This paper reports on the personality changes found in 261 patients after proven subarachnoid haemorrhage, and in particular on the association between these changes and the site and severity of damage to the brain. Psychiatric symptoms and details of intellectual impairment are not considered but will be reported elsewhere.

The main contention of this paper is that some of the transient side-effects of electroconvulsive therapy on human memory resemble, in kind if not in degree, those more severe and chronic learning defects that are known to appear as an incidental result of temporal lobectomy in man. If this claim can plausibly be supported it would imply a pressing need for the more systematic study of other modes of therapeutically effective ECT that would interfere as little as possible with the normal activity of those parts of the human brain that are essential for adequate learning and memory function.

This report describes an attempt to assess the validity of a number of cognitive tests in distinguishing between brain-damaged and non brain-damaged psychiatric patients over the age of 65 years.

The manifestations of the chronic brain syndrome associated with cerebral arteriosclerosis are notoriously diverse, ranging from disturbance of cerebral functions which can be recognized by physical examination to those which can be identified by examination of the patient's mental state. With widespread arteriosclerotic involvement of the cerebral circulation there are important alterations in the individual's thinking and behaviour. There is disturbance of memory, accompanied by disorientation, at first in time and place and later as to person; and intellectual functions including comprehension, problem solving, learning, and judgement are also impaired.

The syndrome of transsexualism has become widely known in psychiatry and is now clearly distinguished from both homosexuality and transvestism, as well as from hermaphrodism (Benjamin, 1953). Other authors such as Wålinder (1968), Hoenig et al. (1964) and others have given definitions of the syndrome, which might be circumscribed as follows: The transsexualists, although physically apparently normal, are nevertheless convinced that they are ‘inwardly really’ persons of the opposite sex; they claim to ‘feel’ like a person of the opposite sex, but think that the body has somehow—by a freak of nature—developed abnormally, and not in accordance with their ‘true nature’. They seek medical treatment, if necessary surgery, to have their body changed into what they conceive to be their ‘real’ sex.

This paper presents the results of electric aversion therapy in 24 patients with transvestism, fetishism, and sado-masochism. Preliminary findings have been reported elsewhere, together with a review of the literature and a discussion of the process of change during treatment (Marks and Gelder, 1967; Bancroft and Marks, 1968; Gelder and Marks, 1969). In these studies the available evidence indicated that the manifestations of the sexual disorder were diminished by treatment, and this appeared to be directly due to aversion rather than to non-specific components of treatment. The present report is concerned with the clinical outcome of these cases, with prognostic variables, and with the part aversion therapy should play in the treatment of these sexual disorders.

That there are wide regional differences in the demand for psychiatric beds is common knowledge, and is frequently commented upon. There is no generally accepted interpretation, and it is difficult to draw conclusions from a comparison between different areas when the crucial treatment facilities—in-patient and out-patient services, admission policies, after-care in the community—are far from uniform. It has been argued that much of the variability in admission rates is independent of mental disorder incidence and reflects other forces at work, such as the organization of the services available to the mentally ill.

Already an extensive literature exists on affective disorders, particularly depressive illness, in various developing countries of the world (Carothers, 1947; Tooth, 1950; Lambo, 1956 and 1960; Asuni, 1962; Pfeiffer, 1962 and 1963; Yap, 1965). Different authors have commented on different aspects of these disorders, and variations in their incidence, symptomatology and course have aroused widespread speculation regarding possible cultural influences on aetiology and clinical picture.

A number of patients referred for psychiatric consultation were found to show an insurmountable reluctance to return to work. This problem is of wide importance, medically and socially. The author's total failure, despite all efforts, to achieve rehabilitation in terms of a return to work prompted a detailed family study.

The application of modern technology to medical treatment offers new avenues of approach, including the use of closed-circuit television (Trethowan, 1968; Moore et al., 1965). This paper describes the successful treatment of a patient in which video-tape recording was used.

Mandrax (Roussel, Ltd.) is a combination of methaqualone 250 mg. and diphenhydramine 25 mg. and there have been several reports on its efficacy, as an hypnotic, which are cited by Derbez and Grauer (1967) and Haider (1968). It has been found to have approximately the same potency as various commonly used hypnotics, and it has been particularly recommended because of indications that overdosage is not associated with severe respiratory depression, as is the case with barbiturates (Lawson and Brown, 1967), and also because it does not reduce REM sleep as barbiturates do (Davison et al., 1970). It is stated to be particularly suitable for elderly patients. There is however, only one published trial on its use with patients with a variety of psychiatric diagnoses (Burke and Mahadevan, 1966); it is not specified in that report whether the patients were acute or chronic.

This is a preliminary report on a clinical trial designed to evaluate the effect of intravenous infusions of chlorimipramine as a possible alternative to ECT in the treatment of severe depression.

A number of publications have appeared in the last few years advocating the use of diazepam in the treatment of status epilepticus (Boyer, 1966; Gordon, 1966; Lombroso, 1966; Parsonage and Norris, 1967). The long term therapeutic value of diazepam in epilepsy is not yet so widely reported. However, Lehmann and Ban (1968) showed that the excitement and hostility so commonly encountered in epileptic patients can be successfully and selectively controlled by diazepam. It was also revealed in this study that diazepam had definite anti-convulsant effects in a certain number of epileptic patients; one third (7 patients) also improved psychiatrically.

While the treatment alliance (Sandler, Holder and Dare, 1970a) and some aspects of transference (Sandler, Dare and Holder, 1970b) relate to tendencies within the patient which act to maintain the treatment relationship, the concept of resistance is concerned with elements and forces in the patient which oppose the treatment process. Although resistance is a clinical rather than a psychological concept (Sandler, Dare and Holder, 1970a), originally described in connection with psychoanalytic treatment, it is one which can readily be extended, without substantial revision, to other clinical situations.