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Patients unable to submit themselves to routine dental treatment under local anaesthesia were studied during treatment under diazepam sedation accompanied by local anaesthesia, and compared with a matched control group for psychiatric assessment. Physiological responses, operating conditions, amnesia, pain threshold, and recovery were all assessed by various tests.Some of the patients had an anxiety neurosis, and several had been referred because of previous failure to complete dental treatment. Satisfactory conditions were obtained in all but two instances, and no adverse physiological responses occurred with diazepam in an intravenous dose of 0.2 mg./kg. Patients were clinically safe to leave accompanied by a responsible adult within one hour of administration of the drug. Some patients showed an improvement in attitude towards dentistry following treatment.

Eight males were studied during 27 weeks, including two periods of five weeks during which they received clinical doses of sodium amylobarbitone and benzoctamine. Substitution of placebo for either drug caused raised anxiety and impairment of mental concentration. The drugs reduced restlessness during sleep and reduced paradoxical sleep. By the fifth week of sodium amylobarbitone, although sleep was still less restless in the early night it was more restless than normal in the late night. Blood samples were taken half-hourly during sleep by indwelling venous catheter. Plasma growth hormone concentration was little affected during drug administration but rose temporarily after withdrawal. There was a reduction of plasma corticosteroid concentration during sleep throughout administration of the drugs and a rebound above normal during the first withdrawal week.

Since parathion and other cholinesterase insecticides are being used extensively, safety precautions are important, and the need for prompt and adequate therapy if poisoning does occur must be emphasized. This paper stresses the acute nature of the poisoning and attempts to outline the basic principles of therapy so that practicing physicians may handle cases with more confidence, which should help prevent prolonged periods of functional disturbances due to anxiety following poisoning.

A total of 12 chronically anxious psychiatric outpatients were treated with racemic propranolol (Inderal), diazepam (Valium), and placebo for one week each, using a balanced cross-over experimental design. Six patients had predominantly somatic anxiety, complaining mostly of bodily symptoms, and six had mainly psychic anxiety, complaining primarily of psychological symptoms. Clinical ratings of anxiety were made by patient and psychiatrist after each treatment. Though diazepam was in general more effective than propranolol or placebo in relieving anxiety, propranolol was more effective than placebo in patients with somatic anxiety but not in those with psychic anxiety. We suggest that propranolol should be reserved for patients whose anxiety symptoms are mainly somatic.

Seventy-two patients with eczema were randomly allotted to one of two treatment groups: A, those receiving dermatological treatment only, and B, those receiving the same dermatological treatment plus psychiatric treatment, limited where possible to four months. Cases were followed up at six-monthly dermatological assessments, 57 (79%) for 18 months. The findings suggest that in the presence of overt emotional disturbance, of new psychological or psychophysiological symptoms preceding the rash by up to a year, and of high motivation for it, brief psychiatric treatment improves the outcome in eczema (the proportion clear at 18 months was about doubled), whereas in their absence such treatment may worsen it, especially in the short term.

A double-blind crossover comparison of medazepam 10 mg three times a day against amylobarbitone 60 mg three times a day in outpatients with neurotic anxiety showed that medazepam was superior in relieving symptoms. At this dose of medazepam drowsiness or ataxia was rarely a problem.

It has been suggested in a previous paper (Sedman and Reed, 1963) that depersonalization phenomena were most likely to occur in patients with premorbid insecure personalities during a phase of depressive mood. Schneider (1958), includes under the term Insecure Personalities both Anankasts (obsessionals) and Sensitives. In such individuals there is “… a nagging inner uncertainty under various forms of compensatory or over-compensatory activity, especially where the inferiority feelings are of a physical or social character”. The purpose of this paper is to examine further the suggested linking of depersonalization, insecure personality and mood change in schizophrenia.

