Ataractic drugs have been the mainstay of treatment in schizophrenia for the last eight years. Since their introduction, mental hospitals, in various areas of the United States and in every country, have been able to discharge more patients than they admit. Despite this fact there remains much divergent opinion about the value of these drugs, doubt arising from inconsistent therapeutic results and the relapse rate. Also, some double-blind studies have cast some doubt upon the efficiency of these drugs. We are reporting this relatively small study because we feel that it opens an insight and possibly suggests a method of standardizing treatment in the near future.

In this paper age- and sex-specific first admission rates to hospital for involutional psychoses (Malzberg, 1955), are submitted to the same type of mathematical analysis as that used in the two preceding papers. To judge from the nature of the fit between the observed rates (for both sexes) and a highly restrictive mathematical function it seems probable that this diagnostic category—as used in New York State, 1949 to 1951, and by Kallmann (1953)—corresponds to a definite organic disease. Its relationship to the so-called involutional phase of life would appear to be coincidental. The disease is confined to a genetically specific sub-population and the phenotypic expression apparently requires the accumulation of 12 random events. Certain statistical properties of the system affected by these random events are closely similar to those of the “lymphoid system” in autoimmunity. The hypothesis can therefore be entertained that involutional psychosis—together with manic depressive psychosis and schizophrenia—is fundamentally an autoimmune disorder. However the primary pathogenic agent and its “target” organ have not yet been identified and the disease could equally well arise from stochastic disturbances in some other, hitherto unidentified, system, certain statistical characteristics of which are similar to those of the lymphoid system.

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.

Despite the important place occupied by delusional thinking in psychiatric theory, comparatively little experimental work has been undertaken on this particular form of thought disorder. This is perhaps surprising considering its relevance to reasoning and belief as a social process, the role of the delusion in differential diagnosis, and the number of deluded patients available for investigation. Most investigators have been concerned with the content of delusions rather than their force, for the type of delusion has an undoubted influence on behaviour—quite clearly the patient with grandiose delusions acts differently from the paranoid individual; nevertheless, the available evidence suggests that the type of delusion reflects the individual's social history rather than the nature or degree of his psychopathology. More relevant to the latter is the degree of belief expressed by the patient in his delusions, the transitory (and malleable) ideas of an early depressive illness often contrasting with the implacable beliefs found in a condition of chronic melancholia. Some longitudinal studies have been undertaken recently in which the degree of delusional belief has been examined in terms of its resistance to manipulation, and this avenue of approach offers an extremely valuable scale of assessment of the individual psychiatric patient.

Two hundred years ago “griefe” was officially regarded as a cause of death. It is doubtful if the Registrar-General would accept such a diagnosis today but the loss of a loved person continues to be seen as a cause of a wide variety of physical and mental ailments.

The nervous origin of paroxysmal tachycardia was stressed by many German-speaking authors (Hering, 1911; Rothberger and Winterberg, 1911a; Rothberger and Winterberg, 1911b; Schlesinger, 1906) at the beginning of the century. Thus Schlesinger (1906) pointed out that many patients who suffered from this disorder had neurasthenic or hysterical personalities. He postulated that there was a mechanism responsible for the attacks of tachycardia which could be set in motion by a stimulus in the nervous system. Somewhat later a French cardiologist (Gallavardin, 1922) described a type of paroxysmal tachycardia which he believed was of nervous origin. In more recent times Stokvis (1947) has given an account of a Jewish patient who was taught to think himself into an attack in order to avoid deportation by the German occupation authorities in Holland. There is some pharmacological support for the central origin of paroxysmal tachycardia. Thus Klein (1940) described a schizophrenic patient who when treated with pentamethylene tetrazol developed supraventricular paroxysmal tachycardia four minutes after the injection of the drug. He suggested that the delay between the injection and the onset of the attack indicated that the attack was due to an effect of the drug on the central nervous system. Several different workers (Evans, 1940; Peters and Penner, 1946) have claimed that intravenous injection of ergotamine tartrate will relieve an attack of supraventricular paroxysmal tachycardia within a few minutes. Rothlin and Cerletti (1949) have shown that the effect of adrenaline on the heart is not altered by ergot alkaloids, so that the effect of ergotamine in paroxysmal tachycardia cannot be due to an unopposed vagal effect and must therefore be due to a direct action on the brain centres which regulate cardiac activity.

This study is concerned with the relationships between TAT measures of Organization and Hostility and scores on Progressive Matrices (PM), Age and Stay (time in hospital) in a schizophrenic sample.

This contribution is based on observations made in the course of the psycho-analytic treatment of thirty-six adolescents, 24 boys and 12 girls. These are pardy cases I have treated and supervised myself; but to a greater extent relate to material brought together over the past three years by many colleagues and students co-operating in the study of adolescents in treatment at the Hampstead Child Therapy Clinic. The study includes young people between puberty and late adolescence with neurotic or borderline psychotic disturbances. Cases are not included which presented a clear picture of delinquent personalities from the outset, though this does not mean that in the course of treatment such features have not appeared. The appearance of impulsive and delinquent features in clinical pictures where we would not expect them in other age groups belongs to the typical experiences and problems of treatment during this phase.

