Mayer-Gross, Slater and Roth (1963) distinguish two ‘affective conditions’: affective Constitution and affective Disorders. The former comprises three personality types: (a) the hypomanic or hyperthymic, (b) the depressive or dysthymic and (c) the cyclothymic; the latter embodies the manic-depressive disorder of Kraepelin.

In the Republic of Ireland hospital services are available without charge to persons on the General Medical Services Register. Eligibility for registration is decided by an individual means test and is reserved for those ‘unable to provide by their own industry or other lawful means the medical or surgical treatment or medicines or medical or surgical appliances necessary for themselves or their dependants'. These amount to some 30 per cent of the total population.

In a comparative study (Vinoda, 1966) of personality characteristics of 50 female attempted suicides and an individually matched group of 50 psychiatric controls and 50 normals, it was observed that the attempted suicides differed from the psychiatric and normal controls on measures of hostility, guilt, rigidity and neuroticism. Attempted suicides (AS) were significantly more hostile and rigid than both psychiatric controls (PC) and normal controls (NC), and they were significantly more personally ill (neurotic) than normal controls but not more than psychiatric controls. On the basis of previous researches it was hypothesized that the group of attempted suicides would be more hysteroid in their personality and intropunitive in the direction of their punitiveness than the control groups. The first study (Vinoda, 1966) did not reveal such differences. The scrutiny of results showed that there were more or less equal numbers of hysteroid and obsessoid personalities among attempted suicides and similarly a more or less equal number of persons who were intropunitive or extrapunitive in the direction of their aggression. This led the author to hypothesize that these variables might be more related to the nature of suicidal attempts in terms of seriousness of the attempts made.

To an analytically oriented psychiatrist a neurotic symptom is a meaningful expression or result of an unconscious conflict. To a behavioural therapist it is maladaptive, learned behaviour. The psychotherapist sees his task as a joint venture in which patient and therapist explore the patient's life history in order to determine how the trauma of the past manifests itself in the distortions of the present. Behavioural therapists contend that analytical theory, of whatever sort, is invalidated by their successes and by the fact that successful treatment of a symptom or set of symptoms has not, in their experience, led to substitution of some other symptom or to more serious pathological consequences. The claimed success rate for behaviour therapy is very high. Journals of recent years abound in reports of spectacular cures, especially of individual patients with traditionally refractory conditions (Clark, 1963; Cooper, A. J., 1963, 1965; Raymond and O'Keefe, 1965). The psychotherapist's aim is to help his patient to understand his problems and find his own solutions for them. Would he be better advised to use his authority to reward “acceptable” and punish “unacceptable” behaviour; or his imagination and inventive skill to figure out ever more ingenious procedures of deconditioning? Is the time-consuming process of intensive psychotherapy not only wasteful but inferior in results to techniques based on conditioning? It seems to me, to judge by recent reports, that some of the results of behaviour therapy are less impressive than a cursory reading would suggest.

Neither older (Raiman, 1902; Ehrenberg, 1909; Wigert, 1918; Reiter, 1925) nor more recent papers (Diethelm, 1936; McFarland and Goldstein, 1939; Holmgren and Wohlfarhrt, 1944) provide general agreement about impairment of glucose tolerance in mental disease. Plum (1958) considers a high incidence of decrease among epileptics established, but while Freeman and Zaborenke (1949) reported a decrease in schizophrenics Shattock (1950) found an increased tolerance in such patients. Waelsch and Weil-Malherbe (1964) comment that a reduction in the rate of glucose utilization in cases of severe depression stands out as perhaps the most significant and constant finding, but Coppen (1967) claims that quite recent work by him and his co-workers (Herzberg, Coppen and Marks, 1968) provided evidence that there was no impairment in glucose tolerance when depressed patients were given diets high in carbohydrate for three or four days before testing. It would be expected that much conflicting evidence could be due to difficulties inherent in psychiatric nosology. But a review of the surprisingly large number of reports which have left the problem unsolved could not but impress one with the rather casual attitudes of some workers to the chemistry of different methods for “blood sugar” determination.

