Reports of significant changes in water and electrolytes during recovery from depression may provide insight into important physiological factors in depressive illnesses. Brown et al. (1963) demonstrated an increase in the extracellular fluid volume in 22 of 28 patients suffering from primary depressive disorders treated with E.C.T. or imipramine. The findings of these authors, which were discussed in relation to previous work on sodium metabolism and water balance in depressive disorders, were thought to support the idea of a shift of fluid from intracellular to extracellular spaces during the response to treatment. Coppen and Shaw (1963) found an increase in total body water, extracellular fluid and a decrease in the residual sodium space on recovery from depression.

Most of the water and electrolyte studies in mental illness have been carried out on patients suffering from periodic disorders and have been reviewed by Crammer (1962). Coppen and Shaw (1963) found increases in total body water and extracellular fluid and a decrease in residual sodium space on recovery from depression. Manic patients with a high vocal productivity were found by Anderson et al. (1964) to have a negative sodium balance, low plasma potassium levels and a positive potassium balance. Depressed patients with a low vocal productivity had a reduced rate of sodium loss and higher plasma potassium levels. Dawson et al. (1956) found extracellular expansion on spontaneous recovery from manic or depressive attacks. The purpose of the present study was to investigate variations in total body water and its distribution in manic-depressive psychosis. The investigation was complementary to a similar study of variations in body composition during recovery from depression reported by Hullin et al. (1967).

Many instances of regular cyclic or periodic psychiatric and clinical syndromes have been reported (Richter, 1957). The duration of each cycle varies from 2 days to 18 months but is usually constant in a given subject and bears no relationship to external factors. Presumably they have their origin within the body, and a disturbance of endocrine function has been suggested in many cases. Some women show cycles corresponding to the menstrual rhythm, the abnormal phase preceding or accompanying the menstrual flow.

There have been a number of studies attempting to quantify anxiety under stress, using biochemical measures such as plasma Cortisol concentration and urinary catecholamine excretion as concomitants of the emotional response. A limitation of some of this work has been the lack of predictable and adequate stresses studied, which have included disturbing interviews (Bliss et al., 1956), admission to hospital and anticipation of operation (Mason, 1959), stressful films (Levi, 1965) and hypnotically induced anxiety (Persky et at., 1959).

The syndrome of multiple motor tics accompanied by explosive utterances was originally described by Itard (1825) and later differentiated as a syndrome by Gilles de la Tourette (1885). Koster (1899) discovered two cases among 2,500 patients admitted to a hospital for nervous diseases in Leipzig and found only 50 recorded cases in the literature available to him. Since then, cases have been reported from Germany (Strauss, 1927), Switzerland (Heuscher, 1950), Poland (Dolmierski and Klossowna, 1958), France (Seignot, 1961), Finland, (Salmi, 1961) and Canada (Baker, 1962), in addition to several from the United States and Great Britain (see below). Mahler et al. (1945) found that 18 out of 541 children admitted to a children's ward in a New York psychiatric hospital had tics, but only 11 of them suffered from “the tic syndrome” (Mahler and Luke, 1946)—a synonym for Gilles de la Tourette's syndrome. Ascher (1948) found four cases of this condition among 9,000 in-patients and 50,000 out-patients at a psychiatric centre in Baltimore. There was only one case detected among 5,300 children attending an education guidance centre in Turku, Finland (Salmi, 1961). Creak and Guttman (1935) found 14 cases in which tics were noted in the diagnosis among in-patients of the Maudsley Hospital, London, between 1932 and 1935. The rarity of Gilles de la Tourette's syndrome is such that a review of published case reports is the only feasible method of surveying the broad aspects of the condition. Three cases treated at Runwell Hospital, Wickford, Essex, and a fourth case treated personally in London are presented and published case reports reviewed.

The particular mental state described by Korsakov (1890, 1891) is, in most cases, a sequel of Wernicke's encephalopathy, which itself is the result of alcoholism. Korsakov, however, also observed the same mental condition in persons, not alcoholic, who had been exposed to carbon monoxide, to phosphorus poisoning, or to profound toxic states. Within a few years, Monckenmoller (1899) and Meyer (1899) had each described the Korsakov state appearing late in the natural history of sarcomata of the sella turcica and third ventricle respectively. Delay et al. (1964) ably reviewed 108 instances in the literature of the association of cerebral tumour and Korsakov state, and concluded that cerebral tumour is most likely to lead to the Korsakov state if it leads to a bilateral lesion in the hippocampo - mamillo - thalamo - cingulate pathways, an observation previously made by Grünthal (1939), Kleist (1934), and Orthner (1957). By virtue of their possible situation, craniopharyngiomas are so placed anatomically that they are associated with the Korsakov state with disproportionate frequency compared to other intracranial tumours. However, in some of the reported cases the Korsakov features were tenuous, were a near terminal or postoperative event, or were outweighed by gross endocrine disturbances. Even so, only 3 out of 28 such cases described in the literature were diagnosed during life. Early diagnosis is thus extremely difficult, for the neurological signs are sparse and then are mainly ophthalmological, whilst the onset is insidious and accompanied by mental changes which deceptively suggest a functional basis to the whole picture.

