Creatinine has long been used as a basis for urinary excretion studies of drugs and metabolites. Nevertheless, the validity of this has been seriously challenged by Paterson (4), whose findings were confirmed by Scott and Hurley in adults (5) and by Applegarth, Hardwick and Ross in children (1). These authors found that evaluation of urinary creatinine output cannot replace the practice of careful timing of 24-hour specimens as a basis of excretion rate. However, collection of well-timed specimens in ambulant psychiatric patients usually presents a great deal of difficulty.

The Eysenck Personality Inventory (E.P.I.) was developed by Eysenck and Eysenck (1964) to measure two dimensions of personality—extraversion (E) and neuroticism (N). This personality questionnaire has been extensively used in clinical practice and psychosomatic research. In our own department we have been using the E.P.I. as a tool in some psychosomatic investigations, which have been reported in various journals (Verghese, 1970, 1971; Verghese et al. (1971a), (1971b).

Until relatively recently, senile dementia has been a much ignored problem in psychiatry, but largely due to considerable social, medical and demographic influences much needed interest and energy have been injected into geriatric psychiatry. Although the historical development of this diagnostic concept has been shrouded by the use of ambiguous and often emotive language, certain major threads in its history can be teased out.

There have been reports of the association of alterations in the divalent cation content of plasma with depressive illness. Coirault and colleagues (1959) found increased ionized calcium levels despite decreased total plasma calcium concentration in patients recovered from depression. More recently, Frizel and colleagues (1969) have reported normal plasma ionized and total calcium levels both before and after recovery from depression.

Department of Health and Social Security statistics show a steady rise in the use of outpatient services from the inception of the National Health Service; since the Mental Health Act of 1959, the numbers of new outpatient and clinic attendances have increased by one-third and one-fifth respectively (D.H.S.S., 1971). However, as our knowledge of the actual functions of out-patient services and their relationship to in-patient care is at best only rudimentary, the recent article by Mezey and Evans (Journal, June 1971, 118, p. 609) is a much needed contribution towards evaluating these different facilities of the psychiatric services.

From a sex-chromatin survey of patients in hospitals for the subnormal, Hunter (1966) concluded that the great height and large build of XYY (and XXYY) males might present such a frightening picture that when such a person was convicted of an offence, judges and psychiatrists would be biased towards directing them to Special Hospitals in the interests of community safety. In a study of 464 defective delinquents we found 97 inmates who were at least 72 inches tall (Welch, Borgaonkar and Herr, 1967). There were two 47, XYY and four 47, XXY males in this group. Nielsen and Tsuboi (1970) have indicated that patients with tall stature have a comparatively pronounced disposition to character disorder and criminality. However, Baker et al. (1970) believe that the role of extraordinary height in generating both antisocial behaviour and selective commitment to maximum security facilities remains undefined. Although all these reports have been concerned with adult offenders, we considered about a possible relationship between 47, XYY karyotype, height and admission to institutions of juvenile delinquents.

The following study has been made on the background of the finding by Kramp and Nielsen (1968) of enlarged short arms of a chromosome in the 21-22 group in four out of five psychoinfantile members of a family with a case of Down's syndrome.

In 1969 Barton and Whitehead reported two cases in which there were definite plots to remove an unwanted and restricting relative by securing admission to a mental hospital, and one case of an old lady admitted to a mental hospital following induced faecal incontinence. The old lady was considered a nursing home nuisance and she was given purgatives regularly. Inevitably she had some ‘accidents' and these were used as an excuse for removing her to hospital. They labelled such attempts ‘The Gaslight Phenomenon’, inspired by Patrick Hamilton's play Gaslight which was first produced in London in 1939 and later formed the basis for a film.∗ Their survey of the literature uncovered few recent reports of such manipulations.

Urinary retention without apparent organic causation is infrequently commented upon in the psychiatric literature. Cooper (1965) described the use of conditioning therapy in the treatment of a patient with hysterical retention of urine. In our experience urinary retention without organic causation is more frequently seen as a post-operative complication, lengthening considerably the period of stay in hospital. Two such cases were successfully treated by a new psychodynamic technique which we have recently developed. This technique makes use of dream suggestion to the patient in clear consciousness, in that respect differing from other techniques of dream suggestion such as Stoyva's (1965) dream instructions to patients in the hypnotic state.

In a previous paper (Cheadle et al., 1967) we described a form in use in this hospital since 1961 for rating the work performance of psychiatric patients. The form was shown to possess adequate inter-rater reliability and predictive validity, but it had certain shortcomings which we have tried to remove in a revised version. This (Fig. 1) consists of 16 items of work behaviour each rated on a five point scale and scoreable by awarding o for each tick in the left hand column, 1 for each in the next column and so on, 4 being given for each tick in the right hand column. The lower the score the better the performance.

There is evidence that dependence can develop to tranquillizers and that they can cause states of physical dependence similar to those obtained with barbiturates. Withdrawal manifestations are usually less severe and of shorter duration. They include agitation, restlessness, tremor, muscle twitching, insomnia, anxiety, depression and confusional states with disorientation. After high doses hallucinations, delirium and convulsions can occur.