In carrying out short term therapy involving one to six sessions with doses of 75 μg. to 200 μg. of LSD, the author gained a definite clinical impression that suggestibility was influenced by LSD, although there is little mention of such a parameter in the classification of LSD effects. Remarks meant to be helpful sometimes proved much more effective whilst patients were influenced by LSD than when they had been given in ordinary interview. Classification of the phenomena of LSD intoxication may have therapeutic orientation and dynamic concepts or it may draw on purely descriptive terms with symptomatic significance.

From diverse physiological and psychological studies in animals and in man, it is generally concluded that increased secretion of adrenocortical steroids accompanies emotional stress. The relationship between mood, especially the pathological changes of mood found in a depressive illness, and adrenocortical hormones is not so clearly defined.

The reports of the Registry of Human Kidney Transplantation show that the operation is being carried out with increasing frequency. Its medical, surgical and immunological problems are well documented, but attention needs also to be paid to the psychological difficulties of patients in chronic renal failure for whom this operation is recommended. Thus, Kemph (1966), in a study of seven cases has drawn attention to the unconscious hostility shown by some donors to recipients. The present paper is one of a series (Cramond, Court et al., 1967; Cramond, Knight et al., 1967; MacNamara, 1967) in which the psychiatric contribution to a renal unit and the criteria used in donor-selection have been discussed, as well as some of the psycho-social problems arising in connection with the work of the unit. It is now proposed to deal with some psychological, social and economic problems which recipients meet during rehabilitation, and the ambivalent dependency that may develop between recipient and donor. Although only a short series of cases has been studied so far, an awareness of this interaction will help to establish better criteria for future donor selection.

The great changes that have occurred in mental hospitals over the last fifteen years due to improvements in treatment of both acute and chronic psychiatric illnesses are reflected in the dramatic running down of the long-stay patient population. The Ministry of Health (1961) and Tooth and Brooke (1961) envisaged a continuing fall in the number of beds for psychiatric patients, so that by the mid 1970s these would have been reduced by nearly 50 per cent. from their 1960 figure (3·4 to 1·8 per thousand population). This prediction has been criticized because it was considered too optimistic, while the implication that the mental hospital, as we know it today, might cease to exist has provoked controversy.

The particular mental state described by Korsakov (1890, 1891) is, in most cases, a sequel of Wernicke's encephalopathy, which itself is the result of alcoholism. Korsakov, however, also observed the same mental condition in persons, not alcoholic, who had been exposed to carbon monoxide, to phosphorus poisoning, or to profound toxic states. Within a few years, Monckenmoller (1899) and Meyer (1899) had each described the Korsakov state appearing late in the natural history of sarcomata of the sella turcica and third ventricle respectively. Delay et al. (1964) ably reviewed 108 instances in the literature of the association of cerebral tumour and Korsakov state, and concluded that cerebral tumour is most likely to lead to the Korsakov state if it leads to a bilateral lesion in the hippocampo - mamillo - thalamo - cingulate pathways, an observation previously made by Grünthal (1939), Kleist (1934), and Orthner (1957). By virtue of their possible situation, craniopharyngiomas are so placed anatomically that they are associated with the Korsakov state with disproportionate frequency compared to other intracranial tumours. However, in some of the reported cases the Korsakov features were tenuous, were a near terminal or postoperative event, or were outweighed by gross endocrine disturbances. Even so, only 3 out of 28 such cases described in the literature were diagnosed during life. Early diagnosis is thus extremely difficult, for the neurological signs are sparse and then are mainly ophthalmological, whilst the onset is insidious and accompanied by mental changes which deceptively suggest a functional basis to the whole picture.

Males with chromatin positive Klinefelter's syndrome are observed to have one or more extra X chromosomes within their cells. Diagnosis is by buccal mucosa smear and chromosome analysis. Clinically they have delayed puberty, abnormal physique, small testicles and little facial hair. This paper presents some observed differences between Klinefelter patients who were being treated in subnormality units and other patients not having the condition but with similar I.Q.s.

In a recent survey of males detained in a State hospital for dangerous, violent and criminal psychiatric patients, seven subjects with an XYY sex-chromosome constitution were discovered (Jacobs et al., 1965). Further investigation (Price et al., 1966) yielded two more patients with this abnormality. Psychological testing of these same patients was undertaken in order to detect cognitive or clinical features which distinguish them from other men in the same hospital.

An appreciable number of chronic schizophrenic patients otherwise destined to remain long-stay patients in mental hospitals, are able to live in the community if they undergo active rehabilitation. In this paper, an attempt is made to correlate the post-rehabilitation progress of long-stay schizophrenic patients with observations made during their rehabilitation.

