Phenytoin Sodium (Sodium diphenylhydantoinate) is established in the treatment of epilepsy. Toxic side effects, especially on the nervous system, have been well documented. Untoward reactions may follow therapeutic doses taken over a period of time, or as the result of a single massive dose taken accidentally or with suicidal intent.

The following case of toxic reaction is reported because of the unusual mode of presentation and the associated C.S.F. changes.

Eysenck (1957a) has recently cogitated the relation between personality and drug response. He quotes McDougall (1929) as stating “I have observed in a number of cases that the marked extraverted personality is very susceptible to the influence of alcohol. The introvert, on the other hand, is much more resistant to alcohol“. This is a remark capable of confirmation, for Eysenck (1953) has described at least two personality dimensions, each a continuum and each orthogonal to the other. These two dimensions were termed “Neuroticism-Normality” and “Extraversion-Introversion”. A number of tests have been elaborated by Eysenck (1955, 1956, 1957b) for measuring such personality quantities.

Recent research has shown that constancy of perception breaks down in schizophrenics. Size constancy in these patients has been investigated by Raush (13, 14), Weckowicz (16), and Crookes (2). Raush found that paranoid schizophrenics had increased size constancy compared with normals and other schizophrenics. He predicted that in other types of schizophrenia size constancy might be poorer than in normals. However the difference he found was not statistically significant. Weckowicz found that chronic hospitalized schizophrenics had poorer size constancy than other hospitalized patients and normals. These two investigators determined size constancy by instructing the subjects to adjust the size of an object (a rod or a square) to the size of a standard object at a distance. Crookes used a direct method. His subjects were instructed to reproduce the size of the image of the standard object seen at a distance and not the size of the object itself. He came to the same conclusion as Weckowicz that size constancy in schizophrenic patients was impaired.

Chlorpromazine (“Largactil”) was introduced to this country some five years ago, and since that time a considerable number of reports on its clinical efficacy have appeared, including Anton-Stephens (1954) and Garmany et al. (1954). There is now general agreement that it is a useful form of treatment in chronic schizophrenia, especially for the aggressive, disturbed patient (Salisbury and Hare, 1957). More recently another phenothiazine derivative, incorporating a piperazine ring in the side chain, has been produced.

Prochlorperazine, 1-[3-(3-chloro-10-phenothiazinyl)propyl]-4-methyl-piperazine dimaleate, a phenothiazine derivative related to chlorpromazine, was discovered in the Rhône Poulenc laboratories, and studied pharmacologically in 1956, by Ducrot and Koetschet, for its anti-emetic properties. Clinical trials, following this experimental evidence, suggested that, as well as possessing powerful anti-emetic properties, the drug was of considerable therapeutic value in migraine, Ménière's syndrome, and vertigo of other origins.

Trifluoperazine, which is 2-trifluoromethyl-10-(3′-[1″-methylpiperazinyl-4″]-propyl)-phenothiazine dihydrochloride—a preparation manufactured by Smith, Kline and French Laboratories Limited under the description SKF5019—is the most recent phenothiazine derivative reported to have a beneficial effect on certain types of mental illness. On the basis of animal tests trifluoperazine is described as having nine times the potency of chlorpromazine in blocking the conditioned response, and its specificity is greater than that of chlorpromazine.

Promazine hydrochloride (“Sparine”) is a phenothiazine derivative which has recently been introduced to this country with claims to be a “tranquillizing” drug. It is closely related chemically to chlorpromazine but does not contain the chlorine atom which has been thought to cause the undesirable side effects of the promazine group. The structural formula of Sparine compares with that of chlorpromazine as follows:

That chorea may sometimes occur as a result of cerebral syphilis has been accepted for some years (Kinnier Wilson 1940) and it has often previously been reported in association with G.P.I. The literature on the topic is dealt with by Lowrey and Smith (1918), Stone and Falstein (1938) and Weickhardt (1945). In all the reports however I can find only three previous instances where clinical and serological evidence of G.P.I. in a patient was associated with a family history and clinical syndrome of Huntington's chorea. These cases were reported by Pagliano and Aviennos (1922), Urechia and Rusdea (1922) and Stone and Falstein (1938) and the case here described appears to be only the fourth similar example to be reported. It has a practical as well as an academic interest since the differential diagnosis of the early stages of Huntington's chorea from those of G.P.I. is still sometimes necessary.

Head injuries in children have been studied less extensively than those in adults, in particular, their psychiatric aspects. Ssouchareva and Einhorn (1935), Blau (1936), Riggenbach (1946), Fabian and Bender (1947), Lutz (1951) and others have given special attention to such aspects. However, there are still marked discrepancies in the assessment of the various aetiological factors and their prognostic importance in determining prolonged psychiatric sequelae.

Cyclizine hydrochloride (1-benzhydryl-4-methylpiperazine monohydrochloride) is a popular remedy for motion-sickness. The success which is reputed to attend the use of the drug in this condition may be a function of of two distinct effects: (a) a direct, specific inhibition of the vestibular mechanism; (b) a general, central inhibition or sedation. A consideration of the latter, rather than the former, suggested the possibility that cyclizine might prove to be of value as a potential “tranquillizer”. A controlled clinical trial was carried out in order to establish whether any tranquillizing effects might be associated with the use of the drug in a number of chronic psychotics, all of whom manifested some gross disturbance of behaviour. This paper describes the experimental method which was used; the results which were obtained; and a general comment upon the possible implications of the results in relation to other drugs used in psychiatry.

The present analysis pertains to the experiment reported by Brengelmann, Pare and Sandler (15) to assess the effect of 5-hydroxytryptophan (5-HTP) on lysergic acid diethylamide (LSD) by means of psychological tests. In the following, problems of measurement and validity of the LSD- “psychosis” are discussed.

In the investigation described, the hypothesis was tested that 5-hydroxytryptamine (5HT) acts to reduce the psychological effects of lysergic acid diethylamide (LSD). The method was to inject 5-hydroxytryptophan (5HTP) prior to LSD and to compare the results of psychological tests performed after these injections. Placebo controls were used.