When subjects act as their own controls in drug experiments there is a risk of asymmetrical transfer between treatment conditions, with the result that treatment effects are determined largely by order of administration. In such cases the effect of a drug may be reduced or exaggerated, and prior treatment with a drug may affect placebo conditions. Asymmetrical transfer is probably much more common than is generally realized. Suggested causes include inadequate wash-out between treatments, state-dependent learning, adoption of learning strategies, and practice effects. The problem is illustrated by the re-analysis of a paper on the effects of benzhexol on memory, published recently in this journal (Potamianos and Kellet, 1982). The advantages of separate-group experimental design are reconsidered.

Pierce-James (1967), has shown that British heroin addicts have a very much higher mortality rate than the general population. The same applies to American narcotic addicts; a 20-year follow-up study of a group of narcotic dependents showed the very high death rate of 23 per cent over this period (Vaillant, 1973). Pierce-James (1967), distinguished between suicidal, accidental, and other causes of death, and also demonstrated a higher rate of successful suicide attempts among heroin addicts than in the general population. Connell (1965) suggested that the incidence of suicidal threats and attempts in childhood and adolescence is higher than is generally recognized, and in both adolescents (Gould, 1965) and intravenous narcotic addicts (Frederick et al., 1973) suicidal and self-destructive behaviour is more common than successful suicide. The distinction between suicidal attempts and self-destructive behaviour is unclear. Stengel (1964) defined as suicidal attempts, ‘all cases of potentially dangerous self-poisoning or self-inflicted injury.’ The present study, however, does not assume that self-poisoning or self-inflicted injury necessarily implies suicidal intent.

It is a fact that there is, within the National Health Service, a gradually increasing demand for psycho-analytical psychotherapy. This demand is reflected in the large number of patients referred and in many articles dealing with the treatment of psychiatric and physical illnesses. Such satisfaction gained by this recognition is offset by the knowledge that both inside and outside the medical profession there is an abysmal ignorance of what psycho-analytical psychotherapy is, what it can or cannot achieve and what it involves in that most precious commodity—doctor time.

A 67-year-old anxious and depressed woman was withdrawn from a long-term course of a benzodiazepine and soon after was given ECT. This proved ineffective, but ECT given some months later was successful. It is suggested that the chronic administration of the benzodiazepine may have induced changes in the brain that interfered with ECT.

British Journal of Psychiatry (1992), 160, 545–546

Whatever will be the verdict of posterity on the scientific value of psychoanalysis, its place in the history of thought and of psychiatry is assured. A profuse psycho-analytic literature exists and many eulogies of Freud have been published, but there are few first hand accounts of what went on behind the scenes of the various psychoanalytic societies that train and give professional status to analysts.

Two young adolescents are reported in whom fears of contracting AIDS were a prominent part of their clinical presentation. Public anxiety, specific developmental vulnerability, and exposure to the media information campaign about HIV infection and AIDS are discussed as factors in the genesis and precipitation of emotional disorder in these youngsters.

This paper examines the capital costs and accommodation provided in three different types of residential facility for mentally handicapped people—a large campus hospital, a small campus hospital and a network of individually-sited hospital units. The findings do not indicate any economy arising from increased size, or from centralization of facilities on a single site. These findings, together with the other research cited, have implications for the design of future residential services.

The treatment of people with severe and persistent mental illness entails long-term intervention and may be very costly, primarily due to their frequent use of acute and subacute treatment services or because of prolonged stays in health care institutions. Given the rising costs of health care and the decreasing public funding for treating people with severe mental illness, mental health professionals are adopting case management approaches to provide more efficient care to these individuals.

A schizophrenic patient with different forms of experiences of inappropriate familiarity is described. The authors discuss traumatic experiences as aetiological factors in déjà vu experiences and reduplicative paramnesia. Finally, the differential diagnostic problem in psychotic and dissociative phenomena is stressed.

An account is given of impressions and observations collected during three weeks in November 1975 which the writer spent with two of his chronic schizophrenic patients in a purpose-built isolation unit inside which it was impossible to have any idea of the real time.

This experience gave the observer an unusually close view of schizophrenic and institutional behaviour and some insight into the natural outcome of staff-patient interaction.

Society's attitude to psychiatry has always been ambivalent. When, as a young doctor, I announced my intention to take up this discipline to my then chief, who was a distinguished clinical pathologist, his face turned a deeper shade of purple, and he muttered something about “mumbo-jumbo and guesswork” before stalking off into his den. Much more recently, I broke a lifelong tradition by actually entering into conversation with a stranger on a British railway train. Somehow or another, he extracted from me the information that I was a Professor of Psychological Medicine. “Well, well, he murmured, “and I always thought that was the stuff they put into those huge bottles of red and blue liquid you sometimes see in the windows of the older chemist shops”. That gentle twitting is small beer by comparison with the grave reservations expressed by many individuals and groups.

This paper describes an investigation into the significance of physique in effort syndrome.

The clinical manifestations that may result from abuse of alcohol are numerous. Profound, sometimes fatal, hypoglycaemia, first described a little over 20 years ago (Brown and Harvey, 1941), is among them although as far as we are aware, not previously described in this country. This may be due partly to differences in drinking habits here and abroad where “bootleg” liquor is more readily available, and partly to failure to recognize this complication of alcohol. Many cases of alcohol induced hypoglycaemia may well go undiagnosed, alcoholaemia alone being held responsible for bizarre behaviour or alteration in consciousness following the drinking of alcohol-containing beverages. In some cases, a patient brought into the casualty department with a provisional diagnosis of “drunkenness” is found to have a low blood sugar and the diagnosis hastily altered to the more socially acceptable one of “hypoglycaemia”, but without the cause of the hypoglycaemia ever being determined.

Variation in the CACNA1C gene has been associated with bipolar disorder in several genome-wide association studies. This gene encodes the alpha 1C subunit of L-type voltage-gated calcium channels, which play an essential role in neurons. We analysed 39 biomarkers in either cerebrospinal fluid or serum in relation to six different CACNA1C variants in 282 patients with bipolar disorder and 90 controls. We report associations of CACNA1C risk alleles with serum levels of BDNF as well as tissue plasminogen activator, which converts pro-BDNF to mature BDNF. This sheds light on links between CACNA1C genetic variants and pathophysiological mechanisms in bipolar disorder.

Out-patient referrals to the Edinburgh adult psychiatric service between 1981 and 1985 were studied using the Edinburgh Psychiatric Case Register. The hypotheses that primary-care clinics have more patients with less severe illnesses and fewer patients with psychotic illnesses were confirmed.

Plasma levels of amitriptyline and nortriptyline were similar in ten depressed patients after administration of amitriptyline hydrochloride in three divided doses or as a single daily dose. Maximum comparability of the plasma levels is achieved by sampling 12 to 16 hours after the single daily dose, or 3 to 7 hours after the morning dose on a thrice-daily schedule. Owing to the long biological half-life of these drugs, therapeutic plasma levels are maintained on a once a day dosage schedule, and the need for sustained release preparations appears questionable.

The present work is a psychiatric cytogenetic study of a patient with “pure gonadal dysgenesis”. This term was first used by Harnden and Stewart (1959), but Swyer (1955) had already drawn attention to the clinical condition of a tall female with hypogonadal signs, amenorrhoea and poorly developed secondary sex characteristics, and Hoffenberg et al. (1957) had described two tall patients with gonadal dysgenesis and recognized this as a variant of Turner's Syndrome because of the normal stature and lack of congenital malformations; they termed it gonadal dysgenesis in the normal-looking female.