The study of the form and content of hallucinations remains a fascinating and intriguing one to all who are interested in psychopathology. In our present state of knowledge it provides the basis for experimental approaches to the aetiology of hallucinations. This paper is a brief review of the relationship between experimental and phenomenological approaches to the problem of hallucinations associated with organic cerebral lesions.

Individual variations in drug metabolism are important factors affecting both toxicity and clinical effectiveness (Brodie, 1964; Kalow, 1965; Price Evans, 1965). In most cases the best available index of the drug concentration at the site of action is the plasma level. An estimate of this will show whether the optimal concentration is present and in some cases may indicate whether new symptoms can be attributed to toxic side reactions.

It is a fact that there is, within the National Health Service, a gradually increasing demand for psycho-analytical psychotherapy. This demand is reflected in the large number of patients referred and in many articles dealing with the treatment of psychiatric and physical illnesses. Such satisfaction gained by this recognition is offset by the knowledge that both inside and outside the medical profession there is an abysmal ignorance of what psycho-analytical psychotherapy is, what it can or cannot achieve and what it involves in that most precious commodity—doctor time.

In 1957 Krantz, Truitt, Ling and Speers found that the inhalation of small amounts of hexafluorodiethyl ether (Indoklon) produced convulsions in animals, and it was later used as a therapeutic convulsant for the treatment of psychiatric patients (Krantz, Truitt, Speers and Ling, 1957).

Consistent decrements in schizophrenic performance on a reaction time (RT) task obtained by a number of investigators indicate that RT procedures yield reliable indices of schizophrenic deficits in attention (1, 2, 10), motivation (3), preparatory set (8), and psychomotor function (4). In previous studies (6, 7), the writer has presented evidence that these deficits may be attributable to impaired social motivation, in that these RT disturbances can be eliminated in most schizophrenics by activating biological motivation through shocks to the reacting finger. Older, more disorganized patients were unable to improve, however, even with shock motivation. Systematic comparisons of older and younger schizophrenic patients with and without ground privilege status, resulted in the finding that reduced social motivation, lessened reactivity to shock stimulation, and inability to cope with unpredictable anxiety cues constituted relatively independent dimensions of schizophrenic deficit in RT.

Since human electroencephalography was first introduced by Berger in 1929, there have been many attempts to correlate the alpha rhythm with various aspects of personality. Lemere (1936) first reported a relationship between “good” and “poor” alpha rhythms and cyclothymic and schizoid personalities respectively. Gottlober (1938) found a correlation between a high alpha index (per cent. time alpha) and extraversion. However, Henry and Knott (1941) pointed out that the group studied by Gottlober was loaded both with high alpha indices and extraverts, and with additional data were unable to find a significant relationship between extraversion-introversion and alpha index.

This paper describes a “double-blind” trial comparing ‘Triptafen’ tablets—each containing amitriptyline hydrochloride 25 mg. and perphenazine 2 mg.—with a matching placebo in the treatment of depressive illness.

Observations have been made on the stereotyped behaviours of a group of autistic children by means of one-way mirrors; Hutt and Hutt (1965) systematically varied the complexity of the situations in which the children were placed and noted the incidence and severity of the stereotyped behaviours exhibited. Jones (1965) also attempted the quantification and classification of stereotyped behaviours in a group of adult schizophrenic patients. In this experiment the observer was present in the same room. In both experiments the stereotyped behaviours were shown to be responsive to social influences.

In recent years the mental health of British university undergraduates has aroused considerable interest. The findings of Parnell (1951) at Oxford, Davy (1957 and 1960) at Cambridge, Malleson (1958) at University College, London, and Juel-Jensen (1962) at Oxford indicate that up to 20 per cent. of students suffer psychiatric disturbances of sufficient degree to constitute a handicap in their daily life. Furthermore, mental ill-health is one of the most important reasons why undergraduates lose time from their studies or withdraw from university altogether. Read (1954) stressed the advantages of the psychiatric service for students at the London School for Economics.

