This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.

Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.

Numerous recent electroencephalographic studies have revealed the cyclical alternation of two distinct types of sleep (Dement and Kleitman, 1957a), which have been termed “fore-brain” and “hind-brain” sleep by Jouvet (1962). The former is accompanied by slow waves and spindles in the electroencephalogram (EEG) and the latter by a low-voltage, fairly fast EEG pattern; spasmodic, conjugate rapid eye movements (REMs); relaxation of neck and throat muscles in cat (Jouvet, 1962) and human (Berger, 1961); and recall of dreams following awakening (Dement and Kleitman, 1957b).

Depressive illness is protean in its manifestations. The symptoms may be primarily psychological, such as misery, indecisiveness, irritability, inability to concentrate, or insomnia. They may be mainly physical, and the patient may present with one or more of a bewildering number of somatic complaints, often blaming those for his change in mood (Watts, 1957). Pain is a common and diagnostically puzzling presenting symptom of depression and other psychiatric disorders (Walters, 1961). It may take the form of generalized or poorly localized aches and pains, often associated with a feeling of tension, or it may be sharply delimited (Critchley, 1935). This form of localized pain may so dominate the symptomatology that the patient is referred by his general practitioner to a variety of specialists, who may perform a series of special investigations or even exploratory operations. Clearly, every effort must be made to exclude organic disease, even if positive signs of psychiatric illness are recognized, as an organic disease can obviously co-exist with a psychiatric one. In spite of thorough investigation, there will remain a proportion of patients in whom no lesion can be found to account for their symptoms.

In the investigation of prognostic factors relevant to remission in schizophrenia little attention has been paid to positive heredity for affective psychosis. One result of this relative disinterest has been to foster the opinion that heredity is of no prognostic value. Although his own work (8) supports the assumption that manic-depressive heredity is of good prognostic import in schizophrenia, Langfeldt (8) cautions:

Cross, Harrington and Mayer-Gross (1957), in a survey of the long-stay population of a Birmingham mental hospital, came to the conclusion that “only very small proportions required constant vigilance and about two-thirds required routine care only…. The large majority of patients were ambulant the whole day” but almost one-third had physical diseases of some kind. The major problem was the “large number of passive, indolent and harmless chronic schizophrenics”. The authors specifically made the point that, “to avoid chronicity and utilize every sign of improved behaviour and better adaptation which may lead to discharge, well-trained nursing staff and specialized knowledge is as much needed as in the treatment of earlier patients”.

In the Children's Department of the Maudsley Hospital an “Item Sheet” is routinely completed in respect of each child who attends. The items on this sheet (or “check-list”) cover a wide range of possible features in a child's personality, history, background and environment, as well as in his psychological and physical condition, and symptomatology.

A number of samples of these Item Sheets have been submitted to statistical analysis, with a view to identifying any common factors that may be present in the case data they summarize. The various samples have been arrived at according to age and sex of the children concerned. An earlier paper (1) has described the results of this procedure in respect of two such samples, boys and girls between eight and ten years of age. A subsequent paper will give an account of the results in respect of thirteen to fifteen year olds. The present report gives the results that emerged for the younger ages of referral to the clinic, boys and girls between approximately five and seven years of age.

Kuwait, the country with the world's highest per capita income,∗ has a population of roughly 325,000, of whom only half are ethnically Kuwaiti. The original settlers left the Nejd in Central Arabia about 1710 because of a severe drought, and after wandering about for several years with their herds and flocks eventually settled at the head of the Persian Gulf. The country they founded, about the size of Northern Ireland or of the State of New Jersey, is wedged in between Iraq and Saudi Arabia. Next to the Kuwaiti, the second largest group of inhabitants is the Bedouins who “are recognizable by their particular Arabic accent, their characteristic smell, and their long hair and beard”, according to a resident of Kuwait City. The Bedouin women can also be recognized easily because the black “thaub” which covers them completely from head to foot is made of solid cloth with narrow slits for the eyes, whereas the “thaub” of the Kuwaiti women has a black veil built into it.

This paper is a continuation of a previous study (Monro, 1962), on the Self-Referent Attitudes of Neurotic and Inadequate Personalities. It deals with the social attitudes of the same population of 150 patients. The techniques used derive from Professor Drever (1949) of the Department of Psychology, University of Edinburgh, from Cattell (1946) and from Eysenck (1944, 1947). The orientation towards social factors is in accord with one of the main traditions of psychology, exemplified by Adler (1927), H. S. Sullivan (1953), and Murphy (1947), to mention only a few outstanding exponents.

