Maddison and Mackey, in their review article “Suicide, the Clinical Problem” (1966), emphasize “the interpersonal significance of suicide, a viewpoint which is complementary and not alternative to an intensive study of the patient's intrapsychic life.” They continue: “More than usual attention needs to be given to the specially significant individual to whom the suicidal patient is often ambivalently bound in a symbiotic relationship, for highly relevant psychopathology will very frequently be found in this person …”.

The present study is concerned with what is inherited in mental disorder. Is it an unspecific tendency to mental disorder, is it specific symptoms or features such as age of onset, course or outcome, or is it psychiatric diagnosis?

The study of pairs of relatives with mental disorder is certainly the best approach to investigating the problem of what is inherited. Unfortunately there has been a paucity of studies primarily dealing with this particular problem.

The title of this review would be regarded by some psychiatrists as provocative; they would relegate the biochemical concomitants of depression and mania to a secondary position and deny that biochemical changes have any place in the aetiology of these conditions. However, in my view, the weight of evidence, although it is by no means conclusive, suggests that biochemical changes are most important in the aetiology of affective disorders. A biochemical aetiology implies that there are certain biochemical changes in the brain which need to be restored to normal before the patient's clinical condition will improve. This does not deny that psychological and environmental events may precipitate and maintain the biochemical events which in turn lead to the affective disorder. The study of these biochemical events is clearly at too early a stage for speculations about the interrelationship between environmental and endogenous elements to be fruitful; this study must wait until the biochemical aetiology is clearer than at present.

Since the inception of the use of artificially induced convulsions as a therapeutic agent in 1935 by Meduna and the modification of this method of treatment by the use of electric currents by Cerletti and Bini in 1938, a vast literature has accumulated on this form of psychiatric treatment. Yet, despite this vast literature and the passage of over 30 years of experimental opportunity, no predominant or convincing rationale for the use of electroconvulsive therapy (E.C.T.) has emerged; Meduna's (53) original theory of the incompatibility of schizophrenia and epilepsy having been long discredited. E.C.T. remains, therefore, an empirical form of treatment.

In recent years a number of studies on attempted suicide in various cities in England and Scotland have been published (Batchelor, 1954a and b; Stengel and Cook, 1958; Harrington and Cross, 1959; Middleton et al., 1961; Kessel and Lee, 1962; Sclare and Hamilton, 1963). Direct comparison between these suicides is difficult, not only because they differ in presentation but also because regional and cultural differences contribute to varying clinical and epidemiological data. There is, however, general agreement that cases of attempted suicide have become depressingly common problems in the casualty departments and wards of most general hospitals in larger cities. The Ministry of Health Circular H.M. (61) 94 estimates that the annual incidence of attempted suicide in England and Wales is around 30,000 cases. The present writers agree with Stengel (1963) that this is likely to be an underestimate.

The value of oxypertine in the treatment of chronic schizophrenia has been the subject of several clinical trials, the results of which have been reviewed recently (Skarbek and Jacobsen, 1965). In particular a comparison of the effects of oxypertine and trifluoperazine in thirty-five schizophrenic women revealed statistically significant differences between the drugs, oxypertine showing a tendency to activate the withdrawn cases (Calwell, Jacobsen and Skarbek, 1964). An opportunity arose to study five of these patients again under controlled conditions, and it was felt that this would be useful for two reasons. First, it would show whether the response to oxypertine was repeatable, as the patients had meanwhile resumed their previous treatment. Secondly, by a detailed examination over an extended period, using a battery of tests and flexible dosage, a more exact delineation of the optimal symptomatic response to oxypertine could be made.

Nitrazepam (Mogadon), a benzodiazepine compound, chemically related to diazepam (Valium) and chlordiazepoxide (Librium) is a recently introduced sleep-inducing agent. Other studies (Baum et al., 1965; Fraser and Shepherd, 1966), found it to be both safe and effective. It is thought to induce sleep by “shielding the brain centre responsible for waking from emotioned stimuli”, and is therefore of particular interest for psychiatric illness. This study is a clinical comparison with sodium amylobarbitone, using a double-blind cross-over technique.

This enquiry is part of a wider investigation into the characteristics of children attending special schools for the educationally subnormal in South Wales. Seven local authorities are co-operating in the project, and they have made available records of children attending the eight special schools that they maintain. Two residential schools are provided by four rural authorities and six day schools are provided by three urban authorities. The characteristics of the population of 801 children who were attending the eight schools at the time of the enquiry have been reported previously in this Journal (Williams, 1966).

