“What's the use of their having names” the Gnat said, “if they won't answer to them?” “No use to them“, said Alice, “but it's useful to the people that name them, I suppose. If not, why do things have names at all?”

There seems little doubt from available statistics that the Republic of Ireland has the highest rate of hospitalized psychiatric morbidity in the world. There are no complete international figures available for this statistic but the World Health Organization published for the first time in 1961 returns for numbers of patients treated in hospital in 119 different countries (W.H.O. 1961). In many cases the returns were incomplete or unsatisfactory in one or more particulars. The ideal was to establish for each country the total number of patients treated during each one of the five years 1955–1959. The number treated was defined as “the patients present at the beginning of the year in the various public and private institutions specializing in psychiatry and in other institutions (general hospitals, etc.) plus admissions and readmissions during the year”. Unfortunately this ideal was achieved for only a minority of the 119 countries. The difficulties encountered in compiling the figures are set out in the publication itself.

An earlier commentary on the level and regional variation of Irish hospitalized psychiatric illness was limited by the absence of age-specific and standardized data (Walsh and Walsh, 1968). The present paper presents age- and sex-standardized rates by county for 1959, and then suggests some socioeconomic influences in [partial explanation of the variation in these rates. Psychiatric services in Ireland are provided on a county basis: in eleven instances one hospital serves a single county, in six cases there is one hospital to two counties and the remaining hospital serves three counties.

This is the first report of a six month survey of treated psychiatric illness in Lebanon, carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside of these institutions.

This is an interim summary pending a full account of four years' work in the villages of nine representative tribes of Ghana.

Prevalence studies of mental subnormality among regional populations are few. Detailed epidemiological enquiries have been carried out in the regions of Northern Ireland (Scally and MacKay, 1964), Wessex (Kushlick, 1965) and, for severe mental subnormality in children, in Middlesex and London (Goodman and Tizard, 1962). The North-East Region of Scotland is especially suitable for epidemiological studies in psychiatric morbidity by reason of its geography, demography and centralization of psychiatric services (Innes and Sharp, 1962; Baldwin and Millar, 1964). A Regional Psychiatric Case Register giving rapid access to social and clinical information on all patients is fully operational (Baldwin et al., 1965). Using this facility as a primary source of data, a prevalence study of mental subnormality among the half million population of the North-East of Scotland was carried out. The objects of the study were three-fold: first and primarily, to establish case rates for known subnormality, examine patterns of morbidity and the factors that influence this and to compare these with the findings of similar epidemiological studies; second, to gain operational data relevant to existing practice, needs and planning of services; third, to provide a data bank within the Regional Psychiatric Case Register for mounting detailed clinical, genetical, social or biochemical studies on an area population of subnormal patients.

Contextual constraint is a measure of the degree to which any one word in a passage is determined by the words which precede it, and can be expressed in terms of dependent probabilities. A recall task devised to investigate this topic was designed by Miller and Selfridge (1950) for an investigation on the statistical structure of words in context. Contextual constraint is at its highest in a passage of English text and at its lowest in a passage of unrelated words selected at random. The Miller and Selfridge task requires the subject to listen to seven passages of words in turn and at the end of each passage to write down the words he can remember. The seven passages are arranged in order of increasing contextual constraint from random words to a piece of text.

Foulds (1965) proposed that the classes of psychiatric illness can be described in terms of a continuum of increasing degrees of failure to maintain or establish mutual personal relationships. This concept of all psychiatric illness as an “illness of the person” centres on processes which occur in the mentally ill that interfere with the satisfactory establishment and relative endurance of adequate personal relationships. Foulds conceptualizes these interfering processes as barriers to achieving “personhood”: they may present as signs or symptoms of psychiatric illness or as abnormal degrees of personality traits. Thus, for example, cognitive disorder would make the schizophrenic unable to cope with the demands of interpersonal situations. Similarly, egocentricity would render the psychopath incapable of empathy and with a tendency to treat “others as objects or as organisms than as persons”. In both examples social alienation is inferred, manifested in the first case as withdrawal and in the second case as rejection. It is Foulds' thesis that this incapacity for mutual relations increases along a continuum from normality, through the personality disorders, neurosis, integrated psychosis (melancholics, manics and paranoids) to non-integrated psychosis (the schizophrenics).

There is a growing body of evidence which points to a high prevalence of psychiatric disorder in students and to the contribution of such disturbance to wastage and under-achievement. The relationship between psychiatric illness and academic difficulty is, however, a complex one, for severely ill individuals may be capable of high achievement while apparently mildly disturbed students may fail academically through the operation of emotional factors. The ability to predict or detect at an early stage the psychiatrically or academically vulnerable student would clearly be of great value.

The validation of personality questionnaires presents the psychologist with knotty problems. His reaction all too often is to plead that, as it is difficult to find criteria for validating measures of personality, he is justified in relying on face validity alone. Fortunately, this has not been true of the Maudsley Personality Inventory (MPI), nor even of its more recent successor, the Eysenck Personality Inventory (EPI). Serious attempts have been made to validate these questionnaires, and the problem has been tackled from a number of different angles. S. B. G. Eysenck (1962) and Eysenck and Eysenck (1963) found that subjects nominated by judges as extraverted, introverted, stable and neurotic scored significantly differently on scales measuring these dimensions. A further study (Eysenck and Eysenck, 1964), in which larger numbers of both judges and subjects were used, confirmed these findings. Vingoe (1966) found that subjects who rated themselves extraverted on a seven-point scale of extraversion–introversion differed significantly on the extraversion scale of the EPI from those who rated themselves introverted.

