Clinical conditions simulating various degrees of intellectual handicap have been described quite frequently in the past. Individuals with such a deficiency have been observed in increasing numbers by psychiatrists, pediatricians, psychologists and social workers in schools for the mentally defective as well as in psychiatric hospitals and mental hygiene clinics.

The older psychiatric literature has here and there valuable reports about mental illnesses amongst African, Asian and other societies which are very different from Europe. These authors normally express opinions or speculations based on chance experiences rather than systematic observations. It is only in recent years that more extensive mental health work has been done in these countries, which also has enabled many workers to collect a great deal of information. This is important not only for the countries concerned, so as to help them to plan an appropriate health service, but also for psychiatry as a whole. It gives an impetus to comparative psychiatry, one of the most important basic sciences to clinical psychiatry.

Almost 125 years ago Addison (1836) suggested the existence of a causal relationship between alcoholism and cirrhosis of the liver and more than 100 years ago Rokitansky noted accumulation of fat as the earliest effect on the liver of over-indulgence in alcohol (cited from Connor, 1938). Though the relative importance of infective hepatitis and alcoholism as aetiological agents in liver cirrhosis may vary a great deal in different countries, “alcohol and infective hepatitis are at present the only two unequivocal aetiological factors” (Annotation, Brit. Med. J., 1957). It is usually accepted that over-indulgence in alcoholic drinks often produces liver dysfunction—maybe in an indirect manner—which though reversible at first, tends to become irreversible as over-indulgence is continued and prolonged (Leevy, Cunniff, Walton and Healey, 1954). The terminal phases are characterized by cirrhosis, hypertrophic at first and then contracted, with ascites and eventual death. When individuals whose drinking habits lead them to this state need hospital treatment, they seem to find their way into general hospitals rather than into mental hospitals. Among them may be alcoholics of the type described by a World Health Organization Expert Committee as “habitual symptomatic excessive drinkers” (W.H.O. Rep., 1952) or “non-addictive alcoholics”, and those excessive drinkers whose alcoholism manifests itself in their “inability to stop” continual daily drinking in the face of dangerous consequences (W.H.O. Rep., 1955).

Recent work at this hospital (Thorpe and Baker, 1958) has suggested that schizophrenic patients tested one week after completing a course of twenty E.C.T.s do not show significantly more impairment in some psychological functions than similar patients treated with insulin coma or chlorpromazine therapies. This finding may come as a surprise to many, particularly in view of the fact that disorientation, memory loss, and confusion are frequently seen during the course of electrical treatment.

Phenylketonuria is an inborn metabolic disorder affecting the body's ability to hydroxylate phenylalanine to tyrosine.

Its incidence in the general population has been estimated at 0.004 per cent. and its institutional frequency at approximately 0.2 to 0.9 per cent.

In the present investigation verbal statements of certainty, or confidence in the performance of immediate recall and recognition, were related to the neurotic/schizophrenic dichotomy and, within the neurotic group, to personality questionnaires of rigidity, extreme response set, extraversion and neuroticism. The aim was to find pointers to conditions favourable for the investigation of individual differences in certainty and to assess the relative validity of a number of independent personality criteria. Statements of certainty analysed are derived from an immediate recall experiment, the results of which have already been reported (6). An analysis of the interaction between certainty and other measures derived from the same experiment is to be presented at a later date.

It is well known that a factor analysis may be carried out in various ways; the subjective elements involved make it by no means clear that two people beginning with the same data will arrive at the same conclusions. Furthermore, not enough attention has been paid to the confirmation of factors revealed in one analysis by repetition of the tests on another sample from a similar or different population.

In a previous paper (Seager, 1958) I described a retrospective examination of the records of patients who had been suffering from depressive illness and who had received electroplexy, with or without an anaesthetic or relaxant drug. The results of that survey suggested that patients who received unmodified E.C.T. were in hospital for a shorter period, received fewer treatments and were more likely to remain well than those treated with modified E.C.T. Recognizing that the method of retrospective evaluation could give rise to many errors which would affect the results, I have now carried out a controlled trial of these treatments. The aim of the trial was to ascertain any difference between the results of modified and unmodified electroplexy, and if so, to find out which factor or factors were responsible for the difference.

For some years now it has been recognized that the symptoms induced by hypoglycaemia may resemble narcolepsy. Cases of islet-celled pancreatic adenomas simulating narcolepsy have been described by Harris (7), Delay (4) and Wyke (18). The resemblance may be a superficial one, however, and Wyke observed in his case during a “sleepy attack” that “the EEG pattern bore no resemblance to that of natural or artificial sleep”. In a more recent paper Ziegler and Presthus (19) described thirteen patients who showed normal EEGs at blood glucose levels (induced by fasting and intravenous insulin) of from under 15 mg. per cent. to 54 mg. per cent. In eight of these patients there were no clinical symptoms; in the remaining five patients the symptoms were described as follows: “feel like a ton of lead”, “warm and sleepy”, “tired”, “drowsy and sweaty” and “dizzy and tired”. It seems, in fact, that the clinical description of drowsiness in hypoglycaemia may correspond either to no EEG changes or to various degrees of slowing rather than to the typical recurrent light sleep patterns characteristic of narcolepsy. It will be recalled that hypnosis too is ushered in by a sense of drowsiness but that the EEG changes are not those of sleep (1, 2, 5). Many hysterical trance states—often loosely, and unfortunately, described as narcolepsy—come into this category. In short, it is apparent that all that sleeps is not narcolepsy (6, 12, 13, 14).

Unstable mental defectives in an institution present handling and training difficulties out of all proportion to their number. The following is an account of an attempt to modify or control their behaviour by the use of chlorpromazine.

