The Henderson Hospital is a 68 bed unit for the in-patient treatment of young people of both sexes who are described as psychopaths, sociopaths, personality disorders or character disorders. Treatment is by means of a Therapeutic Community, and prospective patients are referred by external psychiatrists with no working commitment in the hospital, by prison medical officers and sometimes by Probation Officers and other social workers with the medical backing of a general practitioner. All prospective patients are seen at a group interview and on the basis of this will be selected for admission or not.

This study was conducted at an out-patient clinic employing group therapy techniques, where some workers felt that a balance between frequent participators and more silent members was advantageous to the group as a whole. As Taylor (1961) has observed, frequent speakers tend to withdraw from groups if not given enough scope for participation. Very silent members sometimes have difficulty in establishing themselves at all, yet the lack of even one active member may lead to a decline in group morale, hence in motivation to continue treatment.

Behavioural symptoms suggestive of the so-called functional psychiatric disorders are often observed during the course of sub-acute or chronic encephalitides, particularly sub-acute sclerosing panencephalitis. This has been regarded as an invariably fatal neurological illness, but Cobb et al. (1) have recently presented two non-fatal cases and have drawn attention to rare scattered reports of others, some with behavioural disorders. We have therefore made a survey of cases of sub-acute encephalitis at the Yale-New Haven Hospital, especially noting their behavioural aspects.

Considerable interest is at present focused on the possibility of an association between mental illness in epileptics and metabolic abnormalities resulting from the anticonvulsant drugs they have been taking; in fact it has been suggested that these drug-induced abnormalities may be actually causative of the psychiatric disorders. For a good summary of this literature the interested reader is referred to Reynolds (1968).

Abnormalities in the EEG of schizophrenics were first described by Lemere (1936) who found schizophrenic EEGs had poor alpha waves. Earlier workers were more interested in frequency abnormalities and Davis (1941) found, from study of the frequencies, the more unstable the EEG in schizophrenia the more unstable the behaviour. This concept is well established and has been confirmed by Brazier (1962) and other workers. However, the study of the different frequencies has shed little or no light upon the aetiology of schizophrenia.

The importance of psychotherapy, as one of the commonest and most distinctive methods of treatment used by psychiatrists, is hardly disputed, although the definition, theoretical basis and effectiveness of its various forms are subject to much debate. In the present article we are concerned with psychotherapy only as a form of service available to N.H.S. patients. Our aims are: (1) to calculate the numbers of patients, living in an area with relatively good services, who are receiving two operationally-defined types of psychotherapy, (2) to estimate the numbers of local patients already attending out-patient clinics who might be referred to a specialized psychotherapy department if certain rules of selection were applied, and (3)to discuss the relevance, if any, of these data for planning local psychotherapy services. The limitations of the material will be obvious and the calculations crude, but they should be adequate to open the subject to realistic discussion.

During the past twenty years, the unity of manic-depressive disease as defined by Kraepelin (1913) has been questioned by investigators who have presented clinical and genetic evidence that the disease is heterogeneous and contains at least two discrete groups (Leonhard, 1957; Perris, 1966). In one of these groups mania occurs and patients exhibit both manic and depressive phases during the course of their illness. This group has been designated bipolar by most investigators (Leonhard, 1957; Perris, 1966). In the other group there are only episodes of depression, and this has been designated the unipolar group by some (Perris, 1966) and corresponds largely to the ‘monopolar’ group of Leonhard (1957). In this paper we shall use the term unipolar throughout to designate an affective illness in which only depression occurs.

Freud's Mourning and Melancholia (1917) stimulated much psychoanalytic speculation regarding the relationship between loss of a loved object and subsequent depression. Abraham (1924) considered ‘a severe injury to infantile narcissism brought about by successive disappointments in love’ to be an important factor in melancholia, and used the term ‘primal parathymia’ to describe the disagreeable experiences of childhood which give rise to adult depression. Klein (1940) related all states of depression and mourning in adults to a reawakening of the infant's struggle to make reparation to the mother he fears he has destroyed. She believed that adults who are prone to depression have never successfully worked through this earlier ‘depressive position’. Bowlby (i960) has likened adult grief and mourning to the reaction of children to separation from their mothers. He proposed the view (1961) that children are less capable of coping with death of a parent than adults and adopt the defensive mechanism of ego-splitting by which part of the ego still considers the parent to be alive. This imperfect resolution of the loss situation leads to a fixation on the lost parent and a tendency to react badly to further separations. Brown (1961), extending this theory, maintained that rejections in adult life are likely to release the repressed urges to recover the lost object, and to precipitate a depressive illness.

Gilles de la Tourette's syndrome has not been reported outside Europe and America, and all the patients reported have been of the white or negro races (Singer, 1963). Although the condition was described as early as in 1825 by Itard and later differentiated as a syndrome by Gilles de la Tourette (1885), and although the syndrome is an unusual condition with undetermined aetiology, treatment and prognosis (Eisenberg et al., 1959, Kelman, 1965), and Kinnier Wilson (1940) had given the syndrome ‘a sinister’ outlook characteristically ending in insanity, Fernando (1967) could find only 85 cases published in English literature as cases of the syndrome. He rejected 20 cases, and of the 65 ‘proven cases' 50 were from the United States, 13 from Britain, one each from Finland and Canada. Shapiro and Shapiro (1968) commented on the scarcity of the syndrome even in the Western culture. Extensive search in the literature has shown that Gilles de la Tourette's syndrome has not been reported in Asians. This paper presents a detailed report of the first case from India.

