The anti-convulsant value of sodium diphenyl hydantoinate (S.D.H.), marketed in America as Dilantin and in England as Epanutin, as found by Putnam and Merritt and introduced by them in the treatment of epilepsy has been amply confirmed by all subsequent reports, as it is by this one. Its clinical application, however, will, it is thought, be modified by reason of its toxic nature becoming more generally known.

The past 20 years have seen a remarkable development of neuroimaging methodologies that allow fine-tuned examination of abnormalities in the structure and function of neural circuitry, supporting cognition and emotion in individuals with psychiatric disorders. This editorial highlights the potential of neuroimaging to address major challenges in psychiatric clinical practice.

The object of this paper is to test the following two hypotheses:

1. 1. That the physique of female adults can be regarded as the resultant of two independent modes of variation, one determining differences in size or bulk, and the other determining differences in proportion or type.

2. 2. That a relation exists between schizophrenia and manic-depres sion, on the one hand, and differences in physical proportion or type, on the other.

A number of observations have been published with regard to elevated serum uric acid levels in patients with atherosclerotic (Eidlitz, 1961, 1962) and coronary disease (Gertler, Garn and Levine, 1951) and hyperuricaemia after myocardial infarction (Dreyfuss, 1959; Kohn and Prozan, 1959). Work has also been done on dominant traits for hyperuricaemia together with hypercholesterolaemia (Adlersberg, 1949; Harris-Jones, 1957; Salvini and Verdi, 1959; Schoenfeld and Goldberger, 1963). A greater incidence of cardiovascular diseases among gouty patients than among others has been noted (Gertler and Oppenheimer, 1953), as well as a tendency for spontaneous changes in the serum cholesterol level to be associated with changes of similar direction and magnitude in the serum uric acid level (Schoenfeld and Goldberger, 1963). In view of all these observations, an investigation was undertaken to ascertain whether the serum uric acid levels change with dietary fat composition as do the serum cholesterol levels.

Recently increased interest has been shown in the physiological and behavioural consequences of DC polarization of the brain.

Throughout medical history we find evidence that hysteria has predominated over all other psychological disorders in attracting the attention of philosophers and physicians, yet despite the leading part which the study of hysteria has played in building up our present-day knowledge of psychopathology, it is remarkable how little we have advanced in acquiring an understanding of the cause of the hysterical syndrome itself. Even the wisdom of Freud has failed to offer us a readily acceptable explanation of hysteria, and to this day medical literature contains many theses suggesting that hysteria is related to disorders of the diencephalon, or to glandular dysfunction, and other such organic approaches to the problem. Seemingly we have no yardstick by which we can measure to what extent the hysteric is born, predestined by some elusive factor to develop the malady, and to what extent hysteria is imposed on persons by environmental circumstances. Much significant information on hysteria may be neglected by those who study it as an isolated phenomenon or disease entity, whereas it may well be that the truth of the matter is that at least a little bit of the hysterical reaction goes to form most of the neurotic syndromes met with in practice, and that the pure hysterical reaction is only an academic concept.

In the course of planning a research into spontaneous movements (expressive movements and disorders of involuntary movement, such as tics), it was essential to devise some means whereby these forms of motor behaviour might be objectively measured. The purpose of this paper is to describe one of our methods of doing this by the use of motion pictures, and to demonstrate experimentally the reliability and validity of a method which, it is believed, may prove to have a wider application.

The main purpose of this paper is to report our experience in developing a psychiatric in-patient unit for adolescent boys. The Unit is known as Beech House and contains 16 beds and has been operating since January, 1959. It is a non-statutory ward and is the first treatment unit of this kind attached to a large provincial mental hospital such as St. Augustine's. Its catchment area is limited to the South-East Metropolitan region which comprises Kent and part of East Sussex. Only exceptionally are cases from outside these two counties accepted into the unit.

The popular conception of mental defect is that it is a common abnormality of a kind fairly easy to understand and to study, and for whose ætiology simple rules can be laid down. Textbooks on general medicine usually dismiss the subject in a few paragraphs, and even those devoted to diseases of the mind rarely find room for more than one short chapter on mental defect.

