There is accumulating evidence of the clinical effectiveness of selective stereotactic psychosurgery in some severely disabled psychiatric patients who have not responded to other forms of treatment (Ström-Olsen and Carlisle, 1971; Bridges, Göktepe and Maratos, 1973; Kelly et al., 1973). The risks of adverse effects resulting from operation are now small, and their significance is further diminished when related to the distress over long periods of those patients who are suitable for psychosurgery. The criteria for selection have been considered by Bridges and Bartlett (1973).

This preliminary communication draws attention to a condition that may adversely affect psychiatric personnel, and to some of its determinants. Personnel working in institutions where meetings are a major occupational activity appear especially at risk. The condition is a pathological response to groups or collections of colleagues met together in circles for professional purposes. Idealization of these groups and their activities leads to a craving to join them and to dependency once membership is achieved; less often rejection symptoms arise.

Evidences suggest that the predisposed individual can develop dependence to various tranquillizers even to the extent of physical dependence similar to that seen with the barbiturates. Dependence can develop to benzodiazepine derivatives, and cases have been reported mainly for chlordiazepoxide, diazepam and oxazepam. These drugs can also produce withdrawal reactions (Hollister et al., 1963; Barten, 1965; Krypsin-Exner, 1966; Bakewell and Wikler, 1966; Essing, 1966; Gordon, 1967; Ewing and Bakewell, 1967; Hanna, 1972).

Evidence continues to accumulate for the proposition that lithium salts have a marked prophylactic effect on recurrent affective disorders. An earlier paper (1), together with reports from Baastrup et al. (2) and Coppen et al. (3) indicate that this effect is a strong one. This paper reports the current position regarding a trial in one centre which has been in progress for eight years, in which the effect of lithium was investigated on the frequency of admission to and time spent in psychiatric hospitals.

One of the problems with the administration of unilateral ECT is to select the correct side for giving the treatment. If it is given routinely to the right side of the head, a proportion of patients will receive ECT to the dominant hemisphere, which is more unpleasant for the patient and more disruptive of memory than even bilateral ECT (Halliday et al., 1968; Fleminger, Horne and Nott, 1970).

Lithium was given to eight aggressive, non-manic-depressive female defectives in a double-blind placebo-controlled study. The group as a whole showed a reduction in aggression scores while on lithium (p < 0.01): three patients became less aggressive, one became worse and two were unchanged. Both affective and predatory aggression seemed to be reduced. Two patients had to be withdrawn from the trial at an early stage because of the development of neurotoxicity.

R.B.C./plasma lithium ratios showed a wide inter-patient variation in this group of non-manic-depressives.

The study adds further weight to evidence that lithium has an antiaggressive effect at normal therapeutic dosage in non-manic-depressives. The implications of this for hypotheses about the mode of action of lithium and its putative specificity for manic-depressive psychosis are discussed.

There is a general agreement about the less disruptive effect on memory and the shorter post-treatment confusion after unilateral electroconvulsive therapy (UNI-ECT) as compared with the traditional bifrontotemporal ECT (BI-ECT). However, there are divergent opinions about its therapeutic efficacy.

A technique of psychotherapy seemingly compatible with psychoanalytical knowledge is described, and compared and contrasted with psychoanalysis. Its mode of action, efficacy, advantages and difficulties, and its suitability for once-a-week individual or group psychotherapy and therefore for Health Service use is discussed.

1. 1. The clinical functioning of the Young People's Unit, Edinburgh is described. This involves a relatively permissive, democratic ‘milieu‘. Psychotherapeutic efforts are devoted to the resolution of family psychopathology and the achievement of maturational progress for the adolescent.

2. 2. Data on the first seventy admittions to the Unit were examined. Two-thirds of the patients were diagnosed ‘developmental crisis’; the majority of these also had a personality disorder.

3. 3. Assessments of family functioning showed high levels of disturbance and psychiatric morbidity among the parents. The adolescents had mutually good, positive relationships with their opposite-sexed parents, but markedly negative ones with the same-sexed parents. This was not in accordance with the usual findings in ‘normal’ families. Delinquent and impulsive patients showed uniformly negative family attitudes.

4. 4. A simple estimation of treatment outcome at discharge gave results comparable to those of other units, with 70 per cent of patients rated as improved. Neurotic and psychotic patients had a relatively better outcome. Tension-discharge personality disorder and a history of very disruptive or antisocial behaviour were associated with poor outcome.

5. 5. The poor response of very disturbed, impulsive adolescents to this type of therapeutic regime is discussed. These individuals do not appear to have sufficient personality resources and organization to benefit from this type of treatment. Emerging from this is a suggestion for an increased provision of specialized units offering containment and intensive care to the very disturbed adolescent.