In the last decade the use of disulfiram (Antabuse) has considerably altered the treatment of chronic alcoholism. However, unpleasant side-effects of headache, metallic taste in the mouth, abdominal discomfort and impotence are found in patients on maintenance treatment with this drug and deters them from taking it (4, 10). Alcohol-disulfiram reactions can be accompanied by cardiac complications or sudden death (9, 11). Despite these difficulties alcoholics who take disulfiram regularly have better abstinence records than those who do not (15). Many reasons may be postulated for these results, but we have regarded the use of disulfiram as a means of providing a period of “forced” abstinence while the alcoholic is readjusting to the demands of resuming his job, family relations, etc. During this time some insight and understanding of the nature of his difficulties may be established. The remainder of this paper describes the investigation of a new substance, Temposil, which produces a similar effect to disulfiram.

Work with the tertiary amine arecoline is reported to show that this para-sympathomimetic agent can produce inhibition of conditioned avoidance responses in rats (Pfeiffer and Jenney, 1957a). When given to atropine-protected patients, the compound is said to give intervals of lucidity of an order broadly comparable to that produced by carbon dioxide or amylobarbitone (Fulcher et al., 1957).

Since the introduction of reserpine by Kline in 1954 there have been relatively few studies of its use in schizophrenia and most of these have been uncontrolled. It is characteristic of these uncontrolled trials that when the results are assessed, they are described in glowing terms, and the percentage of patients reported as showing “moderate” or “marked” improvement is high.

The aim of this paper is to investigate some para-hallucinatory visual phenomena, to classify them into certain groups, to describe their phenomenology, and to try to explain their psychodynamics and their significance in everyday life.

Cohen (1958) has shown that obese children have increased 17-ketogenic steroid excretion and Norval and King (1950) showed that urinary corticosteroids in normal children were closely related to their weight. Lugg and Bowness (1957) found a positive correlation between weight and 17-ketosteroid excretion in adults. Dutton (1958) found that mongol boys were about 15 per cent. over weight for their height although their height and weight were depressed for their life age.

Tranquillizing drugs that have been used in mental deficiency include reserpine, chlorpromazine, promazine, mepazine, hydroxyzine and prochlorperazine.

Esen and Durling (1) thought that the tranquillizing drugs in general were a useful preliminary to psychotherapy. However, the response to individual drugs has been variable.

The Müller-Lyer illusion is one of the best-known geometrical optical illusions. It was described by Müller-Lyer in 1889 (7) and first studied quantitatively by Heymans in 1896 (5).

β-Dimethylamine ethyl 2-methylbenzhydryl ether hydrochloride (Orphenadrine, “Disipal”) is a synthetic substance closely resembling in chemical structure the antihistamine dephenhydramine (“Benadryl”). It was developed in Holland (Harms, 1957) for use in parkinsonism and in this context reported upon favourably in this country by Gillhespy and Ratcliffe (1956). Claims have also been made that the drug is (i) effective in treating the pseudo-parkinsonism produced by reserpine, (ii) active in alleviating other (e.g. autonomic or vasomotor) side-effects of reserpine, (iii) has independent “psychic” activity, or (iv) enhances the tranquillizing effect of reserpine (Frieswinkel, 1957a, 1957b; Van Rhijn, 1957; Meulenbeld, 1957; Scheurle, 1957). The following trial is designed to assess some of these claims.

A clinical relationship between obsessional illness and epilepsy is unusual, but the few electroencephalographic (EEG) investigations of obsessional patients which have been published claim a high incidence of abnormal electrical activity. Records of twenty-six neurotic and five schizophrenic patients, all with obsessional symptoms, were examined by Pacella et al. (13), who found twenty-two of the thirty-one EEGs to be abnormal. Fourteen showed definite convulsive patterns with frequent 2–4 c.p.s. activity and increased high voltage waves after overbreathing. Rockwell and Simons (14) found only two abnormal records in eleven uncomplicated obsessional neurotics, using Gibb's criteria of normality, but of ten patients classified as psychopathic personalities with obsessional symptoms, all had abnormal EEGs although two were borderline. Their definition of psychopathic personality is not made explicit and the clinical distinction between their two groups is unclear. Jarvie (4) reports a case in which slow activity on hyperventilation in the EEG was associated with phobias and obsessional impulses preceded by a two-year history of episodes of rage.

