Twenty-seven diabetic men with erectile impotence were given physical and psychosexual assessments. Physical assessment included vascular and neurological evaluation. Psychosexual assessment was by means of a semi-structured interview. Seven potent diabetic men formed a control group. Patients with erectile failure Had a varied clinical picture which differed from the stereotype of diabetic impotence: morning erections were preserved in over a half (55 per cent), eight patients (30 per cent) had intact spontaneous erections, and sexual interest was reduced in 12 patients (44 per cent). In 13 patients (48 per cent) ejaculation was disturbed and a further four patients (15 per cent) described unusual disorders of sexual function.

Within the group there were no differences in clinical picture between those with and without autonomic neuropathy, retinopathy or potential psychogenic factors.

This pilot study seeks to identify the psychological problems in middle aged and elderly subjects with impaired hearing, and to determine whether hearing aids improve these.

The results indicate three main areas of psychological handicap and suggest that these are reduced by the provision of a hearing aid.

Reality orientation is now extensively used with psychogeriatric patients. The evidence for its effectiveness is reviewed and the underlying philosophy and assumptions are critically examined. Whilst reality orientation does appear to have some effect the benefits are small and restricted in range. It can be argued that it is not directed at the most appropriate therapeutic goals. Reality orientation should be seen as the starting point for the development of more effective intervention techniques for use with this client population and not as an end in itself.

Plasmas of 12 patients currently taking part in a double-blind trial of lecithin in senile or presenile dementia of Alzheimer type were analysed for plasma choline levels at fixed intervals during lecithin treatment. The values were not maintained at a constant level and showed a decline after one or two months of treatment, often followed by a subsequent rise. Possible explanations for this observation are given, and its significance to the treatment of dementia discussed.

A double blind trial on the effects of 2 mg of benzhexol on memory was performed on thirteen elderly subjects without cognitive impairment. The tests given 90 minutes after the drug or placebo involved learning a list of ten words, a paired-associate learning task, learning a short story and a test of digit span. Subjects were asked to recall the word list one minute after an interfering task, and 6 items from the story directly. Digit span involved immediate recall and the paired learning was measured by the number of trials necessary to learn. All tests were significantly impaired by the benzhexol except for digit span. This suggests that muscarinic blocking drugs should be avoided in the elderly, as they mimic the memory deficits found in senile dementia of Alzheimer type.

Trihexyphenidyl (benzhexol, Artane) is an anticholinergic drug widely used among the psychiatric population in order to control extrapyramidal symptoms from the use of anti-psychotic drugs. In addition to the many well-known somatic and psychiatric side effects caused by the drug (Shader and Greenblatt, 1971), including toxic psychosis, trihexyphenidyl has been reported as causing a euphoriant effect (Bolin, 1960; Jellinek, 1977; Parker, 1978; Rubinstein, 1978; Shader and Greenblatt, 1971; Goggin and Solomon, 1979). Benztropine and biperiden are known to have caused similar phenomena (Jellinek, 1977; Stephens, 1967). Trihexyphenidyl is known as an hallucinogenic agent amongst thrill-seeking adolescents (Rouchell and Dixon, 1977) and among prisoners in the US who abuse the drug either orally or by smoking it as a powder mixed with tobacco (Woody and O'Brien, 1974).

A double-blind controlled trial of phenelzine, amitriptyline and placebo was carried out in out-patients suffering from depression or mixed anxiety and depression. After six weeks treatment both active drugs were clearly superior to placebo and of similar efficacy; therapeutic effects started to appear at two weeks. Comparisons on symptom ratings showed that both drugs acted as true antidepressants, producing their greatest effects on ratings of depressive mood and thought content. There were additional weak differences, phenelzine producing more improvement on anxiety ratings, while amitriptyline gave greater effects on depressive impairment of work and interests and anergia. Analyses showed little evidence of clinical subgroups responding preferentially to either drug. The findings indicate that MAO inhibitors and tricyclic antidepressants have more closely similar clinical effects than has been thought and that either may be a useful treatment for these patients who are often considered to respond poorly to antidepressant drug treatment.

A 10 week double blind study of 24 agoraphobics and 16 social phobics all on clomipramine compared the effect of adding tryptophan or placebo. Tryptophan did not potentiate the beneficial effect of clomipramine on phobic avoidance, phobic fears or the incidence of panic attacks. Neither was the presence of depression a factor of outcome.

In an in-patient psychiatric unit attached to a teaching general hospital in Hong Kong, community meetings went through doctor-directed and nurse-directed forms to develop into a non-directive one. The therapeutic value of these different forms was tested by retrospective and prospective studies. In the retrospective study the rates of ward incidents and discharge rates of inpatients before and during the three stages were compared. In the prospective study an ABA design was used with ten-week blocks of regular non-directive meetings, cessation of meetings and then resumption; ward incidents, discharge rates and ward atmosphere during these blocks were compared. Both the non-directive and nurse-directed forms were equally associated with a reduction in ward incidents, aggressive incidents showing the greatest tendency to change; ward atmosphere and patient discharge rates did not change with community meetings.

First rank symptoms have assumed an important role in the assessment of schizophrenia. Only recently, however, have there been empirical studies of their reliability and validity. In this study, we examined the relationship between first rank and other psychiatric symptoms in 100 schizophrenic patients. The results are consistent with other research reports suggesting that first rank symptoms do not represent a homogeneous group of symptoms within an individual patient.

