Sodium bicarbonate abuse is unusual, and rarely reported. A patient was extensively investigated at several hospitals for a recurrent hypokalaemic metabolic alkalosis; it transpired that she had been abusing sodium bicarbonate for 8 years and had gained hospital admission at will by taking large amounts. She also showed features of the Munchausen syndrome.

The results obtained with the Cold Pressor test were considered by the authors to provide further, supporting, evidence that variations in sedation threshold are due, in part at least, to differences in autonomic responsiveness. Further investigation of the problem seemed justified, and in the next stage of the research it was decided to employ as a measure of autonomic lability the response to a drug rather than the cold water stressor.

Interest in this problem on the part of parents, sociologists and paediatricians, among others, has grown of recent years. So much is this so that the casual observer might well conclude that there had been a real increase in backwardness, and that anxious parents now have a more genuine cause for anxiety on this score than was the case a generation ago. This view indeed is held by certain well established authorities in the fields of education and psychology, for example Burt and Professor Godfrey Thompson, who have expressed gloomy views about the intelligence of the nation. Moreover, considerable publicity by means of wireless broadcasts or otherwise has been given to these prognostications. It is not therefore surprising that many parents should be concerned as to whether their offspring will after all prove to be something less of a genius than they had anticipated. The smaller size of modern families is also a factor in increasing paternal anxiety. I say paternal advisedly, since it is more often the male parent, especially in middle-class circles, who has set his heart on his child being an infant prodigy. With only one string to his bow, the whole tension of paternal ambition is concentrated in a single object. Moreover in these days of compulsory examinations at the age of eleven, together with widespread coaching for the intelligence tests which form part of the examination, the unfortunate, innocent babe is barely able to lift a mug or a spoon when his rattle is whisked away and replaced by a host of constructional toys designed on similar lines to modern American intelligence tests. The slightest failure in performance or slackening of interest is liable to produce a state akin to panic in the proud parent, who has just been comparing notes about his prodigy with the owner of another (but naturally, somewhat inferior) budding genius next door.

Many service users and professionals are not satisfied with current hospital care: they call for a safer and more friendly environment, with greater freedom and less social distance between staff and patients. Phase 2 of the Alternatives Study was designed to improve the evidence base for such residential alternatives. Findings suggest that offering a more acceptable environment increases satisfaction with treatment, although it does not improve the clinical outcome. This set of coordinated studies also suggest that we should listen (and talk) more to our patients, and make our style of working in hospital and community facilities less paternalistic.

A clinical evaluation of the effects of a recently introduced monoamine oxidase inhibitor, N - isonicotinoyl - N1—(β - N - benzylcarboxamido - ethyl) hydrazine (Niamid, Pfizer, Ltd.) on certain types of mentally subnormal patients has been carried out over the past year.

In determining the parameters of structure and function in the group of patients designated as schizophrenic, increasing stress has been laid on endocrinal function. A great deal of work is being done to clarify adrenocortical function. We are about to begin similar studies in respect to thyroid responsivity, using radioactive iodine as an indicator. The present report deals with a third aspect of the endocrine system.

The present study was undertaken to relate testicular changes such as those reported by Hemphill, Reiss and Taylor to adrenocortical and thyroid responsivity.

Very few patients with ulcerative colitis are likely to be referred or to refer themselves for psychotherapy for their condition. Recently I was asked by a gastro-enterologist to see Caroline, a young woman in her early thirties, who had ulcerative colitis, with a view to her discussing having psychotherapy. This was because she had caused him and a social worker in this hospital to be concerned about her emotional state.

The extent to which anxiety, irritability and depression were differentiated as separate entities associated with characteristic patterns of somatic and cognitive symptoms by field dependent (FD) and field independent (Fl) normal female subjects was studied with the Hidden Figures Test and Unpleasant Emotions Questionnaire. In the Fl group the correlations between the three emotions were low and non-significant, reflecting a clear-cut differentiation in symptom configuration, as shown by psychiatrists. In the FD group the inter-correlations were significant and positive, corresponding to relatively poor symptom differentiation, comparable to that of a psychiatric patient group. This suggests that the cognitive style variable of field dependence may underly differences in symptom differentiation associated with psychiatrist/patient differences and, more generally, with social class and sex differences.

