Electroconvulsive therapy: results in depressive illness from the Leicestershire trial

Electroconvulsive therapy was investigated in a double blind trial. Altogether 186 clinically selected patients were referred to the trial, but 48 of these did not participate. According to the present state examination, 95 of the remaining 138 patients fell into one of the classes of major depression. Patients were randomly allocated to a course of real or simulated electroconvulsive therapy. Treatment was given twice a week with a maximum of eight treatments. On the Hamilton depressive rating scale the improvement in the group given real treatment was significantly greater than that in the group given simulated treatment both at two weeks (p = 0.014) and at four weeks (p = 0.0001). At follow up at 12 and 28 weeks there was no difference between the treatment groups. At the end of the four week trial consultants, who were blind to the allocation of treatment, rated the patients who had received real treatment as having made a significantly greater improvement than the patients who had received simulated treatment (p less than 0.00005). Further analysis showed that electroconvulsive therapy was effective in depression associated with delusions and in depression associated with retardation.

Partnership in transsexualism. Part I. Paired and nonpaired groups

In a group of 72 transsexuals, 26 out of 55 male-to-female transsexuals had partners and 9 out of 17 female-to-male transsexuals had partners. Forty percent of the group of 35 paired transsexuals had been married, but most of these marriages had ended in divorce or separation. Six male patients were still married at the time of the enquiry. The two groups differed significantly in several respects. Those with partners (the paired group) had more fathers or heads of family in social classes I-III, while those without partners (the nonpaired group) were more often without their father in the first decade of life. Significantly more of the paired group received psychiatrists' rating of stable social adjustment. There was a tendency for the paired group to have a more successful employment history since leaving school and to change their National Insurance cards more often in order to obtain employment in their adopted gender. The groups did not differ in the amount of social drift, self-confessed criminal behavior, age at referral, history of prostitution, or incidence of rejecting parents. There were also no significant differences on the following psychological tests: Wechsler Bellevue, Progressive Matrices, Mill Hill Vocabulary Scale, Maudsley Personality Inventory, Slater Selective Vocabulary--except that the nonpaired group knew fewer male words. Any differences between the two groups are perhaps best described in terms of social adjustment rather than any background social factors, personality, or clinical differences.

Morbidity from acute carbon monoxide poisoning at three-year follow-up

Seventy-four survivors of acute carbon monoxide poisoning were followed up for an average of three years. In eight patients gross neuropsychiatric damage was directly attributable to the poisoning. Three patients had committed suicide and eight had died from other causes. Morbidity and mortality in those deliberately and accidentally poisoned was approximately equal.Of 63 patients alive at follow-up eight showed an improvement and 21 (33.3%) a deterioration of personality after poisoning, and 27 (43%) reported a subsequent impairment of memory. Deterioration of personality and memory impairment were highly correlated. The level of consciousness on admission to hospital in the acute phase of poisoning correlated significantly with the development of gross neuropsychiatric sequelae. These findings emphasize the importance of prompt and efficient treatment of carbon monoxide poisoning and the need to follow-up all cases in the anticipation of a relapsing course or the development of sequelae.

A study of facial dyskinesia in a mental hospital population

Abnormal movements are common and accepted complications of phenothiazine therapy. They are usually regarded as of extrapyramidal origin, develop soon after medication is started and are often abolished by stopping the drug or giving specific chemotherapy. The commonly occurring syndromes are: