The “mnestic syndromes” proper belong to the class of “organic syndromes” of which they are a more or less ill defined sub-group. Though memory disturbances do occur in psychogenic disorders, the mnestic syndrome has in relation to these only a differential diagnostic significance. Disturbances of memory may, of course, appear in other organic syndromes, but only when memory defects are the dominant clinical feature or the sole defect (probably quite rare) should one speak of the “mnestic syndrome”. A number of sub-types or syndromes, e.g. the so-called Korsakov syndrome, are contained in the mnestic syndrome. As the syndrome may show various types of amnesia, dysmnesia or hypermnesia, the term “mnestic syndrome” was suggested rather than “amnestic syndrome” (Conrad, 1953).

Dementia, of several types, has long been known as one of the possible fates of the alcoholic. Since Gigon and Odermatt (1925) and Shattuck (1928) called attention to the likeness between alcoholic polyneuritis and that found in beriberi evidence has accumulated of the part played by lack of B vitamins. It is now accepted that Wernicke's encephalopathy is identical with cerebral beriberi (de Wardener and Lennox, 1947) and results primarily from a deficiency of thiamine. The same brain lesions are found in Wernicke's encephalopathy and Korsakov's psychosis, allowing for the length of the illness (e.g., Victor et al., 1952; Malamud and Skillicorn, 1956) and Victor and Adams (1961) consider that Korsakov's psychosis in alcoholics is the psychic manifestation of Wernicke's encephalopathy.

This paper reports the work of a clinical team on 100 consecutive first admissions to a unit constructed for the treatment of psychopaths at Balderton Hospital, Newark, Notts, and opened 1958–61. To prevent bias all male admission with behaviour disorder admitted between 1958–60 are here reported except: five admitted for observation of less than a week, twenty-two admitted only for remand, and those with a Wechsler or Stanford Binet I.Q. less than 56. The unit specialized in delinquents with mental disorder, and received admissions from all over Britain.

The relationship in the same patient of epilepsy and psychosis is little understood. Although patients with temporal lobe epilepsy especially tend to show more psychiatric disturbances than do other epileptics, it is still not agreed whether an “epileptic psychosis” exists in its own right, any more than whether there is such an entity as the “epileptic personality”. The literature is full of contradictory statements and hypotheses. This is inevitable considering that epilepsy is a symptom-complex of diverse aetiology. However, within the total population of epileptics, it is possible to define groups with one or more common characteristics, e.g., similar pathology, localization, symptomatology, or inheritance. In studying the psychiatric manifestations it is probably better to try to relate them to such sub-groupings than to epileptics as a whole. The problem is of practical concern, for the incidence of epilepsy is between 0·4 and 0·5 per cent. of the general population (College of General Practitioners, 1960), while Pond and Bidwell (1959) in their survey of the practices of 14 family doctors pointed out that about a third of the epileptic patients had psychological difficulties.

Parnell's method of physical anthropometry (Parnell, 1954), which has been derived from that of Sheldon (Sheldon, 1940), measures body build in three components. These three components of physique are designated (1) linearity, which is the ratio of height to weight; (2) muscularity, which is calculated from limb girth and bone measurements; and (3) fat, which is derived from skin fold measurements. The values obtained by actual measurement of a patient to elicit these components are plotted on a chart from which is obtained a first estimate of somatotype. This so called M4 Adult Deviation Chart has been devised so that a rating of 4 in muscularity will bear a constant proportional relationship to stature and is a means of converting the anthropomorphic data into an estimate of the three components of physique. The relative importance of these components is indicated by rating each on a 7 point scale. The first estimate of somatotype obtained in this way is then combined with a visual assessment of somatotype, which is made from a standard three-view photograph, to give the final estimate of somatotype, which must therefore be partially subjective. This final estimate of somatotype is then plotted on a somatochart.

Through the interpretation of certain features of the schizophrenic process, psychoanalytic theory links homosexuality and paranoid schizophrenia. This theoretical link derives from a concept of the dynamic development of the individual constructed from observations about individual cases rather than from any knowledge of the frequency of the linkage in the population of schizophrenic patients.

It is more than twenty years since Lang advanced the hypothesis that some male homosexuals are sex intergrades with male morphological sex characteristics but a female chromosomal pattern (Lang, 1940). Is there now sufficient evidence to prove or disprove the theory? The purpose of this paper is to review the evidence to date, and to present the results of an investigation of the somatic chromosomes in a small series of male homosexuals.

In 1948, Funkenstein, Greenblatt and Solomon reported on a test of autonomic function which is clearly a combination of tests used by earlier workers (McWilliam, 1925; Sachs, 1936; Myerson et al., 1937; Gold, 1943; Altman, 1943). They reported a relationship between the changes in systolic blood pressure induced by injected adrenaline and methacholine and the clinical course, after electro-convulsive treatment in a group of psychiatric patients. This was followed by a considerable volume of work, published by Funkenstein and his colleagues, on the prognostic, diagnostic and other aspects of a test (the adrenaline-methacholine or Funkenstein test) which has aroused steadily increasing interest. The number of papers published has grown continually, and great variation exists in the techniques adopted and the scoring methods used. Some workers have confirmed the original findings whilst others have not. Thus the subsequent literature on the test has shown a pattern not unfamiliar in medicine; enthusiastic first publications followed by reports less satisfactory and more critical, and attempts to carry out a proper evaluation, producing many contradictory results.