Woodbury (1918) described the manifestations of Graves' disease as fatigue, irritability, intolerance to heat, fine tremor, restlessness, insomnia, excitability, labile emotional disposition, nervousness, weight loss, palpitations, doubts, and fears. Similarly, Sachar (1975) included nervousness (manifested as apprehension, restlessness, and inability to concentrate), marked emotional lability, and hyperkinesis as the most common presenting symptoms. That fatigue, irritability, emotional instability, and excitability are all common features of the hyperthyroid state, as are episodes of severe and often disabling anxiety, is therefore, accepted. On the other hand, no clear picture exists concerning any fixed constellation of psychotic symptoms or progression of psychiatric disease. The psychiatric presentations vary from a delirious state to periods of hyperexcitability simulating mania that alternate with periods of exhaustion and depression. Greer & Parsons (1968) reported that some patients do. however, develop a clear schizophrenia-like picture, closely associated with the course of hyperthyroidism, with prominent paranoid symptoms and no pre-morbid history of psychosis.

Epileptic manifestations complicating insulin coma therapy (I.C.T.) were described by Sakel in his original paper (1937). In recent years the administration of chlorpromazine to patients undergoing I.C.T. has been common practice. Lancaster and Jones (1954), however, have commented on the resulting apparent increase in the incidence of epileptic fits.

Sernyl, 1 aryl-cyclo-hexylamine, is a synthetic drug first used by the anaesthetists because, when given intravenously, it produces analgesia. However, the occurrence of psychological disturbances post-operatively led to the investigation of this drug by psychiatrists. It was found that Sernyl produces many interesting psychological disturbances, some of which resemble the primary symptoms of schizophrenia (Davies and Beech, 1960). In a previous paper (Davies, 1960) Sernyl was given intravenously to five patients with long-standing psychoneurotic illnesses. It proved to be an effective abreactive agent and produced some interesting results in three of the patients who had obsessional symptoms. Sernyl, in the doses used, is not an hallucinogen, though it produces other effects similar to lysergic acid diethylamide, which has been used extensively as a therapeutic agent, particularly in obsessional states (Sandison et al., 1954). The preliminary report suggested that Sernyl might have some practical advantages over LSD—in particular, it produced a less severe disturbance and its effects were over more quickly. Further investigations were clearly indicated and this present paper reports on the use of oral Sernyl in five patients with obsessional illnesses.

Cameron (1938, 1939) suggested that schizophrenic thought disorder is largely the result of overinclusive thinking, which he defined as the inability to preserve conceptual boundaries. Payne, Matussek and George (1959) developed a battery of objective measures of overinclusive thinking, which they found differentiated between an acute schizophrenic and a neurotic control group. Payne and Hewlett (1960) found that a battery of tests of overinclusive thinking intercorrelated as expected. They were able to obtain a factor score from their overinclusion test battery which differentiated a group of acute schizophrenic patients from control groups of depressives, neurotics and normal subjects. Payne and Friedlander (1962), on the basis of this factorial study, suggested a short battery of three measures of overinclusive thinking consisting of the number of ‘Non-A’ or unusual responses to the Object Classification Test (Payne, 1962), the average number of words used in explaining the Benjamin Proverbs given under special 'stress free’ instructions, and the average number of objects classified together in the ‘handing over’ section of the Goldstein-Scheerer Object Sorting Test. This standard test battery has been the operational definition of overinclusive thinking in a number of studies. Only one study of the reliability of this test battery appears to have been carried out. Hawks and Payne (1971) report the correlations obtained from a group of 54 psychiatric inpatients who were retested after a 4-day interval. The test-retest correlation coefficient (uncorrected) obtained from the Combined Transformed score (Payne and Friedlander, 1962) was 0 · 87. The reliabilities of the individual tests ranged from 0·77 to 0·86.