Spontaneous eye blink rates, psychiatric symptoms and response to neuroleptic medication may all be mediated by dopamine. Fixed doses of haloperidol, a dopamine blocking agent, were administered for six weeks to 17 chronic schizophrenic patients who had been previously withdrawn from all medications. The change in blink rates caused by haloperidol corresponded to a change in the thought disturbance syndrome which measures positive symptoms (r =.48, P <.05). The relationship was particularly clear in patients with normal cerebral ventricles (r =.74, P <.01).

Ninety-four psychiatric in-patients, receiving regular antipsychotic medication, were videotaped using a standard procedure. The tapes were rated by blind observers using a simple scoring system for the duration of abnormal movements. Using this combined videotape and rating scale assessment technique the re-rating reliability, inter-rater reliability and test-retest reliability were high. In order to demonstrate the validity of the technique the rating scale scores in a sub-sample of 30 patients, were compared with the assessment of three experienced clinicians on the same patients, and AIMS scores. Central (lip, tongue, jaw and neck movements) scores showed close agreement with the clinicians' assessment, suggesting that clinical diagnosis is based principally on the presence and severity of oro-facial dyskinesia. Total rating scale scores were in close accord with total AIMS scores. When the two scales were carried out on the same patients on the same occasion a diagnostic criterion level of 2 or more on the central score produced a tardive dyskinesia prevalence rate identical to that produced by an AIMS criterion level of 2 or more on the global severity rating. The tardive dyskinesia prevalence rate based on the central score criterion level showed an increase with age.

To test the hypothesis that schizophrenia can be differentiated on the basis of family history, the authors compared two matched samples of 20 patients each, distinguished by the presence or absence of family history of schizophrenia. Family history was not associated with either onset characteristics, symptom picture, phenomenological subtypes of schizophrenia, prognostic indicators or global assessment score for psychosocial functioning.

Forty-six users of the hallucinogen lysergic acid diethylamide were compared with 31 controls on a test of colour discrimination an average of two years after their last exposure to the drug. Controls performed better than users, and LSD users without flashbacks performed better than users with flashbacks. An analysis of variance between the three groups was significant at P <0.001. This study suggests that some users of LSD may have a sustained or irreversible impairment in colour discrimination.

A handedness test, administered to 88 manic male patients and 86 male control subjects, showed no difference between the two groups. The results suggest that unlike schizophrenia, mania is not associated with increased left and/or mixed-handedness.

The pattern and severity of alcohol withdrawal in 49 alcohol dependent subjects admitted to the Manchester Detoxification Centre are described. Assessment over 10 days involved the use of the Selected Severity Assessment Scale (SSA) and allocation of patients to subgroups of the alcohol withdrawal syndrome. There were associations between tremor, clouding of sensorium, hallucinations and convulsions (items of the SSA) and the four pre-delirious clinical sub-groups identified. We concluded that clinical assessment of the pre-delirious stage took into account these four variables and that there was little value in the routine use of the SSA on a unit such as ours.

Anorexia nervosa may sometimes be resistant to all forms of therapy, with cases running through a gamut of somatic and psychological treatments. One possible explanation for this may be that the illness is of heterogeneous aetiology (Kay and Leigh, 1938; King, 1963; Feighner et al, 1972), although others regard anorexia as a single condition that tends to breed true though having protean manifestations (Russell, 1970; Crisp et al, 1980). In most of the larger series of cases, a proportion have depressive symptoms both during the illness (Dally, 1969; Theander, 1970; Crisp et al, 1980) and some years later (Morgan and Russell, 1975; Hsu et al, 1979), and a family history of affective disorder is also commonly reported (Dally, 1969; Theander, 1970; Morgan and Russell, 1975). Cantwell et al (1977) have reviewed the complex relationship between depression and anorexia nervosa and have suggested that some of the remedies used in the treatment of depression merit further exploration in the management of anorexia nervosa. We report here a patient who was in hospital for over four years and in whose eventual improvement lithium may have played an important role.

Stimulated by the improvements contained in the ICD-9 of Mental Disorders, the author ventures to revive certain earlier suggestions aimed at its further simplification and homogenization. The major points are: (1) Three separate lists of items, one for each of the variables—Category, Specified Syndrome, and Aetiology, as well as compulsory registration of aetiology even when merely inferred. (2) Threefold diagnoses, built up by one item from each list, but with no catalogue Of preconceived combinations, the manual containing only the lists. (3) No running numbering of diagnoses, but codification by juxtaposition of three independent numerals.

Enormous industry has been devoted during the last half-century to establishing the genetic contribution to the aetiology of schizophrenia. Demonstration of a familial concentration of the disorder among the blood relatives of schizophrenics is supported by the differential concordance for schizophrenia found between monozygotic and dizygotic twins (Slater and Cowie, 1971; Gottesman and Shields, 1972; Shields, 1978). An alternative explanation offered was that the high familial incidence of schizophrenia was accounted for by the influence of a schizophrenic parent, particularly mother, or a sibling, or by a schizophrenogenic family configuration or pattern of communication. This speculation has been dispelled, however, by the brilliant series of studies which compared the outcome in the offspring of schizophrenics brought up at home with that of those adopted and brought up away from the schizophrenic parent (Heston and Denney, 1968; Kety et al, 1968; Rosenthal, 1970; Rosenthal et al, 1971; Wender et al 1971; Kety and Matthyse, 1972; Wender et al, 1974).