I am no expert in the field of mental handicap and what I have to say derives from a general rather than a special acquaintance with the subject you are to discuss. That may be no bad thing, because much of the extensive change which has come over the psychiatric field in the past twenty years has been due to a change of outlook by those outside psychiatry, giving better opportunities for those within.

This paper outlines one method of investigating the phenomenology of spontaneous hallucinations in a mental hospital population; and considers the possibility of using the method as an aid to differential diagnosis.

Capgras syndrome and de Clérambault's syndrome are ‘uncommon psychiatric disorders' (Enoch, Trethowan and Barker, 1967). The literature contains accounts of one or very few cases of each. With both conditions, nosologists have been in dispute as to whether the syndrome is a description of specific bizarre symptoms occurring in the context of another psychosis or is a distinct entity.

Since the French psychiatrists Capgras and Reboul-Lachaux published their paper first describing the ‘illusion of doubles' in 1923, other cases of the syndrome have been published giving the impression that it really occurs only in affective disorder and in schizophrenia. This viewpoint was definitely expressed in the excellent review of the Capgras syndrome in Some Uncommon Psychiatric Syndromes by Enoch, Trethowan and Barker (1967)— ‘Since it occurs in a clear sensorium, it is obvious that there is no organic basis to the condition, but it is rather a functional illness and, as such, is explained on a psychodynamic basis.’

Deviant language behaviour is the primary basis for the clinical inference of thought disorder. Bleuler (1950), for example, emphasizes loose associations and disjointed utterances. Mayer-Gross, Slater, and Roth (1960) state that thought disorder is indicated by such conversation characteristics as ‘woolly vagueness', in-consequential following of side issues, direction by alliteration, analogies or clang associations, and the use of words out of context. However, psychological studies have typically used measures of disordered thinking derived from performance on categorization tasks. Such tasks do not obviously measure the abnormality which is definitive for the clinician. The study reported here was an attempt to relate measures of language effectiveness to overinclusive thought disorder.

In the search for an explanation of the aetiology of psychiatric illness, the study of the family as a unit for psychiatric research is becoming increasingly necessary. That family members resemble one another in many respects seems an intuitively correct idea. Children resemble their parents in both physical attributes and temperament; the former is mainly attributed to heredity and the latter to an interaction of heredity and social learning. Previous psychiatric studies of the family have indicated two areas for further investigation: firstly, sex concordance, and secondly diagnostic concordance among psychiatrically ill first degree relatives. The literature relating to these areas is abundant, and the main conclusions are summarized below.

The possible role of environmental stress in precipitating the onset or relapse of acute schizophrenia was investigated by Brown and Birley (1968), Birley and Brown (1970). They enquired about events which could be dated to a definite point in time and which usually involved either actual or threatened danger or important fulfilments or disappointments. They distinguished between independent events, which were outside the control of the subject, and possibly independent events, which were not so clearly out of his control but which seemed unlikely to be produced by unusual behaviour of the subject himself. In their main group of patients a significant concentration of independent events (about 60 per cent) was found in the three weeks preceding onset or relapse of schizophrenia. In examining two small sub-groups they found that 4 of 13 patients (31 per cent) who relapsed after reducing or discontinuing phenothiazine therapy had experienced a life event in the three weeks before relapse, compared with 3 of 5 patients (60 per cent) who had been taking phenothiazines regularly at the time of relapse. Although these proportions are very different, the numbers in the groups are too small for the difference to reach significance. Furthermore the groups were not matched in any way, and there may be important differences between patients who discontinue medication themselves and those who carry on taking it regularly.

The concept of brain disconnection derives from work in which the two cerebral hemispheres are surgically separated by division of the corpus callosum. The patient behaves as if his two half-brains function to some degree independently. The syndrome of brain disconnection is exemplified by such split-brain cases (Geschwind, 1965). Neither hemisphere shows an awareness of the functions of the other, and there is a marked failure to cross-match stimuli across the midline of the body. The integrity of the corpus callosum is essential to normal integration between the hemispheres.

Obsessional neurosis can be more resistant to treatment, and sometimes even to amelioration, than almost any other form of psychiatric illness. Pollitt (1969) has pointed out that, ‘true obsessional states are among the few illnesses that can still torture patients almost for a lifetime’, and other reports have shown that a generally bad prognosis is to be expected among such patients (Kringlen, 1965; Templer, 1972). As a means of helping patients with obsessional illnesses, various types of psychosurgical operation have been attempted (Lewin, 1961; Knight, 1964; Post, Rees and Schurr, 1968; Knight, 1969). In this paper we present a detailed review of a series of patients who had undergone stereotactic psychosurgical operations for these conditions, in order to assess the value of this method of treatment and also to attempt to identify factors which might have prognostic significance. Some of the patients reviewed had also had second operations of other types.

