Stereotactic surgery has provided a means of producing accurate lesions at selected points in the nervous system where concentrations of nerve cells or fibre pathways possessing specific functions permit some small area of anatomical destruction to produce widespread physiological effects. The value of this method in relation to motor and sensory activity is illustrated by the results of thalamotomy in the treatment of Parkinsonian tremor and by stereotactic division of the spinothalamic tract in the cervical cord for the relief of incurable pain. The accuracy of approach and minimal disturbance of tissue ensures that the beneficial effects of these operations are produced in isolation without associated disfunction in the nervous system. That a similar principle can be applied in relation to the control of emotion has been shown in cases of intractable psychoneurosis treated by the operation of bifrontal stereotactic tractotomy in the substantia innominata (Knight, 1964). Owing to the influence of emotion in psychoneurotic states it is possible to influence many syndromes satisfactorily by operation at a site where connections of the limbic system concerned with instinctive and emotional activity rather than cognitive processes converge to a point beneath the head of the caudate nucleus, thereby producing a reduction in the intensity of emotional reaction without undesirable personality change or post-operative epilepsy. It is felt that it would be useful to summarize the anatomical features in order that the differences between this operation and the old leucotomy procedure can be generally appreciated. It is particularly among cases of chronic and recurrent depression that this form of surgery can be most usefully employed.

Roth and Morrisey (1952), in isolating senile dementia (senile psychosis) as a distinct nosological entity, used as their definition “an illness of insidious onset pursuing a uniformly progressive course with steadily augmenting mental decay”. In 1955 Roth defined senile psychosis as “a condition with a history of gradual and continuously progressive failure in the common activities of everyday life and a clinical picture dominated by failure of memory and intellect and disorganization of a personality, where these were not attributable to specific causes such as infection, neoplasm, chronic intoxication or cerebral vascular disease known to have produced cerebral infarction”. Kay (1962) defines dementia as a “gross deterioration of intellectual capacity and of memory, together with severe and persistent disorientation for time and place”. He diagnosed senile dementia “when there was no evidence of focal brain disease”. Roth et al. (1966) describe senile dementia as “the extreme form of intellectual decay of old age”.

At the close of the last century there began to spread in the field of psychiatry the idea that every specific pathological agent and every individual toxin produced a picture of psychological disorder that was uniquely characteristic of the causative agent. This idea was extensively developed in the work of Kraepelin (1892) and supplanted the view expressed earlier by Morel, who denied the existence of any specificity in psychological disorders related to their aetiology.

Emotionalism, occurring as excessive or inappropriate weepiness or laughter, is a common and distressing symptom of the pseudobulbar state. It interferes with conversation, is socially embarrassing, and occurring during eating or drinking can be dangerous, particularly so in a patient already dysphagia Preliminary and uncontrolled use of imipramine in a few cases of this condition impressed us with its efficacy, and we therefore engaged in a “double-blind” form of therapeutic trial, comparing two dose strengths of imipramine with phenobarbitone and dummy tablets given in random sequence to each patient. Our favourable impression of imipramine being confirmed, we then attempted to assess the effect on this symptom of two other drugs of related pharmacology.

The relationship between a patient's illness and psychiatric disturbance in the spouse is a matter of importance and increasing interest (Penrose, 1944; Slater and Woodside, 1951; Gregory, 1959; Ryle and Hamilton, 1962). Explanations based on environmental conditions (Pond, Ryle and Hamilton, 1963), genetic factors (Coppen, Cowie and Slater, 1965) and assortative mating mechanisms (Kreitman, 1962; Nielsen, 1964) have been found to be inadequate and research has come to focus on the nature of the marital interaction itself (Kreitman, 1964).

Among all the childhood influences that may affect individual development and contribute to breakdown in adult life, the quality of parental care has always appeared of paramount importance. The supposed sequelae of parents’ absence have been the subject of many studies, relating particularly to depression (Dennehy, 1966, and Hill and Price, 1967) and to attempted suicide (Greer et al., 1966). In the latter study a significant association was established between absence of either parent and a later suicidal attempt, especially if the absence started in the first five years of life.

