This paper describes a group of female patients admitted to mental hospital who in the past had undergone thyroidectomy for thyrotoxicosis. It was thought that a group of this kind who had been admitted might show, possibly in an exaggerated form, the personality features said to be common to individuals predisposed to thyrotoxicosis. The series does not include any toxic psychosis attributable to the disease itself and the title may possibly be misleading in this respect. Most psychiatric studies have dealt with the patient at the time of the illness and the emphasis has tended to be on precipitating factors. A much quoted study is that of Conrad (1) (1934). As a psychiatrist working in a thyroid clinic she described 57 cases referred for psychiatric opinion and used 48 cases not so referred as controls. She concluded from a careful study that the onset of the illness was due to two main patterns of emotional disturbance: (1) fear of loss of shelter and affection equivalent to deprivation of mother, (2) fear of dangers of the mother role. She found a large number of cases where there had been loss of the mother at an early age. Ham, Alexander and Carmichael (1951) (2) remind us that the disease occurs spontaneously only in man, not animals, and rarely in primitive communities. They describe a “specific dynamic pattern” in thyrotoxicosis, viz., Frustration of dependent longings and persistent threat to security (exposure to death and other threatening experiences in early life, causing unsuccessful premature attempts to identify with the object of the dependent cravings. There is a continued effort toward premature self sufficiency and to help others. These strivings for self sufficiency and taking care of others fail causing thyrotoxicosis. Lidz and Whitehorn (1949) (3) also regard thyrotoxicosis as following in almost every case a somewhat similar pattern. They regard these patients as a group less wanted than their sibs but eventually achieving parental affection by being “good children” (in the exaggerated sense) and persist in this pattern of behaviour in adult life. They expect the same unswerving fidelity they gave to their parents in return for excess of affection that they give to a parental figure. These authors claim that this almost invariable pattern provides short cuts in therapy, e.g., when the illness arises soon after marriage, problems are apt to revolve about difficulties in leaving the parental home. Working on different and more objective lines Ruesch (4) and his colleagues at the Thyroid Clinic of the University of California studied 43 patients carefully selected to give a fair representation of patients treated by thyroidectomy. They verified thyrotoxicosis by histological reports on the excised portion of the gland. Each patient had 5 interviews and abbreviated Wechsler and Minnesota Multiphasic Personality Inventory Tests. Their main interest was the prolonged psychological invalidism which had been noted to immediately follow operation. They found that patients with delayed recovery tended to have a long record of previous hospitalization, and a high frequency of major and minor operations. In the M.M.P.I. the most common pattern was “undifferentiated normal”. They concluded that patients with thyroid disease are not entirely normal sociopsychologically, but the group could be subdivided into two entities: (1) normal or almost normal, (2) hysterical or anxious type in female patients, or dependent personalities in male patients.

A psychological test of brain-damage, shown to be valid in discriminating between unequivocal brain-damaged and non-brain-damaged psychiatric patients, is limited in its diagnostic role until studies can demonstrate its independent diagnostic contribution in the clinically doubtful case of brain-damage.

Vespral, chemically designated as 10-(3-dimethylaminopropyl-2-trifluoro-methyl)-phenothiazine hydrochloride, or trifluopromazine hydrochloride is a new ataractic drug which has only recently become available in this country. A clinical field trial with Vespral has been reported in a previous issue of this journal (1). It was then suggested that the drug was most effective in the treatment of psychotic disorders, schizophrenia in particular. The aim of this study was to evaluate, with some claim to objectivity, the effectiveness of the administration of trifluopromazine hydrochloride on the behaviour of a small population of chronic schizophrenic patients.

Experimental studies by O'Connor (2) and O'Connor and Rawnsley (3) have indicated the value of separating chronic schizophrenics into those who exhibit and those who do not exhibit paranoid symptoms. Other work by O'Connor and Venables (4) and Venables and O'Connor (6) has shown that performance of schizophrenic patients on experimental laboratory tasks may be clarified by dividing them into active or withdrawn groups by means of a rating scale (Venables, 5) in addition to a division on the basis of the presence of paranoid symptoms.

