An editorial in the British Medical Journal in 1962 drew attention to the fact that research workers have taken relatively little interest in the psychoses of the elderly. The editorial commented on the important paper by Kay and Roth (1961), which analysed the condition known as “late paraphrenia”. Since the publication of this editorial, no significant contribution has been added to the analysis of this illness.

It is generally accepted that the obsessional personality (obsessoid, anal-erotic character) is the premorbid personality most frequently associated with obsessional neurosis. Freud (1908) described the triad of traits of orderliness, parsimoniousness and obstinacy which characterizes this personality. He considered that these traits were due to reaction formation against and sublimation of anal-erotic activities and aggressive impulses into socially acceptable forms of behaviour. According to this view the anal-erotic character and obsessional neurosis share a common developmental basis—the neurosis represents a failure of repression, the regression to the anal-sadistic level of libidinal organization and the use of defences against excessive hostility.

This paper presents a replication of a study by Kiloh and Garside (1963). These workers carried out a factor analysis of 35 clinical features of 143 depressed patients. They demonstrated the presence of a factor which showed strong positive loadings with the clinical features classically accepted as characterizing neurotic depression and strong negative loadings with the clinical features characterizing endogenous depression. Of the 143 patients, 92 were diagnosed as more definitely suffering from endogenous or neurotic depression. Correlation coefficients were calculated between the diagnosis in these 92 cases and each clinical feature.

A revival of interest in psychiatric classification has led to the use of statistical techniques such as factor analysis to help describe the depressive population. Several recent factor analytic studies rating symptoms in depressed patients have had results which portray a common clinical pattern (Hamilton and White, 1959; Kiloh and Garside, 1963; Rosenthal and Klerman, 1966b; Rosenthal and Gudeman, 1967). In each of these studies the first or primary factor has suggested the endogenous depressive pattern. In the most recent of these papers we presented the first factor in our study of 100 depressed women (Rosenthal and Gudeman, 1967). This factor was shown to be similar to the principal factors of the other studies, and to suggest the “endogenous” or “autonomous” pattern. This replication has been an encouraging indication that studies carried out in different patient populations may indeed give reproducible symptom patterns.

A previous study of the incidence of subjective ideas of sexual change in male schizophrenics has briefly noted the lack of precise quantified data in the literature and the standard English language teaching texts (Gittleson and Levine, 1966). There are no controlled studies of these ideas in female schizophrenics. The studies of Klaf and Davis (1960), Planansky and Johnston (1962) and Lukianowicz (1963) refer only to males.

In a recent survey of males detained in a State hospital for dangerous, violent and criminal psychiatric patients, seven subjects with an XYY sex-chromosome constitution were discovered (Jacobs et al., 1965). Further investigation (Price et al., 1966) yielded two more patients with this abnormality. Psychological testing of these same patients was undertaken in order to detect cognitive or clinical features which distinguish them from other men in the same hospital.

It is generally agreed that psychiatric illnesses can fairly reliably be categorized into four broad groups—organic psychoses, functional psychoses, neuroses and personality disorders. Cases are assigned with greatest confidence to the first group and with least confidence to the fourth. The reliability of specific diagnoses within these classes is much less secure and decreases in the same order. The best recent reviews of the literature are by Kreitman (1961) and Foulds (1965).

A number of studies have shown with psychological testing that the form a particular response takes will depend on the personal relevance to the subject of the stimulus, and that the more personally relevant the stimulus the less the effects of other response determinants. For example, Dahlstrom (1962) has listed six “contextual” and five “mediating” variables which he feels account for responses to such test items as those composing the M.M.P.I. These variables include the experimental setting, the examiner and the specific test items (contextual variables), and the veridical facts, personality styles, test instructions (mediating variables). Similar arguments have been advanced with regard to projective testing by Hutt (1951, 1954) and Wertheimer (1957), among others. Caine (1967) has shown that response suppression operates in a sentence building test only when the test material is of limited personal significance to the subject, and that the consistency of response between different testing levels along the overt/covert dimension pertains only when the stimulus material is of psycho-pathological significance. With the T.A.T., Smail (1966) has argued that if meaningful results are to be obtained responses must be interpreted in the light of the patient's particular situation much more than is the general practice, and that responses which are clinically typical of a given diagnostic group may only appear where the stimulus card accurately reflects the situation in which the patient finds himself.

Recent years have seen increase of interest in problems relating to the health of the aged. One of the major difficulties has been the practical problem of assessment, whether it be of physical, social or mental health. It is essential that any measures employed are appropriate to the aged population, should be easy and brief to administer, as well as being reliable and valid. Some advances have been made in tests of cognitive functioning developed or derived for use with the aged (Dixon, 1965; Britton and Savage, 1966). As yet, however, no simple psychometric test has been proposed for aiding the psychologist, psychiatrist, general practitioner, social scientist or those concerned with the care of the community aged in the early recognition of possible psychiatric abnormality. This report aims to remedy this omission to a certain extent. We have derived from an extensively used psychometric measure, the Minnesota Multiphasic Personality Inventory (MMPI, Hathaway and McKinley, 1951), a short scale of fifteen questions which has been shown to be a valid, easily usable measure of mental illness in the aged.

The Symptom Rating Test (S.R.T.) was designed to assess changes in symptoms in non-psychotic patients. Previous studies suggest that the test is a measure of recently experienced neurotic distress. Scores were found to change markedly with changes in the clinical state of patients during treatment, and in anxious neurotics the scores were found to be correlated with psychiatrists' rating of anxiety.

