Ralph McGuire

Cognitive Impairment in New Cases of Epilepsy Randomly Assigned to Carbamazepine, Phenytoin and Sodium Valproate

Sixty‐four new cases of childhood epilepsy were randomly assigned to either carbamazepine, phenytoin or sodium valproate, and were assessed with cognitive tests before medication and three subsequent times over a year. Carbamazepine in moderate dosage adversely affected memory, but sodium valproate and phenytoin did not.

School phobia and agoraphobia.

The incidence of past school phobia was surveyed by questionnaire in 786 women under 60 years of age who were members of an agoraphobia correspondence club. Twenty-two per cent admitted to previous school phobia, a proportion similar to that found in 57 non-agoraphobic neurotic controls. Past school phobia predicted an earlier onset of subsequent agoraphobia and a more severe psychiatric state as far as symptoms not specifically agoraphobic were concerned. Adolescent agoraphobic difficulties were more associated with school phobia than with agoraphobia in adult life. It was concluded that school phobia leads to agoraphobia in only a small proportion of cases. Although school phobia may predispose to later agoraphobia, it seems more likely that both conditions reflect a lasting tendency to neurotic illness.

Selective effects of ECT on hypothalamic—pituitary activity

The hypothesis that ECT produces selective effects on hypothalamic-pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine- and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probably due to direct stimulation of the neuroendocrine neurones themselves.

Parasuicide and the lunar cycle

Admissions to hospital following parasuicide in one city over eighteen years exhibit a cyclical variation apparently synchronized with the lunar quarters. The effect would only account for approximately 0.7 out of the average of 46 parasuicides per 100,000 adults per lunar cycle (95% CI 0.6-0.8), and fails to reach statistical significance.

A Randomly Controlled Trial of Two Court Procedures in Truancy

In 1975 juvenile court magistrates, working in the City of Leeds in the north of England, agreed to carry out an investigation, using random allocation, to evaluate two judicial procedures which they normally used with children brought to court for failure to attend school under care proceedings. The study of these two procedures lasted about a year.

The relationship between the Rutter A Questionnaire and an interview with mother in assessing child psychiatric disturbance among enuretic children

Forty-one children who were being treated in a paediatric clinic for enuresis were studied to see how many of them were psychiatrically disturbed on clinical assessment and to ascertain the usefulness of 2 cut-off points of T (total) scores on the Rutter A scale in identifying them. A score of 13 or more which had previously been recommended was found to be inadequate in this group of cases. There were indications that a cut-off point of 18 or more was more appropriate. The importance of knowing the base rate of psychiatric disorder in the population on which the questionnaire is being used is emphasized, since this affects the selection of an appropriate cut-off point.