In making a diagnosis between psychotic and neurotic depression, characteristic signs and symptoms are usually looked for. Although there is much controversy in the literature in respect to this difference, particularly since Lewis's work in 1934, nevertheless one commonly observes that when people are sad they cry. We would expect, therefore, that this would apply also in depressions. Yet, in our survey of the journal literature and such major textbooks as Mayer-Gross, Slater and Roth's Clinical Psychiatry, Arieti's American Handbook of Psychiatry, and Freedman & Kaplan's Comprehensive Textbook of Psychiatry, the authors fail to include crying as a symptom of depression.

There is considerable disagreement in the literature and in clinical practice on the value of electro-convulsive therapy (E.C.T.) in hysteria. The case to be described adds support to those who believe that E.C.T. has a part to play in carefully selected cases of hysteria that have proven resistant to more orthodox lines of treatment.

In 1965 the Education Committee drew up a questionnaire on postgraduate training which was circulated to recognized psychiatric hospitals and psychiatric units in general hospitab. The results have been published in this Journal (November 1968, 114, 1441). The Committee recognized that this method of inquiry was by no means ideal, and in order to provide confirmatory information another questionnaire on postgraduate experience and training was circulated to a group of consultant psychiatrists in the United Kingdom. This group comprised all those who were appointed as consultants in adult psychiatry (including psychotherapy) by public appointment (i.e. not personally upgraded) for the first time between 1 October 1963 and 30 September 1966, and who had six or more N.H.S. sessions. A list of all those consultants who were thought to fall into this group was compiled with the help of Regional Hospital Boards and the Ministry of Health, and 191 questionnaires were sent out, with a request that the form be returned uncompleted if the individual had been wrongly assigned.

Neuropathological study of the group of presenile dementias, whether apparendy primarily a degeneration of cortical neurones or secondary to vascular, inflammatory or other disease, has for obvious reasons centered on the brain. However, it is possible that the degenerative process may in certain types also affect the peripheral nervous system. If this were so it would be valuable to recognize it not only from the pathological point of view but also, since peripheral nerves are more easily investigated during life, for differential diagnosis which is often difficult and sometimes impossible on clinical findings alone. While involvement of the lower motor neurone is unlikely to be present without causing physical signs impairment of sensation due to involvement of the primary sensory neurone may be overlooked, more especially because sensory testing is often not possible in demented patients.

The most appropriate time and way to inform parents of a diagnosis of mongolism is often discussed among physicians and others who have early contact with mongol children. Despite this, however, few attempts have been made to ascertain systematically the views of the parents themselves. We have had an opportunity to do this in the course of a clinical and cytogenetic investigation of mongolism. Information on the subject was obtained from 95 mothers of mongols, all of whom were personally interviewed by at least one of us during the past three years. Nearly all the parents were from north-west London and adjoining counties, and represented all social classes.

In the biological and social sciences the research worker is frequently faced with a two-dimensional, entity by variable, matrix of numbers. The matrix may contain scores of persons on tests, judgments of persons or objects by persons, measurements of physical characteristics of insects, economic statistics of areas, party votes in electoral districts, demographic or epidemiological or ecological counts of areas, and so on.

The classic and pure form of Gilles de la Tourette's syndrome is characterized by: (1) Multiple motor tics, generally developing during childhood or adolescence, starting in the face, neck or hands, and tending to spread to involve most of the skeletal muscles. Sometimes they are paroxysmal, but the victims never lose consciousness. (2) “Vocal tics”, occurring when the contractions spread to the laryngeal muscles. The victims utter sounds, often resembling the cries of an animal, such as barking, bellowing or whinnying (3). Generally the last to appear, though the order probably varies, is a compulsion to shout obscene or blasphemous words, insults or oaths. Echopraxia and echolalia are disorders bordering on this syndrome, and sometimes accompanying it.

Staffing patterns are a major concern in the planning and administration of psychiatric facilities. The cost of professional and sub-professional personnel are the largest expense on psychiatric institution operating budgets. Trained professionals are in short supply and for the foreseeable future will not be available in adequate numbers to staff existing and developing programmes. Such considerations make important the development of more efficient methods for deciding upon staffing levels. At present, clinical experience and uncontrolled comparison of differently staffed clinical programmes are the usual justifications for improved staffing. This study was undertaken to investigate whether a relationship existed between staff time spent in treatment of patients and outcome for a patient group.

1. The Royal Medico-Psychological Association, being the largest body of medical professional workers most likely to be affected by the establishment of a Hospital Advisory Service, at least until this is developed to cover the whole of the Hospital Service, and being a constituent member of the Joint Consultants Committee, welcomes the Secretary of State's recent statement of intention to establish an Advisory Service which will contain a system of hospital inspection.

In expressing its views on the subjects raised in Sir George Godber's letters,∗ the Royal Medico-Psychological Association has considered the general recommendations made by the Royal Commission on postgraduate education, the number of medical school places and the training of overseas doctors. In addition, the R.M.P.A. has considered those recommendations involving psychiatric education, the assessment of proficiency in psychiatry, the administrative aspects of psychiatric training, the vocational register for psychiatrists, the manpower problems raised by the proposals for postgraduate training and organization, and the proposals for medical education in London. Members of the R.M.P.A. are conscious of the increasing importance of these subjects as the time approaches for the Association to assume the status and responsibilities of a College. Many of the issues raised are controversial and it is difficult to do more than produce interim replies: this document is therefore tentative in its comments. The R.M.P.A.'s approach must remain flexible in the expectation of future developments, especially with regard to the assumption of collegiate status. In March 1969 these issues will again be discussed during the course of a Conference on Postgraduate Psychiatric Education to be held under the auspices of the Royal Medico-Psychological Association and the Association for the Study of Medical Education.

In a series of papers, Slater, Beard and Glithero (1963) reported on a group of 69 patients who had suffered from a schizophrenia-like psychosis at some time after the onset of an earlier but continuing epilepsy. They gave a number of arguments, which need not be considered here, to support the view that the epileptic and the schizophrenic states were not independent of one another and merely coincidental, but that the pre-existing epileptic state was the direct cause of the schizophrenia-like illness, and that this could in fact be regarded as a special form of an epileptic psychosis, which took on for a time the appearance of a (symptomatic) schizophrenia. One of the arguments on which reliance was placed was that there was a non-random relationship between the ages of onset of the epilepsy and of the schizophrenia, such that the interval between the two varied about a mean of 14 years. The three clinical groups into which the 69 patients were classified had significantly different mean ages of onset of epilepsy of 20·5, 16·3 and 9·3 years respectively; but there was no significant difference between the three clinical groups in respect of the mean interval between onset of epilepsy and onset of psychosis, 15·6, 14·0 and 12·8 years respectively. In fact, in the case of the duration of epilepsy, with an F value of 0·24, between-group variance was only a fraction of the within-group variance.

In an investigation of dermatological out-patient attenders, psychometric tests measuring marital patterns, hostility and personal illness were administered to 49 married patients aged under 60. Scores on these tests did not differ significantly between groups of cases classified according to the likelihood that psychosomatic factors were operative.