The value of modified leucotomy in the treatment of psychiatric disorders is undergoing constant reappraisal. Ever since 1948 efforts have been made in the Department of Psychological Medicine of St. Thomas's Hospital and at Belmont Hospital to modify operative techniques and to learn more about the proper and discriminative selection of suitable patients within very varied diagnostic categories. A leading article in the British Medical Journal has called for renewed efforts along such lines. (Editorial, 1965). To enable various surgical procedures to be assessed and their merits and disadvantages compared more accurately, better objective methods of evaluating the effects of the operation are certainly required. Although several studies have been directed towards the measurement of intellectual function before and after operation (Mettler, 1949; Mettler and Landis, 1952; Tow, 1955) much less attention has been directed towards the objective assessment of personality changes and measurement of the reduction of key symptoms such as anxiety. Sykes and Tredgold (1964) emphasized what has been repeatedly stressed from this Department (Sargant, 1946, 1962; Sargant and Slater, 1944, 1948, 1954, 1963), that a decision to operate must take careful note of the individual symptoms, especially the degree of tension present. Falconer and Schurr (1959) consider that “the indication for operation should be, not the diagnostic label, but the tension and anxieties which the illness has produced”.

The occurrence of depressive psychosis in the obsessional neurotic has been noted by Prichard (1835), Heilbronner (1912), Gordon (1925 and 1950), Vurpas and Corman (1933), Lewis (1934), Stengel (1945 and 1948), Terhune (1949), Pollitt (1956 and 1957), Reda and Paretti (1958), and Skoog (1959). Apart from Freud (1923), Vurpas and Corman and Pollitt, the general view is that such cases fare worse than other depressives. It is still uncertain in what ways, if any, a pre-existing obsessional neurosis modifies a superimposed depressive psychosis. The uncertainty is due to the lack of a large controlled series, the provision of which is the purpose of this study.

A previous study of depressive psychosis—Gittleson (1966a) showed that depressives with obsessions attempted suicide six and a half times less often than depressives exhibiting obsession-delusion transitions (without change of content) or those without any obsessions at all. It was suggested that the essential “protective” factor against suicidal attempts was the phenomenological form of the obsession as an obsession and its persistence as such throughout the course of the depression.

There are only three special security hospitals in England and Wales (Broadmoor, Moss Side and Rampton). They provide an opportunity to investigate what amounts to a national sample of severe behavioural problems, with regional bias reduced to a minimum. Since the article by Tong and Mackay (1959) dealing with relationships between certain offence patterns and eventual social prognosis in terms of relapse rate, nothing has been published about the type of male patient sent to Rampton, nor about his conduct after admission. To our knowledge no similar study has ever been carried out in this country on female patients requiring special security treatment.

Reports that schizophrenics have older parents than non-schizophrenics (Barry, 1945; Goodman, 1957; Johanson, 1958; Gregory, 1959) are of considerable importance. If valid, they provide evidence for environmental causes of schizophrenia, and by analogy with other conditions where parental age effects have been noted may give some indication of the nature of these causes. There are, however, inconsistencies in these studies: thus Johanson and Gregory found a significant association between advanced paternal age and schizophrenia, but failed to confirm the maternal age effect noted by Barry and Goodman. These differences indicate the need for further investigation and this paper describes such a study.

There have been relatively few studies concerning the occurrence of depersonalization phenomena in normal subjects. Roberts (1960) and Dixon (1963) studied college students and reported a high incidence of brief depersonalization experiences in their samples. The aim of the present study is to investigate the relationship between depersonalization, the conditions under which it occurred and a measure of extraversion/ introversion in a group of normal subjects.

Introduction

“I can't concentrate, doctor” is a common complaint among psychiatric patients. The phrase is usually applied in a general sense to describe a state in which the patient has ceased to read the newspapers or watch the television and can no longer cope adequately with his work. In clinical practice the performance of the “serial sevens” test has been thought to give an indication of impairment of this function, whatever it may be (Mayer-Gross, Slater and Roth, 1960). As the symptom is so common, a measure of its severity may be of some value. This paper describes an attempt to develop such a measure and discusses the possible implications of its failure.

In the practice of our department at the Middlesex Hospital, the need has been felt for a means of rapid quantification of common symptoms and traits relevant to the conventional diagnostic categories of psychoneurotic illness. Until now, none of the available British scales have fulfilled this requirement. The most widely used is the Maudsley Personality Inventory (Eysenck, 1959) with its subsequent modifications. This, however, although scientifically based, is limited to the assessment of broad categories such as “neuroticism” and “extraversion” which appear to go only a small way towards describing the wide variability of psychoneurotic disturbances. Foulds and his co-workers (Foulds, 1965) have for a number of years developed personality scales in which clinical sophistication and a rigorous methodology are combined. Their Symptom-Sign Inventory, however, consists of eighty questions which have to be presented orally. Furthermore, although the inventory covers psychotic disturbances, it is necessary to use an additional questionnaire, the Hysteroid-Obsessoid Questionnaire (Caine & Hawkins, 1963) to complete the spectrum of psychoneurotic illness. Moreover, the concept of psychiatric illness developed by these workers is individual rather than conventional in a number of respects. The Tavistock Self-Assessment Inventory (Sandler, 1954) is too long for the present purposes (876 items in six booklets). The Taylor Manifest Anxiety Scale (Taylor, 1953) is short and convenient, but it measures one dimension only. As many doctors, including psychiatrists, find it useful to think in terms of orthodox clinical categories for diagnostic, therapeutic, prognostic and research purposes, it was decided to design and attempt to validate a self-rating scale adapted to these categories, taking the patient 5–10 minutes to complete and capable of being rapidly scored by the doctor or an assistant.

In this paper “response inhibition” refers to the individual's capacity to refrain from responding in ways that are inappropriate. Inappropriate responding, usually in the form of over-responding, is more natural when we are young; but as we grow older our capacity to inhibit response, and hence our effectiveness, is normally expected to improve.

Do the relatively high N-scores observed in neurotic patients reflect a stable characteristic of the neurotic's personality, or are they temporary manifestations occurring only in the acute phase of the illness? Similarly, do the relatively low E-scores of dysthymic patients remain low through variations of clinical state or are they also temporary? The temporal stability of M.P.I. scores is of some practical importance. Criteria for psychiatric diagnosis often include assessments of personality before the illness. Fairly reliable information about this can often be obtained from relatives, but in other cases the clinician is faced with a problem that might appear insoluble. How is he to assess previous personality during an acute illness which may influence the behaviour on which personality is judged?

There has been much speculation but little evidence concerning the view that personality characteristics, like cognitive factors, change with age. Consequently, the lack of information on the MMPI for aged populations may well have led to its inadvertent misuse on the assumption that the standard normative data given in the revised Manual (Hathaway and McKinley, 1951) are applicable to the elderly. The authors present data on a sample of the aged taken from the community which shows this assumption to be misleading, and attempt to improve this situation.

Psychiatric research has long been hampered by lack of sophisticated measures of clinical events. The semantic differential is therefore a welcome new tool in the psychiatric kitbag. It was developed by Osgood and his associates (1957), and can essentially be regarded as a limited association technique which readily taps aspects of meaning and attitude. It is adaptable to a great variety of problems, while remaining easy to give and score. Provided one wishes to measure meaning or attitude, and can link one's hypotheses tightly to the outcome of scores on certain concepts and scales, the technique can be extremely valuable. In order to contrast psychiatric disorders one can build up different patterns of meaning for each disorder on concepts crucial to the theories being tested. We can thus obtain a kind of semantic geography for a small region of function which aids our understanding of the disorder in question.