The psychotherapeutic aspects of the care of the 49 terminally ill patients described in the preceding paper are discussed. Their differing ways of coping with the stress of dying and the range of psychotherapeutic strategies used in treatment are described. The work suggests that the therapist's use of psychological insights can improve his understanding of the emotional pain of terminal illness, and well-aimed psychotherapy can contribute to its relief.

A feeling of ‘presence’ is a common but relatively neglected phenomenon. The psychopathology, definition and six clinical associations are discussed. Two case histories are presented to demonstrate the induction of anwesenheit by serotonergic and dopaminergic drugs.

Twenty-three consecutive married and sexually active Chinese women treated for breast cancer were compared with a randomly selected group of 34 female patients suffering from different kinds of malignancies. A structured interview was used to study both groups. The breast cancer group were found to be less depressed and more emotionally stable than those suffering from other malignancies, suggesting that the diagnosis of malignancy was the more important factor in the psychosocial morbidity of these patients.

Short acting barbiturates such as amylobarbitone have long been the standby for relief of anxiety—certainly any new drugs introduced for the relief of such symptoms must stand comparison with these. Furthermore such symptoms are well known to be modifiable by such variables as the attitude of the doctor. For this reason a trial of such a new drug must be carried out under blind conditions.

This discussion follows from a key premise that there is potential clinical value in identifying and directly treating the cognitive abnormalities which for over a century have been seen as the hallmarks of schizophrenia. This is both an old and a relatively new idea. It is old, in that the psychodynamic approaches to psychotherapy, especially ego psychology, have long sought to modify cognition in schizophrenia, if unsystematically and indirectly. It is new, in that only in the last decade have both the contemporary technologies of the information processing laboratory and of cognitive-behaviour modification been applied to the problem of treatment. The failures of psychodynamic treatment approaches with schizophrenic patients have perhaps discouraged widespread experimentation with cognitive models in clinical assessment and treatment. This is unfortunate, as contemporary clinical procedures and laboratory technologies are hardly comparable to psychodynamic methods. In the past decade findings have accumulated, in the form of case reports, single-subject experiments and treatment trials, which support the potential usefulness of assessing and directly treating schizophrenic patients' cognitive abnormalities (reviewed by Spaulding et al, 1986).

The subjects of this study were eighty misusers of heroin who lived in the New Town of Crawley, West Sussex. The relationship between their criminal histories and their histories of drug misuse were examined. It was found that more of the heroin misusers than would be expected had been convicted of criminal offences before they began to misuse drugs, while the reduction or cessation of heroin use during a four-year follow-up period was accompanied by a reduction in convictions. Some social characteristics of the male heroin misusers were compared with those of two other Crawley groups—a group of juvenile offenders who did not misuse heroin and their control group of non-delinquents. Characteristics commonly associated with maladjustment did not distinguish the heroin misusers from the juvenile offenders, nor were they found to be associated with the continued use of heroin. Analysis of the data in epidemiological terms suggested that among the necessary conditions for an outbreak of drug misuse in a particular community the availability of drugs together with socializing drug users were more important than the presence of predisposed individuals.

Two studies are reported, citing the effects of unilateral versus bilateral electroconvulsive shock therapy on the performance of short cognitive tests. In Study 1, seven tests were administered before and after three treatment sessions The most interesting finding was that performance improved significantly on the Knox Cube Imitation test following right unilateral shock. Study 2 replicated this unexpected finding. These results were interpreted as demonstrating that the left cerebral hemisphere is specialized for the processing of sequential time-dependent information.

The association of mental disorders with reduced thyroid function has been recognized for many years, the thyroid disturbances concerned falling into two distinct categories. The first involves a gradual reduction in the output of thyroid hormone over a period of months, or years due, for example, to Hashimoto's disease. Clinically recognizable myxoedema may eventually appear, and in some cases—one-third of Jellinek's (1962) series—it is associated with mental disorders of almost any type and degree (Akelaitis, 1936; Asher, 1949). Two reports (Logothetis, 1963; Pomeranze and King, 1966) make it clear that major mental illness, often clinically indistinguishable from what might be called the normal run of schizophrenias, affective disorders and dementias, can be caused by hypothyroidism even before any clinical evidence of thyroid disorder appears.

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such ‘nominated’ patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their ‘lifetime’ histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65–72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the ‘nominated’ patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.