In several previous studies it has been shown that the mean tremor amplitude displayed by morbidly anxious patients is greater than that of normal control subjects. The most detailed experiments were those carried out by Redfearn (1957). He compared the findings obtained in groups of male morbidly anxious patients and controls, and in addition to confirming the existence of a difference in tremor amplitude, he reported that the tremor of male anxious patients showed a greater degree of accentuation of the 8–10 c/sec. components than the tremor of a matched control group. Halliday and Redfearn (1956) compared the tremor spectra obtained from normal male and female subjects, and found that the curve for men was similar to that for women.

Recent years have seen increase of interest in problems relating to the health of the aged. One of the major difficulties has been the practical problem of assessment, whether it be of physical, social or mental health. It is essential that any measures employed are appropriate to the aged population, should be easy and brief to administer, as well as being reliable and valid. Some advances have been made in tests of cognitive functioning developed or derived for use with the aged (Dixon, 1965; Britton and Savage, 1966). As yet, however, no simple psychometric test has been proposed for aiding the psychologist, psychiatrist, general practitioner, social scientist or those concerned with the care of the community aged in the early recognition of possible psychiatric abnormality. This report aims to remedy this omission to a certain extent. We have derived from an extensively used psychometric measure, the Minnesota Multiphasic Personality Inventory (MMPI, Hathaway and McKinley, 1951), a short scale of fifteen questions which has been shown to be a valid, easily usable measure of mental illness in the aged.

The increasing demand for the institutional care of elderly psychiatric patients has been a growing concern in England and especially in Essex, which has an unusually large number of old people (21 per cent. over 65 compared to a national average of 12 per cent.) (2).

One current classification of depression divides the syndrome into psychotic and non-psychotic varieties. It is interesting that a similar classification developed over a thousand years ago out of some words of St. Paul. In his Second Epistle to the Corinthians, Ch. 7, v. 10, Paul wrote: “For godly sorrow worketh repentance to salvation not to be repented of, but the sorrow of the world worketh death.” The word sorrow used in English translations of the Bible stood for the tristitia of Latin versions (Greek λνπη); connoting sadness, sorrow, despondency, depression. Paul's distinction between the two kinds of tristitia, the one “from God” and the other “of the world”, led mediaeval theologians to enlarge on differences between the two kinds of depression.

An ecological study by Philip and McCulloch (1966) demonstrated very high correlations between the incidence of attempted suicide and the rates of incidence for repeated attempted suicide, overcrowding, having been taken into care by the local authority, having had contact as a child with the Royal Scottish Society for the Prevention of Cruelty to Children, and juvenile delinquency. McCulloch and Philip (1968) showed that persons admitted to hospital following a suicidal attempt manifested these variables to a high degree. In this latter study “juvenile delinquency” was replaced by “all offences” as a variable. The present paper reports on the relationships between a scale based on these variables and a number of psychological measures gathered from 84 of the 95 patients in the latter study.

This paper describes and attempts to evaluate an alcoholism treatment programme in two Caribbean islands with a multi-racial population of just under a million. The programme, initiated by the author in 1956, combined emetine aversion treatment in a group setting, with milieu therapy and group psychotherapy of a didactic kind aimed at producing conversion (rather than aversion) to uncritical belief in the tenets of Alcoholics Anonymous.

Bene (1965) in a previous issue of this Journal, has summarized the main evidence for the view that homosexuality is a product of defective role training and is not a result of any direct genetic mechanism. It is becoming apparent that once a child has been pronounced as a boy or a girl it has to learn the forms of behaviour appropriate to its ascribed sex. The learning or conditioning mechanism by which the child learns to make its role performance congruent with its' ascribed sex is not understood. Comfort (1964) has suggested that sex-typing may be some form of imprinting. Hampson (1965) investigating several types of hermaphroditism has found evidence that if the gender role has to be changed after about the third year of life, increasing psychological difficulties are encountered. He also points out that the development of the gender role coincides with that of language.

The sub-speciality of geriatric psychiatry is coming to be known as “psycho-geriatrics”, an abbreviation which is not a very happy one, but which seems to be becoming generally accepted.

This investigation is part of a larger comparative study of Edinburgh primary school children referred to a psychiatric department with behaviour disorders and of a matched control group of non-referred children.