It has been found that a significant progressive reduction in the amplitude of physiological tremor in the 4–12 c/sec. range occurs when relatively unpractised subjects carry out a series of trials in a motor task involving a controlled muscle effort (Carrie, in press.

Desipramine (Pertofran) is the monomethyl analogue of imipramine (Tofranil) and is marketed as a potent anti-depressant agent. The literature on this drug has already been adequately reviewed by Rose et al. (1964) and Waldron et al. (1965). It is therefore sufficient to note that earlier reports claiming a more rapid action than imipramine have not been supported by more recent investigations. This paper reports a double-blind controlled comparison of imipramine and desipramine, designed to investigate the relative effectiveness, speed of action and side-effects of these two drugs.

For over a decade the Maudsley Monograph Suicide in London (Sainsbury, 1955) has been the most authoritative source of information about the contribution of certain social factors to the incidence of suicide in a British urban population. Sainsbury's investigation tested the hypothesis “that where social mobility and social isolation are pronounced, community life will be unstable, without order or purpose, and that this will be reflected to a greater or less degree in the suicide rates”. Much of his work stems from the pioneer work of Durkheim (1897). Using a combination of sociological and psychiatric methods he correlated rates of suicide and indices of social characteristics for London Boroughs derived from a social survey, the 1931 Census and other studies (Burt, 1944). He found significant differences in suicide rates among the boroughs, which remained consistent over 30 years despite considerable changes in the composition of their populations. Comparing suicide rates with other social factors he found significant correlations with social isolation, social mobility, divorce and illegitimacy. He suggested that suicide tended to be higher in the middle class and to diminish with poverty, but found no correlation with unemployment and overcrowding. He stated that suicide rates increased with age, particularly among males, there being a preponderance of over 55 year olds in his sample. A seasonal variation was observed, with the peak incidence in May. In his sample there were twice as many men as women. Six per cent. of his group were definitely alcoholic. Nine per cent. had made a previous attempt at suicide. Almost half of the group were seen to be psychiatrically ill or abnormal in personality.

An initial report on this study (Sheldon, 1964) demonstrated a significant positive relationship between psychiatric after-care and reduction of readmissions to mental hospital in the six months following hospital discharge when patients were randomly allocated to psychiatric after-care or to the general practitioner. The present paper demonstrates that this effect, although diminished, is still apparent for a similar group of patients allocated to after-care by their discharging psychiatrist and followed up for three years. It attempts to clarify the factors operating in psychiatric selection for after-care, and to explore the relative importance of after-care and of the nature and severity of illness in determining outcome, at least as measured by the number, duration, and time after discharge of rehospitalizations.

Juvenile delinquency is generally considered to be one of present-day society's most serious problems. Indeed, more than half of all serious crimes in the United States are committed by youths under 18 years of age (3). Despite its magnitude and prevalence, juvenile delinquency is still inadequately defined, much less understood, partly because of its having only lately been recognized as a distinct practical problem and thus a fit matter for investigation. Over the past four decades, however, there has been an increasingly active study of the problem, focusing on the delinquent youths themselves and, more recently, on the environment in which they have developed. Methodological approaches to the question of definition and causality of delinquency have been diverse, but can be considered as being of two general types: the deductive-theoretical, in which a stated hypothesis is critically examined in the light of clinical experience as illustrated by clinical material; and, the inductive-empirical approach, in which a body of data, e.g., the environmental factors found in delinquents, is analysed, and conesions are drawn, based on the results of that aysis.

The past decade has seen many new drugs. With use, serious side-effects have become apparent. The need for rapid assessment and advertisement of such effects led to the formation of the ‘Dunlop Committee‘.

To keep psychiatric patients as much as possible in the community rather than have them admitted to mental hospital is a policy which has become more and more favoured and has been shown to work (Leyberg, 1959; Silverman, 1961; Sainsbury et al., 1963 and Hoenig et al., 1965, etc.). This type of management cannot be expected to be equally successful with all groups of patients and is perhaps most open to question as regards the illnesses that affect the elderly.

The Symptom Rating Test (S.R.T.) was designed to assess changes in symptoms in non-psychotic patients. Previous studies suggest that the test is a measure of recently experienced neurotic distress. Scores were found to change markedly with changes in the clinical state of patients during treatment, and in anxious neurotics the scores were found to be correlated with psychiatrists' rating of anxiety.

