Sernyl, 1 aryl-cyclo-hexylamine, is a synthetic drug first used by the anaesthetists because, when given intravenously, it produces analgesia. However, the occurrence of psychological disturbances post-operatively led to the investigation of this drug by psychiatrists. It was found that Sernyl produces many interesting psychological disturbances, some of which resemble the primary symptoms of schizophrenia (Davies and Beech, 1960). In a previous paper (Davies, 1960) Sernyl was given intravenously to five patients with long-standing psychoneurotic illnesses. It proved to be an effective abreactive agent and produced some interesting results in three of the patients who had obsessional symptoms. Sernyl, in the doses used, is not an hallucinogen, though it produces other effects similar to lysergic acid diethylamide, which has been used extensively as a therapeutic agent, particularly in obsessional states (Sandison et al., 1954). The preliminary report suggested that Sernyl might have some practical advantages over LSD—in particular, it produced a less severe disturbance and its effects were over more quickly. Further investigations were clearly indicated and this present paper reports on the use of oral Sernyl in five patients with obsessional illnesses.

In a previous paper, Davies and Beech (4) presented data obtained from both clinical observations and psychological tests on normal subjects under the influence of Sernyl. In that paper an account was given of the chemical constitution and action of the drug. It is not necessary to say more here than that this compound is a synthetic cyclohexylamine derivative that was introduced into anaesthetic practice because of its ability to produce analgesia without loss of consciousness. It appears to act mainly at the thalamic level and produces changes in the reception of sensory stimuli. Post-operatively, however, psychiatric disturbances were common and the use of the drug in anaesthetic practice was curtailed. Our interest in Sernyl has centred upon its psychotomimetic effects and its possible mode of action. It has, in fact, been suggested that normal individuals under the influence of Sernyl behave, in some respects, like schizophrenic patients and that this similarity is most striking in the case of thinking processes. In the further investigation of the effects of this drug it was therefore decided to test the hypothesis that Sernyl produces mental disturbances which are characteristic of thought-disordered schizophrenics.

The purpose of this paper is to describe the results obtained when the Bene-Anthony Family Relations Test was administered to 69 children in 28 families and to relate these results to the health and social characteristics of this group. These children, 17 American Negroes, 46 Puerto Ricans and 6 Americans of European descent receive out-patient paediatric care from two paediatricians and a public health nurse, in a small family neighbourhood clinic located in a Manhattan slum area. The parents of these children also receive out-patient treatment from the two internists associated with this clinic.

Shortly after isoniazid (I.N.A.H.) was first used in the treatment of tuberculosis, it became apparent that side-effects were not uncommon. Thompson (1952) lists euphoria, hyperreflexia, vertigo, muscular twitching, insomnia, paraesthesiae and transient loss of memory among the reactions observed. These were noted to be mild and reversible but did suggest involvement of the nervous system.

The investigation to be reported in this paper was conducted with two principal aims in view. Firstly, it was desired to confirm evidence that memory disorder in elderly psychiatric patients may be due to a breakdown of processes underlying short-term retention (Inglis, 1960; Inglis and Sanderson, 1961). Such previous evidence supported the notion that memory disorder may in fact result from a disturbance of one of the mechanisms adduced by Broadbent (1957) to account for the ability of young normal adults to respond sequentially to information simultaneously presented through different sensory channels (e.g. both ears at once). Secondly, it was desired to extend the study of these retention processes in such patients to the case in which the channels for the simultaneous presentation of digits comprise two different sensory modalities (i.e. eye and ear together).

Since Delay, Deniker and Harl (1952) first reported favourably on the use of chlorpromazine in disturbed psychotic patients the extended use of pheno thiazines has contributed to the transformed atmosphere in mental hospital wards. There is still some doubt as to the precise mechanism of action of the phenothiazines. The blocking of arousal responses to afferent stimulation in animals following chlorpromazine has been fully demonstrated (Bradley and Hance, 1955, 1957). The production in man of a “parkinsoniansyndrome” by chlorpromazine and later phenothiazines has been taken as evidence of drug activity as a basal ganglion level (Kruse, 1957). More recent work suggests that chlorpromazine may act by depressing the collateral inflow into the reticular formation from the afferent pathways rather than the brain stem activating system itself (Key and Bradley, 1958).