In the past, while many sources of anxiety were recognized, the resulting anxiety was always considered as a unitary concept, i. e., as having the same psychological and physiological correlates regardless of etiology. The validity of this implicit working hypothesis has seldom been challenged. However, in recent studies2,3investigating anxiety in paratroopers in training, differences in the types of anxiety elicited were noticed. These differences could be accounted for, in part, by postulating the existence of two distinct types of anxiety, one related to shame, and called "shame-anxiety," the other to guilt, and called "guilt-anxiety." This differentiation of types of anxiety was first fully elaborated in papers by Alexander1and Piers.8 The three terms to be dealt with in this paper, anxiety, guilt, and shame, are defined as follows: Anxiety: "A conscious experience of tension [apprehension, dread or foreboding] which is related to apprehension cued off by

This paper describes a number of observations made by the medical staff of this hospital in its dealings with the relatives of our patients subjected to an intensive psycho-therapeutic program. Our frame of reference has been the recognition of mental illness as a totalized process, involving the family as a psycho-social unit. Hospitalization of one family member is observed to provoke in relatives a number of reactions which can be summarized as anxiety, and defensive operations against such anxiety. The latter characteristically create the various problems a therapist encounters and must solve in order to insure that the relatives’ participation in the treatment program will prove beneficial rather than detrimental to the patient. The importance, particularly with psychotic patients, of having repeated therapist-relative contacts has been stressed. We have found them beneficial to the patient's effective treatment. We believe that only limited goals may be sought in working with relatives since lasting attitudinal and behavioral changes are not common, although certain limited modifications along these lines may be achieved. The paper, further, reviews some of the known sources of anxiety in the relatives of hospitalized psychiatric patients. A number of troublesome defensive operations against anxiety have been illustrated with case material. While we appreciate that this report constitutes a very modest contribution to an understanding of the relatives of psychiatric patients, we do hope that it will stimulate further investigation of this important topic.

This paper makes no claim to be an exhaustive discussion of influential variables in the reciprocal inhibition treatment of phobias. Had it been, it would have also mentioned, at length and in detail, such considerations as lack of faith in the method, insufficient motivation to get well, obsessive-compulsive neurosis, the number of conditioning sessions, and the duration and intensity of phobias, all of which apparently play a role in the final outcome4. The paper concentrates on other of the more important or intriguing limiting factors, as follows: the non-utilization of hypnosis, deficiencies in visualization and relaxation, the presence of free-floating anxiety, severe environmental stress, and the amount of secondary gain. The improvement rate in 26 phobic patients immediately after desensitization therapy was 42%. Follow-up, 16 months to three years later, showed a decline in the improvement rate to 31%. Considering the well-recognized and enormous difficulty in successfully treating phobic patients, one should not be too hasty in condemning these results. The rather meager therapeutic achievement merely points up the complexity of factors intervening between stimulus and response, mainly in the person of the patient, that “black box” of almost infinite variegation. In this respect, conditioning therapy faces the same difficulties as any other and in the field of symptom removal probably does better than most. Reciprocal inhibition treatment is a worthwhile addition to the psychiatrist's armamentarium and should be used wherever indications and expectations warrant it.

There have been many evaluations of the use of chlordiazepoxide in mental illnesses, most of these concerned with its use in the reduction of anxiety. The majority of the papers have emanated from North America and have reported in “open” investigations that the drug is of value in reducing anxiety. Other papers from Britain, Australia and the European Continent have also described the results of similar treatment. Of the British contributions, only two of eight (Jenner et al., 1961; Gore and McComisky, 1961) describe results of placebo-controlled trials. A recent annotation concerning chlordiazepoxide (1961) observed that most of the trials had not involved the use of placebo. Furthermore, as chlordiazepoxide is a drug very much more expensive than a barbiturate, it was considered that more placebo-controlled investigations were desirable.

THE PURPOSE of this paper is to summarize some of the conclusions and data from a comprehensive study of patients with neurocirculatory asthenia, anxiety neurosis or the effort syndrome. 1 These studies were conducted over a five year period 1a (1942 to 1947), for the most part on service personnel. It is intended that this summary should be of use to those who are now handling or studying problems associated with this disorder. Although most of the important investigations on the subject have been made during and immediately after wars, 2 the problem of neurocirculatory asthenia is important in civilian life. In this paper we shall emphasize the data from our studies and the conclusions of the authors and shall not attempt to summarize the abundant literature on neurocirculatory asthenia; nor will we attempt to present in detail all the studies of the project, as they are being reported

This paper describes the preliminary clinical testing of a new sedative drug, and also explores the feasibility of using a single-patient, self-controlled and recorded design in psychiatric drug trials. Hogben and Sim (1953) demonstrated a form of drug trial which emphasized intra-subject fluctuations and their control. Recently, Shapiro (1963) has argued the usefulness of a similar approach in fundamental, clinical research. However, the single-patient drug trial appears not to have been widely used in psychiatry, although several writers, e.g. Shepherd (1963), have indicated its possible advantages.

