In the present paper the author will try to elucidate the stability of nosological categories as revealed by a personal follow-up investigation of 301 previously hospitalized patients with paranoid psychoses. Since the terminology used will be the Scandinavian one, a short review of the diagnostic concepts will be given. The Scandinavian concept of schizophrenia is rather narrower than that employed in the rest of Europe, and especially narrower than that prevailing in the Anglo-American literature. Many American authors include in their concept of schizophrenia what may be called “the schizophrenic reaction types”. In the present paper, the concept of schizophrenia used by Langfeldt (1937, 1939), sometimes, referred to as “process schizophrenia” or “nuclear schizophrenia” is used. “Primary symptoms” occur in clear consciousness; these include disturbances of thinking, disintegration of emotions, autism, marked feeling of influence and passivity, massive depersonalization and derealization. As a rule the illness has an insidious development and a chronic course ending up with a greater or lesser degree of mental deterioration.

Surprisingly little has been written on the interview with the child as a diagnostic tool, in contrast to the voluminous literature on the therapeutic interview. Whereas standard texts on child psychiatry usually include a discussion of the physician-child relationship and of the use of play situation, it is rare for there to be any systematic account of the interview with the child as a diagnostic procedure.

The importance of diagnostic procedure in child psychiatry does not need emphasis. In most clinics dealing with the emotionally disturbed child a substantial proportion of children referred are not seen again after the initial appraisal (Rogers, 1939), and on the basis of information obtained at this single appearance decisions may need to be made about the nature and severity of the child's disorder and the suitability of the child for treatment. Certainly with children taken on for treatment, elements of the diagnostic process enter into the therapy situation, yet even here a programme affecting the child's life will often have been laid down after the first session.

Several recent investigations have focused on the relationship between parental ill health and childhood behaviour disorders.

Clinical observation as well as experimental results have indicated abnormalities in the responses to sensory stimulation in autistic children. Observers have noted occasional over-responsiveness in the absence of any obvious sensory defect, though more frequently under-responsiveness to visual or painful and particularly to sound stimulation is reported. Thus, Goldfarb (1961) observed the frequent absence of startle responses to sound in autistic children, and Anthony (1958a) and Rutter (1967) also noted a lack of reaction to auditory stimuli. Hermelin and O'Connor (1964) and O'Connor and Hermelin (1965) found marked under-responsiveness to sound, if compared with the response to light and touch, though they also reported impairment of visual discrimination.

Anxiety may be present to a greater or lesser degree in almost every psychiatric syndrome. The ability to quantify the degree of anxiety present in an individual patient has important implications for diagnosis, treatment and prognosis. Accurate clinical assessment of anxiety is by no means an easy task, although many psychiatrists believe it to be. If no other methods are used, there is no way of knowing how often an individual clinician is right or wrong. However, if several independent methods of assessing anxiety are used, more data are available, and a better overall judgment on an individual patient can be made.

There have been many reports which suggest that there may be abnormal glucose metabolism in severe depression. Glycosuria was first reported nearly 60 years ago (Allers, 1914). In 1919, using an oral glucose tolerance test, Kooy observed decreased tolerance in a heterogeneous group of mentally ill patients which included melancholics. Since then many investigators have reported decreased glucose tolerance in depressive illness, and the extensive literature is reviewed by McFarland and Goldstein (1939) and Altschule (1953). Oral glucose tolerance tests have usually shown high or delayed peaks and a slow return to fasting levels, although the latter are usually reported normal. Intravenous glucose tolerance tests have also shown results nearer those obtained in diabetic patients than in normal subjects. Pryce (1958) reported decreased glucose tolerance with intravenous tests in a sample of 20 depressed patients, and he also found that glucose tolerance did not alter significantly after clinical recovery. Glucose supplements were added to the diet of six patients prior to testing, but he concluded that these supplements did not appear to alter glucose tolerance.

Drugs that increase the concentration of catechol and indolic amines in brain may relieve depression, while those that lower their concentration may cause it.

Considerable evidence has accumulated that alterations in the direct current fields of the brain can produce alterations in function (O'Leary and Goldring, 1964). In view of this a group of investigators instituted a clinical trial of the possible usefulness of transcranial polarization (Lippold and Redfearn, 1964; Redfearn et al., 1964; Costain et al., 1964). In the approach used a current was passed between electrodes attached just superior to the eyebrows and an electrode on the leg. The principal changes reported consisted of an elevation of mood and an increase in involvement with the environment when the head was positive relatively to the leg and a withdrawal and quietness when the head was negative relatively to the leg. The current level reported as effective was generally of the order of 250 microamperes. Among Lippold and Redfearn's subjects were seven schizophrenics, in six of whom brief D.C. polarization produced the expected effects. Among the subjects of Redfearn et al. were four schizophrenics, in all of whom some favourable effect from D.C. head positive polarization was reported. This study was uncontrolled. In a blind controlled trial, Costain et al. found head-positive polarization to be of therapeutic efficacy in a group of 24 depressed patients. Their interpretation of results was challenged by Dawson and Montagu (1965). In view of these reports, we decided that a pilot study of the possible efficacy of transcranial polarization in altering the non-responsive state of chronic schizophrenic patients was warranted. It was decided that a more longitudinal study would be of greater value in determining possible therapeutic usefulness than a shorter trial on a larger number of patients. The experiment was conducted on one of the research wards of Rockland State Hospital.

The psychogalvanic reflex (P.G.R.) is a decrease in the electrical resistance of the skin which occurs in response to a wide variety of stimuli.