Freud as a medical student accepted the role of a man of science as defined by the medical milieu of Vienna, as well as the accompanying philosophy and methodology of clinical and scientific research. These forms became a part of his thought and into them he fitted his psychological discoveries as well as his view of himself. Without the medical Vienna in which he developed, Freud would not have been what he was.

A feasibility study for a controlled trial of a certain type of formal psychotherapy is described. Patients referred by consultant psychiatrists in the Inner London Area were carefully selected and fully assessed before random allocation to one of three treatment procedures. The results indicate that the trial as initially envisaged is not feasible. The reasons for this conclusion are discussed.

The purpose of this study was to test the hypothesis that there is a positive association between physical and psychiatric disorder. The study was designed to reduce potential sources of bias and the approach included random sampling of a general practice population; independent assessments of the physical and psychiatric states using objective methods and strict criteria for diagnosis; and the use of a control group. The results suggest that the hypothesis is confirmed and furthermore that ‘clustering’ of both types of disorder occurred in some individuals.

The rating behaviour of eight psychiatrists was studied while they learned to use a standardized psychiatric clinical interview schedule. Their progress was followed during live interviews, and also by their ratings of videotape interviews. Significant and consistent changes towards the standards of the teachers were demonstrated, as was a universal tendency to pass through a phase of rating at a higher level of abnormality than the standards they were trying to approach.

Eight phobic outpatients were treated by six sessions of desensitization followed by exposure or vice versa. Treatment was by visualization of phobic images up a hierarchy for 20 minutes at a time. During desensitization patients were relaxed before and after each image, while during exposure they looked at a neutral slide instead. Skin conductance activity was significantly lower during relaxation than during observation of the neutral slide. The patients, therapist, and a ‘blind’ assessor rated the main phobia as significantly improved for both treatments together. Each of the two treatments contributed similarly to improvement during and after treatment sessions, on measures of main phobia, subjective anxiety, and heart rate. Relaxation training appears to be redundant to the desensitization procedure.

SYNOPSIS Skin melanin concentrations were measured by reflectance spectrophotometry in patients during the active phase of a primary affective illness and in normal subjects. There were no significant differences between 27 females with depression (unipolar illness) and 17 females with mania (bipolar illness) or between a mixed group of 30 male patients with mania and depression (predominantly mania) and a normal sample of 27 male subjects. These negative results are discussed in terms of the catecholamine hypothesis of the affective disorders. A study of brain pigmentation is suggested as being a potentially useful investigation in manic-depressive psychosis.

In order to test two theories of the mode of action of imipramine 58 depressive patients were treated at two dosage levels with desmethylimipramine (DMI), its active metabolite. Clinical judgments were used to distinguish therapeutic responders from non-responders, who showed clear differences in depressive rating scales and body weight changes. Measurements of urinary output of DMI, of salivation, and of the incidence of side-effects were compared in responders and non-responders: no differences appeared between the two groups. It is concluded that the therapeutic effect of imipramine does not depend on either its anticholinergic or other action revealed by the common side-effects, and that variability of response cannot be accounted for by differences in the rate of metabolism of DMI.

A double-blind comparison was made of the effects of amantadine hydrochloride, orphenadrine hydrochloride, and placebo in the control of the effects on the extrapyramidal nervous system of fluphenazine decanoate. Patients were assessed with regard to the main symptoms of Parkinsonism, the leading clinical signs, performance in walking, writing and squeezing, changes in mood, and unwanted effects of medication. Neither of the pharmacologically active substances was superior to placebo. Attention is drawn to the paucity of evidence for the effectiveness of anti-cholinergic drugs in both Parkinson's disease and in drug-induced Parkinsonism. The special difficulties in performing trials of substances used in relieving the unwanted effects of other drugs are discussed in relationship to defects in methodology in both this and earlier trials. The findings of the present study are not conclusive but show a clear need for further research in this field. The possible theoretical and practical importance of such research is discussed.

SYNOPSIS Experimental data on the location in the brain of electrode sites supporting electrical self-stimulation are reviewed. All previous studies are in agreement that the behaviour is most easily elicited from lateral hypothalamic sites corresponding approximately to the fibre pathways known as the ‘medial forebrain bundle’. Some brainstem electrode sites will support self-stimulation. Experiments are summarized which indicate that there is a correlation between the sites of electrode tips positive for self-stimulation and the location of catecholamine-containing neurones in two regions: (1) in the region of the dopamine-containing cells in the ventral mesencephalon (cell-body groups A9 and AIO of Dahlstr¨m and Fuxe, 1964), and (2) in the region of the noradrenaline-containing cells of the locus coeruleus (A6 group). These two cell-body groups give rise to axons which pass through the medial forebrain bundle to form terminal systems with a widespread distribution in the prosencephalon. The hypothesis is advanced that electrical self-stimulation results in the majority of cases from activation of one or both of these catecholamine-containing systems.

The results are described of a transcultural psychiatric study of schizophrenia undertaken by WHO in nine countries. The study proved that such a collaboration was feasible, that it was possible to develop research procedures for international use, and that similar types of schizophrenia could be found in each of the countries involved. One thousand two hundred and two patients were studied and over 2 million items of information obtained.

A sudden loud noise produced a large and rapid rise in plasma glucagon in the conscious primate. A similar rise took place when stresses were applied to anaesthetized animals.