In previous investigations (Foulds and Caine, 1958 and 1959) psychoneurotic subjects were classified in terms of the presenting syndrome (Hysteria or Dysthymia) and of the personality type (hysteroid or obsessive) as rated by psychiatrists. It was found that some psychological test measurements differentiated between Hysterics and Dysthymics regardless of personality type; whilst other measures differentiated between hysteroid and obsessive personalities regardless of diagnosis. The successful measures were not, however, identical for men and women. It was argued that one of the advantages of this double classificatory system should be that we would have one set of measures—the diagnostic—which should vary with the patient's clinical condition and another set—the personality measures—which should remain relatively constant.

In a recent paper, Parnell (1957) has criticized the Rees-Eysenck Body Index (Rees and Eysenck, 1945) on a number of grounds. He also showed that high values on the index corresponded to high values of Sheldon's ectomorphy component, while low values on the index corresponded to low values of the ectomorphy component, and high values of the endomorphy and more particularly the mesomorphy components. In this paper a brief attempt will be made to answer Parnell's criticisms and indicate why the Rees-Eysenck Body Index appears to be preferable to the Sheldon system.

Derivatives of glutarimide are known to exert an effect upon the central nervous system. To name only two which are widely used for clinical purposes: Glutethimide (“Doriden”) is a sedative, Bemigride (“Megimide”) a stimulant. Preparation 16038 (Ciba) α-(p-aminophenyl)-α-ethyl glutarimide, in animal experiments had shown properties which suggested its use as an anticonvulsant, and this paper is an account of a clinical trial with the substance on in- and out-patients suffering from epilepsy.

In two previous studies (3 and 4) certain psychological effects of single doses of chlorpromazine and secobarbital (quinalbarbitone) were studied in young normal subjects. It was found that 100 and 200 mg. of chlorpromazine had a greater effect on tests of motor co-ordination than did 100 and 200 mg. of secobarbital, respectively, and that 200 mg. of secobarbital had a greater effect on a test related to intellectual functioning than did 200 mg. of chlorpromazine. The results in our study of the effects of single doses of chlorpromazine differed from the results of studies of the effects of chronic administration of chlorpromazine by Lehmann and Hanrahan (5) and Shaten et al. (7). These investigators found that chronic administration of chlorpromazine to schizophrenic patients was followed by improvement or only slight impairment in performance on most of the psychological tests used. The differences between the results we have obtained following administration of single doses of chlorpromazine to normal subjects, and the results of Lehmann and Hanrahan and Shaten et al. could be attributed either to differences between the effects of chronic and acute administration of chlorpromazine or to differences in the response between normal subjects and schizophrenic patients.

Trifluoperazine (Stelazine) is a phenothiazine derivative and is 2-trifluoromethyl-10-(3′ 1″-methyl piperazinyl-4″-propyl) phenothiazine dihydrochloride. It is related to prochlorperazine, and in fact differs only in having a trifluoromethyl group in place of the latter's chlorine atom in position 2 of the nucleus. However, in laboratory studies, tests based on the inhibition of conditioned responses have indicated that this compound was 5 times as effective as prochlorperazine and 10 times as potent as chlorpromazine on a weight for weight basis.

In 1954 Shaw et al. described the action of Megimide (bemegride) in shortening sleep and restoring consciousness in laboratory animals under the influence of barbiturates. Subsequently, in 1955 Shulman et al. reported the results of the use of this drug in the treatment of barbiturate overdosage in man. Since then Megimide has been widely accepted as a valuable antidote in barbiturate poisoning, but there has been much discussion on whether it is a specific antagonist to barbiturates or a non-specific central analeptic.

