The Uffculme Day Hospital was opened some two and a half years ago as part of an experimental scheme to treat psychiatric patients outside the confines of a mental hospital. The plan was to admit a small number of patients and gradually to develop and organize a group therapeutic technique in the light of experience. It was hoped that a Day Hospital conveniently situated within a large industrial city would help to meet an increasing need for diagnostic and therapeutic facilities. It might find a solution for those patients who could not be adequately treated as out-patients and yet were not likely to benefit from admission to already hard-pressed and overcrowded mental hospitals. While the present Day Hospital scheme is too small to have a significant influence on the total psychiatric problems of some one million and a half people living in the vicinity, it has so far shown signs of being a welcome addition to the mental health services of the region.

This study is an attempt to assess the value of certain drugs commonly used in psychiatric practice in decreasing the hyperactivity of patients. It is one of a series investigating tranquillizers and mental disorder in mental deficiency practice (Craft 1958).

With the advent of effective physical therapies, psychiatrists have become increasingly interested in the problems posed by clinical trials. Professor Bradford Hill, in the Preface to the Sixth Edition of his Principles of Medical Statistics (1) noted that “… passage of time has … brought clinical trials into prominence and fashion …”. More recently Professor Pickering has described the clinical trial as “the most important new method introduced into clinical science in recent years” (2). Some interesting differences between controlled and uncontrolled trials are well brought out in the paper by Foulds (3) in which he found that therapeutic success was claimed in 85 per cent. of studies not using control groups. Among those studies using control groups, however, only 25 per cent. obtained a positive result. He concluded that “claims for the success of a treatment are closely associated with absence of the means whereby these claims can be scientifically substantiated”.

This paper describes a group of female patients admitted to mental hospital who in the past had undergone thyroidectomy for thyrotoxicosis. It was thought that a group of this kind who had been admitted might show, possibly in an exaggerated form, the personality features said to be common to individuals predisposed to thyrotoxicosis. The series does not include any toxic psychosis attributable to the disease itself and the title may possibly be misleading in this respect. Most psychiatric studies have dealt with the patient at the time of the illness and the emphasis has tended to be on precipitating factors. A much quoted study is that of Conrad (1) (1934). As a psychiatrist working in a thyroid clinic she described 57 cases referred for psychiatric opinion and used 48 cases not so referred as controls. She concluded from a careful study that the onset of the illness was due to two main patterns of emotional disturbance: (1) fear of loss of shelter and affection equivalent to deprivation of mother, (2) fear of dangers of the mother role. She found a large number of cases where there had been loss of the mother at an early age. Ham, Alexander and Carmichael (1951) (2) remind us that the disease occurs spontaneously only in man, not animals, and rarely in primitive communities. They describe a “specific dynamic pattern” in thyrotoxicosis, viz., Frustration of dependent longings and persistent threat to security (exposure to death and other threatening experiences in early life, causing unsuccessful premature attempts to identify with the object of the dependent cravings. There is a continued effort toward premature self sufficiency and to help others. These strivings for self sufficiency and taking care of others fail causing thyrotoxicosis. Lidz and Whitehorn (1949) (3) also regard thyrotoxicosis as following in almost every case a somewhat similar pattern. They regard these patients as a group less wanted than their sibs but eventually achieving parental affection by being “good children” (in the exaggerated sense) and persist in this pattern of behaviour in adult life. They expect the same unswerving fidelity they gave to their parents in return for excess of affection that they give to a parental figure. These authors claim that this almost invariable pattern provides short cuts in therapy, e.g., when the illness arises soon after marriage, problems are apt to revolve about difficulties in leaving the parental home. Working on different and more objective lines Ruesch (4) and his colleagues at the Thyroid Clinic of the University of California studied 43 patients carefully selected to give a fair representation of patients treated by thyroidectomy. They verified thyrotoxicosis by histological reports on the excised portion of the gland. Each patient had 5 interviews and abbreviated Wechsler and Minnesota Multiphasic Personality Inventory Tests. Their main interest was the prolonged psychological invalidism which had been noted to immediately follow operation. They found that patients with delayed recovery tended to have a long record of previous hospitalization, and a high frequency of major and minor operations. In the M.M.P.I. the most common pattern was “undifferentiated normal”. They concluded that patients with thyroid disease are not entirely normal sociopsychologically, but the group could be subdivided into two entities: (1) normal or almost normal, (2) hysterical or anxious type in female patients, or dependent personalities in male patients.

A patient in a state of stupor presents one of the most remarkable phenomena seen in medicine. The term “stupor” itself is in widespread use in general medicine and usually refers to partial or near coma. Its precise use in psychiatric practice implies a condition of immobility and muteness without loss of consciousness or organic paralysis. The term “akinetic mutism” is sometimes used to describe such states, particularly by neurologists. The actual clinical appearance or syndrome is too well known to warrant a detailed description. Essentially, for the purposes of this paper, it is equated with akinesis and mutism.

Much interest has been displayed in the past few years in the effect on human subjects of reduction, or as far as possible, abolition of sensory stimulation, so that virtual isolation from the environment is produced. Recent comprehensive reviews have appeared, dealing with experimental work (Solomon et al. 1957) and conditions arising incidentally in the course of various therapeutic procedures (Grünthal 1957), and it is therefore unnecessary to deal with the topic at length here.

Psychologists are frequently asked to say whether, in the case of a particular patient, there is evidence of organic dementia. At first sight this would not appear to be an unreasonable request. A considerable amount is known about the performance of normal people on tests of cognitive function and it might be supposed that people who work with tests of human ability should be able to modify their procedures to the purpose of diagnosing intellectual deterioration when this is not obvious on routine neurological or psychiatric examination. Moreover, it might seem that the frequent presence of independent criteria of brain damage provided by neurological and neurosurgical investigations should facilitate the development of competent diagnostic clinical psychology in the neurological field.

