‘As for the bodily temper of man and his Brain… a very little distemper of the brain… is enough to represent Spirits, Angels and Devils, Sights and Stories of Heaven and Hell to the Fancy… which sober kind of madnesses and delineation (is) little understood vulgarly’.

The purpose of this paper is to present some of the findings concerning the morbidity rate of monozygotic co-twins of schizophrenics and the possible influence on it of environmental factors. The work is based on a statistical study of the clinical records available at the MRC Psychiatric Genetics Research Unit.

Barry and Barry (1961, 1964) have reviewed the evidence for an association between season of birth and the major psychoses. Their figures show that, with a single exception, every study has found an excess (though not always a significant excess) of schizophrenic and manic-depressive patients born between January and April, and a deficit born between May and August, compared with the control populations. The single exception was their own study (1964) on schizophrenic patients in private mental hospitals, a finding which led them to conclude either that the private class of patient is protected from some adverse seasonal influence or that schizophrenic patients come chiefly from a subgroup of the population which has a comparatively high birth rate during the first four months of the year. Norris and Chowning (1962) drew attention to the fact that the seasonal distribution of births in a general population may vary appreciably from year to year in a particular country and from place to place within that country in any one year, and suggested that such variations make difficult any comparison between births of patients and of a large general population taken over a number of years, the procedure which had hitherto been adopted.

The beneficial clinical effects of stereotactic lesions in the ventrolateral nucleus of the thalamus in the treatment of Parkinsonism are well established. Studies of the cognitive and personality changes, however, have given contradictory results. This may be due to the great variety of tests used, to lack of control groups and to the fact that some investigators have studied only unilateral operations, whereas others have included some patients operated on bilaterally. Changes, presumably permanent, have been reported in intelligence (Jurko and Andy, 1961; Lenshoek and Manem, 1960; Niehbuhr, 1962; Jurko and Andy, 1964); concept formation (Jurko and Andy, 1961); extraversion (Fortin, 1960; Jurko and Andy, 1961); and anxiety (Niehbuhr, 1962). Transient changes have been reported in intelligence (Riklan, 1961; Levita et al., 1964); human figure drawing (Riklan et al., 1962); integrity of personality (Fortin et al., 1961; Fortin, 1960; Riklan, 1961); and somatosensory status (Proctor et al., 1963). In other studies no change was found following the operation (Bravo and Cooper, 1959; Gillingham et al., 1960; Gillingham et al., 1964; Levita and Riklan, 1965; Muller and Yasargil, 1959; Riklan, 1962).

Parkinsonism is generally considered to be essentially a disturbance of motor function, yet it is frequently accompanied, according to some writers (Hughes, 1961; Macdonald Critchley, 1955; Niehbuhr, 1961), by some degree of intellectual deterioration, especially in the later stages of the illness.

Neither older (Raiman, 1902; Ehrenberg, 1909; Wigert, 1918; Reiter, 1925) nor more recent papers (Diethelm, 1936; McFarland and Goldstein, 1939; Holmgren and Wohlfarhrt, 1944) provide general agreement about impairment of glucose tolerance in mental disease. Plum (1958) considers a high incidence of decrease among epileptics established, but while Freeman and Zaborenke (1949) reported a decrease in schizophrenics Shattock (1950) found an increased tolerance in such patients. Waelsch and Weil-Malherbe (1964) comment that a reduction in the rate of glucose utilization in cases of severe depression stands out as perhaps the most significant and constant finding, but Coppen (1967) claims that quite recent work by him and his co-workers (Herzberg, Coppen and Marks, 1968) provided evidence that there was no impairment in glucose tolerance when depressed patients were given diets high in carbohydrate for three or four days before testing. It would be expected that much conflicting evidence could be due to difficulties inherent in psychiatric nosology. But a review of the surprisingly large number of reports which have left the problem unsolved could not but impress one with the rather casual attitudes of some workers to the chemistry of different methods for “blood sugar” determination.

In a previous investigation, the concentration of homovanillic acid (HVA) seemed to be related to the degree of dementia (Gottfries et al., 1965). The object of the present work is the further study of the occurrence of HVA in the human brain, especially with regard to senile dementia. The hypothesis is that senile dementia is a disease with a disturbance in the monoamine metabolism, which is reflected in a reduction of HVA in the neostriatum.