A clinical evaluation of the effects of a recently introduced monoamine oxidase inhibitor, N - isonicotinoyl - N1—(β - N - benzylcarboxamido - ethyl) hydrazine (Niamid, Pfizer, Ltd.) on certain types of mentally subnormal patients has been carried out over the past year.

Clinical trials of thioproperazine (7843 R.P.; “Majeptil”) 2-dimethyl-sulphamoyl-10-(3-4′-methy1-1′-piperazinylpropyl) phenothiazine methanesulphonate, carried out in France by Delay, Deniker et al. (1959b); Perrin, Lambert et al. (1958); Coirault et al. (1959); and in America by Denber et al. (1959, 1960), have shown that it is a highly effective agent in the treatment of schizophrenia and acute mania. To examine the claims made for the drug's value in deteriorated or vegetative schizophrenics, and in other cases that have resisted chemotherapy, a trial was undertaken in this country.

A large number of papers has been published in the last two or three years on the use of imipramine in depressive states. Much of this literature has been reviewed by Ball and Kiloh (1959) whose investigations on out-patients represents one of the remarkably few controlled trials that have so far appeared. We feel, therefore, that there is room for a report on another controlled study, this time with in-patients, in which the term “controlled” not only involved the usual “blind” procedures of administering tablets, but also included some of those elementary safeguards of reliability and validity of assessments without which uncertainty must remain concerning the meaning of any findings. Foulds (1958), for example, has presented evidence that uncontrolled investigations have a greater tendency to yield results supporting the hypotheses of investigations than experimentally fully controlled trials. In view of the claims that had been made for the efficacy of imipramine in a number of uncontrolled studies, we were primarily concerned to discover whether or not there existed valid scientific evidence of its value and, if so, in what kinds of depressive illness it appeared to be of most benefit.

“A doctor must know not only the virtue of a drug, but also its drawbacks”—

Carling (1960).

Thioridazine is one of the newer phenothiazine derivatives used in psychiatry. Previous workers have reported few serious side-effects with it. The following pilot trial was carried out on male patients suffering from chronic schizophrenia who required nursing in a closed ward.

Having written a review of Soviet psychiatric literature some years ago without being able to see things for myself, I was eager to avail myself of my first opportunity to visit the Soviet Union, which came in the summer of 1959. Though the visit was not undertaken in any official capacity, preliminary correspondence secured a number of cordial invitations to visit a series of leading Soviet institutions, and soon after our arrival in Moscow permission was received from the Ministry of Health to pursue our visit on a “business” basis, which meant a reduced rate without benefit of personal guide services. My wife and I were thus for the greater part of our sojourn in the U.S.S.R. free to move about the cities of our choice and to seek out and visit hospitals, research institutions and child care facilities that interested us. My conversational Russian, though elementary, was sufficient for this purpose and in most institutions there were staff members who could speak English, French or German. With the single exception of Odessa, where the local health officer did not permit me to visit a chronic psychiatric colony some distance from the city, I was extended every possible courtesy and plenty of opportunity to see what I wanted. During the summer months unfortunately many of the leading research workers were away on vacation, schools and Pioneer Palaces were closed and almost all child care facilities moved out to the country, so that I was unable to get much first-hand information on the care and education of handicapped children, and missed some important people I would have liked to meet. On the other hand, several heads of institutions returned from their summer retreats to meet me in the cities and sometimes urged me to stay on or return again to see more things. Official autos were sent to pick us up and return us to hotels, staff members sometimes awaited us on our arrival in new cities and several festive tea parties culminated our institutional visits, with gracious and cordial exchange of toasts; we were constantly presented with books and gifts, and huge bouquets were given to my wife. Russian hospitality is typically warm and heart-felt, and was at this time especially motivated by the wish to form friendly ties with America and the West. Like most visitors, we could not fail to be impressed by all of this, and did what we could to respond in kind.