This abstract reports a factual study of 48 neurotics aged 20 to 59 years. All were mental hospital patients, whose attitude to admission and life difficulties were explored by means of a questionnaire. Assuming that illness and personality are independent variables (Foulds, G. A., 1955, 1958, 1959) and that they can be related meaningfully to the attitudes studied the relationships of these attitudes to personality, illness, sex and social class were investigated.

Since Faris and Dunham (1939) found that the mental hospital admission rate for schizophrenia was higher in the central slum districts of Chicago than in the rest of the city, many studies have been carried out on the association between low social status and hospital admission with a diagnosis of schizophrenia. With few exceptions (for example, Clausen and Kohn, 1959; Jaco, 1954) these studies have confirmed that those in the lowest social group (in this country class V in the Registrar-General's scheme) have the highest admission rates. Some of these investigations have been “ecological” or “indirect”; i.e., admission rates have been calculated for areas of a city defined, for example, as slum, working, or middle class areas, and the rates for these areas compared; other studies have been “individual” or “direct”, where admission rates have been calculated for aggregates of individuals, defined as belonging to particular social classes, and the rates for the classes compared. An ecological study, like that of Faris and Dunham, may show that rates are higher in poor districts, but it does not necessarily follow that the patients admitted are themselves poor. Individual studies, however, do show that men in unskilled jobs have the highest admission rates.

The action of almost all drugs used so far in psychiatric pharmacotherapy has been directed against psychopathological symptoms or syndromes and not against mental diseases as such, the nosological entities defined by classical clinical psychiatry. In this paper the attention will be drawn towards a different type of drug: compounds with an action specific to a disease rather than to a symptom, and evidence will be presented for the existence within this class of a group that is characterized by being active against affective disorders (manic-depressive psychosis). Normothymotics, “mood-normalizers”, is proposed as a collective name for drugs belonging to this group.

Since the original observations in Australia by Cade (1949) and Noack and Trautner (1951) on the use of lithium salts in psychiatric practice there has been a modest but steady stream of publications on the subject. The most persistent investigator has been Schou in Denmark (1954, 1955, 1956, 1959), who, with his colleagues, has been able to present a series of manic patients, observed over a sufficient period of time and subjected to controlled conditions, in which the clinical value of the drug has been convincingly demonstrated. Other important series have been reported by Teulié et al. (1955), Rice (1956), Adreani et al. (1958), Kingstone (1960), and Gershon and Yuwiller (1960).

In recent years the development of effective anti-depressant drugs has led to much controversy and uncertainty regarding the treatment of depressive states. Indications for the primary use of E.C.T. remain obscure, whilst choice of drug seems to be determined by current personal preference rather than by any specific rationale. If reliable prognostic formulations—and so, rational lines of treatment—are to be developed, there is an urgent need for the accumulation of data from controlled trials rather than a continuing spate of “1”.

Amitriptyline, a new anti-depressant chemically resembling both imipramine and chlorpromazine has, in a blind controlled study carried out by the authors, been shown to be significantly superior to imipramine in the treatment of female patients between 30 and 70 years of age, hospitalized with primary depressive states (Burt, Gordon, Holt and Hordern, 1962). The findings in the first 74 patients were unexpectedly so much in favour of amitriptyline that to confirm them the trial was extended to include a further 65 patients conforming to the same criteria; but as two died, the total sample consisted of 137 female patients. The size of this sample facilitated (1) an investigation of the phenomenology of depressive states in women and (2) a study of the significance of a number of prognostic variables in relation to the outcome of treatment with amitriptyline and imipramine.

Amitriptyline, 5-(3 dimethylaminopropylidine)-dibenzo (a,d) (1,4) cycloheptadicne hydrochloride, though chemically and pharmacologically related to imipramine (Barsa and Saunders, 1961) has a tranquillizing effect which is absent with imipramine (Pressman and Weiss, 1961; Bennett, 1961); it acts simultaneously as an antidepressant through its influence on the “anxiety factor” (Freed, 1960; Dorfman, 1960). In contrast to imipramine and the monoamine oxidase inhibitors, amitriptyline has very little influence on the circulatory system and blood pressure (Jensen, 1961) and less proneness to exacerbate the symptoms of schizophrenia (Barsa and Saunders, 1961). Dunlop (1961) noticed a reduction in other symptoms, such as gastrointestinal distress, hyperventilation and vasomotor dysfunction for which amitriptyline was not primarily administered. This he attributed to an anticholinergic side-effect on the central nervous system.