The methods of treatment employed for most forms of psychiatric disorder are still largely empirical. Furthermore, they are subject to powerful socio-cultural influences. Hence, it is not surprising that examination of medical practice in different countries reveals wider variation in the treatment of psychiatric disorder than in that of most other forms of morbidity (Shepherd, 1962). To establish the patterns of variation, and to assess their importance, it is necessary to develop techniques which permit direct comparison between the therapeutic practices of representative national groups of psychiatrists. This cannot be an easy matter, since in addition to difficulties of language and protocol there are problems specific to the subject of enquiry. There is as yet no internationally accepted nomenclature for psychiatric disorders, and perusal of the available prevalence statistics suggests that there must be considerable variation in the diagnostic criteria recognized by clinical psychiatrists of different nationalities (Lin and Standley, 1962). Moreover, clinicians whose chief concern is with the treatment and management of individual patients, in part through the manipulation of inter-personal relations, may be reluctant to accept any simple, mutually exclusive classification of their therapeutic techniques.

In the July 1964 issue of The Atlantic, William Sargant (6), made some controversial comments on American psychiatry. “Freudian converts”, he said, fear “allowing any other methods of psychiatric treatment to gain any real recognition and acceptance in … teaching centers” where physical and biochemical treatments are “dismissed” as “symptomatic” and “second-rate”. He argued, furthermore, that psychoanalysts' views are unrealistic because these practitioners are experienced merely with the “very mildest forms of mental illness”. “Only psychoanalysis holds out any real hope in treatment” is the credo which Dr. Sargant attributes to U.S. psychoanalysts. If these opinions were solely those of one author, they might be overlooked, but they are held by many European and American psychiatrists (1).

This paper describes and attempts to evaluate an alcoholism treatment programme in two Caribbean islands with a multi-racial population of just under a million. The programme, initiated by the author in 1956, combined emetine aversion treatment in a group setting, with milieu therapy and group psychotherapy of a didactic kind aimed at producing conversion (rather than aversion) to uncritical belief in the tenets of Alcoholics Anonymous.

Desipramine (Pertofran) is the monomethyl analogue of imipramine (Tofranil) and is marketed as a potent anti-depressant agent. The literature on this drug has already been adequately reviewed by Rose et al. (1964) and Waldron et al. (1965). It is therefore sufficient to note that earlier reports claiming a more rapid action than imipramine have not been supported by more recent investigations. This paper reports a double-blind controlled comparison of imipramine and desipramine, designed to investigate the relative effectiveness, speed of action and side-effects of these two drugs.

Chemically, trimipramine has an imino-benzyl nucleus and a side-chain resembling that of methotrimeprazine [5-(3-dimethyl-amino-2-methyl-propyl)-10, 11-dihydrodibenz (b, f,) azepine]. In “double blind” controlled comparisons of trimipramine and imipramine, Salzmann (1965) in 27 hospitalized depressed patients who did not require ECT, found the two drugs not significantly different in effect. Blumenthal and Seppala (1965) obtained similar results. Burns (1965), however, in 44 patients suffering from psychotic depression, found trimipramine to be significantly superior at the 5 per cent. level to imipramine in ratings of recovery from depression, anxiety and insomnia. No difference was found in the latency interval between the drugs.

In view of the structural similarity of imipramine and promazine, an attempt has been made to obtain a stronger anti-depressive effect by means of chlorination of imipramine at the same place in the molecule. Brandner (1964) has described the results of mono-chlorimipi-amine (MCI) administration in a series of 25 cases of various kinds of depression.

During the treatment of mental illness, a phase is reached when the patient is encouraged to resume his life in the community by spending increasing periods of leave at home.

Ireland has the highest rate of hospitalized mental illness on record. This is borne out both by the World Health Organization figures for treated mental illness (W.H.O., 1961), by international comparisons of point prevalence rates (Arentsen and Strdmgren, 1959) and by consideration of first admission rates (Hammer and Lcacock, 1961). The Irish national figures for each of these measures were respectively 7·12, 10·81 and 1·45 per 1,000 population in 1959. The rates exhibit a distinct geographical pattern within Ireland: they are highest on the coastal areas furthest from Dublin, while in the Dublin area they are as low as those of most western European countries. All three measures have risen over time, and the intercounty variation has also increased since 1900. In 1959 the coefficients of variation for both first admission and hospitalization rates were equal to 25·1 per cent.

The view that depersonalization experiences can “be regarded as occupying a position somewhere between the delusional and the non-delusional” was first suggested by Ackner (1954) who gave as an example the depressive's experience of malaise. If this is accepted into the normal framework of experience it will be attributed to illness or fatigue. If it is accepted and organized into a delusional framework, the depressive delusion that the body is rotting away (for example) may be exhibited. If, however, the experience cannot be accepted into either a normal or a delusional framework it will remain peculiar, foreign, strange, and unreal and will appear as depersonalization. Ackner commented that if delusions should develop, experiences of change “will tend to be included” within them, and thus not appear as depersonalization. Discussing depressive depersonalization in particular, he considered that “with delusional development, the unreality feeling tends to recede”.