The use of unilateral ECT as a method of exploring differences between the functions of the cerebral hemispheres has been suggested by Pratt et al. (1971). These authors found a greater impairment on a test of naming and a tendency to slower return to consciousness after left-sided than after right-sided treatments. Assuming that these effects depend on left hemisphere language specialization, they went on to use them as possible indicators of cerebral dominance for speech in left handers. The present enquiry was designed to explore these differences further by comparing patients immediately after right-sided and left-sided ECT for their ability to name objects and to make visual discriminations and for their time of recovery. Handedness was assessed through a measure of relative manual speed as well as by the usual questions of preference and family handedness. The speed differences give a continuous measure of degrees of right and left handedness which can be correlated with measures of differences between the effects of right-sided and left-sided ECT.

The token economy is an application of operant conditioning theory which is particularly relevant to the treatment of patients in institutions. The basic idea is to motivate the patient to behave more appropriately and constructively by giving him tokens whenever he behaves in such a way. The tokens have an incentive function, as the patient can cash them in for a number of different things, such as pleasant single room accommodation, cigarettes, magazines, TV viewing, drinks etc., depending upon what is programmed into the token economy. The theory of operant conditioning is that not only does the token motivate the patient to behave in certain ways, but ‘reinforces' his behaviour. Such reinforced behaviour should eventually become an integral part of the ‘way he is', continuing even when the token is removed.

The occurrence of psychiatric complications following the administration of ACTH and corticosteroids is well recognized. Psychiatric disturbances usually take the form of euphoria or elation in mood. Depression is less likely, and irritability or aggressiveness may occur. In about 5 per cent of cases the alteration in mood may be accompanied by clouding of consciousness, delusions, hallucinations and disorientation. This picture of an organic confusional state is said to result from high doses and prolonged therapy with corticosteroids and ACTH. The latter is recognized to cause psychiatric sequelae more often than the corticosteroids (Truelove and Witts, 1959). Disturbances may appear within six to seven hours of initial therapy (Goolker and Schein, 1953), after prolonged administration, or even after complete withdrawal of the hormone therapy.

Anorexia nervosa is a disorder characterized by loss of appetite, amenorrhoea, and weight loss in the absence of any primary psychiatric or physical illness (Dally and Sargant, 1966). Features which have recently been stated to be of value in distinguishing it from anorexia due to other causes are: denial of illness, bradycardia and lanugo hair (Wright et al., 1969). The weight losses in this condition are usually at least 20 per cent of ideal body weight, depending on the quality and promptness of treatment.

Opinions differ on the effectiveness and the risk involved in treating depressive illnesses with combinations of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants. Some authorities, including the Food and Drug Administration in the United States, the former Witts Committee in this country, and the pharmaceutical firms producing antidepressants, have given serious warnings against combining MAOIs with tricyclic antidepressants. These warnings have been repeated more recently by Beck (1967), Malitz (1966) and Shepherd et al. (1968).

It has not previously been suggested that prolactin may be involved in mental illness. Yet virtually every drug used in psychiatry either stimulates or suppresses prolactin secretion (Fluckiger, 1972). Prolactin causes renal sodium, potassium and water retention (Horrobin, 1973). It is bound to cerebral tissue and alters hypothalamic activity (Turkington and Frantz, 1972; Clemens, Gallo, Whitmoyer and Sawyer, 1971). Prolactin levels up to 100 ng./ml. potentiate the responses of smooth muscle cells to noradrenaline, while higher levels inhibit the responses: preliminary studies suggest that nerve cells behave in a similar way (Manku, Nassar and Horrobin, 1973). Emotional stress, surgery and drugs such as phenothiazines, reserpine and methyldopa can elevate human plasma prolactin levels into the 50–200 ng./ml. range (Frantz, Kleinberg and Noel, 1972; Friesen, Belanger, Guyda and Hwang, 1972).

This paper describes a double-blind drug trial to assess the effect of sulthiame on the behaviour of very disturbed mentally handicapped patients. Behaviour problems (especially hyperkinesis) are among the main causes of admission when parents or guardians cannot cope at home; and in hospital such patients constitute the main problems of management and reduce the time available for other patients. Moreover the present recognized treatments seem to have little effect on such behaviour if given within a dosage that avoids side-effects.

Good results with the use of lithium salts in the premenstrual tension syndrome have been reported (Sletten and Gershon, 1966); these observations await confirmation. The value of lithium is suggested by its known capacity to affect water and electrolyte balance implicated in the pathophysiology of the syndrome, and by its efficacy in psychiatric disorders characterized by periodicity. We therefore undertook a controlled study on the efficacy of lithium in the syndrome.

One of the earliest and best replicated findings resulting from the experimental investigation of animal learning is that conflict can produce disordered behaviour (Pavlov, 1927). These conflicts vary in kind, ranging from a conflict, as in the circle and ellipse discrimination experiments, between responding and not responding, to a conflict between approach and avoidance as in the pairing of electric shock with food. As Kimmel (1971) points out, whether or not a conflict produces disordered behaviour is a function of the animal's previous history. An ellipse has already to be clearly associated with ‘no food’ and a circle with food for disorder to be produced by presenting a circle and ellipse which are very similar to each other. Similarly, special conditions of training can be found which enable a dog to salivate and wag his tail in response to an injury severe enough to draw blood.

It is known that different mental symptoms may occur as early symptoms of acute viral meningoencephalitides. In herpes virus (HSV) infections of the central nervous system (CNS) the appearance of these symptoms is well documented (Juel-Jensen and MacCallum, 1972). The recurrence of psychotic symptoms in cases of recurrent HSV infections has also been described (Shearer and Finch, 1964; Drachman and Adams, 1962). In recent years serological observations of the prevalence of HSV antibodies in patients with psychiatric disorders have suggested a possible association of HSV infections with aggressive behaviour (Cleobury et al., 1971), as well as with psychotic depressions (Rimon and Halonen, 1969).