Many students and practitioners familiar with the available literature on desensitization therapy have nevertheless expressed considerable confusion concerning specific procedural factors in the application of this technique. In general terms, systematic desensitization is the presentation of carefully graded subjectively distressing stimuli to the imagination of a “relaxed” or “hypnotized” patient. In order to ensure that this procedure leads to positive counterconditioning rather than an augmentation of neurotic anxiety, the clinician must take cognizance of several variables. The present paper provides “handling instructions” in this regard.

1. Emesis, or vomiting, considered historically, can be seen in three roles. First it was induced for convivial reasons, to permit continued gormandizing, secondly, on cultural grounds, as part of purification rites and thirdly for curative purposes in the treatment of illness, including mental disorders. Its importance in medicine stems from the fact that it is probably second only to pain in frequency as a symptom of emotional disturbances. Its importance in psychiatry lies in the fact that it is observed in a variety of situations in which its occurrence has different psychological meanings and since it occupies a controversial position in the conceptualizing about conversion phenomena. 2. The physiology of emesis is reviewed and the sequential participation of autonomic and somatic factors is detailed. Psychophysiological aspects of nausea are briefly considered. The roles of various neurophysiological functions, including the limbic system, are discussed in connection with the psychogenic aspects of emesis. 3. Reference is made to pertinent papers on ‘neurotic vomiting’ and to some offering psychodynamic explanations. The relevance of organ language to emesis or ‘neurotic vomiting’ is mentioned. 4. An endeavour is made to separate reflex from psychogenic emesis and a classification of the latter is presented. This shows an increasing complexity as one passes from states in which the mechanism is characterized as arousal to those designated symbolic, expressive and disintegrative. 5. Some semantic implications of the words symbolic, conversion, hysteria, and expressive, are discussed and the unsatisfactory state of ambiguity which surrounds the first three in the psychiatric literature is noted. 6. Certain psychodynamic characteristics of those patients in whom vomiting was a major psychiatric symptom are summarized from the psychiatric literature.

This paper presents some of the more important results of a factor analysis of the mental state ratings made as part of the United States–United Kingdom Diagnostic Project's cross-national study. The project was organized in order to help account for the large differences between the two countries in the admission rates for schizophrenia and for the affective disorders (see Kramer, 1969, and Zubin, 1969). The major results of the study have been reported by Cooper, Kendell et al. (1969), Gurland et al. (1969), Cooper (1970), and Cooper, Kendell, Gurland et al. (1972).

This paper reports the results of a psychiatric study of the families and husbands of patients with hysteria. In a series of previous publications designed to clarify the diagnosis of hysteria, it was shown that certain clinical criteria will define a group of patients with a highly uniform clinical course and prognosis (3, 4, 5, 9). It was also suggested that the same clinical picture is seen among first-degree female relatives more frequently than among the general female population, and that alcoholism and sociopathy are seen more frequently among first-degree male relatives than among the general male population (1). We decided to extend the investigation to more cases, and to study the husbands of the index cases as well.

The Henmon Nelson Test of Mental Ability College level, the Minnesota Paper Form Board and the ETS Verbal Cognitive Tests were administered to 1,100 freshman students. Small negative relationships between these scales and TMAS were found most notably for the verbal tests and females. Significant differences were found between high- and low-anxious groups. It is suggested that previous negative results for female Ss may have resulted from the use of easy verbal tests.

This paper reports on the successful use of bi-weekly intravenous infusions of sodium lactate in alleviating symptoms in 33 patients suffering from intractable anxiety. Data is presented showing differential physiological and biochemical reactions to lactate, sodium chloride, and calcium infusions, as well as significant declines in self-rated anxiety for patients treated with lactate infusions for three weeks. Follow-up three and six weeks later suggests that these psychological changes may be relatively stable. The relevance of these results for a behavioural technique is suggested.