The syndrome of autoerythrocyte sensitization is characterized by painful ecchymotic lesions of the skin that develop in a very stereotypic manner. Onset occurs in a palm-sized skin region, usually on the limbs, with a stinging and burning sensation. After varying lengths of time, in general 2–6 hours, the skin becomes red, hot, oedematous and tender. This inflammatory phase may last anything up to twenty-four hours. Over the next few days the rubescent heated infiltration turns into an ecchymosis which spreads annularly at the same time as the tenderness and swelling diminish. Originally described by Gardner and Diamond (1955), thirty-one cases of the syndrome have now been reported. Up to the present all reported cases have come from North America and Australia and been confined to women with an age at onset of between 15 and 66 years.

It is well known that when affective illness has its onset in later life a family history of this illness is significantly less common than in cases where the onset is early. Thus, Kay (1959) compared cases in this respect before and after 60 years of age; the morbidity risk was 10–12·7 per cent for relatives of the early onset group and only 3·5–5·7 per cent in relatives of those falling ill for the first time after 60. Similarly, Hopkinson (1964), taking the age of 50 to divide his probands, found a significantly lower risk for affective illness in relatives of the older-onset probands.

“Much doubt persists about the different benefits from, and indications for, all the many drugs proposed for the relief of anxiety” (Lancet, 1965). Chlordiazepoxide is one of the most popular minor tranquillizers used by psychiatrists, physicians and general practitioners. Its efficacy has been advocated in the “Today's Drugs” column of the British Medical Journal (1967, 1968a and b). Others, however, have been “impressed by the number of patients who claim great benefit but show little evidence of this” (Jenner, 1965).

Studies on the biological basis of psychosis are currently being conducted in a variety of disciplines and using a wide range of techniques (Smythies, 1968). These include studies of the basic mechanism of action of drugs which mimic, exacerbate or ameliorate psychosis. A major sub-section of the field is composed of structure-activity relationship (S.A.R.) studies in which we determine what effect the systematic manipulation of the molecular structure has on the activity of a drug. In this way valuable data can be obtained as to its possible mode of action. This in turn may suggest hypotheses as to the biochemical lesions in the naturally occurring psychoses. Secondly, specific behavioural responses can be made the dependent variable we measure in experiments where the levels of brain amines, activity of brain enzymes, etc., can be manipulated by any of the many techniques now available.

Since Delay and Deniker's (1) report on the efficacy of chlorpromazine, phenothiazines have become the cornerstone of treatment for schizophrenia. However, the unreliability of patients in taking oral drugs is a major disadvantage which the introduction of fluphenazine enanthate has helped to remedy.

One specific hypothesis concerning the biochemical lesion in schizophrenia was put forward by McIsaac (1961) on the basis of the close chemical relationship between the pineal hormone melatonin and the hallucinogenic drug harmine. On this basis Nicholson et al. (1966) conducted a clinical trial of D-penicillamine plus a low copper diet in schizophrenics, with encouraging results. They used 1,200 mg. daily in a double-blind trial against placebo for six weeks. Hollister et al. (1966) also treated schizophrenic patients with D-penicillamine, but for a different reason—they suggested that depolymerization might be effective if schizophrenia is an autoimmune disorder. They used doses of 1,000 mg. daily for five weeks following an initial build up, and noted no clinical amelioration in 13 schizophrenics studied. A normal diet was given. Walshe (1967) failed to find any improvement in 4 chronic patients on penicillamine for one year.

Among all the childhood influences that may affect individual development and contribute to breakdown in adult life, the quality of parental care has always appeared of paramount importance. The supposed sequelae of parents’ absence have been the subject of many studies, relating particularly to depression (Dennehy, 1966, and Hill and Price, 1967) and to attempted suicide (Greer et al., 1966). In the latter study a significant association was established between absence of either parent and a later suicidal attempt, especially if the absence started in the first five years of life.

