Popular psychiatric terms are often used uncritically and it is salutary to examine our usage from time to time. “Obsessional” is such a word; it may describe a symptom or a type of personality, with immediate possibilities of misunderstanding. Here it is used to describe a type of personality, as in the phrase “obsessional personality”. The current usage of this phrase will be examined and it will be compared with the usage of the “anal-erotic character” of psychoanalysis. The two terms differ: the obsessional personality is purely descriptive while the anal-erotic character is based on a theory of personality development; yet they are often used synonymously. Do they differ in descriptive detail? If so, how and why? An attempt will be made to answer these questions by an analysis of descriptions of the terms.

This case is thought to be of interest because neuropsychiatric complications appeared a relatively short time after the onset of obstructive jaundice.

In the early phenothiazine literature the ataractic properties of Thorazine in the control of disturbed, hyperactive schizophrenics were described (Kurland, 1955; Hall and Dunlap, 1955; Lehmann, 1955). Kurland (1955) gives an excellent description of the powerful activity of Thorazine in this sphere, namely the control of hyperkinesis and hostile, aggressive behaviour; however, he found that there was little basic change in delusional thought disorder other than to divorce the abnormal thinking from its affective attachment. It was noted that the clinical improvement was most dramatic when the affective component of the illness was most marked. Hall and Dunlap (1955) felt that there was significant reduction in delusional ideation but noted that the schizophrenic process was not affected by Thorazine medication.

Glucagon, the hyperglycaemic glycogenolytic factor of the pancreas, was discovered by Kimball and Murlin in 1923 (1). It was crystallized by Staub, Sinn and Behrens in 1953 (2, 3). Glucagon is believed to cause a rise in blood sugar by acting at the site of liver Phosphorylase—converting inactive Phosphorylase to active Phosphorylase (4).

Roth and his associates (1952, 1955, 1956) making observations on the classification and prognosis of psychotic illness occurring in elderly people found that the majority of patients fell into five main diagnostic categories; about half were cases of affective psychosis, most of which responded to E.C.T., and the rest suffered from arteriosclerotic and senile psychosis, paraphrenia and delirium. All the groups, with the exception of the senile psychotics, showed a considerable proportion of physical illness, particularly the cases of affective psychosis whose first attacks occurred after the age of sixty years. Most of the cases of delirium were physically ill and of the paraphrenics 30 per cent. were either blind or deaf.

In a recent paper by Meehl and Rosen (1955) several important criticisms are made against the majority of diagnostic psychological instruments reported in the literature. Some of these criticisms are well known, for example absence of cross-validation data, not stating the type of population most suited for the particular psychometric device, etc. The main purpose of the present paper is to try to meet, with respect to the M.W.-L.T. (Walton and Black, 1957), one of their other major criticisms namely, that “Base rates are virtually never reported. It is, therefore, difficult to determine whether or not a given device results in a greater number of correct decisions than would be possible solely on the basis of the rates from previous experience. When, however, the base rates can be estimated, the reported claims of efficiency of psychometric instruments are often seen to be without foundation.”

There appears to be a feeling at the moment among many psychiatrists that the treatment of early schizophrenia of all types with the recently introduced phenothiazine derivatives is as effective, if not better than, Insulin Coma Treatment (I.C.T.) and that there are many other advantages besides. In some hospitals insulin coma treatment has been discontinued altogether.

During recent years, a good deal of attention has been drawn to the therapeutic and toxic effects of the new thymoleptics. Although most of these preparations have had a reasonable clinical trial before being released for general use, it is a fact that hitherto unsuspected toxic effects continue to come to light. Among the more recently discovered side-effects of Tofranil (imipramine) are the occurrence of jaundice and a tendency in certain patients to epileptic fits. Experimentally it has been shown that Tofranil increases the excitability of the brain of rabbits and may evoke convulsant spikes (1), and in a recent article by Leyberg and Denmark (2) it is recorded that in four cases of a relatively small series the dose of the drug had to be reduced on account of epileptic fits.

The first aim of the study reported in this paper was to check Foulds's finding that claims for the success of a treatment were related to the degree of experimental control which authors exercised in their investigations (77). Foulds, from a selection of papers appearing between 1951 and 1956, showed that five studies (6·9 per cent, of the total) were controlled and claimed success, 15 (20·8 per cent, of the total) were controlled and claimed failure, 43 (59·7 per cent, of the total) were uncontrolled and claimed success and 9 (12·5 per cent. of the total) were uncontrolled and reported failure.

“O the mind, mind has mountains; cliffs of fall, Frightful, sheer, no-man-fathomed.”

The importance of the anatomical basis of the simpler motor and sensory functions of the central nervous system, and their disorders, has been recognized for over a century (Brown-Séquard, 1855). But that more complex intellectual functions and their disorders should also have a relevant anatomical substrate is only slowly coming into recognition. Indeed, a still-fashionable theory of mental function, originating in Vienna towards the end of the last century, regards the study of brain structure as unnecessary and beneath contempt—for all that its founder began as a neuro-anatomist.