This article presents the results of a study initiated by the late G. R. Hargreaves, Nuffield Professor of Psychiatry at the University of Leeds.

During the past two decades an increasing number of investigations have been made into the relationship between maternal age and incidence of disease. The following may be mentioned by way of illustration.

In a previous paper (Abe and Moran, 1969) we analysed observed increases in paternal and maternal ages in 291 male homosexuals admitted to the out-patient or in-patient departments of the Bethlem Royal and Maudsley Hospitals during 1949–1960. It was shown that the mean mothers’ age of these patients was 2.31 years greater than would be expected in the general population after taking account of the years of birth of the patients. The similar shift in mean paternal age, using an indirect method of calculating the expectation, was between 3.15 and 3.55 years. On carrying out an approximate regression analysis of each of these shifts on the other it was shown that the shift in maternal age could be completely explained as an effect due to a shift in paternal age, but not vice versa.

It is well known that an individual with a family history of schizophrenia carries an increased risk of manifesting the disorder in comparison with members of the population at large. Also, within the population of schizophrenic patients, individuals may or may not have other members of the family affected. Obviously also, schizophrenic patients may be distinguished by gradations of severity of the illness. Whether familial incidence of schizophrenia and severity co-vary, however, remains an open question.

A psychotic v. neurotic scale has been presented in the manual of the Symptom-Sign Inventory (Foulds and Hope, 1968). This scale was constructed after comparing each of four female neurotic groups with each of four female psychotic groups and each of four male neurotic groups with each of four male psychotic groups. For an item to be included in the scale 14 of the 16 comparisons within each sex had to show differences significant at least at the 5 per cent. level. On 18 items the psychotic groups had frequencies in excess of the neurotic; on only one item was it the other way round. The scale score is the sum of these 18 items minus the one.

This paper summarizes the experiences of five years of treating sexual disorders with behavioural methods. The simplicity of the methods used made it easier to adhere to the principles of accurate timing than has appeared to be the case where a more complicated set-up has been used. The only elaboration of the basic method was its prolongation into a maintenance phase.

Disorders of body image are reported to be relatively common, and have been observed in some studies to occur in as many as 25 per cent. of psychiatric patients (Lukianowicz, 1967). Reduplication of the body image, however, is comparatively rare. Although classical literature is rich in descriptions of visual hallucinations of the self, it is only comparatively recently that this phenomenon has received medical attention. Coleman (1934) wrote at length on the possible psychological significance of the “double”, but it was left to Lhermitte (1951) to study such autoscopic experiences clinically and to draw attention to their medical importance.

Neuropathological study of the group of presenile dementias, whether apparendy primarily a degeneration of cortical neurones or secondary to vascular, inflammatory or other disease, has for obvious reasons centered on the brain. However, it is possible that the degenerative process may in certain types also affect the peripheral nervous system. If this were so it would be valuable to recognize it not only from the pathological point of view but also, since peripheral nerves are more easily investigated during life, for differential diagnosis which is often difficult and sometimes impossible on clinical findings alone. While involvement of the lower motor neurone is unlikely to be present without causing physical signs impairment of sensation due to involvement of the primary sensory neurone may be overlooked, more especially because sensory testing is often not possible in demented patients.

The classic and pure form of Gilles de la Tourette's syndrome is characterized by: (1) Multiple motor tics, generally developing during childhood or adolescence, starting in the face, neck or hands, and tending to spread to involve most of the skeletal muscles. Sometimes they are paroxysmal, but the victims never lose consciousness. (2) “Vocal tics”, occurring when the contractions spread to the laryngeal muscles. The victims utter sounds, often resembling the cries of an animal, such as barking, bellowing or whinnying (3). Generally the last to appear, though the order probably varies, is a compulsion to shout obscene or blasphemous words, insults or oaths. Echopraxia and echolalia are disorders bordering on this syndrome, and sometimes accompanying it.