Factors from the social history of male psychopaths were examined in relation to their success or failure as measured by re-convictions or psychiatric hospital re-admissions 2–3 years after treatment at Henderson Hospital. From these data a weighted prediction formula was calculated and was tested out on a further cohort of patients. As a prediction instrument it was found to be reliable to a degree of significance just above the 1 per cent level. Other aspects of the subsequent career of treated patients are noted, in particular a tendency to early but often short-lived relapse and then longer standing success.

We compared conventional bilateral ECT treatment electrode placement with simultaneous unilateral electrode placement to both sides of the head (dominant/nondominant unilateral ECT) in 20 patients with endogenous depression. Under double-blind random assignment conditions we found that six bilateral ECT were significantly more effective than six dominant/nondominant unilateral ECT in reducing depression rating scale scores. In the light of data from intracerebral ECT current distribution studies we interpret our findings to support our previously advanced hypothesis that diencephalic stimulation is requisite for the therapeutic benefit of bilateral ECT in endogenous depression.

A group of 33 schizophrenic patients were typed for HLA-SD antigens and their qualitative clinical responses to chlorpromazine therapy determined. A highly significant positive correlation was found between response to chlorpromazine and HLA-A1 positive, while HLA-A2 positive subjects showed a significant negative correlation to chlorpromazine treatment.

In a second group of 17 patients the clinical responses to chlorpromazine were evaluated quantitatively, by WPRS, in HLA-A1 positive and HLA-A1 negative patients. There were no pre-treatment differences in the scores. After treatment the scores of positive patients were significantly lower, indicating that they responded to a greater degree.

Since the frequency of HLA-A1 in hebephrenic patients is higher than that in other schizophrenics this may explain our earlier finding that hebephrenics, as a group, respond better to chlorpromazine than do other schizophrenics.

Generalization of improvement in the behavioural treatment of psychotic patients must be planned in after-care settings, and for durability over time. The transfer of clinical gains is not an automatic by-product of treatment with severely and chronically impaired mental patients. Treatment strategies that facilitate generalization from hospital to community are illustrated in a case study using empirical data. Systematic and specific treatment programmes were co-ordinated between a state hospital ward and a community-based day hospital. Setting step-wise and limited goals is a feature of successful outcomes. Maintaining consistency in reinforcement contingencies from hospital to community settings, using natural reinforcers, pinpointing functional behaviours as therapeutic goals, over-learning, and training natural caregivers are methods that promote generalization.