewell, 1967; Hanna, 1972).

An unusual case of pseudocyesis of almost ten-year duration, characterised by a monosymptomatic hypochondriacal delusion and a selective response to pimozide is reported. The nosological status of the diagnosis, delusional (paranoid) disorder, is suggested to be a variety of the Kraepelinian concept of paranoia. The therapeutic pitfalls of relying on a phenomenological distinction between overvalued ideas and delusional beliefs are discussed.

Research in stuttering can be divided into two broad categories. The focus of attention has either been on the way the stutterer speaks or on the sort of person he is. In the first case, investigators have sought to isolate those conditions under which the stutterer's blocks, repetitions, or prolongations can be modified. For instance, there are studies on the effects of varying the size of the audience (e.g. Siegel and Haugen, 1964; Shulman, 1955), of providing delayed auditory feedback (e.g. Lee, 1951; Neeley, 1961) or various levels of noise (e.g. Mariast and Hutton, 1957; Sutton and Chase, 1961), and on the relationship between number of stutters and rhythmic speech (e.g. Barber, 1940; Fransella and Beech, 1965).

The new American psychiatric classification (DSM–III) features a radically new approach to organic mental disorders. The concept of organicity has been liberalised to allow inclusion of psychiatric correlates of cerebral disorders which not only fail to involve cognitive impairment but in some cases also resemble affective, paranoid, and schizophrenic disorders. The highlights, and implications of the new approach are discussed.

A patient presenting with dependence on opium poppy tea infusion is reported. Poppy tea drinking, although previously described in certain parts of the UK, rarely presents in the form of a dependence syndrome. Issues relating to the management of poppy tea dependence are discussed, including the results of existing laboratory urinalysis for drugs of abuse, the calculation of opiate dose equivalence, and the likelihood of transition (or not) from use of poppy tea to use of other opiates.