There is growing evidence of a connection between the metabolism of monoamines and severe depressive illness, but the exact role of these substances in affective disorders has yet to be defined. We know that reserpine depletes the brain of monoamines and that a proportion of patients treated with this compound develop a depressive illness. Conversely a number of compounds which raise the levels of amines in the brain by blocking the enzyme monoamine oxidase have been used in antidepressant therapy. The knowledge that loss of amines may be associated with depression, and that their replenishment in the brain may induce recovery, immediately leads to the question as to which of the biogenic amines is responsible for the affective changes. Pollin, Cardon and Kety (1961) observed the effect of giving various amino acids together with a monoamine oxidase inhibitor (M.A.O.I.) to patients suffering from chronic schizophrenia. They found that only tryptophan, the precursor of the monoamine 5-hydroxytryptamine (5HT), produced an elevation of mood. On the basis of their results, Coppen, Shaw and Farrell (1963) treated a number of patients suffering from severe depressive illness with M.A.O.I. and half of this group also received an oral dose of a suspension of D L-tryptophan (214 mg./kg. body weight) for one week. The patients taking tryptophan and M.A.O.I. recovered more rapidly than those receiving M.A.O.I. alone both while they were on tryptophan and also subsequently. One explanation for these findings was that the combination of M.A.O.I. and tryptophan increased the amount of amines derived from tryptophan in the brain, and that it was this which was responsible for the therapeutic effect. If this were so, then there were several possibilities. The first was that the level of 5HT in the brain was low in depression and the combination of amine precursor and enzyme inhibitor brought it back to normal. Alternatively it may be that recovery occurred as a result of the presence of abnormally large quantities of 5HT in the central nervous system or even following the production of tryptamine, another amine derived from tryptophan.

Chemically, trimipramine has an imino-benzyl nucleus and a side-chain resembling that of methotrimeprazine [5-(3-dimethyl-amino-2-methyl-propyl)-10, 11-dihydrodibenz (b, f,) azepine]. In “double blind” controlled comparisons of trimipramine and imipramine, Salzmann (1965) in 27 hospitalized depressed patients who did not require ECT, found the two drugs not significantly different in effect. Blumenthal and Seppala (1965) obtained similar results. Burns (1965), however, in 44 patients suffering from psychotic depression, found trimipramine to be significantly superior at the 5 per cent. level to imipramine in ratings of recovery from depression, anxiety and insomnia. No difference was found in the latency interval between the drugs.

Recent investigations of cognitive disorder in schizophrenia (Payne and Hewlett, 1960; Payne, Caird and Laverty, 1964) have indicated that schizophrenic performance in cognitive tests is characterized by a tendency to use very loose, “overinclusive” concepts. This phenomenon which Cameron (1944) termed “overinclusive thinking”, has been re-interpreted by Payne (1961) in terms of an impairment of a hypothetical filter mechanism which normally excludes irrelevant stimuli from consciousness and so allows attention to be directed towards the task in hand. McGhie and Chapman (1961) and Chapman (1966) have presented clinical evidence based on the subjective reports of schizophrenic patients supporting the hypothesis that a primary disorder in this disease is an impairment in the selective and inhibitory functions of attention. Chapman and McGhie (1962) and McGhie, Chapman and Lawson (1965a and b) have substantiated and elaborated this clinically derived hypothesis in an experimental setting where the subjects were required to perform various psychomotor and short-term memory tasks with and without distracting stimuli. The results of these investigations, while supporting the hypothesis in a general way, were nevertheless equivocal. The distraction effect in schizophrenia appeared to be confined to those situations where adequate performance involved the processing of a substantial amount of information. This finding was explained in terms of Broadbent's (1958) theory of the human operator as a limited capacity information channel. It appeared that distraction affected the performance of schizophrenic patients only in situations where the limited information channel was fully occupied in handling relevant aspects of the task—for example, in tracking and short term memory tests. Under these conditions the assimilation of irrelevant information produces overloading of the information channel and a consequent breakdown of performance. On the other hand, in those tasks requiring little information processing—for example, in repetitive psychomotor tasks—the channel is operating well below capacity, the assimilation of irrelevant information does not lead to overloading, and consequently does not have any detrimental effect on performance. An analogue of this situation occurs in normal subjects, in whom division of attention between two sources does not necessarily lead to impairment of performance if the informational requirements of each source are small and total information load does not exceed the critical limit (Broadbent and Herron, 1962). For the schizophrenic patient attention tends to be divided between the relevant and the irrelevant, yet impairment in performance need not occur if the informational requirements of the task are kept small.

In view of the important implications of the subject, it is surprising that there have been so few studies of psychiatric illness within the medical profession, except specifically in regard to drug addiction. Indeed, we could find only two papers on the overall psychiatric morbidity in the profession published during the last decade (Duffy and Litin, 1964; Pearson and Streker, 1960). In Great Britain there have been no published studies of this kind as far as we can discover.

As a result of three decades of painstaking work, R. Gjessing (1932–1960) published ten classical Beiträge zur Somatologie der periodischen Katatonie. These studies are being continued by L. R. Gjessing (1956, 1958, 1964, 1965) on some of the original patients and on additional subjects.

Richter (1960) reviewing knowledge about biological “clocks” in medicine and psychiatry, emphasized the incidence of 48-hour cycles of physical and mental symptoms. He considers that the mental symptoms are not specific and can be manic depressive or schizophrenic. Menninger-Lerchenthal (1960), in his book on periodicity in psychopathology, devoted a section to 48-hour rhythms and lists references to 48-hour cycles in the literature.