Complaints about lack of sleep are frequently made by patients diagnosed as depressed, and various recent studies have examined this symptom by attempting to measure sleep either objectively or subjectively. In the former approach bed movements have been recorded by Cox and Marley (1959), Hinton and Marley (1959), and Hinton (1961, 1962), while Oswald et al. (1963) have based their work on EEG changes during sleep. Since lack of sleep is essentially a personal experience, most of the objective data have been combined with subjective records, such as patients' descriptions of sleep, patients' and nurses' ratings of sleep, patients' estimates of length of sleep and nurses' observations of length of sleep. Isaacs (1957) comments that no one method used alone provides a satisfactory estimate of the hypnotic properties of drugs.

The social adjustment of individuals is studied from different viewpoints by psychiatrists and sociologists. The psychiatrist is concerned with the malfunctioning personality (and with normal function toward which patients must be assisted); the sociologist is concerned with the functioning social system. The basic reference of both disciplines is to the individual and the individual's adaptation in his social group.

The entire population of Tristan da Cunha (264 islanders and 29 temporary inhabitants) was evacuated in October, 1961, after a volcanic eruption which, although it occurred in close proximity to the settlement, only damaged one out of the 70 buildings and caused no casualties. The evacuees were taken first of all to Capetown and thence by sea to England, where they arrived in November, 1961. Temporary hutted accommodation was found for them at Pendell Camp, an army establishment near Redhill, Surrey, where they spent the first eight weeks of their first English winter in conditions of some discomfort. In January, 1961 they were transferred to more permanent homes in R.A.F. married quarters at Calshot, a small place situated on the western bank of Southampton Water near its junction with the Solent.

Frontal leucotomy has been used in the treatment of psychiatric illness for over twenty years. Its popularity has undergone the usual fluctuations of a newly-introduced form of empirical therapy, and at present there are many different opinions about its value (Lancet, 1962; Pippard, 1962). For a critical review of the clinical and psychological literature, see Willett (1960). The standard operation has fallen out of favour, not because it was thought to be ineffective, but because it had undesirable side-effects on the personality. Various “modified” operations have, therefore, been introduced. Using one of these—the “orbital undercutting” technique—Knight (1960) has reported excellent results in 129 cases of long-standing depression. Robin (1958, 1959), however, has reported no difference between the outcome for 198 patients who had a standard leucotomy for functional psychoses, fifty-two of them affective, and an equal number of carefully but retrospectively matched controls.

Imipramine and amitriptyline have each been tested by controlled trials and have been shown to be effective (Garry et al., 1963; Skarbek et al., 1962; Ball et al., 1959; Leyberg et al., 1959, and many others). Their uses have been discussed in articles in the “Today's Drugs” series in the British Medical Journal for 1959 and 1961 respectively. The literature has been summarized by Burt et al. (1962).

A fundamental area, if not the fundamental area, of psychological disturbance, according to classical Freudian psychoanalysis, as is well known, is the fear of being castrated. According to Freud (10; 11, p. 267) this is a fear of being castrated by the father as a reprisal for incestuous desires toward the mother. So closely is the fear of castration related to the father that Braatøy (4) has suggested that it be renamed “father anxiety”. None the less, the concept of the castrating mother also plays a prominent role in psychoanalytic literature. De Monchy (7) Blos (2), Fairbairn (8), Klein (18), and Bergler (1) are among those who have most emphasized the fear of the mother.

It is widely recognized that somatic complaints are frequently encountered in depressive illness and in some instances these may predominate in the clinical presentation. Studies relating to the occurrence of such symptoms in depression have been reviewed by Cleghorn and Curtis (1959), who point out that in a number of patients mood disturbance may not be readily apparent. It is not unusual for these patients to be referred initially to a general medical or surgical clinic, where after investigation it is concluded that their complaints cannot be understood in terms of physical disease (Stoeckle and Davidson, 1962).

The need for the assessment of phenothiazines and other drugs used in mental conditions is increasing as new products are described. Testing these drugs on patients is cumbersome and time-consuming. It would be valuable if a preliminary test could be made on some animal in which the effect on the nervous system can be easily assessed.

In our previous paper (Humphrey and Ounsted, 1963) we found that the symptoms and behaviour problems of children adopted in early infancy resembled those of children reared by their own parents. A significant trend appeared only among children adopted after the age of 6 months, who were more prone to anti-social conduct. But the proportion of adopted children referred to the Park Hospital for Children over a four-year period (2·9 per cent.) was more than double the corresponding estimate for the general population. It is tempting to attribute at least part of this excess to the relatively large number of delayed adoptions in our sample, of whom 34 out of 80 (43 per cent.) were aged 6 months or more at the time of placement.

The only previous studies are referred to in Mental Hospitals at Work (Jones, 1962) and it is stated, “In recent years some attempts have been made, though to our knowledge none have been published, to estimate the amount of time which psychiatrists in mental hospitals actually spend in the care of patients”. In our opinion the topic of medical staffing has received little official recognition. Our own assessments are explained in this article with a view to finding some sort of base line and general agreement.

Whilst it is well known that drugs can cause behavioural changes (Trouton and Eysenck, 1960) relatively little attention has been given to the effects of drugs on complex cognitive functions. The purpose of this study was to determine the effects of two drugs frequently used in psychiatric treatment (chlorpromazine and chlordiazepoxide) on performance in problem solving situations as well as in tests involving speed and accuracy.