The ageing of many populations in recent years has directed increasing attention to the social, medical and biological problems of senescence. The psychological changes associated with ageing occupy a central position in inquiries in this field. The expectation of mental disorder shows a steep increase with advancing chronological age, and beyond 75 years a large part of this increase is accounted for by disorders associated with degenerative changes in the central nervous system for which we lack remedies at the present time. Larsson et al. (1963) have estimated that the aggregate morbidity risk for these disorders up to the age of 70 is 0·4 per cent., up to age 75, 1·2 per cent. and up to age 80, 5 per cent. For higher ages estimates were probably less reliable, but the calculated risk up to the age of 90 was 5·2 per cent. In a survey of a random sample of elderly people aged 65 and over in the general population, Kay et al. (1964), found a total of 4·2 per cent. of elderly subjects to be suffering from senile dementia, 2·9 per cent. being mild cases. The condition is generally recognized as being a major cause of serious infirmity among the elderly in psychiatric, geriatric, general medical and community practice alike.

Antisocial psychopaths are a community problem, not only to themselves but to their family doctors, social workers, and others who become involved in their affairs and their treatment. This article compares two attempts to provide an area service for males with psychopathic traits, the first in England and the second in Wales.

Current views on aggressive behaviour (Buss, 1961; Berkowitz, 1962) propose a direct relationship between the frequency and intensity of aggression, both of which are in turn considered to be related to extraverted personality patterns (Buss, 1961; Bendig, 1961). The frequency and intensity of aggressive responses, it is maintained, are both indications of the habit strength of the aggressive response. Such conclusions are derived from laboratory studies in which, for obvious reasons, intensity of response will not reach extreme proportions. However, studies of those who have indulged in extremely aggressive behaviour are not in accord with this view. Megargee and Mendelsohn (1962), for example, found that extremely assaultive criminals scored lower than nonviolent criminals and normals on personality scales related to hostility and lack of control, and more recently Megargee (1966) has reviewed the literature on this subject, which suggests that a large proportion of those who have committed crimes of extreme violence have no previous history of assaultive behaviour and are well controlled in their behaviour generally.

Rampton is a Special Hospital catering mainly for subnormal and psychopathic patients with histories of dangerous and violent behaviour. Earlier work (McKerracher, Street, Segal, 1966) had shown that female patients were significantly more prone than males to mutilate their own bodies and smash hospital property. Such acts are usually regarded in this hospital as hysterical outbursts in which there is often an insensitivity to pain. Gross lacerations are often inflicted without the patient appearing to experience any suffering. Some kind of hysterical anaesthesia may be involved. It is known that this kind of behaviour is found in long-term patients suffering from (a) schizophrenia and (b) severe character disorder (Offer and Barglow, 1960).

Clopenthixol is a thiaxanthen derivative (Fig. 1). Its full name chemically is 2-chlor-9-[3-(N-B-hydroxyathylpiperazino)-propyliden]-thioxanthen. Numerous uncontrolled trials to date (2, 3, 4, 5, 6, 7) have reported success with this drug in the treatment of schizophrenia, mania and other psychotic disorders.

The need for a long-acting phenothiazine has been long recognized, especially since it has been shown (Parkes et al., 1962; Renton et al., 1963; Kline, 1964; Willcox et al., 1965; Wilson and Enoch, 1967) that a high proportion of schizophrenic patients do not take their prescribed medicines.

In this journal, Hardwick, Pearse and Petrow (1957) advanced the view that slightly lowered steroidal production may predispose individuals to abnormal mental states, thus suggesting the possibility of treating such disorders with some form of replacement therapy. They screened a number of steroidal compounds for such use and concluded that the most promising was 6β hydroxy:3: 5 cyclopregnan 20-one (“neurosterone”). In their small-scale preliminary study this agent appeared to be of value in the treatment of a variety of psychiatric patients, including those with symptoms of anxiety, depression, and obsessive behaviour.

Since Janssen's (1959) introduction of haloperidol, numerous clinical trials have been published showing its usefulness in the treatment of mania and hypomanic states. Davies (1962) found it an effective drug in the treatment of adult patients showing aggressive behaviour resulting from various causes, and in the management of mania. Gerle (1963), in his review, showed the effectiveness of this drug in the control of disturbed behaviour in mentally sub-normal patients. He also showed (1962) that patients taking this drug are remarkably free from toxic reactions such as jaundice, agranulocytosis and allergic dermatitis. Haloperidol has been used in our unit (Rogers, 1955, 1965a) over the past three years. The impression has been gained that it controls aggressive, overactive and destructive behaviour in severely disturbed children, without impairing their ability to participate normally in the therapeutic activities of the unit (Rogers, 1965b).

A number of observations have appeared in the literature indicating that haloperidol may be of value in the treatment of children with certain types of behaviour disorder (Haberlandt, 1963; Rogers, 1965). There has, however, been a dearth of controlled observations to support these impressions, though there is evidence that the drug is of value in the tics of Gilles de la Tourette's disease (Connell et al., 1967). The present paper reports a controlled pilot study of haloperidol in overactive and aggressive children.

Metronidazole (Flagyl) is an established and effective treatment of urogenital trichomoniasis. J. A. T. Taylor (1964) was using metronidazole to treat a husband and wife for this condition, when she observed the following. The husband, who was a chronic alcoholic, seemed to lose his craving for alcoholic drinks. Sometimes he experienced flushing of the face and shoulders and epigastric discomfort when he took metronidazole soon after alcohol, i.e. he experienced a disulfiram type reaction. The wife reported that alcohol drinks tasted unpleasant to her during therapy. Taylor then studied 53 alcoholic patients and concluded that metronidazole (i) decreased tolerance for alcohol, (ii) diminished craving for alcohol and (iii) produced an uncomfortable reaction to alcohol.

The purpose of this drug trial was to compare various methods of assessing changes in anxiety and to determine which would discriminate most effectively between the effects of treatment.

The study of a single case, though less conclusive, sometimes heralds methodological advance. Hopefully, other investigators will be able to replicate the findings on a large number of subjects. This report, based on the case history of Bob R., describes in detail how the Organic Integrity Test (OIT) may be used as a daily therapeutic index in the treatment of schizophrenia.

The national cost of prescriptions for drugs for use in medical practice in the United Kingdome has risen progressively from £35,000,000 in 1949 to well over £100,000,000 a year now (Dunlop, 1965). The number of drugs taken by patients is vast, and the variety of drugs available for prescription is considerable. Prescribed in order to produce a specific therapeutic effect, few drugs, if any, are wholly free from the potential of producing undesirable side-effects. These vary from the trivial to the lethal, from the transient to the permanent. Methods for their accurate detection, qualitative evaluation and risk identification are vital prerequisites to therapeutic safety and refinement. Experimental techniques, using detailed observation on large samples of patients being treated by drugs, have been developed recently. A monitoring system which scans for side-effects of drugs represents a means whereby prospective and cumulative data on the frequency of occurrence and nature of these side-effects can accrue. This is referred to as drug monitoring.

Over the years 1959 to 1962 a study was made of a series of 72 male neurotic patients referred to general hospital and private psychiatric practice in Leeds, the results of which were submitted for an M.D. Thesis (Little, 1966). It emerged clearly that the neurotic group was divisible into two major sub-groups differing significantly in a wide range of personality and other premorbid variables. Various objective tests and measurements were used; in the present context we wish to concentrate attention on five: (1 and 2) The N and E Scales of Eysenck's Maudsley Personality Inventory, (3) Tanner's Discriminant Androgyny Scale, (4) Parnell's Ponderal Index, and (5) The Rees-Eysenck Body Index.