Recent investigations of cognitive disorder in schizophrenia (Payne and Hewlett, 1960; Payne, Caird and Laverty, 1964) have indicated that schizophrenic performance in cognitive tests is characterized by a tendency to use very loose, “overinclusive” concepts. This phenomenon which Cameron (1944) termed “overinclusive thinking”, has been re-interpreted by Payne (1961) in terms of an impairment of a hypothetical filter mechanism which normally excludes irrelevant stimuli from consciousness and so allows attention to be directed towards the task in hand. McGhie and Chapman (1961) and Chapman (1966) have presented clinical evidence based on the subjective reports of schizophrenic patients supporting the hypothesis that a primary disorder in this disease is an impairment in the selective and inhibitory functions of attention. Chapman and McGhie (1962) and McGhie, Chapman and Lawson (1965a and b) have substantiated and elaborated this clinically derived hypothesis in an experimental setting where the subjects were required to perform various psychomotor and short-term memory tasks with and without distracting stimuli. The results of these investigations, while supporting the hypothesis in a general way, were nevertheless equivocal. The distraction effect in schizophrenia appeared to be confined to those situations where adequate performance involved the processing of a substantial amount of information. This finding was explained in terms of Broadbent's (1958) theory of the human operator as a limited capacity information channel. It appeared that distraction affected the performance of schizophrenic patients only in situations where the limited information channel was fully occupied in handling relevant aspects of the task—for example, in tracking and short term memory tests. Under these conditions the assimilation of irrelevant information produces overloading of the information channel and a consequent breakdown of performance. On the other hand, in those tasks requiring little information processing—for example, in repetitive psychomotor tasks—the channel is operating well below capacity, the assimilation of irrelevant information does not lead to overloading, and consequently does not have any detrimental effect on performance. An analogue of this situation occurs in normal subjects, in whom division of attention between two sources does not necessarily lead to impairment of performance if the informational requirements of each source are small and total information load does not exceed the critical limit (Broadbent and Herron, 1962). For the schizophrenic patient attention tends to be divided between the relevant and the irrelevant, yet impairment in performance need not occur if the informational requirements of the task are kept small.

Consistent decrements in schizophrenic performance on a reaction time (RT) task obtained by a number of investigators indicate that RT procedures yield reliable indices of schizophrenic deficits in attention (1, 2, 10), motivation (3), preparatory set (8), and psychomotor function (4). In previous studies (6, 7), the writer has presented evidence that these deficits may be attributable to impaired social motivation, in that these RT disturbances can be eliminated in most schizophrenics by activating biological motivation through shocks to the reacting finger. Older, more disorganized patients were unable to improve, however, even with shock motivation. Systematic comparisons of older and younger schizophrenic patients with and without ground privilege status, resulted in the finding that reduced social motivation, lessened reactivity to shock stimulation, and inability to cope with unpredictable anxiety cues constituted relatively independent dimensions of schizophrenic deficit in RT.

In previous papers (2, 3) we have set forth our neurophysiopathogenic theory of alcoholism, which is an amplification of Jellinek's hypothesis (1) that the gamma and delta types of alcoholism form an addictive disease. The physical dependence characterized by a state of distress and an overpowering desire to consume more ethanol, assumes three forms: (a) “inability to stop” the ingestion (Jellinek's “loss of control”) noted moments after ingesting a small quantity of ethanol following a period of abstinence, which characterizes the gamma or intermittent clinical form of alcoholism; (b) “inability to abstain” from ethanol hours after the last ingestion and after continuous drinking (each 4 to 8 hours during months or years), which characterizes the delta or inveterate clinical form of alcoholism, and (c) primary physical dependence without ethanol having necessarily been ingested previously, which characterizes remittent, or epsilon alcoholism or dipsomania.

It is usual to encounter, in any large mental hospital, a group of patients who are considered by the staff to be difficult. This opinion is slowly formed, but, once established and repeatedly expressed in nursing reports and medical records, it rarely alters and may have a powerful influence on the patient's career in hospital. A difficult patient may find himself deprived of privileges and moved to a “lower level” ward (9, 10, 11) and his demotion in this way can affect his relatives' attitudes towards him (17). On the other hand, patients informally classified by the staff as “good patients” may be granted certain advantages and, as Cohen put it, “if they behave okay, they move to a better billet” (5).

Twenty chronic patients, group 1, entered a hospital factory unit for one month and received varying increases of pay. They were compared with three control groups, each of ten patients. Thus group 2 received increases of pay similar to those of the group entering the factory, but remained outside the factory unit. Another, group 3, had already been in the unit for several months, and were discharged from the unit into other hospital employment for one month without change of pay. Another, group 4, remained in the factory throughout with no change of pay. Forty per cent. of each group was female. The control groups were matched with group 1 for age, duration of stay and group test results. Ranges and averages were: age, gp. 1, 36–66, 52·1, gp. 2, 34–65, 50·1, gp. 3, 38–68, 50·5, gp. 4, 21–63, 46·1; duration of stay, gp. 1, 1–35, 17·6, gp. 2, 3–27, 14·0, gp. 3, 2–32, 12·6, gp. 4, 2–27, 13·9 years. The distribution of patients between hospital wards was the same in each group. Eighty per cent. of each group had a diagnosis of chronic schizophrenia. Eight patients from group 1 and four from each of the control groups took part in an additional group discussion with one of the experimenters during the month trial period. A list of different topics were worked through, e.g. driving, smoking, taking risks, etc., and photographs from the 1963 Year Book and coloured advertisements were used, preferences and associations being asked for with each topic.

There have been two surveys of the patient population of Glenside Hospital, Bristol, in recent years—Cooper and Early (1961), and Early and Magnus (1966). Since the 1961 review, a considerable number of patients admitted have become “chronic”, i.e. have remained continuously in hospital for over one year. An attempt to enquire into this problem has been made.