Neurocirculatory Asthenia versus Anxiety Neurosis THE constellation of symptoms called neurocirculatory asthenia (NCA) is frequently encountered in medical practice, but despite its prevalence it is still a source of much argument and confusion. Extensive clinical and laboratory investigations have resulted in data that are inconsistent and controversial. Some recent reports1 2 3 4 have stressed the opinion that NCA is identical with "anxiety neurosis."§ We believe this to be an unsound postulate and will attempt in the present paper to clarify our views. The patients classified by Wheeler and his co-workers3 as having "neurocirculatory asthenia (effort syndrome, anxiety neurosis)" are grouped together merely . . .

SUMMARY The experiment reported in this paper was designed to examine the belief that the mood state (anxiety) associated with thyrotoxicosis was phenomenologically similar to the anxiety occurring in functional (neurotic) states. For this purpose a psychophysiological technique was used which has been shown to be reliable and objective in the differentiation of neurotically anxious patients. It was shown that, unlike the situation in patients with neurotic anxiety states, the psychogalvanic reflex of patients with thyrotoxicosis habituated to a repeated standard stimulus and an initially high rate of spontaneous fluctuations soon settled. The abnormality detected in the thyrotoxic patients consisted of increased reactivity or responsivity and hyperarousal. Although patients with neurotic anxiety states are chronically hyperaroused, the relation of this hyperarousal to the mode of habituation of their psychogalvanic reflex differs from that found for thyrotoxic patients. It seems, therefore, most unlikely that the hyperarousal associated with thyrotoxicosis shares a common origin and mechanism with the hyperarousal occurring in functional (neurotic) anxiety states.

IN RECENT years, the fields of psychiatry, psychology, and sociology have all experienced an upsurge of interest in the nature of the self-image. The fact that these three fields, differing as they do in their subject matter, research methods, perspectives, and foci of interest, should come to share an interest in this aspect of personality bespeaks, perhaps, the power of this concept to intrude itself upon established ways of thought and procedure. Though each field bears with it the inertia of its distinctive tradition, all have found that the idea of the self-image is, if not central to their concerns, at least relevant to them. The self-image is, of course, a complex concept. In this paper, we will consider one aspect of this concept, viz., the individual’s self-esteem, the degree to which he holds attitudes of acceptance or rejection toward himself. It is one of the peculiarities of the self, as MEAD(~) has noted, that the self is reflexive, that the self is both subject and object, that the judge and the object to be judged are encased within the same skin. Every individual has attitudes towards a multitude of objects in the world, and one of these objects probably the most important is himself. It is this favorable or unfavorable attitude toward oneself that we designate by the term self-esteem. There is ample clinical and theoretical warrant for expecting the individual’s level of selfacceptance to have certain emotional consequences. Some clinicians go so far as to characterize low self-esteem as one of the basic elements of neurosis. HORNEY@) and FROMM@) stress that an underlying feeling of worthlessness is characteristic of the sick personality. A psychotherapist, ANGY,IL@) states: “In the neurotic development there are always a number of unfortunate circumstances which instill in the child a self-derogatory feeling. This involves on the one hand a feeling of weakness which discourages him from the free expression of his wish for mastery, and on the other a feeling that there is something fundamentally wrong with him and that, therefore, he cannot be loved. The whole complicated structure of neurosis appears to be founded on this secret feeling of worthlessness, that is, on the belief that one is inadequate to master the situations that confront him and that he is undeserving of love . . .“. One reason that low self-esteem may be related to certain symptoms of emotional disturbance is that, in MURPHY’S(~) view, the self-image is central to the individual’s value system. “Whatever the self is,” he says, “it becomes a center, an anchorage point, a standard of comparison, an ultimate real. Inevitably, it takes its place as a supreme value . . . . To most

Summary This paper gives an account of the author's technique in giving treatment with LSD. The use of methylphenidate and insulin hypoglycaemia to potentiate the abreactive properties of LSD are described. The roles of the members of the therapeutic team concerned in LSD treatment are considered as are the difficultics found in terminating the LSD reaction. Finally, consideration is given to some of the problems posed by a recent controlled study of the value of LSD reaction.

