A three-year deinstitutionalisation and rehabilitation pilot intervention project was implemented at Leros PIKPA for people with severe learning disabilities. Initial conditions at the asylum were appalling. Residents suffered severe deprivation, extreme institutionalisation, and violation of basic human rights. Intervention involved professionals from different disciplines, and involved residents, their families, care staff, the institution, and the local community. As a result, resident care and adaptive behaviour has started to improve. Communication between residents and families has increased. Owing to training and sensitisation, care staff's poor resident-management practices and negative attitudes toward disabled people have changed. Living and hygienic conditions have been upgraded and building renovation is under way. Asylum administration and the local community have been sensitised to residents' needs. Eleven residents have moved to the project's pilot community home in Athens; two others now live with foster families. The results suggest that deinstitutionalisation and rehabilitation can be successfully initiated even in residential institutions of the severest kind.

It is widely believed by psychiatrists that patients who require behavioural psychotherapy need to be referred for such treatment to a specialist in the subject. Two assumptions underlie this idea. One is that behavioural treatment requires a detailed knowledge of learning theory which is possessed by few psychiatrists. The other assumption is that behavioural methods are too time-consuming for a busy psychiatrist in a routine outpatient or primary care clinic.

Psychotherapy and the changes it produces can be understood in terms of simple basic essentials. Intensive and longstanding clinical experience demonstrates its therapeutic potency. Those factors in the therapist which are most important in leading to change are described. The significance of the therapeutic relationship is discussed, as well as the necessity of its candid and intensive examination during the therapy, if marked change is to occur. What is not psychotherapy is also explored.

Four men with learning disabilities were considered to show transvestic fetishism, and a fifth to show transvestism. However, developmental retardation and personality problems may modify the concepts behind such categorisation.

Five patients are described, whose common fear of contracting, or a belief of having contracted, AIDS is the presenting feature. There is a need for liaison with psychiatrists in the provision of counselling services for AIDS patients.

To determine the usefulness of the DST in differentiating depression from dementia, the test was administered to three diagnostic groups of psychogeriatric patients: depression; dementia; and dementia with depression. Clinical assessments were supplemented by ratings on the HRSD and SCAG, as well as by EEG and CT. All three groups showed a high incidence of abnormal DST results unrelated to presence or severity of affective symptoms, but showing a better association with SCAG and its ‘organic’ subsets. The mechanism(s) underlying these abnormal results may reflect organic brain disease. The usefulness of the DST in differentiating depression from dementia in the elderly was not confirmed.

Like recent medication studies, it appears that when cognitive-behaviouraltherapy is tested in pragmatic effectiveness trials involving routineclinical populations it does not fare as well as in efficacy trials. Giventhe multitude of factors that can ‘muddy the waters’ in clinical trials, howdo we best make sense of the findings?

People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their respective areas of expertise. Good treatment outcomes should also be underpinned by robust research evidence. Key research priorities are highlighted.

In a previous paper in this series Eysenck, Holland and Trouton (1957) showed that the seen after-effects resulting from stimulation by means of a rotating spiral were increased very little by a stimulant drug and decreased significantly by a depressant drug. At that time there was little evidence that these aftereffects were in fact correlated, as the theory demanded, with extraversion and introversion. Since then two separate experiments dealing with normal and neurotic subjects respectively produced very strong evidence in favour of this hypothesis (Eysenck, 1960), and it seemed desirable to repeat the experiment in order to discover whether the failure of the stimulant drug in the first experiment to produce very positive results was merely a chance effect or was in fact a genuine failure of the theory.