Vespral, or triflupromazine Squibb, is a new phenothiazine derivative. Chemically the compound is 10-(3-dimethylaminopropyl)-2-(trifluoro methyl) phenothiazine hydrochloride. Its structural formula compares with that of chlorpromazine as follows:

Until recently “Vespral” has been available in this country only for clinical trials, but its supposed therapeutic effects have been investigated fairly extensively in the United States and Canada (Goldman; Gallagher and Pfeiffer; Niswander, Lind and Schlesinger; Freed; Azima; Pennington; Saunders; Freyhan; Cahn and Levy).

There have been a few studies of the nature and frequency of mental disorder in the offspring of marriages in which both parents were known to have been mentally ill (Schulz, 1940; 1941, Elsaesser, 1952; Lewis, 1957). A number of psychoses affecting both husband and wife have also been described as examples of folie à deux. Gralnick (1942) reviewed the literature, and found altogether 118 cases of folie à deux, but Ascher (1949) has concluded that such cases are commoner than would appear. The majority of those reported have involved blood relatives, in whom the implications of a “psychosis of association” are questionable, because of similarities in their genetic endowment (Kallmann and Mickey, 1946). However, Gralnick recorded 26 cases of folie à deux involving husband and wife.

Turle (1) in a double-blind trial using hydroxyzine found that of 18 patients admitted to a neurosis unit (7 anxiety neurosis, 1 obsessive-compulsive state, 6 depressive states and 1 involutional melancholia) only 3 patients showed signs of improvement on a dosage of 30 mg. by mouth, t.d.s. Only 1 out of 8 selected on account of tension symptoms was relieved. The other 2 improved cases were depressive cases with secondary anxiety features. He concluded that the drug was of no manifest benefit in neurotics. The serene tension-free effect reputedly produced by the drug and described by American workers was not observed.

Frenquel, α-(4-piperidyl) benzhydrol hydrochloride, generically known as Azacyclonal hydrochloride was introduced commercially into this country in the early part of 1957 although it had already been available in the United States of America for several months previously. Sargant (1956) obtained a supply of Azacyclonal from America and in his paper on Chemical Tranquillizers he refers to Azacyclonal as “an interesting drug”. Azacyclonal was thought to be the first drug to possess a specific anti-hallucinatory effect.

A review of the literature which is accumulating on the so-called tranquillizing drugs shows:

1. A relatively small number of adequately controlled trials with, in general, more conservative conclusions than those of the much greater number of uncontrolled trials (Foulds, 1958).

2. Diffuseness in patient selection, with subjects often being chosen for behavioural qualities (e.g. overactivity) or general characteristics (e.g. chronicity) rather than for diagnosis.

It is natural for psychiatrists and others dealing with mental patients to enquire what the prognosis is for a patient showing certain symptoms or syndromes of symptoms—taking age and the history of the patient's illness into account. The very fact that the symptoms generally form syndromes points to their interdependence to a greater or lesser degree, but this interdependence may not be a straightforward linear relationship such as is revealed by an ordinary correlation coefficient for the symptoms may interact with each other in a complicated way. When this is the case the problem of prediction is difficult from a statistical as well as from a psychiatric point of view. In this paper an effort is made to clarify the statistical problem by describing briefly and by comparing two statistical models which may be used for predictive purposes. The models are introduced by means of an example using data for patients who have attended this hospital. For reasons of clarity the number of variables included in the study is a bare minimum.

In a previous investigation (Foulds and Caine, 1958) a series of consecutive admissions (women) admitted to Runwell Hospital and diagnosed as psychoneurotic were found to divide into four groups in terms of presenting syndrome (hysteria or dysthymia) and of personality type (hysteroid or obsessive). When psychological tests were administered to these groups it was found that some measurements were related to diagnostic category whilst others were related to personality type.

A case closely comparable with that reported below does not appear to have been described, possibly because of the ethical problems involved. Watkins (1947, 1951), in the description of two cases, has made the most nearly related contribution to the old debate as to whether an unwilling subject can be hypnotized. His cases were both trained subjects who were offered money rewards to attempt to resist the formal induction of hypnosis before an audience. They were both successfully hypnotized. The fear-inspired unwillingness of the patient to be described would appear to have been in a rather different category.