“Stelazine” is the trademark name for Trifluoperazine. It is a derivative of phenothiazine with the following chemical formula: 10-3-(1-methyl-4-piperazinyl)-propyl-2-trifluoromethylphenothiazine dihydrochloride, or structurally:

In 1953, Twarog and Page (1) demonstrated that 5-hydroxytryptamine (serotonin) is present in relatively high concentrations in the brain. At about the same time Gaddum (2) and Woolley and Shaw (3) observed that LSD is a highly potent serotonin antagonist in such tissues as rat uterus and hypothesized that the hallucinogenic effect of LSD might be due to interference in the action of serotonin.

In the six years since Delay and his associates first used chlorpromazine in psychiatry, at least forty-eight separate side-effects have been attributed to the drug. While many of these are minor, and indeed the majority are readily controlled in in-patients, the search for a phenothiazine of therapeutic value equal to or better than chlorpromazine, but with less or no side-effects, is well worth while. In out-patients there are two reasons for taking side-effects seriously. Firstly, they frequently lead to the patient ceasing to take the drug and thus relapse may occur. Secondly, they may be dangerous or even fatal if unreported—for example the signs of agranulocytosis.

An outstanding problem with neurotics in the psychiatric out-patient clinic is that of coping with the pressure of numbers whilst continuing to afford an adequate degree of therapy. Views do evidently vary enormously as to what constitutes adequate therapy. Within the same clinic it is possible to find one psychiatrist habitually seeing neurotic patients at weekly returns, and another seeing comparable patients once or twice only. The higher frequency of interviews gravely limits the case load and is only slightly preferable to the other extreme in which the service provided is discouraging both the patients and home doctor. It might be agreed that if the symptoms which the patient first presents are thought capable of abatement, then therapy should be afforded through the clinic until some reasonable moderation of the disability is established and progressive. It is presumably also justifiable to continue clinic attention where such work may be expected to prevent or much to limit an otherwise certain deterioration.

During the course of an investigation of the effectiveness of various components of electric convulsive therapy in the treatment of hospitalized psychiatric patients (Brill et al., 1957, 1959) observations were made on the spinal fluid concentrations of cations and total protein before and after treatment. The possibility existed that alterations in brain function and structure (which are believed by many to occur during a course of electro-convulsive treatment, and to be responsible for improvement in patients receiving such treatment) might be associated with, or reflected by measurable changes in the cerebral spinal fluid.

A double-blind controlled trial of iproniazid in endogenous depression and a comparison of its effects with those of E.C.T. was reported in this journal by Kiloh et al. (1960). To summarize the results—of 26 patients treated with iproniazid a good immediate response was found in 14 cases (54 per cent.) whereas only 3 of 28 patients (11 per cent.) given placebo tablets showed a significant improvement at the end of three weeks. Of 27 patients treated with E.C.T. 24 (89 per cent.) showed a good immediate response.

Woolley has repeatedly drawn attention to the possible role of serotonin (5-hydroxytryptamine) in mental functioning (1, 2, 3, 4). In particular, this author has stressed the possibility that some forms of mental illness, such as schizophrenia, may be related to disorders in cerebral serotonin metabolism.

The beneficial effect of monoamine oxidase blockers on depressive states has been established. Their therapeutic effect has been assessed at ranging between 60 and 80 per cent. of all cases treated. We have tried to improve on this rate by combined treatment with iproniazid and reserpine, a combination which has been used in experimental animals by Chessin et al. (1, 2) and Brodie et al. (3). The results of our treatment will be briefly described in this paper.

In the past few years papers have appeared in the U.S.A. and in Europe which discuss the role played by 5 hydroxy-tryptamine (serotonin) in cerebral metabolism, both in health and disease. The aim of this paper is to report a trial of a benzyl analogue of serotonin, a serotonin antagonist, and to shed some light upon its possible side-effects.

Epileptic manifestations complicating insulin coma therapy (I.C.T.) were described by Sakel in his original paper (1937). In recent years the administration of chlorpromazine to patients undergoing I.C.T. has been common practice. Lancaster and Jones (1954), however, have commented on the resulting apparent increase in the incidence of epileptic fits.

Levomepromazine, levo-3-methoxy-10(2' methyl-3'-dimethylamino-l' propyl) phenothiazine is a phenothiazine derivative which was isolated in the Rhone-Poulenc Laboratories and studied pharmacologically by Sigwald et al. (2) in 1956.