In a previous paper (Hodges, Jones, Elithorn and Bridges, 1964) we reported on adrenocortical activity in depressed and schizophrenic patients as revealed by plasma cortisol levels before and after electro-convulsive therapy (E.C.T.). Close similarity was found between the two groups except for three depressed patients who appeared to show considerably higher cortisol levels after the treatment than did the remaining subjects. The patients were examined at random different treatments during the whole treatment course and it appeared possible, both that the observed cortisol response to E.C.T. might depend partly on which treatment of the series in a whole course was under examination, and also that the response of the illness to therapy might be a significant factor. It was therefore decided to observe in a number of subjects the response to successive treatments throughout courses of E.C.T.

Most of the studies of steroid metabolism in depression conducted thus far have been of glucocorticoid activity. Rubin and Mandell (31) reviewed adrenal cortisol production in pathological emotional states and concluded that there was ample evidence of heightened cortical release of 17-hydroxycorticoids (17 OHGS) in depression.

The personality of people who develop a depressive illness has been the subject of much controversy. Most of what has been written is based on clinical observations made during the illness and on inferences drawn from symptoms and there are few investigations based on studies of patients when they were not ill. The present investigation was carried out on women after they had recovered from a depressive illness.

Tests of thought-disorder may perhaps all be measuring a common entity, but the degree to which this is true has yet to be established.

A number of searching studies on transsexualism have been published during recent years (Roth and Ball, 1964; Benjamin, 1966; Wålinder, 1967). In the present paper we shall attempt to demonstrate that transsexualism has another direct social consequence besides the large risk of suicide which one of us has already demonstrated (Wålinder, 1967). Our study was prompted by our experience that transsexuals change their address unusually often in comparison with others.

A number of reports suggest that schizophrenia and coeliac disease (gluten enteropathy) occur in the same individual more often than expected by chance. The latter is an hereditary disease, with marked psychic and somatic symptoms which usually improve when wheat gluten and its analogues in other cereals are not eaten. This possible relationship, and the high correlation of the per cent. changes in wheat plus rye consumption with first admissions for schizophrenia during World War II (unrelated to availability of work, hospital beds and physicians or wartime status of the country), suggest that cereals may also be involved in the pathogenesis of schizophrenia (Dohan, 1, 2).

In making a diagnosis between psychotic and neurotic depression, characteristic signs and symptoms are usually looked for. Although there is much controversy in the literature in respect to this difference, particularly since Lewis's work in 1934, nevertheless one commonly observes that when people are sad they cry. We would expect, therefore, that this would apply also in depressions. Yet, in our survey of the journal literature and such major textbooks as Mayer-Gross, Slater and Roth's Clinical Psychiatry, Arieti's American Handbook of Psychiatry, and Freedman & Kaplan's Comprehensive Textbook of Psychiatry, the authors fail to include crying as a symptom of depression.

In a series of papers, Slater, Beard and Glithero (1963) reported on a group of 69 patients who had suffered from a schizophrenia-like psychosis at some time after the onset of an earlier but continuing epilepsy. They gave a number of arguments, which need not be considered here, to support the view that the epileptic and the schizophrenic states were not independent of one another and merely coincidental, but that the pre-existing epileptic state was the direct cause of the schizophrenia-like illness, and that this could in fact be regarded as a special form of an epileptic psychosis, which took on for a time the appearance of a (symptomatic) schizophrenia. One of the arguments on which reliance was placed was that there was a non-random relationship between the ages of onset of the epilepsy and of the schizophrenia, such that the interval between the two varied about a mean of 14 years. The three clinical groups into which the 69 patients were classified had significantly different mean ages of onset of epilepsy of 20·5, 16·3 and 9·3 years respectively; but there was no significant difference between the three clinical groups in respect of the mean interval between onset of epilepsy and onset of psychosis, 15·6, 14·0 and 12·8 years respectively. In fact, in the case of the duration of epilepsy, with an F value of 0·24, between-group variance was only a fraction of the within-group variance.

The Committee discussed at length the administrative structure at present prevailing, with particular reference to current principles and practice in the mental health field. Undoubtedly varying standards of successful collaboration and integration exist, with, however, the greatest signs of stress and strain in communities where there is dissociation between the local health services and the distant psychiatric hospitals that serve them. Any attempt at integration of the present tripartite administration into a single authority for a single community of optimum size would be welcomed by the Association, provided satisfactory arrangements could be made that are better than the existing ones.

The Royal Medico-Psychological Association has given its general support to the unification implied in the Green Paper on the Administrative Structure of the Medical and Related Services in England and Wales. This document specifically states that ‘the effective development of comprehensive services for them (categories including the mentally disordered) requires that all aspects of their health care should be the responsibility of a single authority’. In our Memorandum on this subject we stated ‘we accept the need for a single authority in each area to coordinate the wide range of health services, to plan the use of related services, and to apportion resources between care in the community and hospital care’.