In view of the significant role the sexual instinct plays in psychiatric illness, it is surprising that there are in the literature so few reports of attempts to suppress male sexual behaviour by the direct method of modifying the physiological basis of sexual activity by oestrogen therapy. Dunn (2, 3) established that administration of stilboestrol could result in marked reduction of male libido and sexual behaviour. He treated two non-psychotic hypersexual patients and, apart from the clinical effects, observed gynaecomastia, histological evidence of reversible testicular degeneration, and depressed urinary androgen excretion. Hamburger (6) later demonstrated in one case that oestradiol administration produced the same degree of urinary androgen excretion as did actual surgical castration of the same patient. Thus, present evidence indicates that oestrogen therapy produces in the male what is, in effect, a reversible chemical castration.

In 1956 the Henderson Research Trust awarded the writer a scholarship which enabled him to spend a year in Scandinavia, studying the care and treatment of psychopathic offenders. This paper is based on observations and enquiries by the writer during that year.

In his examination of elderly patients the psychiatrist is commonly concerned to obtain some indication of the individual's “memory function“. When the psychologist is asked to help in such assessment there are at least two factors which may handicap his ability to do so. Firstly, the conception of “memory”. as popularly used, even in the clinic, is rather narrow in its connotation, having come to refer almost exclusively to the reproduction of learned material. It would seem more satisfactory, from the psychologist's point of view, to substitute instead the notion of “learning ability” since this expression has a wider meaning. It admits of the discussion of separate aspects and takes into account, for example, the two broad phases of “acquisition” and “retention“. Secondly, those tests which the psychologist may have by him which purport to assess “memory” usually suffer from a number of disadvantages. For example, as Williams (12) has recently pointed out, they are seldom so constructed as to ensure that every subject has a standard opportunity to acquire what the test requires him to reproduce; in any case few of the tests available have ever been given to elderly people, so that “normal” performance in such age groups is unknown. A more important, and less often emphasized, disadvantage, however, is that performance on such tests is commonly closely related to performance on intelligence tests, so that although the ostensible content of the material used seems to be related to “memory”, in the popular sense, what the psychologist in fact gets from them is another measure of general intellectual ability. A study by Hall (1) has shown that, for a young population at least (mean age 29.11, sd 2.77), the results of the Wechsler Memory Scale (10) correlate with results on the Wechsler Bellevue Intelligence Scale (9) almost to the degree (r=0.77) to which the intelligence measure correlates with itself (r=0.94).

The authors have independently used drug-aided psychotherapeutic techniques. Some good results were being obtained but we were not entirely satisfied with existing agents. The first few applications of parenteral “Ritalin” appeared promising and prompted the work on which this paper is based.

The present investigation represents a logical continuation of a previous experiment where it was shown that the injection of 5-hydroxytryptophan (5HTP) alleviates the psychological effects of lysergic acid diethylamide (LSD-25) (Brengelmann, Pare and Sandler, 1958). LSD is of interest in psychiatry because the psychotomimetic effects of the drug bear a resemblance to schizophrenia clinically, in psychological tests and, according to Hoagland, Rinkel and Hyde (1955), in their abnormal excretion of urinary phosphate. The possibility presents itself that, in some cases of schizophrenia, the functional abnormality is similar to that produced by LSD.

Since Evarts, Fabing and Marrazzi reported on bufotenine and Szára on N-N dimethyltryptamine (DMT) the tryptamine derivatives have been arousing increased interest. A team of the above Institute was the first to test DMT and N-N diethyltryptamine (DET) in man. These compounds were synthesized by Szára, by the method of Speeter and Anthony. DET was then synthesized again and analysed pharmacologically by Borsi and Lénárt.

In the past thirty years a great deal of attention has been paid to the problems of differentiating mental deficiency from psychosis, and recognizing the distorting effects of mental defect and deprivation upon supervening mental illnesses. The incidence of psychotic syndromes in mental deficiency hospitals has been variously estimated as 5 per cent (Greene 1933), 8 per cent (Vanuxem 1935), and 11 per cent (James 1939), while a survey made by Hackbush (1935) on a very large number of patients on the waiting list for admission to mental deficiency hospitals, suggested a figure of 10 per cent. James considered that three-quarters of his psychotic group were schizophrenic, and Bergman et al. (1951) agreed that schizophrenic illnesses were very common in mental defectives. Whereas the incidence of schizophrenia in the general population is 0.85 per cent (Mayer-Gross et al. 1954), it occurs as much as nine times more frequently in certain mentally defective groups.

The following is a short report on the results obtained from 204 two-way paper chromatograms for urinary indoles. The material examined came from 58 schizophrenics, 34 organic psychoses, 58 affective psychoses (33 complicated by physical disease, and 25 not), 48 neurotics etc. (18 complicated by physical disease and 30 not) and 6 mentally normals.

The word “depression” has come to be used in psychiatry to denote both a syndrome (or symptom:sign cluster) and one or more of the symptoms commonly occurring in this cluster. This attribution of two meanings to one term has led to considerable confusion. Thus it is often claimed that depression may be present in almost any mental illness. This statement may be true in the sense that the mood of depression may occur in almost any mental illness; but it cannot be true in the sense that the depressive syndrome may enter into almost any mental illness, since the term depressive syndrome has already, at least by implication, been used to denote a particular symptom:sign cluster which differentiates it from all other symptom:sign clusters. To deny this would be to deny the original principles of division.

Historical Background. The possibility of relationship between a person's birth experiences and his later reaction tendencies has long been recognized. Such recognition is expressed in the ancient Chinese saying (translated approximately), “Difficult birth, difficult child”. As early as 1794, Erasmus Darwin (4) wrote that “the association of the disagreeable sensations and actions occasioned by birth” persists throughout life and forms the basis of all later fear reactions.