The use of tranquillizers in mental deficiency has shown a divergency of effects. Noce, Williams and Rapaport (1) claimed that reserpine produced some improvement in all their thirteen adult hyperactive low-grades, and Rettig (2) reported that chlorpromazine produced decreased hyperactivity in twenty-three of his twenty-seven adult defectives of all grades. Blair and Herold (3), using ten “matched-pairs” of hyperactive defective children, found behaviour improvements in nine of them on chlorpromazine, with an average I.Q. gain of 10.4. Using six different tranquillizers on twenty-five adult defectives of all grades, Rudy, Himwich and Rinaldi (4), found that all gave some benefit, with chlorpromazine the most effective. Fischer (5) showed that twenty out of his twenty-two low-grade adult defectives (many with psychotic overlay) were improved in behaviour on reserpine. Using sixteen “matched-pairs” of E.S.N. children, Segal and Tansley (6) claimed that hydroxyzine produced improved scholastic performance in fourteen of them, and Bergin and Bergin (7) stated that the epileptics in particular in their thirty-four low-grades were improved by promazine hydrochloride.

Perivascular cysts visible to the naked eye have been described in the brain of several cases of gargoylism (Lindsay et al., 1948; Henderson et al., 1952; Naidoo, 1953). In most instances they were small, not exceeding 1 mm. in diameter and confined to the white matter of the cerebral hemispheres. The present case is remarkable for the exceptional size of the perivascular cysts which had led to gross bilateral cavitation of the thalamus and putamen.

Prochlorperazine (Compazine, Stemetil) and chlorpromazine (Thorazine, Largactil) frequently produce tremor and rigidity. Less well known are the severe tonic spasms of the muscles of the head and neck which can result from these phenothiazine derivatives. This paper directs attention to these spasms and their similarity with “extrapyramidal seizures” and oculogyric crises.

In recent issues of The Journal of Mental Science there have appeared two critical papers (5, 7) dealing with some aspects of the dimensional analysis of personality which the writer has put forward. As replies to these papers separately would seem to require a good deal of repetition, it seemed better to frame a joint reply. This has been kept rather short on purpose, primarily because the writer does not believe that arguments are very helpful to the advancement of science, unless they are accompanied by new data of an experimental kind. In the main, therefore, this reply has restricted itself to simply pointing out that many of the points raised are factually incorrect, or, although they might be correct in themselves, are not relevant to the theory they are criticizing.

Since disulfiram (tetraethylthiuram disulphide) was first reported to cause intolerance to alcoholic beverages (Hald et al., 1948) it has been used extensively as an adjunct in the treatment of alcoholism. Impressions of most therapists have been favourable (e.g. Martensen-Larsen, 1953; Wallerstein et al., 1957). At Warlingham Park Hospital the drug has been administered over the past five years to more than 250 alcoholics (as part of a fairly comprehensive therapeutic programme—Glatt, 1955) and has been found by a great many patients very helpful after discharge from hospital.

In its classical form this peculiar disease is characterized by an irresistible compulsion to swear, together with motor tics. First recorded by Itard in 1825, it was later fully described (1885) and followed up (1899) by Gilles de la Tourette, whose name has been given to the condition. Associated with the compulsive utterances are multiple motor tics, hence Convulsive Tic is a synonym for the malady. The motor movements are more severe and widespread than those met with in simple tic, and they may involve the whole body in a violent spasm. Facial grimaces, violent jerks of the head, limbs and trunk may occur, often combined with an explosive utterance. This exclamation may consist of an unorganized sound such as a bark or a groan or a grunt. Or it may be a word—frequently of an obscene nature (coprolalia) which greatly embarrasses the patient. Other features of the condition are echolalia—the impulse to repeat sounds or words which the patient hears, and echbpraxia—the compulsion to copy the actions of others.