It has recently been pointed out by several authors that the psychometric assessment of the elderly patient has largely been geared to, or preoccupied with, the solution of diagnostic problems, measuring deterioration or discovering early dementia (Post, 1966; Inglis, 1962). Therefore, it appears that little attention has been paid to the use of psychometric tests in the broad area of prognosis. Often the psychiatric diagnosis of an elderly patient is quite clear, and in these circumstances it would be valuable to be able to discern reliable and significant changes in the cognitive status of such patients. For example, it may well prove quite significant, prognostically, to measure the rate of change in cognition of an elderly person suffering from a progressive cerebral disease. The rate of decline could be a prognostic indicator for the future disposal of the patient or for impending death. A variety of studies have shown that scores on measures of physical and cognitive abilities can predict death or discharge from hospital (Cosin et al., 1957; Inglis, 1959; Kleemeier, 1961; Kral, 1963). In the case of patients suffering from depressive “pseudo-dementia” (Post, 1965) it will probably be valuable to know if their cognitive status reflects changes in their clinical status. But probably the most important aspect of the psychometric assessment of the geriatric patient will be found to lie in measuring changes in function which may be the sequelae of treatment affecting brain function in general, i.e. anti-depressant preparations and electroconvulsive therapy.

Recent studies of childhood bereavement in depressive populations (Forrest, Fraser, and Priest, 1965; Munro, 1966) indicate that parental bereavement in childhood may be of aetiological significance in depressive illness (Forrest et al., 1965) and may affect the severity of the clinical picture (Munro, 1966).

The occurrence of psychotic episodes indistinguishable from schizophrenia in epileptic patients has long been recognized, and Slater, Beard and Glithero have recently published their findings in sixty-nine such cases.

Quite a number of reports have been published on serum lipids and especially serum cholesterol in manic-depressives. The results, however, are contradictory, and the experimental designs have not been satisfactory. Altschule (1953), and Hoch and Zubin (1954) have reviewed this field, but little original work of importance has been published recently.

In view of the increasing demand for the in-patient care of old people in Essex, a psycho-geriatric unit was set up at Severalls Hospital, Colchester in 1960 to provide a comprehensive service in its catchment area. The organization of this unit has been described by Whitehead (1966) and that of the day hospital by Haider (1967).

The nurse's role in caring for the psychologically sick has undergone sweeping changes during the past century. This study investigates some of the new techniques which the nurse needs to acquire if she is to be effective within the therapeutic milieu that is increasingly being adopted in mental hospitals. It is essential that the training of the nurse should fit her properly for the new role and that we should examine the treatment skills which will be required.

This paper attempts to show something of the interaction between social factors and the response to treatment in patients with chronic renal failure who embark on a programme of recurrent dialysis. The social work involved was carried out on the series of patients reported by Professor Cramond and his colleagues in the three articles preceding this one.

The term “phenomenology” was imported into psychiatry from the field of philosophy. I intend to give a brief and necessarily simplified account of its philosophical background, the various meanings applied to it, and some of the clinical implications following from it.

This report evaluates the use of the Hamilton Rating Scale for Depression (HRS) (5) in a general medical in-patient population; it is one part of a comprehensive study of depression in these patients (10, 11). The Hamilton Rating Scale was designed to measure the severity of depression in patients already diagnosed as having depressive illness. Hamilton (5) states, “the scale quantifies the results of an interview and is of practical value in assessing the results of treatment.” Recently, the HRS has been used for measuring psychiatric patients' responses to antidepressant medications (7, 9, 12), but there are no reports of its use with medical patients.

In recent years there has been a considerable shift towards the treatment of psychiatric patients outside hospital; and although progress in the expansion of such services as hostels, day centres and social work has in many places been slow, the idea of a Community Service based on home care whenever possible has become a popular one and forms the basis of official planning in this country (16). Doubts have, however, been expressed as to the wisdom of so great an emphasis on this untried method of management (13, 34, 39); the proper evaluation of Community Care is therefore of great importance.

Sex chromatin studies of the mentally defective have revealed a higher than average prevalence of positive sex chromatin among retarded males, and of double Barr bodies among retarded females (Prader et al., 1958; Israelsohn and Taylor, 1961; Maclean et al., 1962; Anderson et al., 1964; and others). It is not yet clear whether mentally defective women also contain an unusually large number with the XO constitution. That mild mental deficiency is a common accompaniment of an XYY constitution in males has been shown recently (Jacobs et al., 1965; Casey et al., 1966; Price et al., 1966). As yet no epidemiological studies have been reported on the XYY constitution.

The methods of treatment employed for most forms of psychiatric disorder are still largely empirical. Furthermore, they are subject to powerful socio-cultural influences. Hence, it is not surprising that examination of medical practice in different countries reveals wider variation in the treatment of psychiatric disorder than in that of most other forms of morbidity (Shepherd, 1962). To establish the patterns of variation, and to assess their importance, it is necessary to develop techniques which permit direct comparison between the therapeutic practices of representative national groups of psychiatrists. This cannot be an easy matter, since in addition to difficulties of language and protocol there are problems specific to the subject of enquiry. There is as yet no internationally accepted nomenclature for psychiatric disorders, and perusal of the available prevalence statistics suggests that there must be considerable variation in the diagnostic criteria recognized by clinical psychiatrists of different nationalities (Lin and Standley, 1962). Moreover, clinicians whose chief concern is with the treatment and management of individual patients, in part through the manipulation of inter-personal relations, may be reluctant to accept any simple, mutually exclusive classification of their therapeutic techniques.