Response to a token economy was assessed in male chronic schizophrenic in-patients who were given, in a double-blind cross-over trial, pimozide (up to 20 mg daily) or chlorpromazine (up to 1,000 mg daily), each for three months. After six months there was little change in the patients' mental state, but general ward behaviour and token-rewarded target behaviours improved significantly. There were no statistically significant between-drug differences, but the trend was that general ward behaviour, but not token-rewarded behaviour, improved more on pimozide. The patients who showed initiative and cooperated best with staff were those whose token-rewarded behaviour was most satisfactory.

Cognitive deterioration is so commonly observed in the elderly that it is considered by many to be an inevitable feature of the ageing process. Some researchers have proposed that the senile dementias are the inevitable end-point of this process, should the person live long enough. The differentiation of normal cerebral ageing from disease process is important in the selection of control groups for research, and also for clinical decision-making. In the latter context it is important to ask at what level of dysfunction intervention should occur, and whether this should be active or palliative. Cognitive change in the elderly is here considered from biological, neuropsychological and epidemiological viewpoints. Current research suggests that senile dementia is the result of the interplay of genetically determined disease processes, ageing-related decline which may be regulated at a cellular level, and neuronal repair and compensation mechanisms. Therefore, to debate whether dementia is simply an extension of a normal ageing process or not is probably too simplistic an approach.

Nuclear magnetic resonance (NMR) imaging of hydrogen in body water and fat is proving valuable in clinical investigation of the brain. An introduction to the technique and to the biological significance of the images is presented here. The ‘multi-parameter’ nature of these images is stressed, and the individual parameters described. NMR imaging may well be of value in investigating the pathology of organic and functional psychoses.

To assess the future requirements for long-stay psychiatric beds, every consultant psychiatrist in Glasgow was asked to consider whether long-stay patients in his or her wards would be fit for rehabilitation and return to the community. For the purposes of the survey, long stay was defined as a single admission of at least six months, but patients with an organic diagnosis who were aged over 65 were excluded. It was estimated that, with rehabilitation, almost a third of the patients surveyed could return to the community, and that, with more participation in self-care, over 15% might be able to manage in a ward or hostel within the hospital. Patients judged fit to return to the community were preponderantly younger patients with a shorter period of inpatient care, and those suffering from a functional psychotic illness.

The use of an immunological metaphor allows the incorporation of established theoretical ideas about trauma and stress in an integrative way which enables delineation and illustration of several varieties of combat stress reaction, including subtle forms of that condition which do not often appear in post-traumatic stress disorder literature.

In England, public intoxication has been a criminal offence ever since an Act of Parliament was passed in the reign of James I, somewhat over three and a half centuries ago. Edwards (1970) compiled some figures on these offences for the last two hundred years, showing that the rate of arrest was much higher in the nineteenth century than at present. For example, in 1878 there were 70 arrests per 10,000 of the population, compared with a comparable figure for 1968 of 16. Nevertheless, the latest available figures from the Home Office (1971) show that 82,961 persons were found guilty of simple or aggravated public drunkenness in 1971. In the U.S.A., with its apparently much larger alcoholism problem, there were nearly one and a half million arrests for this group of offences in 1966 (Pittman, 1969); this accounts for one third of all arrests in that country (Chafetz, 1971).

Retrospective questionnaire information was sought from 175 Royal Air Force officers who had survived ejection from an aircraft and 88% replied. A profile of risk factors, both objective and subjective, was found in the 40% who subsequently experienced prolonged emotional disturbances. Confidential counselling of ejection survivors should therefore be routine. Consultation between involved medical staff and a Service psychiatrist can increase awareness that surviving aircrew may not be as composed and unaffected as they seem, while appropriate counselling can reduce prolonged emotional morbidity.

The late prognosis of childhood encopresis is unclear: our literature reviews have failed to reveal any studies of it. Halpern (1977), discussing the effectiveness of treatment, states that this is difficult to evaluate “since encopresis is a self-limiting symptom”. Bellman (1966) followed up 186 children with encopresis seen at two Stockholm clinics; their age range at follow-up was 6–19 years. She found a steady decline in encopresis from the age of six in boys and eight in girls. It disappeared by the age of 16, although there were two relapses—one at 17 and one at 19.

Forty-eight depressed panic-agoraphobic patients - clinically matched for severity of depression with 35 primary chronic depressives - had significantly better adjustment in most areas of social functioning, especially those related to interpersonal contact, work, leisure activities, and sexual life. Even when depressed, panic-agoraphobic patients appear to possess sufficient interpersonal skills - that is, by leaning on significant others - to engage in a range of social activities, both at home and beyond. These data, which are open to different interpretations, nonetheless suggest that anxiety and mood disorders differently affect certain key areas of social adjustment.

Anxiety states sometimes lead to hyperventilation (HV) which may, in turn, give rise to a variety of physical symptoms. One way in which HV may present is with unilateral somatosensory symptoms, often left-sided. We report nine such cases. The mechanism of lateralisation was examined using EEG and bilateral somatosensory evoked potentials which were carried out before and after HV. No difference in conduction velocity was found between affected and unaffected arms, but non-specific abnormalities were frequently noted in the EEGs. The results support the role of a central rather than a peripheral mechanism in the production of unilateral symptoms in HV.

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls.

The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.

A 40-year-old man suffered both a short-term memory defect and bipolar mood disorder. It is postulated that both conditions are due to progressive cerebral sarcoidosis affecting the limbic system. The need for early detection and treatment is emphasised.

Amark (1951, p. 154) discovered a high frequency of ixoid and ixothymic personality traits resembling those encountered among epileptics in a clinical material (49.5 per cent), and institutional material (38.0 per cent) and a material from the Temperance Board (37.1 per cent). Amark's description of these ‘epileptoid’ personality traits (1951, p. 151)) which also covers normal character variations, is fairly wide and includes a tendency to perseveration, adhesiveness, explosions or dysphoric states of dejection, querulousness and paranoid reactions. In a previous study (Kristianson, 1970, p. 173) it was suggested that Amark probably overestimated the frequencies of ixoid and ixothymic personalities, because alcoholics are so often explosive. But this quite unspecific pattern of behaviour is not sufficient for the diagnosis of ‘epileptoid’ traits, if this concept is to have a reasonable definition. Explosive aggressiveness is scarcely a primary personality trait, but is one of the symptoms of a deterioration in the chronic alcoholic's mental condition. However, it is important to differentiate these explosive aggressive reactions caused by chronic alcoholism from the adequately defined personality traits of epileptics. This problem of differentiation will be analysed in greater detail in this study.

This paper reports an investigation in which it was found that, by dividing “paranoids” on a scale of “non-integrated psychosis”, two groups were formed which differed significantly from each other on several independent measures. When the same division was made within non-paranoid schizophrenics and within melancholics, very few such differences were disclosed.

The evidence suggests that integrated and non-integrated “paranoids” can usefully be regarded as differentiable groups, the latter being more closely related to other forms of schizophrenia.

Scientific arguments showing ‘how the world is’ are fundamentally different from political assertions about ‘how the world should be’. Ideologically motivated political attacks can hamper our understanding of mental disorders by preventing academics from pursuing research in contentious areas. Evidence should be countered by better evidence, not by shooting the messenger.