Epimenides, a Cretan poet of the 6th century b.c., withdrew into a cave where he fell asleep; he awoke 57 years later (7). This anecdote is probably the first recorded case of hypersomnia. Sleeping Beauty, Rip Van Winkle and other personalities of folklore and literature followed. Clinically valid contributions, however, first appeared around the turn of this century.

Attention was first drawn to this syndrome by Kleine (1925), who described five patients with periodic somnolence, two of whom also had an excessive appetite. Levin (1929) described a youth aged 19 who had suffered from nine attacks of sleepiness and pathological hunger from the age of 16. The attacks lasted from one to six weeks and recurred at intervals of up to twenty-eight weeks, but he eventually recovered spontaneously.

The effects of ethyl alcohol in man may be classified into two main groups. The first, consisting of all those symptoms and signs that can be directly attributed to the action of alcohol itself, includes all the features of acute alcohol intoxication. The second group, with which this study is concerned, consists of a wide variety of conditions which do not appear to result directly from the action of alcohol and which may be regarded as secondary complications. They occur only when excess alcohol intake has occurred over a prolonged period.

Huntington's Chorea is a hereditary neurological disease which occurs in adulthood and manifests itself in involuntary bodily movements and progressive physical and mental deterioration. It is irreversible and responds to no therapy. Its course is about fifteen years in duration, death usually resulting from an intercurrent illness. Not only does it entail a catastrophic health problem for the person affected, but it also creates major emotional-social-financial problems for his family, and challenges the medical-social resources of the entire community.

Pregnancy and the post-partum period are generally regarded as maturational crises equal in importance to those of adolescence and the menopause. Stresses undergone during this period include (a) endocrine changes, (b) activation of unconscious psychological conflicts pertaining to pregnancy and (c) the intrapsychic reorganization of becoming a mother. In light of this, it seems likely that clinically significant interactions of psychosocial and endocrine factors will be found in the aetiology of these disorders. The first month post-partum shows the greatest incidence of overt mental illness (7, 9), and this has led many to relate this disturbance to the termination of placental function and the metabolic and/or endocrine changes accompanying this.

Considerable inconsistency exists in the literature concerning the clinical features of depression associated with a good response to anti-depressant medication. Abraham et al. (1963) summarized the literature to that date; the general consensus of opinion was that imipramine had its best effect in depressions of the endogenous rather than those of the neurotic type, but their study on depressed out-patients did not support this conclusion. Browne et al. (1963), working with in-patients, reported that reactive depressives showed a better response to amitriptyline than did endogenous depressives. Burt et al. (1962), in their report of the response of 73 depressed female in-patients treated with imipramine or amitriptyline, demonstrated a much better response to both drugs by reactive as compared with endogenous depressives. Spear et al. (1964) found no significant difference in respect to “endogenicity”, in the response of depressed in- and out-patients to tranylcypromine and imipramine. Richmond and Roberts (1964) reported that out-patients suffering from endogenous depression responded much better to a variety of anti-depressant drugs than did those suffering from reactive depression.

Since its inception in 1961 the policy of the psychogeriatric unit at Severalls has been to maintain elderly patients in their own homes for as long as possible. There are a number of reasons for this attitude. Many old people are afraid of hospitals. Some with memory defects not significant in the home become confused and distressed in unfamiliar surroundings. Admission to hospital may permanently dislocate the habits of a lifetime and break the delicate threads of informal support by neighbours, friends and others who call regularly. Once admitted, re-establishment in the community may be difficult or impossible.

In psychiatry, lithium has been used mainly in the treatment of manic states and other forms of affective psychoses (Cade, 1949; Schou, 1956; Maggs, 1963; Baastrup, 1964). Strömgren (1965) puts forward the view that the usefulness of lithium is very questionable in the treatment of other psychiatric disturbances than affective disorders. Even earlier, Teulie et al. (1955) had found lithium to have a relatively weak therapeutic effect in schizophrenic, hallucinatory and epileptic psychoses. The Russian investigators, Mosketi et al. (1963), treated different kinds of psychotic disturbances by administering lithium iodide (0·5–1·0 g/die) intravenously. They found the effect of the drug to be highly favourable within 7 to 15 days, in some cases in 30 to 60 minutes. They obtained the best results in cases of paranoid-hallucinatory, confusional and depressive-paranoid psychoses. Compared with earlier observations, these results indicate a surprisingly favourable effect of lithium in non-affective psychoses.

This report describes a clinical trial in which pericyazine and chlorpromazine were used with 45 disturbed patients resident in a hospital for the mentally subnormal. The patients, who comprised a clinically heterogeneous sample, were randomly allocated by the hospital pharmacist to two major groups; in one, half the patients were given pericyazine for a 12-week period and an inert preparation for a further 12-week period while the remaining patients had the inert preparation during the first period and pericyazine during the second. In the other group, which was given chlorpromazine, the same procedure was followed. Prior to the trial proper, there was a six-week period during which all drugs except anti-convulsants were tapered off. All preparations were in syrup form and were indistinguishable from each other by taste or smell. Only the pharmacist was aware of what syrup a given patient received.

The practice of making routine serological tests for syphilis on all admissions is carried on in many mental hospitals, but no assessment of the advantage of this procedure at the present time seems to have been reported. Rosahn (1958), viewing the matter from the laboratories of a general hospital, concluded that syphilis was still a sufficiently important disease to justify routine screening tests. Bell (1959) studied the admissions in a 12-month period to a large Canadian general hospital He pointed out that some previous figures (Editorial, J. Amer. med. Ass., 1957), based on total numbers of positive reactors, did not give a realistic measure of the value of the testing procedure, and he attempted to determine the proportion of admission screening tests which were of practical significance, in that the clinicians concerned were led to initiate treatment as a result of them. He found a “useful discovery rate” (discounting two patients who he thought might well have had elective serology performed in any case) of 0·03 per cent.