Over the past hundred years, a great deal has been written about obsessional neurosis. Much of the literature is theoretical, concerned with putting forward explanations for obsessional behaviour. Little attention has been given, however, to the question of what it is that requires to be explained, what it is about the obsessional symptom that is pathological. It is the aim of this paper to examine this question more closely.

This case report describes an apparently effective treatment of severe obsessional rituals which was carried out along with therapy of marital discord. Previous treatments directed towards the obsessional symptoms had little effect, but conjoint marital therapy produced marked improvement. The treatment consisted of asking each spouse to list the desired behaviour in the other; each then agreed to carry out a previously specified activity which the other desired.

A diagnosis of personality disorder is commonly used in psychiatry. It is generally agreed to refer to a disorder manifested by limited adaptive flexibility and certain relatively fixed ineffectual modes of behaviour (Ausubel, 1961; Brody and Lindbergh, 1967; DSM II, 1968; Noyes and Kolb, 1958; Schneider, 1950; Small, Small, Alig and Moore, 1970; Walton, Foulds, Littman and Presly, 1970). However, of twenty or more different types of personality disorders only antisocial personality has been differentiated by rigorous criteria as a distinct diagnostic entity (Robins, 1967; Feighner, Robins, Guze, Woodruff, Winokur and Munoz, 1972; Robins, 1966).

The theory has been put forward in Crime and Personality (Eysenck, 1964) that criminals are characterized by a combination of extraverted and neurotic personality traits; put in operational terms, it was suggested that compared with a control group of normal (non-criminal) subjects they would have higher scores on the N and E scales of the MPI or the EPI (Eysenck, 1959; Eysenck and Eysenck, 1964). In the second edition of the book the further hypothesis was added that prisoners would also be characterized by high P scores; the letter P refers to a third dimension of personality provisionally entitled ‘psychoticism’. Earlier investigations of the N x E hypothesis have been reviewed in the second edition of Crime and Personality (Eysenck, 1970) and by Passingham (1972); the most recent study of both hypotheses is contained in two papers dealing with the personality makeup of male prisoners (Eysenck and Eysenck, 1970, 1971). The conclusions to be drawn from an examination of the literature are as follows: (1) As far as P is concerned, prisoners undoubtedly have much higher scores than do various types of control groups. (2) As far as N is concerned, most studies show prisoners to have significantly higher scores than controls. (3) As far as E is concerned, it appears that scores sometimes do and sometimes do not separate prisoners and controls in the predicted direction; it seems that we must distinguish between the two main components of E, i.e. sociability and impulsivity (Eysenck and Eysenck, 1969). Prisoners are significantly more impulsive, but less sociable, than controls.

In this study an attempt was made to relate personality as measured by the Middlesex Hospital Questionnaire (Crown and Crisp, 1966, 1970) to selected psychosocial characteristics of undergraduates in residence, the majority of whom were between 18 and 22 years of age. Individual questionnaires were sent out. Just under 50 per cent of the questionnaires were returned, and the present analysis is based on this sample.

It is widely believed that knowledge of an adult patient's childhood is of great assistance in understanding the development of his illness. It has been thought that with advances in the understanding of psychogenesis of illnesses, where this is a major pathogenetic mechanism, it would eventually be possible to predict specifically who will develop which particular adult illness; a further hope would be that these adult illnesses could then be prevented.

This paper draws attention to an increase in the number of cases of anorexia nervosa presenting at a University Student Health Centre in the last few years.

There is evidence that depression may be associated with retention of sodium, and on recovery electrolyte changes return to normal (Shaw, 1966; Elithorn et al., 1966). In the premenstrual syndrome, psychiatric symptoms commonly occur, particularly depression; together with fluid retention. Thiazide diuretics, which cause excretion of water, potassium and sodium, are an effective form of treatment of the syndrome. In consequence, it would seem logical to assess the effects of a thiazide diuretic given to depressed patients.

Psychiatric Day Hospitals are likely to play an important role in the development of community psychiatry. Although they have existed in Britain for approximately 25 years, there is much that remains unknown about them. The present is a report of the functioning of a Day Hospital over a period of ten years. Stress is laid on (a) the source of patient referrals; (b) the diagnostic categories of the patient, and (c) the follow-up of patients after discharge.