Iohannes Cassianus, more commonly known as John Cassian, wrote his treatise De Institutis Coenobiorum et de Octo Principalium Vitiorum Remediis Libri XII around the beginning of the fifth century A.D. This work is important because it introduced certain Eastern ideas into Western thought. Some of these ideas are of considerable psychiatric interest.

Although the efficacy of chlorpromazine and other phenothiazine derivatives in the treatment of schizophrenic psychotic reactions has been established for almost a decade, there remain differences of opinion regarding which symptoms and behaviours are affected favourably by psychopharmacologic treatment. By and large, the phenothiazines have been characterized as “ataractics” or “tranquillizers”, the implication being that their predominant action is to calm excited patients by relieving the patient's anxiety or other forms of psychic distress. However, clinical experience increasingly asserts that the phenothiazines influence many manifestations of schizophrenic patients other than anxiety and excitement, including symptoms such as incoherent thought and apathy.

Following the introduction of imipramine hydrochloride as the first specific thymoleptic drug, further compounds related to the iminodibenzyl family were developed. One of these was an iminostilbene derivative with a piperazine sidechain: opipramol (Insidon, Geigy), which has the formula 4-[3-(5H-dibenzo[b,f] azepine-5-yl)-propyl]-1-(2-hydroxyethyl)-piperazine-dihydrochloride (Schindler and Blattner, 1961). The nucleus is almost identical to that of imipramine and the sidechain is identical to that of perphenazine. This compound has since been used by a number of Continental and American investigators. They have claimed thymoleptic, neuroleptic and tranquillizing properties for the drug. Some authors found an antidepressive effect inferior to that of imipramine (Schneider and Villa, 1961; Racamier, 1962); others considered it superior to imipramine in that it causes fewer side-effects and helps patients unresponsive to imipramine (Schmitt et al., 1962). Most workers mention a mild sedative effect. Donzallaz (1961) achieved most favourable results treating “psycho-autonomic disturbances”, and Hoff (1962) reported good effects on neurasthenic patients with depressive traits. All these studies were uncontrolled and, on the whole, rather impressionistic. The only blind trial known to us was done by S. R. Splitter (1963), who gave opipramol and placebo on a double-blind basis to 100 medical out-patients suffering from various disorders, with or without psychosomatic symptoms, and also exhibiting some degree of anxiety and depression. Using concomitant drug therapy as required in about half his cases, he observed excellent or good responses of target symptoms including depression, anxiety and psychosomatic complaints, as well as amelioration of any physiologic disorder in 94 per cent. of the opipramol group as against 4 per cent. in the placebo group. However Splitter's material covered a large number of divergent conditions such as adolescent behaviour problems, diabetes and cancer; they were insufficiently matched for diagnosis and apparently not at all for age.

The sheer volume of new drugs introduced into psychiatry within the past decade has created an urgency to get to the point as quickly as possible: Is Drug B better than A, and, if so, what about B and C? With some abatement of the tide of new compounds it becomes possible to look, not just for a quick answer, but at some of the conditions of the trial which determine the outcome.

This paper describes the preliminary clinical testing of a new sedative drug, and also explores the feasibility of using a single-patient, self-controlled and recorded design in psychiatric drug trials. Hogben and Sim (1953) demonstrated a form of drug trial which emphasized intra-subject fluctuations and their control. Recently, Shapiro (1963) has argued the usefulness of a similar approach in fundamental, clinical research. However, the single-patient drug trial appears not to have been widely used in psychiatry, although several writers, e.g. Shepherd (1963), have indicated its possible advantages.

A recent survey (Coppen and Kessel, 1963) of a random sample of 500 women from the general population investigated the prevalence of common menstrual symptoms and their relationship to personality as assessed by the Maudsley Personality Inventory (M.P.I.). The results showed that certain of these common symptoms have a positive and significant correlation with the Neuroticism scale of the M.P.I.; this was particularly notable for the symptoms of the premenstrual syndrome, i.e. premenstrual depression, irritability, swelling, etc., as well as for menstrual irregularity. Dysmenorrhoea, to the contrary of previous reports, showed no such association with neuroticism in this general population sample. The age and parity of the subjects were also found to influence the prevalence of many of these symptoms.

The two studies described here were concerned with the effect of intravenous sodium amytal on autonomic and muscle activity in groups of female patients admitted to the Bethlem Royal Hospital with a primary depressive illness. The first aimed to repeat certain aspects of the work of Shagass et al. (1956) on sleep thresholds in which reactions to sodium amytal were correlated with clinical groupings. The clinical findings of this experiment have already been reported (Martin and Davies, 1962), and its results suggested some methodological problems which prompted a second experiment employing a modified experimental design.

The purpose of this study was to investigate the relationships between the changes in the urinary excretion of the major metabolites of some monoamines and the clinical effects induced in schizophrenic subjects by treatment with reserpine or chlorpromazine.

The finding of chromosomal mosaicism in mongolism (Clarke et al., 1961) has added a new dimension to the problem of mongolism which has helped to answer some questions, but which has also created some new ones. It has been suggested that mosaicism may explain some of the microsymptoms of mongolism found in the siblings, parents and relatives of mongols. This has particular application to the increased atd angles on the palms of some mothers of mongols (Penrose, 1963).

Two previous papers (Monro, 1962, 1963) dealt respectively with the Self-Referent and the Social Attitudes of a sample population of neurotic and inadequate personalities. In each previous paper, the sample population was used, and the same technique of correlation (that of Cattell, 1946) applied. After the two papers mentioned had been written, it occurred to me that it should be possible to correlate their findings and demonstrate a relationship between particular self-referent and particular social attitudes. That is the task which this paper sets out to do.

This study reports certain test findings and generalizations on the performance of a small number of top ranking British Motor Racing drivers. The first section deals with the formal tests, the second is speculative about the motives involved in choosing motor racing as a career.