This is a reply to a critique by Karon and Saunders (9) of the Eysenck and Prell work on the inheritance of neuroticism (6). This paper is a curious combination of sophisticated statistical analysis and argument by irrelevant association. Thus the authors mention the fact that we found a strong heredity predisposition but go on to say that “the results are so much at variance with general clinical experience that doubts arise in the minds of many psychologists … particularly those who have investigated, in a therapeutic situation, the source and development of neurotic reactions”. The authors do not indicate how it is possible through general clinical experience or in the therapeutic situation, to find an answer to one of the most difficult and complex problems in the whole field of psychology. Whether neurotic predisposition is largely inherited or has little hereditary basis, would not seem to be capable of being discerned simply by giving psychotherapy to a few neurotics.

The present investigation confirms once again that E increases and N is reduced when psychiatric subjects are tested before and after treatment. The greatest differences are observed in the endogenous depressions group. In this particular study interest has mainly been directed to considering the possible value of the initial MPI results as a prognostic instrument. In respect of length of treatment in hospital there seems to be no correlation with MPI results. It is also to be anticipated that the period of treatment should be bound up with a number of complex factors which one cannot expect to measure with the MPI. As regards the social functioning of neurotic subjects, the MPI has a certain prognostic value, and especially the L variable. This is in accord with the paper presented earlier by [SEE THE TABLE V IN SOURCE PDF] Wretmark, Astrlom and Olander (7) from investigations into endogenous depressive subjects. The bimodal distribution of L scores in the group of neurotics which had not resumed work has made it possible to construct a sort of risk table which clearly shows that the risk of not resuming work increases quickly from an L value of 10. In respect of the L variable both the endogenous depressions group and the alcoholics show the same strong tendency as the neurosis group, but the material was too small to draw any conclusions. The E variable has, as distinguished from the L variable, no great ability to make individual predictions, even if the small group of patients very low down on the E variable, run a risk of not returning to work four times greater than the others. The N variable seems completely to lack prognostic value regarding the resumption of work. The initial MPI scores showed no prognostic ability for the schizophrenic group. The MPI results on admittance proved to be connected with whether the patient resumed work, but not with how the patient claimed to manage his job six months after discharge. With regard to persistent nervous symptoms the investigation showed that both the neuroticism and the extraversion variables gave some support for prognosis in the case of the neurosis group. This was, however, less marked in the other clinical groups. A low grade of extraversion combined with a high grade of neuroticism (i.e. dysthymia) seem to indicate a slightly less favourable prognosis as regards the nervous symptoms.

Sunzmary.-This experiment assessed the effects of (a) appropriate, random, and no reinforcemcnr; and (b) stress (St) vs reassurance (Re) instructions in a learning situation on anxiety reduction and inducrion as measurecl by the Test Anxiety Quesrionnaire. The results, from a sample of 54 university students, showed no anxiety reduction or induction due to reinforcement conditions but did show anxiety reduction for the Re group and anxiety induction for the St group. The former results indicate that anxiety reduction and induction are not associated with another reinforcing stimulus. However, the latter results support the theory relating motivating instructions and test anxiety to learning. About 25 years ago Mowrer (1939) wrote a very important paper proposing chat fear or anxiety was a learned response that functions as a drive and chat anxiety reduction funczions as a reward. In his own words, this thesis was

Summary In the experiments reported in this paper, the subject chain-associates for 15 seconds to each of a list of 40 stimulus words. After each of six presentations of one of these words, electric shock is administered. Although the subject is unaware of the relationship between word-signal and shock, as determined by intensive interview subsequent to the conditioning session, the subject's autonomic responses in the 15 second interval between hearing the stimulus word and receiving the shock reveal the existence of unconscious anticipation of shock. This unconscious anxiety is not limited to the conditioned word-stimulus itself but spreads to other words meaningfully related to the conditioned word. Subjects shocked after the word "cow" develop relative overreaction to other words with rural connotations. The development of such responses is very rapid, revealing the anxiety-proneness of humans. Summary The conditioning curves of aware and unaware subjects differ sharply. Aware subjects immediately develop a strong emergency response that does not grow as a function of the number of reinforcements, but instead shows gradual adaptation. Unaware subjects show typical conditioning curves at a much lower level of autonomic activity and discrimination. Summary The spread of anxiety as seen in curves of generalization seems greater at the unconscious than at the conscious level. Summary The chronic anxiety level of the subject may be related to the ease of acquisition and spread of new anxiety responses. Low anxiety subjects condition better but generalize less. This implies more accurate discrimination and appropriateness of response in low anxiety subjects. Summary The possibilities of using conditioning in the study of unconscious emotional processes are thus seen to be considerable.