In recent years there has been growing interest in the subject of circadian rhythms of various metabolic processes in manic-depressive psychosis. This has been prompted in part by the cyclic self-limiting course of the condition itself as well as by such characteristic changes in its clinical manifestation over the twenty-four-hour period as mood variation, disturbed sleep pattern with early morning wakening, and impaired appetite, which Pollitt (1965) has attributed to a primary change in hypothalamic function. Alterations in the circadian rhythms of plasma corticosteroids, urinary corticosteroid excretion (Bridges and Jones, 1966; Curtis et al., 1966; Knapp et al., 1967; McClure, 1966), salivary flow and salivary electrolyte excretion (Jenner et al., 1967; Palmai and Blackwell, 1965) have been reported.

For a long time it has been thought that deviations from the average in certain body measurements might be associated with an increased expectation of mental illness. The features to attract most interest have been size, linearity, and masculinity.

The relationship between mental illness and physical disease in elderly patients has been the subject of a number of studies, notably those by Kay and Roth (1955) and Roth and Kay (1956). Stenstedt (1952, 1959) reported a high mortality rate among patients with manic-depressive psychosis and involutional melancholia, which he attributed to ‘the high frequency of suicide and to the fact that several patients had died in a mental hospital’. In a survey of elderly people living in the community, Kay and Bergmann (1966) demonstrated a relationship between physical illness and diminished life expectancy on the one hand and functional psychiatric disorders on the other. Shepherd et al. (1964), in a general practice survey in London, found a 'strongly marked association between psychiatric disorder and chronic organic illness'.

One of the hypotheses advanced to explain the processes underlying severe depression postulates a change in brain function due to an alteration in the distribution of cations across the neuronal membranes (Shaw and Coppen, 1966; Shaw, 1966). Electrophysiological evidence of abnormal function of pathways in the nervous system in depression has been obtained by the study of evoked cortical potentials (Shagass and Schwartz, 1966), but evidence of derangement in the distribution of cations between the cells and extracellular space has come only from “whole body” studies (Coppen and Shaw, 1963; Coppen, Shaw, Malleson and Costain, 1966; Shaw and Coppen, 1966).

This article presents the results of a study initiated by the late G. R. Hargreaves, Nuffield Professor of Psychiatry at the University of Leeds.

Nitrazepam is a benzodiazepine closely related to diazepam and chlordiazepoxide. It has been marketed as a sleep-inducing drug, and as such has proved to have an overall effectiveness comparable to that of the barbiturates and related drugs (3, 4, 5, 6, 8, 12).

The impression that alcoholism is common among the Irish is a very old one. It has been given some scientific basis by comparative studies of alcoholism in various ethnic groups in the United States. Thus, Hyde and Chisholm (1944) found that the rejection rate for enlistees in the United States army because of chronic alcoholism was higher in the Irish than in any other national group. Confirmatory evidence came from Malzberg (1940) in a study of first hospitalization rates for various diagnostic categories in New York State, and Roberts and Myers (1954) in a prevalence study in New Haven found that the Irish had a far higher proportion under treatment for alcoholism and drug addiction than other national groups.

Emotional change during pregnancy and the postpartum period is very common (37, 42); mental illness of psychotic proportions occurs more frequently in the postpartum period than in the period of pregnancy (33). These psychotic illnesses occurring in the postpartum period have remained an area of controversy for several reasons. The clinical phenomenology of these psychotic reactions seems unusually rich in confusional and delirious features (19), even when reported by those who contend they are no different from the usual run of psychotic illness (41). The fact that 80 per cent. of these serious reactions occur in the first 30 days postpartum (33) has raised doubt in the minds of some that these reactions merely represent the stress of pregnancy falling on a predisposed personality. An alternative hypothesis might be that the interaction of psychological and endocrine factors at the end of pregnancy makes this a particularly stressful period. The delirious and confusional symptoms might also be better explained as being related to endocrine dysfunction of some kind.