In discussing current trends in mental hospital statistics, it is convenient to make a distinction between patients who have been resident for more than two years (the longstay group) and short or medium stay patients. The chances of discharge, once an individual has been resident for two years, are low and become progressively lower the longer he stays. In mental hospitals in England and Wales from 70 to 80 per cent. of patients are longstay; and the majority of these are diagnosed as schizophrenic (75 per cent. in 1954), although no more than one-third of newly admitted patients are given this diagnosis. There has been a consistent tendency over the past 30 years for a decreasing proportion of schizophrenic patients to be retained continuously for two years after admission—for example, about 60 per cent. of schizophrenics admitted in 1930 were retained in this way, compared with 30 per cent. in 1950 (Brown, 1960). Since then there have been important changes in social treatments and administrative policies, and the major tranquillizers have been introduced. The proportion of schizophrenics retained for two years or more has now approached 10 per cent. at many hospitals (Brown, 1959; Wing et al., 1959). However, very little is known in numerical terms about the extent to which the patients have to be readmitted to hospital once they have been discharged. The only satisfactory studies of the readmission of schizophrenic patients were made before the introduction of the recent changes in discharge policy, and dealt with admission cohorts in which the proportion retained for two years ranged from 60 to 30 per cent. (e.g. Freyhan, 1958; Shepherd, 1957). Reduction within this range did not appear to lead to an increased risk of readmission. However, the possibility cannot be dismissed that a further reduction would lead to the discharge of patients with a special liability to relapse and readmission.

In view of the drastic changes which have occurred in psychiatric treatment during the past five years and in the attitude towards it we have assessed our results, in order to compare them with those recently published by other writers. (Parnell (3)).

Antarctica is the southern end of Earth, a continent surrounded by oceans. It is a land of extreme cold and it has been estimated that it contains over 85 per cent. of all the world's ice. It is larger than the United States and Europe combined but contains practically no vegetation or wildlife except along its coasts. The coldest temperature ever recorded anywhere in the world was noted here (minus 109 · 6 degrees Fahrenheit) and temperatures rarely go above freezing. The wind blows almost constantly, including 200 m.p.h. blizzards. In appearance, it is like a great white desert and it includes a cap of ice that in some places is 100,000 feet think.

There are few incidents more calculated to disturb the well-ordered routine of a surgical unit than when a patient develops a severe psychiatric disorder in the post-operative period. Such episodes may occur suddenly after an interval of seemingly uneventful recovery and in some instances may be of such severity as to result in an appreciable and even dangerous deterioration in the patient's physical state. The impact on relatives must also be considered, for it is easy to understand the dismay which they must experience on observing the patient pass from a state of apparent composure into one of hyperkinetic excitement, panic, or confusion.

Most people now accept the value of the tranquillizer or ataractic drugs, which play a major role in individual therapeutic results and in environmental change in major psychiatric hospitals. Numerous surveys have stressed the influence of these drugs and they have recently been confirmed by Brill and Patton (1959) in a twelve-year review of mental hospitals capable of dealing with over ninety-three thousand patients. As the number of patients on tranquillizing drugs (mainly chlorpromazine) increased, so the patients requiring restraint decreased, the discharges increased and the re-admissions decreased: a direct cause and effect relationship was established.

Depression is a serious illness in Western Europe and the United States of America. It is estimated that in 1957 the combined total of suicides in the United States, Britain, France and Western Germany was approximately 30, 000 (1). The attempted suicide rate is considered to be six or seven times as great, which could give a grand total of 200, 000 suicide attempts in that year in these countries. Many of these patients are depressives, as stated in a recent British Medical Journal leading article (2).