IN GENERAL, the evidence for the usefulness of psychologically based treatment of iilness is limited,l and the treatment typically administered is usually rather long. There is hope that newer methods, emphasizing learning principles and cognition, will be more efficient and more acceptable to large numbers of patients. One such method is Rational-Emotive Therapy (RET),2 which is based on the belief that irrational or unrealistic thinking is associated with emotional, behavioral and visceral disturbances. RET consists essentially of efforts to effect emotional and other behavioral changes by teaching patients to perceive themselves and the world more accurately, and to think more rationally about their perceptions. The present paper reports a controlled comparison in a psychiatric out-patient clinic of the course of patients receiving RET with the course of patients receiving no treatment. Our chief interest was in relief of presenting symptoms, but we also observed changes in the Taylor Manifest Anxiety Scale (TMAS) and in the frequency of occurrence of attitudes previously reported to be specifically associated with various psychosomatic diseases.3p4 The “psychosomatic attitudes” were included, even though our patients did not have any of the diseases usually considered psychosomatic, because we were interested in possible future application of RET to those diseases. Change in the attitudes during therapy in the present group of patients might encourage later application of RET to patients with psychosomatic diseases. A related aim of the present work was to discover whether successfully-treated patients, i.e., those whose symptoms were significantly improved during RET, would likewise show improvement in TMAS scores and in the frequency of occurrence of the psychosomatic attitudes. For this purpose, we studied not only successfully-treated patients from the controlled investigation, but also, in order to increase the number available for study, an

The question posed in the present paper arises from the relationship of psychiatric disorder to culture. This question is: Do we have in Egypt mental sicknesses which are the specific production of the Egyptian cultural setting? After a careful review of the literature supplemented by his own anthropological observations and Egyptian psychiatric reports, the author was able to conclude that the psychopathological manifestations expressed in the RABT and ZAR cult phenomena which reflect in their behaviour the specific cultural content of the victim's society, are simply local varieties of a common disease process to which human beings, as such, are vulnerable.

1. Psychoanalysis is usually the treatment of choice in the severe anxiety states. This treatment was not available to the patient whose case is reported in this paper. 2. The patient was treated in a veterans' hospital for 13 months with psychotherapy in the form of narcosynthesis with intravenous sodium amytal, hypnosis, “free association,” and support and reassurance. 3. With partial remission of anxiety symptoms, 19 electric shock treatments were given three times weekly. 4. After a transient psychotic episode lasting one month, there followed total remission of the anxiety symptoms, and the patient was discharged from the hospital. 5. There has been no recurrence of symptoms for 16 months.

In recent years a number of new drugs have appeared, grouped together as so-called tranquillizing agents. The publication of three very encouraging papers describing the use of meprobamate prompted the present trial. Selling (1955) prescribed one 400 mg. tablet daily after each meal and one at bedtime in 187 cases, combined with psychotherapy, and found its use in anxiety and tension states was of considerable value (90 per cent and 95 per cent respectively improved or recovered). Borrus (1955) used one to six 400 mg. tablets daily in 104 cases. In 68 per cent of all cases, and 78 per cent of the anxiety states, there were favourable results. Lemere (1955) contrasting chlorpromazine and reserpine, found meprobamate (used in over 250 patients with at least 70 per cent good results) to be relatively uniform in its action, remarkably free from side reaction and more effective in the relief of insomnia. All three authors stressed the absence of toxicity.

