The establishment of a classification of affective disorders commanding wide agreement among clinical practitioners and investigators is one of the most pressing needs of contemporary psychiatry. This group of conditions has, in recent decades, displaced schizophrenia from the centre of the clinical stage. However, despite its prominence and importance in clinical practice, the territory remains inadequately charted. There is evidence to indicate that the uncertainty about the most clear and convenient lines of demarcation within this clinical territory makes a large contribution to the unreliability of psychiatric diagnosis. Thus, in a recent enquiry (Sandifer, Pettus and Quade, 1965) into the reliability of diagnoses made in 91 first admissions to a mental hospital by ten experienced psychiatrists, it was shown that the resolution of disagreement in the areas of “psychoneurosis—affective disorder” and “psychoneurosis—personality disorder” would have raised the overall reliability of diagnosis in this enquiry from 57 per cent. to 83 per cent.

Since its introduction by Cerletti and Bini in 1938 electroconvulsive therapy has become a major bulwark of therapy in psychiatric practice. Until a few years ago, before the introduction of the psychotropic drugs, it was the commonest method of physical treatment employed in psychiatry.

It is common practice to divide depression into two illnesses: reactive (or neurotic) and endogenous (or manic-depressive psychosis). This dichotomy is a source of extensive argument, and its value is controversial.

After 25 years there is still considerable disagreement surrounding the indications for electro-convulsive therapy (E.C.T.). This is a particular problem in the treatment of depression, both because of the controversy over the division of depression into endogenous and reactive illnesses and because of the increasing use of the antidepressant drugs. These drugs will induce a remission in many patients, and will alter the clinical picture in others. As their use becomes still more widespread (Freyhan (1) has recommended that intensive imipramine treatment should be tried routinely before E.C.T. in all depressed patients) there may be further difficulties in the selection of depressed patients likely to respond well to E.C.T. Furthermore several recent reviews draw attention to a reduction in the use of E.C.T., and the lack of a consistent rationale for its use (2–4).

Mumps, or epidemic parotitis, is caused by a filterable virus and is characterized by temporary enlargement of the parotid and sometimes other salivary glands and by the occurrence of complications, of which orchitis in adults and in post-pubertal boys is the most common. The virus is pantropic causing central and peripheral nervous complications in many cases. In civilized countries the disease is endemic but local outbreaks occur. One such outbreak occurred in Bristol during 1964, in the spring, the season when mumps is most prevalent. The case that is described here formed a part of that particular epidemic. Before proceeding to the case report the literature on the psychiatric complications of mumps will be discussed.

Neuropsychiatric sequelae after cardiac arrest or anaesthesia are infrequently reported. A review of the literature is given by Blackwood et al. (1963). Fletcher (1945) described permanent but comparatively mild effects which were attributed to nitrous oxide rather than to circulatory disturbances. Bedford (1955) described 18 cases of extreme dementia following general anaesthesia in geriatric patients who were quite well mentally before their operations. He indicated the diagnostic pitfalls involved in attributing minor psychiatric disabilities to the anaesthetic. Neuburger (1954) described diffuse cerebral damage combined with Wernicke-like lesions in the mamillary bodies in 2 patients. Brierley (1961) described the pathological changes in the brain of a 2-year-old child, who died 1 month after a cardiac arrest of 10–15 minutes. There were lesions in the mamillary bodies and inferior colliculi resembling those seen in Wernicke's encephalopathy. However, Brierley and Cooper (1962) later described a 43-year-old woman, whose blood pressure fell to unrecordable levels for 3 minutes and who became severely demented, developed Parkinsonism and had a Korsakoff type learning defect. She survived for 23 months. The brain showed most damage in the occipital cortex and thalamus, and less in the midbrain. Unfortunately the mamillary bodies were not identifiable.

Amphetamine psychosis arising during the course of long-continued amphetamine addiction resembles paranoid schizophrenia (Connell, 1958). Gradually the euphoriant effects of the drug are modified by anxiety accompanying ideas of reference and paranoid delusions. Auditory and visual hallucinations occur in a setting of clear consciousness and correct orientation. Restlessness, agitation and excitement are common accompaniments. An identical end-result has been reported in those cases that resulted from a single large dose of amphetamine or ingestion of the drug over a short period only (Wallis, McHarg and Scott, 1949; Herman and Nagler, 1954; Carr, 1954; Greenwood and Peachey, 1957; Connell, 1958). Accidental poisoning with amphetamine in childhood has been reported by Shanson (1956) and Patuck (1956) to result in hallucinations, hyperactivity, and a state of excitement and terror.

