Two cases of Gilles de la Tourette's syndrome occurring in Sri Lanka are reported. Both patients had the characteristics of the syndrome as described by Fernando (1967): (1) Childhood onset (below 16 years of age); (2) Multiple motor tics; (3) Unprovoked vocal utterances which may progress to coprolalia. Both responded to haloperidol, withdrawal of medication being followed by relapse, and reintroduction by remission.

The literature on the aetiology of the condition has been reviewed. The weight of evidence favours an organic cause, although psychological precipitation cannot be ruled out.

A survey was made of all female admissions to the State Hospital, Carstairs, between the time of the first female admissions in 1959, and 31 December 1973. There were 66 female admissions, constituting 7·1 per cent of the total admissions over the same period. The females fall into two separate sub-groups. The first consists of persistently violent patients transferred from other hospitals, suffering from mental subnormality or personality disorder; they have a poorer prognosis than the second group, who are sent from Courts or prison because of single serious acts of violence often directed at a member of the family, and who suffer from a personality disorder or from schizophrenia. Some features of the two groups are compared and contrasted. There may be an increase in the proportion of patients in the first group being admitted to the State Hospital, and some implications of this trend are discussed.

Early reports on enhancing occipital alpha through feedback noted that subjects reported the experience as being pleasant and relaxing. This paper reports the subjective experiences of 140 subjects who participated in four studies which examined the alpha enhancement phenomenon. Under both eyes-open and eyes-closed conditions, approximately 50 per cent of the subjects reported that alpha enhancement was ‘pleasant’ and 50 per cent ‘unpleasant/neutral’. With eyes-open training conditions, about half the subjects stated that the experience was ‘relaxing’ and the other half ‘not relaxing’. During eyes-closed training, 63 per cent of the subjects noted that enhancing alpha was ‘relaxing’, while 37 per cent reported that the experience was ‘not relaxing’. However, in the last case the circular relationship between increased alpha and deep relaxation may obtain.

This memorandum is concerned with manpower needs for psychotherapy. Discussion will be principally concerned with the consultant grade and its associated career structure, but reference will be made to other sources of psychotherapeutic manpower.

Its recommendations should be regarded as supplementing those in the College’s previous memorandum, submitted to the Central Manpower Committee in 1973, on the level of medical staffing needed to achieve acceptable standards of psychiatric care for ‘mental illness’ only.

A battery of psychological tests was administered on three occasions over a three-month period to 75 patients admitted to a geriatric hospital and 75 patients admitted to psychiatric hospitals serving the same catchment area. The test results, used as an independent criterion, provided evidence that the criteria of psychiatric diagnosis were applied with constancy and accuracy in the two types of hospital, and supported the psychiatrists' findings that there were no strong grounds to believe that elderly patients were being ‘misplaced’ in one or other type of hospital facility.

In a controlled trial, ‘reality orientation’ for elderly patients diagnosed as suffering from dementia is shown to be effective only where therapists actively participate. Exposure to change in a more stimulating environment than their own wards is not enough to produce sustained improvement.

The physiological response to stress falls mainly on the cardiovascular system, adrenergic stimulation resulting in peripheral vasoconstriction and an increase in systemic blood pressure. The analogous effects that occur in anxiety-provoking situations immediately suggest an association, whether causal or effectual, between raised blood pressure and anxiety. It has also been suggested that hypertensive individuals exhibit more aggressive traits than others and that these may be hidden or suppressed, becoming manifest by abnormal elevation of the blood pressure (Smirk, 1957).

This paper describes a controlled study of 22 non-psychotic female habitual self-cutters. In this study an habitual self-cutter is defined as a patient who has cut herself with a sharp object on at least two separate occasions.

Personality profiles of 79 non-psychotic male offenders admitted to a security hospital were subjected to a cluster analysis. Four profile types were generated, classifying four-fifths of the sample, and differences were found between the types in previous antisocial behaviour. Two of the types were identifiable as primary and secondary psychopaths, while the remaining two showed little resemblance to the concept of the psychopathic personality. The primary psychopaths were extraverted but not neurotic, while the secondary psychopaths were neurotic, but not extraverted. Both were highly impulsive but distinguished by a dimension of sociability-withdrawal.

A replication study of the effects of single-night sleep deprivation therapy was carried out as a preliminary to a controlled comparison with orthodox antidepressant measures. The results show that sleep deprivation therapy was acceptable to a majority of the patients studied, and was followed by an improvement in over half those who completed treatment. Adverse effects were minimal. The authors feel that further clinical and physiological study is warranted.

This study attempted to assess the applicability of the Clinical Interview Schedule (Goldberg et al., 1970) to mentally handicapped patients in a hospital. Twenty-seven patients were rated simultaneously by three raters. Of the 31 items assessed for reliability, 11 were completely satisfactory, 8 were satisfactory, 6 unsatisfactory and 6 ‘not proven’. Ratings made by all raters for overall severity of psychiatric illness correlated significantly with similar ratings made by the consultants responsible for the patients.

It is known from the Education and Manpower survey of 1971 (Brook, 1973) that some psychiatric senior registrars will not, for a variety of reasons, be aiming for a consultant post in general psychiatry in this country. Some will change to another psychiatric specialty or even to a non-psychiatric specialty, some overseas graduates will want to return to their own countries and some home graduates will emigrate. What is not known is the numbers involved. This is of some importance in manpower planning; if, for example, a substantial minority do not go on to consultant posts in general psychiatry, the number of senior registrar posts will have to be increased so that there are sufficient senior trainees to fill consultant vacancies.