The view that depersonalization experiences can “be regarded as occupying a position somewhere between the delusional and the non-delusional” was first suggested by Ackner (1954) who gave as an example the depressive's experience of malaise. If this is accepted into the normal framework of experience it will be attributed to illness or fatigue. If it is accepted and organized into a delusional framework, the depressive delusion that the body is rotting away (for example) may be exhibited. If, however, the experience cannot be accepted into either a normal or a delusional framework it will remain peculiar, foreign, strange, and unreal and will appear as depersonalization. Ackner commented that if delusions should develop, experiences of change “will tend to be included” within them, and thus not appear as depersonalization. Discussing depressive depersonalization in particular, he considered that “with delusional development, the unreality feeling tends to recede”.

This paper reports primarily the use of the MWLT (Walton and Black, 1957) on aged subjects with a variety of clinical conditions. Earlier studies by Walton (1958), Walton, White, Black and Young (1959) and Walton and Mather (1961) demonstrated that the MWLT identified over 80 per cent. of organics without any misclassification of non-organics. More recently, Orme, Lee and Smith (1964) found that 81 per cent. of organics were correctly classified, but only 69 per cent. of non-organics. Misclassification was particularly serious with schizophrenics (70 per cent.). Other reports, including Newcombe and Steinberg (1964), White and Knox (1965), have found as few as 47 per cent. of the organic group correctly classified. These recent studies cast some doubt upon the original claims of the MWLT as a diagnostic test of generalized brain damage. We hope to present further evidence on the efficiency of the MWLT; particularly on its use with elderly subjects.

Benzhexol hydrochloride (Artane, Pipanol, Trihexyphenidyl) was the first of a range of synthetic antispasmodic drugs to be made available for the symptomatic treatment of Parkinsonism. Selected as the most potent of a series of substituted piperidyl propanols examined pharmacologically by Cunningham et al. (1949), it was shown to have half the activity of atropine sulphate in inhibiting neurogenic spasm in isolated rabbit intestine. This activity was associated with advantageously reduced mydriatic, anti-sialogogic and vagal inhibitory properties in laboratory animals.

The essential function of the clinical psychologist, from the point of view of society as a whole, must be to make available to the Health Service the contribution of the science of psychology. This means much more than the kind of sophistication which stems from an experience of psychiatric disorder and from a study of the psychiatric literature. We will now consider the implications of such an approach for the three main aspects of clinical work: assessment, modification, and research.

There is evidence that the susceptibility to certain diseases varies in people of different blood groups. Associations have been claimed to exist between the ABO blood groups and diseases such as duodenal ulcer, carcinoma of the stomach, pernicious anaemia, diabetes mellitus, and rheumatic fever. The most convincing evidence for an association between a blood group and a disease is that of the increased frequency of group O in patients with duodenal ulcer (Aird et al., 1954), and also an increased frequency of non-secretion in the same disorder (Clarke et al., 1956).

Previous assessments of nortriptyline (Bennett, 1962; Rose and Leahy, 1964) have suggested that it has useful anti-depressant properties, and a preliminary trial in which the present authors were involved (Rose et al., 1965) found that it compared sufficiently favourably with amitriptyline to merit further controlled study.

Twenty chronic patients, group 1, entered a hospital factory unit for one month and received varying increases of pay. They were compared with three control groups, each of ten patients. Thus group 2 received increases of pay similar to those of the group entering the factory, but remained outside the factory unit. Another, group 3, had already been in the unit for several months, and were discharged from the unit into other hospital employment for one month without change of pay. Another, group 4, remained in the factory throughout with no change of pay. Forty per cent. of each group was female. The control groups were matched with group 1 for age, duration of stay and group test results. Ranges and averages were: age, gp. 1, 36–66, 52·1, gp. 2, 34–65, 50·1, gp. 3, 38–68, 50·5, gp. 4, 21–63, 46·1; duration of stay, gp. 1, 1–35, 17·6, gp. 2, 3–27, 14·0, gp. 3, 2–32, 12·6, gp. 4, 2–27, 13·9 years. The distribution of patients between hospital wards was the same in each group. Eighty per cent. of each group had a diagnosis of chronic schizophrenia. Eight patients from group 1 and four from each of the control groups took part in an additional group discussion with one of the experimenters during the month trial period. A list of different topics were worked through, e.g. driving, smoking, taking risks, etc., and photographs from the 1963 Year Book and coloured advertisements were used, preferences and associations being asked for with each topic.

In a previous study (Willcox et al., 1965), we reported the results of urine tests on a series of psychiatric out-patients, done with the aim of determining whether the patients were taking their pills as prescribed. We now report a similar study on in-patients. It is a matter of clinical experience that some psychiatric in-patients avoid taking their pills as prescribed, for in-patients who take an overdose in a suicidal gesture often say that they 'saved up’ their prescribed pills in order to do this. There are many other reasons, such as the occurrence of unpleasant side-effects or a belief that the pills are not doing any good, which might lead in-patients to avoid swallowing their pills at medicine-time, and though we should not expect to find this happening as often in in-patients as in out-patients yet the proportion of cases in which this occurs and whether it occurs more often with one type of drug than another are matters of general concern.

There have been two surveys of the patient population of Glenside Hospital, Bristol, in recent years—Cooper and Early (1961), and Early and Magnus (1966). Since the 1961 review, a considerable number of patients admitted have become “chronic”, i.e. have remained continuously in hospital for over one year. An attempt to enquire into this problem has been made.

This paper reports a series of experiments with a short self-rating scale derived from Zung (1965). Conceivedas a measure of depression, its value in a psychiatric setting has been confirmed. It also shows promise of identifying neurotic disability in a wider context, whether as an epidemiological tool or as a rapid screening device in general medicine.