The development of megaloblastic anaemia as a complication of anticonvulsant therapy is now well recognized, and a total of thirty cases has been recorded.

Badenoch (1) reported the first detailed studies of megaloblastic anaemia developing in epileptic patients treated with phenobarbitone and epanutin, whilst Fuld and Moorhouse (6) reported the association with primidone (Mysoline) alone. In all the cases reported, the anaemia responded to folic acid therapy, whilst anticonvulsant drugs were continued.

Changes in sympathetic nervous system responses have been noted to accompany changes in psychological states during psychiatric treatment. Funkenstein, Greenblatt and Solomon, observing the blood pressure response to epinephrine and methacholine, have reported a change in blood pressure patterns on the part of patients who benefited from electric shock treatment (1). Gellhorn has presented evidence that improvement in the psychoses is associated with heightened sympathetic reactivity (2).

Phocomelia is a congenital malformation of the osseous system characterized by the absence or extreme smallness of the arms, forearms, thighs and legs, producing a pronounced shortening of limbs. The hands and feet, which may be fairly normal in appearance and development, seem inserted more or less directly into the shoulders or pelvis of the patient. As the micromelic appendages resemble the physical outlines of a seal's flippers, the condition is known as phocomelia.

The autonomic nervous system activity that has been observed to accompany grand mal epilepsy does not occur consistently with the seizures produced by electric convulsive treatment. The dilated pupils, flushing, lacrimation and gooseflesh which appear during the tonic spasm of the electrically induced seizure, and which are the outward manifestations of the autonomic storm within, are often not readily observed because of their transience; they begin to fade almost as soon as they appear and may be gone with the onset of the clonic spasm. Different patients exhibit them in different degrees and the same individual may show changes in the amount of autonomic response over a course of treatments.

The general aim of the experiment was to discover whether, during an interview directed at discussing the patient's life, there was any significant alteration of blood-pressure, heart rate or brain waves in association with emotional content; as it turned out, changes in blood-pressure proved to be the most rewarding field for study and in consequence this aspect was accorded more attention.

Over the past few years, there has been an increasing interest in drugs having a tranquillizing or ataractic effect on the central nervous system. Pharmaceutical houses, both here and on the other side of the Atlantic, have vied with one another to be the first to introduce the perfect tranquillizer, providing relief from tension and anxiety with no unpleasant or dangerous side-effects or tendency to addiction, and at the same time if possible to effect an improvement in the management of, if not the cure of, the psychoses.

Helping the senile patient is not easy, and treatment today is largely palliative. Recent cybernetic work (Ashby, 2), however, offered a suggestion that some alleviation might be possible. This paper describes briefly the underlying theory and how we investigated the matter clinically. (Only an outline of the theory can be given here.)

The detection of early or subclinical schizophrenia is a major psychiatric problem. Patients who are finally classified as schizophrenic often may not have been so considered on previous examination. In other words their true condition was not detected clinically in the first place.

Perphenazine is a phenothiazine derivative, recommended as a tranquillizer (Ayd, 1957; O'Reilly et al., 1957; Goldman, 1958; Preisig and Landman, 1958) and as an anti-emetic (Scurr and Robbie, 1958). The structural formula is 1-(2-hydroxyethyl)-4-3-(2-chloro-10-phenothiazyl)-propyl-piperazine; it has also been called Fentazin and Trilafon. Its action is similar to chlorpromazine, but it is said to be 5 or 6 times as potent, the side-effects are less severe and the potentiating effect on barbiturates is minimal. Extra-pyramidal symptoms have occurred but no serious blood-disorders or jaundice have been reported. The recommended out-patient dosage is 6 to 16 mg. daily; doses of 24 to 64 mg. daily may be used with in-patients. Autonomic side-effects such as blurred vision and dry mouth are said not to occur below 40 mg. daily, hypotension not below 150 mg. daily. The purpose of this trial was to see if perphenazine improved the symptoms of out-patients with anxiety and depression, as compared with a placebo, and also to match it with a recognized and widely used sedative, sodium amylobarbitone, in order to note any difference in effect.