Although the clinical tests of the sensorium (CTS) recommended in some standard psychiatric textbooks (Slater and Roth, 1969) are in common use, and although there have been studies using most of the constituent tests, there have been few investigations into the entire collection of tests.

Although the clinical tests of sensorium (CTS) are widely used as a quick check of mental efficiency (Slater and Roth, 1969), they have come together in a haphazard way and their validity has been questioned (Shapiro et al., 1956). For example, a patient may be able to perform well on so-called memory tests such as Digit Span and Babcock Sentence and still have a florid memory disturbance (Roth and Hopkins, 1953; Zangwill, 1946).

In this article seven cases of frontal brain tumour, all of which were meningiomas, are reviewed and observation of their psychiatric presentation given. For various reasons frontal meningiomas are found more frequently in mental hospitals than in neurological centres (Hunter et al., 1968).

The Capgras syndrome, first described by Capgras and Rebould-Lachaux (1923), is the name applied to a peculiar delusional system in which the patients come to believe that persons well known to them—usually close relatives—are impostors who have assumed the exact appearances of those whom they have supplanted. The majority of examples of this condition have been observed in schizophrenic patients but, like most eponymous titles in medicine, the term was applied to a disease pattern that failed to fit conveniently into existing classification. Most branches of medicine, with the gradual accumulation of new information, pass through an ‘identification’ phase when new syndromes are being discovered. A further 'synthesizing’ phase is eventually reached when researchers, equipped with greater knowledge regarding likely aetiology, pattern of symptoms and treatment, are able to appreciate the wider implications and ramifications of the problem, as well as uncertainties surrounding the initially identified disease pattern. In psychiatry, titles that emphasize specific patterns of symptomatology tend to be the rule rather than the exception, but advances in psychopathology, neuropsychology and neuropathology imply a need for reassessing the contribution of a purely phenomenological approach to the problem. Such an approach may well be overdue as far as the Capgras and other syndromes are concerned. The following case is presented in the hope that the condition, when it is recognized, will be evaluated in terms of its aetiology, and that attention will be paid to the more fundamental questions of psychopathology and related patterns of neuropsychological function.

The classification of affective disorders has been a topic of controversy for years. The literature is filled with tentative attempts to order this large group of patients. Such attempts have brought surprisingly little resolution of the issues involved. There are those who would make numerous subdivisions within the affective disorders, and others who see affective illness as a unitary disorder.

Breathlessness is a difficult symptom to define (Howell and Campbell, 1966). Comroe (1966) spoke of the value of obtaining detailed accounts, in the patients' own words, of how they experience their breathlessness. Olsen (1964), who wrote that, ‘the problem of defining dyspnoea becomes a little easier if it is considered as a complex of completely subjective symptoms,’ also stated ‘it is recognized that difficult breathing may be observed by the physician without the patient being aware of respiratory embarrassment’.

Psychoanalysis is not regarded as having a significant part to play in the treatment of the psychoses. This view has been strengthened by the ease with which the phenothiazine and other drugs may bring many psychotic symptoms under control. Nevertheless, there are psychiatrists who believe that psychoanalysis, in its classical form or suitably modified, can benefit patients suffering from psychoses. The issues which have been raised by these claims are still the subject of controversy among psychiatrists and psychoanalysts. This paper is not concerned with details of the different kinds of analytical treatment which may be recommended for patients. Such an account would be inappropriate in the circumstances of current psychiatric practice in the United Kingdom. Instead attention will be focused on the way in which psychoanalysis can be integrated into therapeutic regimes presently employed in mental hospitals.

The literature on the treatment of sexual frigidity indicates that some success can be obtained by a variety of methods, including psychoanalytic interviews (Abrahams, 1956), insight therapy with physical self-examination (Dawkins and Taylor, 1961; Ellison, 1968), group therapy (Stone and Levine, 1950), desensitization (Lazarus, 1963), and directive advice and counselling (Hastings, 1967; Masters and Johnson, 1970). This investigation aims to look at the different kinds of frigid women and to see if this is related to outcome in treatment.

As part of a study of the predictive value of a picture-story test in relation to verbal behaviour in group therapy, a positive relationship was recently found between the number of participations patients made in the first session of a new therapy group and the number of times they described human figures on a projective story test as making active, observable ‘approach’ movements toward another person or place (Aston, 1970). It was hoped that this finding might prove helpful in selecting patients for group therapy.

This investigation is a direct sequel to the work on evaluation of group psychotherapy already published in this journal (Sethna and Harrington, 1971). The method, setting and aims of the main investigation were described in the original paper and will not be repeated here. The need for the present study became evident when it was found that of the 94 patients considered for the evaluation study as many as 37 (41 per cent) lapsed or discharged themselves without completing their treatment, and against medical advice.

Five years ago, with the co-operation of the Jesmond Council of Churches, I opened a Clinic in Church premises in Newcastle upon Tyne. A rota of clergymen of all denominations volunteered to help at each session, which were held on a Monday afternoon and, later, also in the evening.

In this study memory changes during and after electroconvulsive therapy were investigated by means of three different tests. The investigation was double-blind and the subjects were 96 patients hospitalized with depressive illness. Amounts of post-ECT amnesia were evaluated in relation to number of treatments for symptom remission and stability of the therapeutic result over the period of one year.

Memory deficit persists as the principal undesirable side effect of convulsive therapy. In an attempt to minimize this deficit Lancaster, Steinert and Frost (1958) introduced unilateral electrode placement to the non-dominant hemisphere as an alternative to the standard bilateral placement of electrodes. They suggested that clinical improvement with unilateral placement was the same as for bilateral ECT, but that memory impairment was less severe.

The growing adoption of ECT given unilaterally to the right hemisphere in right-handed patients, in preference to the classical bilateral treatment, is due to its shortening of the duration of post-treatment confusion, to its superiority in preserving memory and learning assessed three months after the start of treatment (Halliday et al., 1968) and to its therapeutic equivalence. (For a critical assessment of published results, see d'Elia, 1970.)

The use of metronidazole as an adjunct to treatment in alcoholism was first reported by Taylor (1964). Her study of 52 alcoholics led Taylor to suggest three effects of metronidazole in alcoholism—a reduction of craving for alcohol, a psychic aversion to alcohol, and in some cases an antabuse-like response.

An analysis of the general results of a drug monitor in a psychiatric unit have been reported previously (Gardiner and Hall, 1971). One of the principal findings of that analysis was that the propensity for ‘untoward events' increased as the number of drugs that a patient received increased. The definition of ‘untoward event’ was that given by Finney (1965)—a‘n event is a particular untoward happening experienced by a patient, undesirable either generally or in the context of his disease. The term is not to be limited either to recognised side-effects of a drug or to incidents that are in some sense unexpected’. This paper takes this particular aspect of the investigation further in an attempt to describe the prescribing practice and to discover any particular drug or combination of drugs that was associated with a high frequency of ‘untoward events'.