The object of this paper is to present a preliminary report on an experimental unit within the grounds of the mental hospital, but outside the Mental Treatment Acts, for patients suffering from the psychoneuroses. It is necessary, by way of introduction, to give some account of the way in which this unit came into being. One year before it was opened, we became particularly conscious of the problem of institutionalization, and attempted to study the forces active within the mental hospital which lead a patient, for the most part unconsciously, into a state of institutionalization. This is, of course, no new problem; in every mental hospital there is a nucleus of patients, of varying diagnostic categories, who no longer need to remain in hospital on account of the original symptoms or illness which brought them there, but who, under the subtle influence of the institutional life, have become quite incapable of returning to the outside world. This process of institutionalization cannot be dealt with extensively here, but briefly, the forces at work in bringing about this state are felt to be, firstly, those that tend in many minor or subtle ways to relieve the patient of all responsibility for himself, so that he ceases to be aware of the need to tackle his problems seriously, and, secondly, the authoritarian basis of staff and staff-patient relationships which, however benign, requires an attitude of submission on the part of the patient which readily leads to loss of initiative, and to institutionalization. It was, therefore, decided to reverse this process as completely as possible with a small group of patients, to see what further light could be thrown upon the problem.

The history of electro-encephalography contains both triumphs and disappointments. The most profound of the disappointments is the relative failure to elucidate any of the important problems which concern the psychiatrist. It was hoped that some real electro-physiological alteration would be seen in patients whose mental condition suggested something bordering on the organic, but the negative findings even in the most profound mental disorders are almost as striking as if they were positive. Before considering the published work it would be well to review in a few words the nature and significance of electro-encephalographic records.

The olfactory organ in man appears in a rudimentary condition as compared with its highly developed state in certain macrosmatic animals. To comprehend the immense change that has taken place in the smell apparatus, together with the development of the higher brain, and which has attained its climax in man (of those animals still possessing a sense of smell), it is necessary to be acquainted with the anatomy of the limbic lobe in macrosmatic animals, and to follow the transitions occurring until the high mammal type of brain be reached. Moreover, in this process is to be found the only means of discerning in the human cerebrum the rudiments of an important organ and of allocating its present site of functional activity. The researches of Kölliker, and, still later, of Elliot Smith, have largely removed the confusion existing in respect to the true limbic lobe, and the definition of this and its constituent parts may now be safely attempted. The extensive and hardly yet completed work of the latter author, contained in a series of valuable contributions to the Journal of Anatomy and Physiology, and in the Transactions of the Linnean Society, N.S.W., has been used by the present writer in giving the following sketch of the constitution of the limbic lobe and the cerebral commissures.

The controlled study of the major physical treatments in schizophrenia (and other psychiatric conditions) has been retarded by the view that it is unethical to withhold treatment from the patient. Although this argument is clearly dubious until a treatment is proved, the number of forward-looking controlled studies of E.C.T., insulin coma therapy and leucotomy may nevertheless be counted on the fingers of two hands. Not all schizophrenics have, however, received every possible treatment, and if it were possible to make comparisons of treated and untreated cases retrospectively, there would be no ethical objection to overcome.

A comparative study of the work performance of normal and schizophrenic workers was undertaken in the Rehabilitation Unit of Cheadle Royal Hospital. (Wadsworth, Scott and Wells, 1961). A group of 12 long-stay schizophrenics with a mean duration of hospitalization of 17 years, ±12·3 were matched with 12 normal subjects recruited to perform a normal industrial task. The task studied was the assembly, by gluing, of crepe to board; one of the initial stages in the manufacture of a carnival hat. The purpose of the study was to obtain comparative data that would help one to produce indices of employability, rather than to make evaluative statements which would relate only to mental hospital standards.

When normal human skin is moderately cooled it goes blue, owing to a contraction of the arteries and arterioles, and a relaxation of the capillaries and subpapillary venous plexus of the epidermis. This blueness is light in colour. In certain individuals, however, it is deep, or relatively saturated, in the hands or feet or both; these include cases of acrocyanosis (extremity, = dark blue). This condition, though rare in the general population, is common among the inmates of mental institutions.

This paper reports the finding of one section of the third of a series of surveys on the training and background of a group of recently appointed consultant psychiatrists. The original survey was a postal enquiry primarily concerned with training, which was circulated to every consultant psychiatrist in the United Kingdom who had been appointed to a post in general psychiatry, with at least 6 N.H.S. sessions, between 1 October 1963 and 30 September 1966 (Royal Medico-Psychological Association, 1969). The second survey, using a different form of questionnaire, and enquiring more closely into background and motives for going into the specialty, was circulated to consultants appointed between the 1 October 1966 and 30 September 1969 (Brook, 1972; Brook, 1973).