In the following paper a short clinical, descriptive account is given of the first 1,000 patients attending Ain Shams University Psychiatric Clinic from the beginning of 1966. Although the clinic is in the centre of Cairo, its catchment area extends all over Egypt. Patients are referred through three channels; either general practitioners send them for a psychiatric opinion or they come from other medical out-patient clinics at the University. The third group represents those who come independently and ask for psychiatric examination. Usually these are patients from the countryside who have tried lay therapy in their villages but without improvement. This group represents a deficit in the organization of referral, as many of them, having been examined at the psychiatric clinic may have to be referred to another medical out-patient clinic because of a non-psychiatric organic pathology.

Summary The sedation threshold is an objective pharmacological determination which represents the amount of intravenous Sodium Amytal required to elicit certain EEG and speech changes. The purpose of this paper was to present the evidence which bears on the validity of this method as a clinical neurophysiological approach to investigation of psychopathological problems. Summary Data were drawn from tests on over 500 psychiatric patients and 45 nonpatient controls. The following general results were obtained: (a) The sedation threshold was positively correlated with degree of manifest anxiety in nonpsychotic subjects. The greater the manifest anxiety in psychoneurotics or control subjects, the higher the threshold. (b) Obsessional personality characteristics tended to be associated with a high threshold, hysterical characteristics with a low threshold. (c) The sedation threshold was negatively correlated with degree of gross impairment of ego functioning in psychotics. The greater the ego impairment, the lower the threshold. (d) The threshold differentiated between neurotic and psychotic depressions with a high degree of accuracy. Thresholds were low in psychotic depressions and high in neurotic depressions. Summary It was concluded that the sedation threshold was meaningfully related to several important psychopathological phenomena, and that the results supported its validity as an investigative approach. The findings were discussed from the following standpoints: clinical and research applications; some neurophysiological aspects of anxiety, depression, and ego functioning; and relation to personality theory, with special emphasis upon Eysenck's theory.

This paper reports the results of an exploratory investigation of the differential effects of carbon dioxide and nitrous oxide gas inhalation treatment upon patients with anxiety symptoms under permissive and nonpermissive conditions. Forty-eight psychoneurotic patients with anxiety were divided into four groups: (1) 26 patients received N2O followed by CO2 and (2) 22 patients received N2O alone. These groups were subdivided into (3) a permissive group of 27 patients who were permitted to talk with the therapist before and after the gas inhalation, and (4) a nonpermissive group of 21 patients who were not allowed a similar opportunity. All patients were rated for improvement in anxiety symptoms utilizing two raters and two different techniques of evaluation. More CO2 patients than N2O patients were rated improved by the two techniques of evaluation although this difference was not statistically significant. A statistically significant difference (reliable at the 1 per cent and 2 per cent levels of confidence) was found between the permissive and nonpermissive groups, with the permissive group showing the greater improvement. It is concluded that more intensive research with a greater number of subjects and better controls is indicated in order to provide more adequate understanding of the determinants of therapeutic improvement in the gas inhalation therapy of the psychoneuroses.

Introduction and Problem During the last few years a number of papers have appeared in the medical journals which have been concerned with the "sedation threshold."1-4Briefly, amobarbital (Amytal) sodium is injected intravenously at a specified rate until certain EEG changes occur in association with the onset of slurred speech. The concept of the sedation threshold owes its inception to Shagass, who defines it as "the amount of sodium amytal, in mg/kg, required to produce an inflexion point in the 15 to 30 c/sec amplitude curve, which occurs within 80 sec (1 mg/kg) of the time when slur is noted."4Shagass goes on to say that "the slur localises the threshold roughly, the EEG inflexion point does it more precisely." During the course of a preliminary investigation into the general usefulness of a patient's sedation threshold as measured by the onset of slurred speech, we were impressed by

The purpose of this paper is to report a series of clinical observations having to do with the prognostication of death in the presence of serious organic disease. These observations are based on the premise that there is an unconscious awareness on the part of the patient of his impending death and that this is reacted to with anxiety which may be repressed. The anxiety, however, is often betrayed by various clinical signs which the alert physician can recognize and use in making a prognosis and planning management. There are references in the psychiatric and psychoanalytic literature describing unconscious psychologic reactions to organic disease. Freud1quotes Aristotle as concluding that "dreams may very well betray to a physician the first signs of some bodily change which has not been observed in waking." He also quotes Hippocrates1,2and more recent writers who vouched for the diagnostic value of dreams.