The results from a small series of persons suffering from alcoholism suggested that the amounts of water and electrolytes in their brains (obtained post mortem) differed from those of control and depressed individuals (Shaw, Frizel, Camps and White, 1969). Since publishing this work we have analysed brain tissue from a further series of alcoholic subjects, and in this paper we compare these findings with the original data from control and depressed groups.

The idea of a relationship between respiration and mental functioning can be traced back to ancient superstition that the diaphragm is the centre of the soul as well as of emotion.

Various studies of the numbers of patients in mental hospitals have been made, e.g. Brooke (1963); General Register Office (1960); Gore and Jones (1961); Hassall, Spencer, and Cross (1965); Malzberg (1955); Norris (1959); Norton (1961); Registrar General (1958, 1960, 1961, 1962, 1964); Tooth and Brooke (1961), but little attempt has been made to find whether these numbers are subject to natural law. In this paper I have tried to establish this. These researches have been made on the patients of the Central Hospital, Warwick, which has been in continuous use since 30 June 1852. The case sheets of the older patients are accessible; the recent ones are also personally known.

The present study is one of a series of investigations concerned with the relationship between parent death and mental illness. In previous studies (Birtchnell 1970 a and b) it has been shown that significantly more psychiatric patients, compared with a general population control group, experienced parent death during the first five years of life and during a period of one to five years before admission to hospital. It was further shown (Birtchnell 1970c) that within the patient group, though the incidence of early and recent parent death was similar among depressed and non-depressed patients, the severely depressed compared with the moderately depressed patients experienced sig- nificandy more parental bereavements during the first twenty years of life and during a period of one to twenty years before admission. In a large sample of depressed in-patients, Hill (1969) demonstrated a significant excess of early parent deaths in those who attempted suicide, and he suggested that this might be secondary to the association between early parent death and severe depression.

In their article published in this Journal in 1965, May and Tuma (1) suggested that only the use of medication made a difference in the outcome with schizophrenics, and that psychotherapy, whether or not combined with medication, made essentially no difference. Their data, however, as in so many psychotherapy projects, referred only to patients treated by inexperienced therapists, namely psychiatric hospital residents under supervision.

Pollin et al. (12) found that in a series of 11 monozygotic twins (MZ) discordant for schizophrenia all of the index twins weighed less at birth, 8 of the index twins were second- born and 7 out of the 11 mothers had varying thyroid pathology ‘of clinical significance’. The following report is probably the first giving details of investigations into a pair of MZ twins who were given thyroid extract during the neonatal period because of failure to make normal progress.

The syndrome of cleidocranial dysostosis was first reported by Marie and Sainton in 1898. It is a congenital condition giving rise to a defect in ossification. The principal clinical features are dwarfism, a large head with a small fades, and a depressed or saddle-shaped nose. The clavicles are incomplete or absent, scapulae are small and poorly formed, and frequently the symphysis pubis fails to fuse.

From time to time patients come to one who have had years of unsuccessful psychotherapy and are in desperate need of help. To undertake the treatment of such patients is to face many difficulties. Understandably they are suspicious of the new therapist; it will not do if he reminds them of the one who disillusioned them, but if they come to like or trust him they may feel that they are being disloyal to their first therapist, to whom they still have some attachment. If they notice improvement in their condition it gives them no pleasure, for they know that they have relapsed after appearing to improve in the past. On the other hand, any setback upsets them greatly; they are convinced that they will never get well, and blame either the therapist or themselves or both. They have been made to feel that analysis is the only worthwhile therapy, and that there must be something quite specially wrong with them if it cannot help them as it has helped others; so their depression and sense of failure are reinforced. Often it is not only their psychological condition but also their realistic situation that has deteriorated, sometimes beyond repair.

Amphetamine psychosis and severe amphetamine dependence are now well recognized clinical pictures leading to psychiatric in-patient treatment (Connell, 1964). These pictures, however, are probably seen in only a small proportion of those who take amphetamines. The true assessment of the total incidence of unprescribed amphetamine taking in any group is made difficult by the absence of specific clinical signs (Connell, 1966), denial of drug-taking by the patient (Scott and Willcox, 1965) and the large number of false positives found with the methyl orange screening test (Johnson and Milner, 1966). Gas chromatography for amphetamine substances in the urine (Rowland and Beckett, 1965), though both expensive and time-consuming, provides for the specific detection of amphetamine and many other drugs in the microgram and submicrogram quantities. This paper describes the use of the method to obtain a picture of amphetamine abuse amongst patients in a 20-bedded acute psychiatric ward in a Teaching Hospital.

An epidemiological approach to the problem of suicide may help to identify high risk groups and aid in the design of preventive programs. The aim of the present study was to determine the incidence of suicide among various population groups in Israel and to assess the methods employed. All records of suicide in Israel during the years 1962-63 were extracted from the files of the Central Bureau of Statistics, where data had been obtained from police records. Presentation will be limited to the Jewish population due to a lower reliability of data in the Arab segment.

In two previous papers (Kay et al., 1969a and b) the results obtained from a material of 104 depressed in-patients were discussed. One hundred of these patients were given the Mauds- ley Personality Inventory (M.P.I.) (Eysenck, 1959) at follow-up (5–7 years after the index admission) with the aim of relating M.P.I. scores at follow-up with the symptomatology of the original illness.