Electroconvulsive therapy in Ibadan

An analysis of the result of administering electroconvulsive therapy (E.C.T.) to 292 patients suffering predominantly from psychosis and depression is presented. The results show that the courses of E.C.T. administered range from three to twenty-five. The most frequently administered course was six to eight. Favourable response to treatment was reported in all diagnostic groups immediately after completing the course but less so in cases of depression and paranoid schizophrenia. The reasons thought to account for this were discussed. It is concluded that there is need for careful selection of patients for E.C.T.

Methodology and personality in Briquet's syndrome: a reappraisal

The authors describe a case of Briquet's syndrome in a man and discuss the relationship of that condition to personality features. They view Briquet's syndrome as a set of behaviors arising from personality traits and suggest that examination of the genesis and treatment of the condition be shifted to a characterological approach.

Motor sensory dysfunction of upper limb due to conversion syndrome

Seven patients had functional paralysis that occurred in the dominant limb together with joint contracture and sensory disturbances associated with emotional problems. In five of these patients, the syndrome was preceded by trauma to the affected upper limb and in one patient by a myocardial infarction. The treatment consisted of persuasion, suggestion, general rhythmic exercises and emotional support given by the physiatrist (not a psychiatrist). In five of the subjects treated, the symptoms disappeared and the patients soon returned to work. In two patients the treatment did not succeed since no satisfactory rapport could be established between the patient and the physician.

Time factor as a prognostic indicator on the Bender-Gestalt test

Z-scores from Bender-Gestalt records of 62 psychiatric in- and outpatients were computed. The patients were put on active treatment, and a psychiatric rating was done to evaluate therapeutic recovery after a period of 19 to 24 months. These patients were grouped into three categories, i.e., patients with low Z-scores and good therapeutic recovery; patients with high Z-scores and poor therapeutic recovery; patients with low Z-scores who still showed poor response to treatment. Total time taken by each patient to reprduce the BG designs was noted as well. Results indicate that Z-score was a significant prognostic indicator for schizophrenics, affective psychotics, organic psychotics and patients who were suffering from anxiety and conversion reactions, but not for obsessive compulsive neurotics. Time taken for BG reproductions proved to be an important prognostic indicator, as patients who did not respond satisfactorily to the treatment took significantly more time than those who responded well to treatment. Hence, time taken by the patients for BG reproductions also needs to be considered when any predictions are made with regard to therapeutic outcome.

Use of the Lombard response in cases of hysterical aphonia

Lombard is best known for his work on the effect of noise on vocal intensity. In 1917, he applied this concept to the treatment of hysterical aphonia and described the procedure he used in a military publication. He suggested that a masking noise will interfere with the auditory monitoring system sufficiently that the patient will not be aware he has regained use of phonation. Removal of the noise from the patient's ears confirms the return of phonation, and the aphonia disappears. Credit is given to Lombard for this pioneering effort, and suggestions for present-day clinical use are made.

Instructions and reinforcement in modification of a case of astasia-abasia

The effects of instructions, social reinforcement, and sex of the therapist administering reinforcement contingencies were examined in an analysis of one case of astasia-abasia. Instructions alone appeared to result in some improvement in the patient's ability to walk, but a combination of instructions and contingent verbal praise (social reinforcement) yielded the most dramatic effects. The sex of the therapist administering contingencies did not seem relevant.

[A rare case of psychogenic scoliosis]

A case is reported of non-structural lateral deviation of the spine thought to be of psychogenic origin and classified as so-called hysterical scoliosis. Unusual features are its great rarity and the fact that rotation of the vertebral bodies, the costal gibbus and the lateral deviation are all spontaneously reversible with suitable treatment. Essentially the latter comprised psychotherapy and physiotherapy. Passive correction by such methods as non-mobile corrective corsets or plaster jackets are contra-indicated. Relapses in this type of patient are frequent. Periodic follow-up is essential.

Research report: Institute of Psychiatry Clinical Psychopharmacology Research Team

In 1960, the National Institute of Mental Health of the U.S.A. provided research support to Professor H. O. Schild of the Department of Pharmacology, University College London (U.C.L.) and to Dr. (now Professor) Michael Shepherd of the Department of Psychiatry, Institute of Psychiatry, University of London, for studies in human psychopharmacology. The research assistants initially employed were Dr. Lorna Wing, Dr. J. D. Montagu, and Dr. Malcolm Lader and work was carried out at U.C.L., the Institute of Psychiatry, and Runwell Hospital, Essex. In 1966, the Medical Research Council assumed responsibility by appointing Dr. Lader to their External Scientific Staff. Other support has come from the Bethlem Research Fund and from the pharmaceutical industry, in particular Roche (U.K.) Ltd. and May and Baker, Ltd. A group of six to eight workers has thus been built up based mainly in the Institute of Psychiatry but with continuing links to U.C.L. At present our team comprises pharmacologists, psychiatrists, psychologists, a physiologist, a chemist, and a mathematician. Several workers from abroad on British Council or Commonwealth Fellowships have been attached to the team at various times, and students for higher degrees such as PhD and MD have been welcomed.

The uses of hypnotically produced emotional responses in therapy

This paper outlines a specialised use of hypnosis as a complement to counselling or interpretive psychotherapy in suitable cases. The techniques capitalise on the ease of manipulating emotions and on the vividness of fantasy experience in hypnosis, to allow patients to learn more adaptive patterns of affective response and to rehearse more adequate repertoires of social behaviour. Implications of the authors' work with a sample of 37 non-psychotic patients is discussed.

Instructions and reinforcement in the modification of a conversion reaction

The effects of two variables, instructions and social reinforcement, were examined sequentially in a case of a conversion reaction. Reinforcement in the form of praise resulted in an increase in S's ability to walk. When reinforcement was removed, other variables including instructions, expectancy, social reinforcement from other patients, and self-reinforcement may have contributed to unexpected improvements in walking. However, reinstitution of reinforcement led to the most dramatic increases in walking.