In a paper in the American Journal of Psychiatry, Chapman (1963) states categorically that no extensive follow-up investigations of neurotic patients exist. So long as we do not know the prognosis of neurotic illness, every evaluation of the results of therapy is impossible. Most psychiatrists feel that they help their patients, but one does not know with certainty.

One of the earliest studies on limb blood flow, using a volume plethysmograph to enclose the hand and forearm, was carried out by Hewlett and Van Zwaluwenburg (1909). Two of their patients were pronounced neurasthenics “with labile vasomotor systems” and these authors noted that, excluding subjects with thyrotoxicosis, “the majority of the remaining fast rates occurred in neurasthenics of the vasomotor type”. In 1938 Grant and Pearson, who developed forearm plethysmography to determine blood flow mainly in the skeletal muscle rather than the skin, noted transient increases in forearm flow with mental arithmetic in some subjects, but did not pursue this observation further. This response was studied in more detail by Abramson and Ferris (1940). Their conclusion that mental arithmetic produced an increase in forearm flow due to vasodilatation in the forearm muscles was confirmed by the work of Brod, Fencl, Hejl, and Jirka (1959), who attributed the change to emotional stress.

This investigation was prompted by the work of the late Dr. D. E. Sands and his colleagues on the boys in the Adolescent Unit at St. Ebba's Hospital, Epsom. As a result of a variety of endocrinological investigations and studies on physique they concluded that a substantial proportion of these children showed evidence of physical immaturity. It was consequently decided that certain boys might benefit from a course of injections of Human Chorionic Gonadotrophs (H.C.G.) in order to hasten their physical maturity, as it was felt that this could have a beneficial effect on their psychological development.

Hoffer and Mahon (2), using an extraction method of their own, have shown that certain compounds, separated on paper chromatograms, give a mauve colour. This colour comes on slowly over 30 minutes as a pink area which slowly turns mauve and then within a half to 1 hour has a typical mauve appearance. It then begins to fade and usually, within several hours, has gone. The presence of this mauve colour is taken as a positive indication of the presence of these substances, and Hoffer and Mahon state that the majority of schizophrenics have these unknown substances in their urine.

The avowed intention of a recent paper by Dann (1964) on psychological disturbance in students of psychology was to encourage others to collect and publish further data. It was suggested by that writer that “the general impression amongst doctors” was that students and ex-students of psychology suffer more from psychiatric disorders than do other members of the population. Taking a sample of students reading psychology at University College, Swansea and comparing it with students reading other subjects at the same College, Dann found a statistically significantly greater proportion of the former to exhibit psychiatric disorder, mostly of a neurotic or psychosomatic sort. The criterion of when a consultation became one for a psychiatric disorder was subjective and “was stretched fairly widely”, and there is no information about whether the consultant was or was not aware of what course the student was on before arriving at the diagnosis.

The aim of this paper is to report our experience with a new psychometric test, the Eysenck Personality Inventory, or E.P.I. (Eysenck and Eysenck, 1964).

The Symptom-Sign Inventory (SSI) consists of 80 questions presented orally. The administration and part of the scoring have already been described in some detail (Foulds, 1962); but, since then, a continuum has been suggested from neurosis through integrated psychosis to non-integrated psychosis. This continuum is considered to represent increasing degrees of failure to maintain or establish mutual personal relationships (Foulds, 1965). Measurement of this continuum, which has only been completed for women, involves three scales.

In 1963 there fell to be celebrated the 150th anniversary of a modest book giving an account of the new mild or “moral” treatment of the insane at the Asylum opened by the Quakers in 1796, Samuel Tuke's Description of The Retreat, an institution near York for insane persons of the Society of Friends. Containing an account of its origin and progress, the modes of treatment, and a statement of cases, York, 1813. Tuke achieved in England and America what Philippe Pinel did in France, and their names remain coupled in history as they were by contemporaries. “To those two great and good men, society is indebted for nearly all the improvements which followed their essays” said John Conolly, the third of the triumvirate who inaugurated the modern mental hospital era (1). In the course of preparing a reprint of Tuke's book recently we were privileged to have access to the privately printed Memoirs of Samuel Tuke, London, 1860, 26 copies “for the use of the family only”, edited in two volumes of together more than 1,000 pages. (A selection from these volumes emphasizing the religious aspects of Tuke's philanthropic works formed the basis of Charles Tylor's biography of Samuel Tuke (2), published for general circulation.)