Introduction Obsessional neurosis is considered to be resistant to behaviour therapy; the literature is reviewed by Marks et al. (1969). Wolpe and Lazarus (1966) described a ‘thought-stopping’ technique for this condition, but subsequent workers have largely ignored this method. In the case to be described, it was used experimentally with apparent success, and in view of the therapeutic nihilism felt about obsessional neurosis it was thought worthwhile to report this long-standing and previously resistant case.

A recent note by Karon and VandenBos (1) on psychotherapy of schizophrenic patients claims to have demonstrated that additional psychotherapy produced significantly better results than the usual hospital treatment; and that outcome depended strikingly on an interaction between the use of drugs and the experience of the therapist. In presenting their findings as a challenge to a report by May and Tuma, they fail to point out that their results run contrary also to the general trend in other studies of psychotherapy and schizophrenia. These indicate that, even when given by experienced therapists, psychotherapy for hospitalized schizophrenic patients is, in general, relatively ineffective, while drug therapy enhances results regardless of the therapist's experience.

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.

Riemer (1955) has argued that gaze is an ‘expression of affect’ between individuals. Kendon (1967) writes that the direction of gaze has a regulatory and expressive function, and ‘fluctuations in the amount of eye-contact during the course of one conversation showed that it was inversely related to the amount of emotionality displayed by the participants'. Also that it has a regulatory function which governs the pattern of social interaction. Argyle and Dean (1965) made similar observations in their concept of intimacy. They postulate that there is an Intimacy Equilibrium; Intimacy is a function of eye-contact, physical proximity, intimacy of topic, amount of smiling etc. They have shown that an alteration in one variable produces a change in the others until an equilibrium is reached. Exline et al. (1965, 1966, 1967) have described other aspects of eye-contact in relation to sex, dependency, social reinforcement, affiliative needs and affective relations. These findings support those of Kendon and Argyle.

In recent studies in alcoholism where systematic desensitization of social anxiety has been used, it would appear that there are many changes in the total behaviour of the patient, as well as the removal of the need for excessive alcohol (Kraft, 1968). This paper aims at evaluating the changes which occurred in nine patients treated in this way, as shown in a variety of psychometric tests. Although the small size of the sample limits the scope of the study, it is hoped that the information might be of use to further investigators in this field.

Pimozide is a new neuroleptic drug and is chemically described as bis-para-fluoro-phenyl-butylpiperidine. It is active after oral administration, with a 24 hour duration of action and a peak effect lasting four to six hours (1). Superiority over placebo has been demonstrated by Brugmans (2).

The classification of depressive illnesses continues to be a problematic and controversial issue (Kendell, 1968; Hope, 1969). The many statistical approaches applied to this complex question since Hamilton's original study (1960) have been reviewed by Kendell (1968). More recently, Pilowsky, Levine and Boulton (1969) have offered evidence (based on the application of information theory taxonomy to patients' questionnaire responses) which supports the validity of regarding ‘endogenous' depression as a clinical entity. Following on this study, Pilowsky and Boulton (1970) have developed a decision rule for the identification of depressive class members and have shown that class membership is related to the response to electroconvulsive therapy; patients in the ‘endogenous' Class B group having a better clinical outcome.

Many text-books of psychiatry include an inquiry about a history of nail-biting in their scheme of history taking, and if nail-biting is noted when a patient is examined it is often recorded.

The use of mono-amine oxidase inhibitors (MAOI) entails the risk of hypertensive crises with various foodstuffs and other drugs. On the other hand, the tricyclic antidepressants have a slow onset of action, and this may be a serious disadvantage in a condition like acute depression where there is always a danger of suicide. The use of an MAOI can therefore be justified if it is shown to be more effective than the tricyclic compounds.

Unilateral E.C.T. applied to the non-dominant hemisphere has been tried by several workers in cases of depressive illness. Although Levy (1968) has pointed out that the evidence is not sufficient to recommend unilateral E.C.T. as a routine procedure, its main advantages over bilateral E.C.T. have been demonstrated as reduction of post-E.C.T. memory disturbances (Zinkin and Birtchnell 1968 and Valentine et al., 1968), and diminution of post-E.C.T. confusion (Halliday et al., 1968). The present investigation studies the effect of unilateral E.C.T. on schizophrenic delusions and hallucinations with a view to testing the hypothesis that the apparent superiority represented by the diminished side-effects with the unilateral technique might be therapeutically disadvantageous where treatment of patients with delusions and hallucinations is concerned. According to this hypothesis memory impairment may be part of the therapeutic mechanism responsible for the disruption of delusions and hallucinations and their ultimate amelioration or disappearance. If this hypothesis is correct patients treated with bilateral E.C.T. should do better than those treated with the unilateral technique.

Recently increased interest has been shown in the physiological and behavioural consequences of DC polarization of the brain.