“When we consider the immense human significance of sleep, the absolute necessity for us to spend a considerable part of our lives in abject mental annihilation, it is remarkable how little we know about it. …” In these words, Sir John Eccles introduced the recently published Ciba Foundation Symposium on “The Nature of Sleep” (3), in which are described many of the advances which have been made in recent years in our attempts to understand the phenomena which are involved in the state of sleep. In one of the papers included in this Symposium, Bremer (2) reviews the work which has been reported since 1954 on the neurophysiological mechanisms involved in sleep. The relationship of dreaming to the depth of sleep has been investigated by such workers as Kleitman (5), Dement (4) and Wolpert (11). These studies have been made possible by the application of modern techniques of measuring mental activity. The use of electroencephalographic methods has allowed an approximate classification of the different levels of sleep which enables different workers to adopt a standard frame of reference. Measurements of rapid eye movements and of changes in muscle potential during sleep have provided more objective methods of assessing dream activity. Other recent studies have attempted to make an objective assessment of the physical and mental effects of sleep deprivation (Morris et al., 7, Bliss et al., 1, Murray et al., 8, Wilkinson, 9, Williams et al., 10).

Previous papers in this series (Shapiro, 2, 3, 4; Shapiro and Tizard, 6; Yates, 13 and 16) have been concerned with the investigation of an aspect of the reproduction of designs called the rotation effect. Rotation is the term used to describe the fact that subjects often, when copying a design, make their reproductions in an orientation which is different from that of the model (see Figure 1).

The argument to be put forward in this paper is that the way in which psychometric tests are often employed in geriatric problems may be less useful and, indeed, less sensible than is generally supposed. This applies to straightforward “intelligence testing” as well as to so-called “diagnostic testing”. It is recommended that the principles and practices of experimental psychology should be applied to these problems instead.

In the introduction to his Chairman's address in 1959, Warren (24) reminded us that both Cameron (6) from this country and Kanner (17) from the United States, had, in recent years, surveyed the historical background of child psychiatry. Chairmen of this Section may thus deem themselves exempted from repeating that task for some years to come. Warren took as his theme some relationships between the psychiatry of childhood and that of adulthood. It seemed to me appropriate to follow his lead and to carry our thoughts a step further by considering the child and adult as members of the family group, and to study how far it would be useful to accept the nuclear family, rather than the individual patient, as the functional unit in psychiatry.

Eighty chronic schizophrenic women hospitalized for an average of 6·8 years received group hypnotherapy twice weekly in addition to tranquillizers. After four months, 42 per cent. were discharged on convalescent leave; by the end of a year, a total of 48 patients (60 per cent.) had been released. All discharged patients—except four who required rehospitalization —made a satisfactory adjustment to their family and social responsibilities during the one-year follow-up period.

Most patients with endogenous depression who receive electroconvulsive treatment (E.C.T.) recover completely or improve considerably. However, it is evident that the effect of E.C.T. varies in different individuals. In some cases more treatments are necessary than in others and sometimes the final result is unsatisfactory even after a great number of treatments. Many attempts have been made to explain these variations.

Since the introduction of anti-depressant drugs into general use in the psychiatric field, there have been several statements to the effect that such a drug administered concurrently with electrical treatment reduces the number of shocks required to achieve a satisfactory response. This has been claimed by Sargant (1961) but without experimental support. Dunlop (1960) has published a comparison between the number of electrical treatments given with the anti-depressant drug during a particular attack, and the number of treatments without the aid of a drug in an earlier attack in the same patient: however, comparison of treatments in the same group of patients at different times is unreliable because there may be other factors to account for the differences noted. A controlled trial is necessary to ensure that all factors are constant other than the one under consideration.

The mono-amine oxidase inhibitors, of which phenelzine (“Nardil”) is one example, were introduced for the treatment of depressive illness as a result of the observation that iproniazid, which is a mono-amine oxidase inhibitor, produced euphoria and increased mental alertness in some tuberculous patients to whom it was given. Trials of iproniazid in mental illness were carried out (Loomer et al., 1957; Cesarman, 1959), but it was found to be very liable to give rise to side-effects, being particularly toxic to the liver. Other less toxic mono-amine oxidase inhibitors such as phenelzine, which is chemically related to iproniazid, were later developed.

Since its introduction in 1938, electroconvulsive therapy (E.C.T.) has shown itself to be a dramatically effective, unusually safe treatment for severe depressive states (“melancholias”, “endogenous” or “psychotic” depressions). Nevertheless, it is repugnant to many patients and psychiatrists, produces a troublesome, if transient, amnesia—especially in older individuals—and is occasionally complicated by fractures and dislocations as well as by anaesthetic and relaxant misadventures. Worst of all, as early studies showed, of the 80–90 per cent. of severe depressives who respond to E.C.T., some 30 per cent. relapse (Huston and Locher, 1948 a, b). Recent work suggests that the rate of relapse may often be higher still—thus of 94 per cent. of a group of patients who had responded to E.C.T., Kiloh and Ball (1961) reported that 46 per cent. had relapsed during the six months following the cessation of treatment. For these reasons, the trend to chemotherapy initiated by the advent of effective antidepressant compounds in 1957 continues to develop, and signs are becoming manifest that within a few years E.C.T. may be replaced by pharmacotherapy.

Death due to barbiturate overdosage has been an increasing problem, rising steadily in England and Wales from a death rate of 2 per million population in 1949 to 5 per million in 1958 (1). Of 2,044 consecutive fatal poisonings studied in Denmark between 1953 and 1959, over a quarter were due to barbiturates (2). 300 tons of barbiturate are consumed in the U.S.A. every year and acute poisoning with it in that country accounts for 1,500 deaths per year (3).