A retrospective comparison was made between two groups, each consisting of 30 depressed patients, one in which the outcome following discharge had been good, the other where it had been poor. A previous psychiatric history, earlier admission for psychiatric illness, particularly for affective disorders and a poorer performance on routine intelligence tests were found in the poor prognosis group. In this group the duration of the index admission was longer and the condition of the patient was less improved at the time of discharge. Several symptom variables also discriminated between the groups. These findings are discussed.

To keep psychiatric patients as much as possible in the community rather than have them admitted to mental hospital is a policy which has become more and more favoured and has been shown to work (Leyberg, 1959; Silverman, 1961; Sainsbury et al., 1963 and Hoenig et al., 1965, etc.). This type of management cannot be expected to be equally successful with all groups of patients and is perhaps most open to question as regards the illnesses that affect the elderly.

Transvestism is characterized by a repetitive morbid predilection to dress in the attire of the opposite sex. It is distinguishable from fetishism on the one hand and trans-sexualism on the other.

Twenty-three patients taking lithium carbonate alone in therapeutic dosage for a mean period of 43 months (range 6–108 months) and 23 control subjects matched for age and sex had the frequency and amplitude of postural tremor measured and extrapyramidal symptoms assessed by standard techniques. Patients on lithium had a significantly lower peak frequency of tremor than control subjects (P <0.05) and significantly greater extrapyramidal symptoms (P <0.01), indicating that tremor appearing after chronic lithium therapy is likely to be an extrapyramidal symptom. Such symptoms are common long-term adverse effects of lithium carbonate.

This annotation is concerned with how soon and at what rate antidepressant effects become apparent over a course of electroconvulsive therapy (ECT). The first question is of importance in the design and interpretation of biological studies of the mode of action of ECT. The second question is of practical interest to the treating psychiatrist when we ask how the speed of recovery is influenced by what the psychiatrist prescribes, that is, the number and frequency of treatments. These questions are little better answered now than 20 years ago. This may come as a surprise to many readers, who have been advised to use ECT when “seeking rapid improvement” in depressive disorders (ECT Sub-Committee of the Research Committee of the Royal College of Psychiatrists, 1989). This lack of progress is attributable to a dearth of appropriately designed ECT studies.

Despite the popularity of group psychotherapy in its many different forms over several decades, we seem to be little nearer to an understanding of how it works and how effective it is. This lack in our understanding stems largely from deficiencies in research in this field. Bennis (1960) found that research on group psychotherapy was more often based on descriptions, anecdotes and clinical observations than on systematic collection and analysis of data. Slavson (1962) found that many of the papers which he dealt with as the editor of International Journal of Group Psychotherapy ‘lacked in scientific discipline, and often drew conclusions from inadequate evidence’. Luchins (1947) felt that there was ‘a decided deficiency in the use of objective methods of establishing outcome of group psychotherapy programmes', and Burchard et at. (1948), in their comparative evaluation of fifteen reported programmes of group psychotherapy, concluded that failure to consider pertinent variables, the lack of operational definitions, and the absence of any frame of reference, made comparison of methods or evaluation of outcome almost impossible.

This pilot study seeks to identify the psychological problems in middle aged and elderly subjects with impaired hearing, and to determine whether hearing aids improve these.

The results indicate three main areas of psychological handicap and suggest that these are reduced by the provision of a hearing aid.

Naloxone hydrochloride eyedrops 1 mg/ml dilated the pupils of 36 out of 47 opiate addicts on methadone maintenance treatment, without precipitation of acute withdrawal effects, but not those of healthy unmedicated subjects. The response in addicts was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. The size of the response suggests some potential clinical use for topical naloxone as a diagnostic test of current opioid influence and possibility of physical dependence. The local mydriatic response, which was restricted to the treated eye, indicates that the effect of opiates on the pupil in man is determined, at least in part, by a peripheral action.

A woman who suffered multiple losses in childhood and adolescence became depressed 40 years later, after a series of new losses. Concomitant alexithymic features caused a masking of her depression by somatic symptoms. The relationships between alexithymia, masked depression and loss are discussed.

A case of folie à trois affecting a mother and her children is described. The subjects fully recovered with treatment, but all relapsed two months later, when the primary subject discontinued medication.

The concurrence of Capgras and koro syndromes in a man with affective disorder is reported.

Fifty-four patients suffering from a variety of psychotic states were graded by their degree of psychomotor activity. Serum creatine Phosphokinase (CPK) levels were found to be related to the degree of psychomotor activity, irrespective of the diagnostic category. Retarded and withdrawn patients had normal serum CPK, but on their return to normal psychomotor activity the CPK levels tended to rise transiently. It appears that unphysiological motor activity has a more direct relationship to the rise of serum CPK than motor activity per se.

A comparison was made of initial assessment, treatment, and pattern of care of two groups of non-psychotic patients, referred to a Central London psychiatric outpatient department. The patients, none of whom had been in recent psychiatric treatment, were differentiated into those receiving short-term care (less than one year) and those having long-term care (greater than one year). Chronic psychiatric disorders predominated in both groups. It was also common to have physical illness and contact with other hospital departments. Short-term care consisted of very brief contact for 70% of patients, and psychiatrists seemed unable to engage these referrals in treatment. Long-term attendance was associated with acutely ill young, or chronically ill older patients, more active initial intervention, and referral within the same hospital group. Follow-up revealed that long-term patients reported little symptomatic improvement, experienced considerable disruption in course of care, made increased demands on all aspects of psychiatric service, and often proved to have personality disturbance and social problems that were not perceived on initial contact. Types of intervention and their effects on other hospital departments were examined.

Seventy-one school phobic children seen at a child guidance clinic were followed up after they had passed school leaving age. Their record in work and further education was compared with the length of time they were off school, whether or not they returned to school, and the occurrence of further psychiatric treatment after discharge from the clinic. It was found that whether or not the child returned to school and the length of time he was off school had no relationship to future performance at work or in further education. A significantly larger number of children receiving further psychiatric treatment after discharge from the clinic failed to reach their potential in work or further education. Adequate treatment of the underlying conditions appears to be more important than returning the child to school.

The term “phenomenology” was imported into psychiatry from the field of philosophy. I intend to give a brief and necessarily simplified account of its philosophical background, the various meanings applied to it, and some of the clinical implications following from it.