Control subjects voluntarily overbreathed to produce end-tidal PCO2 levels similar to those found in patients suffering from neurotic or endogenous non-retarded depression. Red cell sodium content was found to decrease during overbreathing in all the subjects. The changes were similar to those usually reported for depressed patients.

The results imply that red cell sodium levels are in part dependent on respiratory behaviour. They suggest a need for considerable caution in interpreting red cell sodium values from psychiatric patients.

This study reports certain test findings and generalizations on the performance of a small number of top ranking British Motor Racing drivers. The first section deals with the formal tests, the second is speculative about the motives involved in choosing motor racing as a career.

It became apparent soon after the introduction of chlorpromazine and reserpine that these drugs were capable both of influencing psychoses and of producing neurological disturbances closely resembling those seen in post-encephalitic Parkinsonism. In classifying drugs with these effects as “neuroleptics” Delay et al. (2) indicated that they considered the two actions to be inseparable thus implying that both resulted from common or closely related neurophysiological changes. On this basis it seemed likely that drugs which more readily produced these neurological disturbances would prove more effective in psychotic illness. It also seemed possible that there might be therapeutic value in the deliberate provocation of such disturbances, as was first advocated by Fleugel (6). The theoretical issues involved were referred to in a previous paper (MacLeod and Moffat (8)).

All patients presenting for psychiatric care should receive a comprehensive descriptive psychopathological evaluation. This should include a broad symptomatological assessment specifying the time frames of the findings, as well as a mental state examination at the time of the patient interview (Table 4.1).

Some investigations suggest that the attitude of a psychiatrist to therapy with drugs may affect his patient's response to treatment (Sheard, 1963; Reynolds, Joyce, Swift, Tooley and Weatherall, 1965), though the evidence is far from conclusive and earlier findings have not always been confirmed by further research (Hordern and Hamilton, 1963; Uhlenhuth and Park, 1964). The possibility that a particular drug may be more effective if administered by a physician who believes it to be superior to alternative drugs appears to have received little attention. Such preferences exist in medical practice. The present study was undertaken to test the hypothesis that they have a measurable effect, provided the drug is administered knowingly. The efficacy of the drug of choice of three psychiatrists was therefore compared (a) under single blind and double blind conditions, and (b) with that of alternative medication.