The first clinical histories of this condition were reported in Norway by Stengel (1826). Batten (1903) described changes in the macula in two members of a family who had undergone progressive mental deterioration with loss of visual and motor functions. Vogt (1906) published similar cases and attempted to delimit them as a juvenile form of Tay Sachs disease. It differed from the infantile form in that it occurred in childhood after a period of normal development; the rate of progression was slower; it was not limited to Jewish children and the ophthalmological appearances were those of optic atrophy. The following year Spielmeyer described the pathological changes in juvenile Tay Sachs disease as essentially similar to the infantile form. Further detailed pathological studies were made by Greenfield and Holmes (1925).

Exploratory experimental work into the effects of sensory deprivation on human subjects has developed rapidly during the past decade and many reports have been published. It would appear to be necessary, however, to pause for a moment and to review the work which has so far been executed with a view to facilitating the systematic investigation of this phenomenon.

Feldman (1951) published a scale for predicting the response of patients to E.C.T. and insulin coma therapy. Using only Minnesota Multiphasic Personality Inventory profiles meeting stated requirements (at least one elevated scale, moderate F scale scores, etc.) he carried out an item analysis of the M.M.P.I. responses of 42 patients who had responded well to shock therapy and 42 patients who had remained unimproved (psychiatrists' ratings). He derived a 52-item scale, scored as an additional M.M.P.I. scale and labelled Ps, high scores indicating poor prognosis. This he cross-validated on a further 100 patients (categorized as recovered, improved or unimproved) and all categories were well discriminated by Ps scale scores.

When discussing some of the problems associated with chlorpromazine (Largactil) therapy, Denber and Travis (2) point out that it is desirable that the drug be given as infrequently as is compatible with therapeutic efficacy. They found this to be twice a day. Haden (5) and Tibbits (10) report that satisfactory results can be obtained with single daily doses. While studying the single daily dose administration of drugs in a psychiatric hospital, Lara and Wells (7) found that phenothiazine compounds could reasonably be given in this way. In order to explore these reports the medication of 17 chronic, well stabilized, male schizophrenic patients was changed by giving their chlorpromazine once instead of three times a day. These patients had been on an average dosage of 200 mg. of chlorpromazine t.d.s. The dosage was altered by giving the total daily dose at one time, limiting the maximum dose to 600 mg. In some cases this resulted in a small reduction in the total dosage. The main side-effects complained of before the change were photo-sensitivity from 8 patients and drowsiness during the day from 9 patients. Because of this latter complaint the single dose was given at 9 p.m. Three weeks after the change to the single dose no alteration in symptoms or behaviour had been noted except that there were now no complaints of drowsiness during the day. Two patients complained that they disliked taking 6 large tablets at one time.

In the WISC manual Wechsler (1949) gives correlation matrices for his battery of 12 cognitive tests for three random samples of normal children aged 7½, 10½ and 13½ years respectively. A factor analysis of each of these matrices, excluding the information and mazes tests which are seldom used in Britain, is reported elsewhere (Maxwell, 1959), and it is shown that the pattern of loadings is similar for all three age groups. The question then arose as to how the pattern of loadings for a sample of children attending a psychiatric clinic would compare with that obtained for normal children. The problem is investigated in this article.

The aim of this study was to determine the incidence of selected blood types in a homogeneously diagnosed group of manic-depressive patients as compared to the incidence of these blood types in a control group and in reported figures for the general population. This interest in the blood characteristics of manic-depressive subjects was stimulated by the finding of a relatively high incidence of active duodenal ulcer or medically and roentgenographically confirmed duodenal ulcer histories in manic-depressive patients (16 per cent.) (12) as contrasted with the reported incidence of duodenal ulcer in the general population (5-10 per cent.) (4). The specific association of duodenal ulcer with O-type blood has been reported by several investigators (1, 2). Although the reported relationships between blood type and specific disease entities have been critically questioned in a recent review, the reviewer concluded that the evidence “tends to suggest that a relationship between duodenal ulcer and group O blood actually exists” (10). The known and suspected relationships of blood types with various disease processes have been summarized by established investigators in the field of blood grouping and classification (14).

Recent research has suggested that the social desirability factor may be considered both as a response set, which exerts a contaminating influence on personality tests (Edwards, 1957), and as a measure of pathology. With respect to the latter, Tolor and Boitano (1960) found that increased severity of psycho-pathology tends to be associated with a decreased ability to make socially acceptable choices on a check list consisting of an equal number of socially approved and socially disapproved items. Moreover, Fordyce (1956) pointed out that the “psychotic factor” resembles a definition of social undesirability. The present study represented an attempt to focus attention on the possible meaning of differences in social desirability in terms of differences in degree of ego-strengths of subjects. The purpose, therefore, was to determine the relationship between one aspect of ego strength, namely, the body image as reflected in the figure drawings, and the social desirability variable, as measured by a check list.