The renewed use of modified forms of narcosis, generally given together with ECT and antidepressant drugs, arose from a series of observations made during attempts to treat a group of chronically tense patients. These patients, the majority of whom had been diagnosed as ‘chronic tension states', had been referred to the Department of Psychological Medicine at St. Thomas' Hospital for assessment regarding their suitability for modified leucotomy. Birley (1964), in a follow-up study of previous patients with ‘tension states' treated by leucotomy at St. Thomas' Hospital, had found that many developed clear-cut attacks of depression following the operation. This suggested to one of us (W.S.) that such ‘tension states' might have been masked depressive illnesses, in whom the underlying diagnosis had been missed. Consequently it was decided that in the future such patients should be treated with suitably long courses of ECT, together with one or both groups of antidepressant drugs, before any question of recommending leucotomy arose. As a result, a considerable number of these patients were greatly improved and no longer required a leucotomy. Others, however, became more tense and distressed during treatment with ECT and drugs; modified narcosis, therefore, was given in addition, to allow the full course of ECT to be completed. It was then that another of us (C.W.) observed that patients who were treated with combined narcosis, ECT and antidepressants appeared to respond more favourably, and were much less upset by the treatment, than those receiving ECT and antidepressants alone. In a preliminary report published in 1966, Sargant, Walter and Wright described a group of 73 patients with ‘chronic tension states', of whom 67 per cent had improved markedly with further treatment of their underlying depression. It was noted that 15 of the 37 patients treated with ECT and antidepressants alone still required a leucotomy, while in the group treated with modified narcosis in addition to ECT and antidepressants the operation was needed in only 3 of the 36 patients. It appeared, therefore, that the addition of narcosis to drugs and ECT greatly improved the recovery rate.

During the last decade, social psychologists and ethologists have become increasingly interested in the non-verbal elements of social interaction, as recent reviews testify (Argyle, 1969; Vine, 1970; Hinde, 1972). Research into facial expression, visual interaction, posture, gesture, non-verbal aspects of speech, etc., has considerable clinical implications, but carefully conducted investigations of non-verbal social interaction in psychiatric patients have been rare (Grant, 1972). The purpose of this paper is to review the evidence concerned with one aspect of social behaviour in psychiatric patients, namely visual interaction, in an attempt to summarize the current state of knowledge and to suggest ways in which research in this area might develop.

An attempt was made to extend and cross-validate Mayo's (1969) study of ‘normals with symptoms' using the new Personal Illness measures. Groups of psychiatric patients and symptom-free normals were matched with a ‘normals with symptoms' group for age and sex. The two symptom groups were similarly matched on the number of symptoms as assessed by the Delusions-Symptoms-States Inventory. On the Personality Deviance Scales the ‘normals with symptoms' were found to be the most Extrapunitive group, the symptom-free normals had the lowest Intropunitive scores, whilst the patient group were the lowest scorers on Dominance.

Previous reviews of hysteria have emphasized the most severe and disabling forms and ignored evidence from a wide variety of sources. It is argued that hysteria is more prevalent in medical settings than is usually recognized, that the same psychological mechanisms are of wide occurrence, often being accepted as normal for the culture. Discussion of the social factors affecting prevalence suggests that there is a universal potential for the hysterical reaction, with individual variation in susceptibility in appropriate circumstances.

The present paper reviews six years of operation of I.T.O. (Bristol) Limited, during which there were 605 referrals. The majority came from Glenside Hospital, 374 patients (62 per cent.), and approximately 8 per cent. were referred from each of the following sources—Local Authority, Day Hospitals, Hospitals for the Subnormal, other psychiatric sources and non-psychiatric sources. Male admissions totalled 326 (54 per cent.) and female 279 (46 per cent.): of these only 84 (14 per cent.) were married with a surviving partner and 492 (81 per cent.) had never been married.

Patients receiving prophylactic lithium therapy for primary affective disorder during a four year period were studied for recurrence of affective illness. Patients who had affective episodes during this period did not differ from those who remained well in age, sex or diagnosis. Those with a favourable outcome had spent significantly less time at serum lithium levels above 0.9 mmol/litre than those who had a recurrence of affective episodes.

This study reports the demography, weight, and alcohol and psychiatric histories of the sexual partners of 112 consecutive patients with bulimia nervosa, all from an urban catchment area. Seventy-three patients (65%) had a current sexual partner. The partners were of similar social background, but slightly older. On average, partners were overweight (110% of MMPW) and over 27% reported having an eating or weight problem. A quarter of the partners had been treated for a psychiatric or emotional disorder. Nearly 40% drank more than 36 units of alcohol a week, and 14% had received treatment or consulted a doctor for alcohol-related problems. Heavy-drinking partners and multi-impulsive bulimics sought out each other. A quarter of partners had themselves been raised in a nuclear family in which a member had received psychiatric treatment; 12% had had a mother or sister with an eating disorder. Thirty-seven per cent of patients used a ‘safe man’, their fear of being hurt stemming from low self-esteem and a general sense of ‘failure’, and for 11% the relationship was abusive.

Within the past few years a series of papers emanating from this laboratory has dealt with the respiration of normal subjects and psychotic patients from psychological and physiological points of view. Linking up the chain of these investigations, we have tried in this study to get some information about the respiratory type and the ventilation in different groups of mental patients, especially of schizophrenics.

Anterior pituitary response to TRH 200 μg i.v. was studied in ten chronic schizophrenic patients during long-term neuroleptic treatment. Nine patients had normal prolactin (PRL) response as compared with controls but in one the response was blunted; one patient had an exaggerated response. Prolactin increment was higher following TRH than haloperidol challenge. No growth hormone (GH) response to TRH was found and TSH responses were comparable to controls.

Not all interventions that show promise in exploratory trials will be supported in phase III studies. But the high failure rate in recent trials of complex mental health interventions is a concern. Proper consideration of trial processes and greater use of adaptive trial designs could ensure better use of available resources.

The diagnostic process involves more than simply identifying a disorder or distinguishing one disorder from another. It should lead to a thorough, contextualised and interactive understanding of a clinical condition and of the wholeness of the person who presents for evaluation and care.

Two out of three children diagnosed with conduct disorder will not outgrow it without treatment. It is costly to the individual in terms of negative life outcomes and to society in terms of increased health, social and education service use. Psychosocial interventions are effective in psychologically managing and preventing the onset of conduct disorder.