Since it was first described by Mannheimer, Pakesch, Reimer and Vetter in 1952 megaloblastic anaemia has come to be recognized as an occasional complication of anticonvulsant drug therapy. More recently a disturbance in folic acid and vitamin B12 metabolism has been observed in many non-anaemic drug-treated epileptic patients (Hawkins and Meynell, 1958; Klipstein, 1964; Malpas, Spray and Witts, 1966; Reynolds, Milner, Matthews and Chanarin, 1966a). Reynolds et al. (1966a) found megaloblastic haemopoiesis in 38 per cent. and subnormal serum folates in over 75 per cent. of a series of 54 out-patient epileptics. In addition, serum vitamin B12 levels, though still within the normal range, were significantly lower in the megaloblastic group of patients than in controls. They suggested (1) that the anti-folate effects of phenobarbitone, phenytoin and primidone may be related to their therapeutic actions, and (2) that prolonged drug-induced disturbances of folate and vitamin B12 metabolism may be responsible for certain side-effects, particularly mental symptoms. The latter possibility is supported by the increasing recognition of psychiatric illness due to vitamin B12 deficiency in the absence of anaemia or subacute combined degeneration of the cord. (Langdon, 1905; McAlpine, 1929; Holmes, 1956; Smith, 1960; Edwin, Holten, Norum, Schrumpf and Skaug, 1965; Strachan and Henderson, 1965).

In view of the structural similarity of imipramine and promazine, an attempt has been made to obtain a stronger anti-depressive effect by means of chlorination of imipramine at the same place in the molecule. Brandner (1964) has described the results of mono-chlorimipi-amine (MCI) administration in a series of 25 cases of various kinds of depression.

In 1876 the Danish physician, Julius Thomas Thomsen, described the disease entity of myotonia congenita, from which he himself and some members of his family suffered. This muscular disorder is now accepted as a clinical and genetic entity, distinct from other forms of myotonia, viz. dystrophia myotonica and paramyotonia (De Jong, 1955).

There is a growing body of evidence that oxypertine (Win. 18,501), a recently developed indolylalkyl-phenyl-piperazine (1, 9), is of value in the treatment of schizophrenia (6). Oxypertine has been described as superior to trifluoperazine in its effect on certain aspects of schizophrenic behaviour (2, 5).

The object of this paper is to assess, in retrospect, the relative effectiveness of amitriptyline (‘Triptizol’) and amitriptyline with perphenazine (‘Triptafen’) in the treatment of depressed patients.

In a leading article on mental symptoms in vitamin B12 deficiency (Lancet, 1965), it was pointed out that “though mental illness due to vitamin B12 deficiency is uncommon, it is readily treated, and, as in general paralysis of the insane, its protean manifestations and uncertain physical signs call for an easily applied screening test comparable to the Wassermann reaction”. In the correspondence which followed it was suggested that in psychiatric practice today mental symptoms were likely to be found more frequently in association with vitamin B12 deficiency than with a positive serological test for syphilis (owing in part to the increasing number of patients with deficiency syndromes following gastro-intestinal surgery); and that estimation of serum B12 concentration should be performed much more readily without waiting for clear-cut haematological evidence or neurological complications of megaloblastic anaemia (Hunter and Matthews, 1965). This was emphasized by the evidence of Strachan and Henderson (1965) who described three patients with psychiatric syndromes attributed to vitamin B12 deficiency in whom not only peripheral blood but also bone marrow was normal; and the report from a mental hospital in Norway by Edwin et al. (1965) that of 396 patients over the age of thirty years admitted over a twelve months period, 23 (5·8 per cent.) had serum B12 concentrations below the critical level of 100 μμg. per ml. as estimated by Euglena gracilis assay. This finding was challenged by Herbert et al. (1965), who suggested that drugs of the phenothiazine group administered to the patients might have suppressed the growth of the organism, but this was disputed by Edwin et al. (1966).