A psychological test of brain-damage, shown to be valid in discriminating between unequivocal brain-damaged and non-brain-damaged psychiatric patients, is limited in its diagnostic role until studies can demonstrate its independent diagnostic contribution in the clinically doubtful case of brain-damage.

Stoll, in 1947, reported on the effects of LSD-25, an ergot alkaloid which can produce striking mental changes in normal persons, when given in microgram quantities. Since this original report, many papers and provocative ideas on the subject have appeared.

There have been numerous reports in recent years of prolonged apnoea resulting from the use of suxamethonium (succinylcholine, “Scoline”) in general anaesthesia and for electroplexy. For example, Grant (16) described a case of respiratory paralysis lasting 2 to 3 post-operative days following an intravenous dose of 80 mg. of suxamethonium, and Cowan (7) reported a patient who underwent a partial gastrectomy and exhibited complete apnoea for 9 hours duration after only 25 mg. of suxamethonium had been given, and who subsequently died. Hurley and Monro (22) reported apnoea lasting for 10 minutes following 20 mg. of suxamethonium used as a relaxant for electroplexy, and for 20 minutes after decamethonium iodide.

Vespral, chemically designated as 10-(3-dimethylaminopropyl-2-trifluoro-methyl)-phenothiazine hydrochloride, or trifluopromazine hydrochloride is a new ataractic drug which has only recently become available in this country. A clinical field trial with Vespral has been reported in a previous issue of this journal (1). It was then suggested that the drug was most effective in the treatment of psychotic disorders, schizophrenia in particular. The aim of this study was to evaluate, with some claim to objectivity, the effectiveness of the administration of trifluopromazine hydrochloride on the behaviour of a small population of chronic schizophrenic patients.

The Maudsley Personality Inventory (MPI) that purports to assess the two personality dimensions, extraversion-introversion (E-I) and neuroticism-normality (N-N), has been used extensively in recent research work and a number of published papers in somewhat different spheres bear witness to the use made of the questionnaire (Eysenck, 1956a; Coppen, 1958; Franks, 1957; Bartholomew, Franks and Marley, 1958). A clear description of its construction and use has been presented by Eysenck (1956b) and a comparison between it and other personality scales, as well as some criticisms of its construction, has been set out by Jensen (1958). The particular interest this questionnaire has evoked is due in part to the fact that it is one of the few personality inventories constructed and standardized this side of the Atlantic. The importance of a reliable questionnaire of this type is noted by Eysenck (1958) in his attempt to produce a shortened version of the MPI that will be of value in such work as market research.

Experimental studies by O'Connor (2) and O'Connor and Rawnsley (3) have indicated the value of separating chronic schizophrenics into those who exhibit and those who do not exhibit paranoid symptoms. Other work by O'Connor and Venables (4) and Venables and O'Connor (6) has shown that performance of schizophrenic patients on experimental laboratory tasks may be clarified by dividing them into active or withdrawn groups by means of a rating scale (Venables, 5) in addition to a division on the basis of the presence of paranoid symptoms.

It is a well-known fact that patients dislike E.C.T. and that part of this dislike is based on the unpleasant period of waiting which occurs before all operative procedures. There may be indeed other features involved in E.C.T. as patients seem to have a fear and dislike of this treatment out of proportion to what would be expected. That this dislike of E.C.T. is an important matter is brought out by the difficulty in persuading patients who have suffered a recurrence of a depressive illness to undergo this treatment once again, and if any means could be devised to increase their readiness to accept medical advice on this subject then an advance would be made.

In a recent paper Walton (3) has described the diagnostic and predictive accuracy of the Modified Word Learning Test (Walton and Black (4)) in relation to psychiatric disorders of the senium. Walton assessed the predictive value of the test in terms of changes in diagnosis over a two-year period. However, as Payne (2) has pointed out, a diagnosis, as such, can only be regarded as a kind of label, of interest not in its own right, but because of its implications. These, Payne has argued, are commonly fourfold, being related to (a) aetiology, (b) description, (c) the effects of treatment and (d) prognosis.

Diphenhydramine hydrochloride has been found to have a sedative effect, and various modifications of it have been prepared in order to enhance its effect. A promising variant is Covatin, which is p-butylthiodiphenylmethyl-2-dimethyl-aminoethyl sulphide hydrochloride; or, structurally:

A double-blind study of chlorpromazine and promazine was conducted to measure their comparative therapeutic effectiveness on a short-term basis at medium dosage levels, such as might be used for out-patient purposes. The patients chosen, however, represented a more therapeutically challenging group of hospitalized acute schizophrenics in whom a dramatic and convincing effect might offer an evaluation of comparative response.

There is a considerable literature dealing with the relation of anxiety to conditioning performance in human subjects. When compared with normal subjects, those with marked anxiety have been observed to show more rapid conditioning and slower extinction of certain responses. Typical observations have been those of Taylor (17) concerning conditioned eyelid responses, and of Welch (20), and Bitterman and Holtzman (3), concerning the galvanic skin response. In contrast, Bindra et al. (2) found no difference in the conditioning of salivary responses between anxious and non-anxious subjects.

In spite of the vast literature concerning Haemophilia, I have been unable to find any reference to the concomitant occurrence of a psychosis with this condition.

The development of megaloblastic anaemia as a complication of anticonvulsant therapy is now well recognized, and a total of thirty cases has been recorded.

Badenoch (1) reported the first detailed studies of megaloblastic anaemia developing in epileptic patients treated with phenobarbitone and epanutin, whilst Fuld and Moorhouse (6) reported the association with primidone (Mysoline) alone. In all the cases reported, the anaemia responded to folic acid therapy, whilst anticonvulsant drugs were continued.