In another paper (Grosz, 1968) I reported that among 267 depressive patients from three sibling families admitted to the Bethlem Royal and Maudsley Hospitals, London, the middle born were significantly (p·001) over-represented and the youngest born under-represented among patients with two differently sexed siblings. There was no significant birth order effect among depressive patients with two same-sexed sibs (i.e. with either two brothers or two sisters).

Most of the investigators to date have been comparing desipramine with imipramine, and little work has been published on comparative studies of the demethylated compounds of imipramine and amitriptyline, i.e. desipramine and nortriptyline. Arieff (1966) conducted a clinical study, but did not find any difference between the two drugs, and stated “However, the improvement was never as striking or as rapid as when imipramine or amitriptyline was effective.” Steward and Mitchell (1966) in a double-blind controlled study also found no difference between the two drugs.

The Maudsley Personality Inventory (MPI) and its successor the Eysenck Personality Inventory (EPI) are frequently used to assess the personalities of psychiatric patients, and Eysenck advocates their routine administration as an aid to both diagnosis and treatment. However, a fundamental requirement of any personality test given to patients is that it should be relatively independent of the patient's mental state and reflect his personality rather than his illness. In depressive illnesses at least, it is doubtful whether this requirement is met. Coppen and Metcalfe (1965) administered the MPI to 39 patients with severe depression while they were depressed and again after recovery. Their mean N (neuroticism) score fell from 30.5 to 18.7 on recovery, and their mean E (extraversion) score rose from 17.3 to 20.6. Both changes were statistically significant. Assuming that the true scores were those obtained after recovery, it follows that the mean N score increased 63 per cent. and the E score decreased 19 per cent. during the episode of depression. The customary definition of personality as the relatively stable and enduring aspects of an individual's behaviour precludes such gross changes from being interpreted as changes in personality. One can only conclude, therefore, either that N and E scores obtained in the presence of severe depression are meaningless, or that they are a reflection of something other than the individual's personality. In the case of Coppen and Metcalfe's findings the most obvious explanation is that although patients are enjoined in the test instructions to rate their “usual way of acting or feeling” they do not in practice do so, but remain preoccupied with their current state of mind. Several MPI questions like “Does your mind often wander while you are trying to concentrate?” and “Have you often lost sleep over your worries?” are clearly relevant to the mental state of depression and probably attract positive replies from most patients regardless of their normal feelings.

There is a growing body of evidence which points to a high prevalence of psychiatric disorder in students and to the contribution of such disturbance to wastage and under-achievement. The relationship between psychiatric illness and academic difficulty is, however, a complex one, for severely ill individuals may be capable of high achievement while apparently mildly disturbed students may fail academically through the operation of emotional factors. The ability to predict or detect at an early stage the psychiatrically or academically vulnerable student would clearly be of great value.

A number of observations have appeared in the literature indicating that haloperidol may be of value in the treatment of children with certain types of behaviour disorder (Haberlandt, 1963; Rogers, 1965). There has, however, been a dearth of controlled observations to support these impressions, though there is evidence that the drug is of value in the tics of Gilles de la Tourette's disease (Connell et al., 1967). The present paper reports a controlled pilot study of haloperidol in overactive and aggressive children.

References to compulsive gambling are found in the psychiatric literature as early as 1914 (von Hattingberg) and 1920 (Simmel). These and subsequent literature on the psychodynamics and treatment by analytical methods were summarized by Harris in 1964. In the past year references have been made to the treatment by aversion therapy of isolated cases of horse race gamblers and of a “one-armed bandit” gambler (Barker and Miller, 1966b, Seager et al., 1966, Barker and Miller, 1966a). A further case of a compulsive horse race gambler treated by aversion therapy seems worth presenting, in view of the sparse literature on treatment of the condition by this method, and also because in this case, the therapy was immediately followed by remission of a longstanding marital disharmony which is believed to have been one major precipitating cause of the gambling.

Seven drugs of the imino-dibenzyl group are now generally available in Great Britain (imipramine, amitriptyline, desipramine, nortriptyline, protriptyline, trimipramine and opipramol). All are similar in their actions and side-effects. Imipramine, the first to appear, has been shown to be more effective than placebo in the treatment of depression, though with much better results in men than in women (M.R.C. Clinical Trial, 1965). Desipramine, a metabolite of impramine, was introduced with the claim that its action was quicker than that of imipramine, though this has never been clearly demonstrated. Trials of desipramine against imipramine (Waldron and Bates, 1965; Rose and Westhead, 1964) showed no significant difference between these drugs. Comparison of amitriptyline and imipramine (Burt, Gordon, Holt and Hordern, 1962), showed amitriptyline to be at least as effective as imipramine and significantly superior in the treatment of endogenous depression. Comparisons of nortriptyline and amitriptyline (Forrest, Affleck, Gibb and Priest, 1964; Rose, Leahy, Martin and Westhead, 1965) showed no significant difference between these drugs.

Four years after E.C.T. was first introduced by Cerletti and Bini (1938), Friedman and Wilcox (1942) investigated the effect of unilateral E.C.T. in eleven psychotic patients, using a pair of electrodes on the vertex and on the left temple above the ear (or, in one case, the left frontal region). Since that time there have been a number of published reports of the effect of administering E.C.T. unilaterally, using a variety of electrode placements and shock parameters, some limited to the supposedly non-dominant right side of the head (Goldman, 1949; Lancaster, Steinert and Frost, 1958; Cannicott, 1962; Bilikiewicz and Krzyzowski, 1964; Dolenz, 1964; Martin, Ford, McDanald and Towler, 1965; Impastato and Karliner, 1966; Cannicott and Waggoner, 1967), others comparing right- and left-sided treatment (Blaurock, Lorimer, Segal and Gibbs, 1950; Pacella and Impastato, 1954; Zamora and Kaelbling, 1965; Gottlieb and Wilson, 1965).

The specific therapeutic effect of lithium salts in the treatment of the manic phases of manicdepressive psychosis was first reported by Cade (1949) and has been confirmed in a number of studies since (Schou, Juel-Nielson, Strömgren and Voldby, 1954; Maggs, 1963; Hartigan, 1963). In view of the claims made by Baastrup (1964) and more recendy by Baastrup and Schou (1967) that lithium also has a prophylactic action against both manic and depressive phases of manic-depressive psychosis it is likely that lithium salts will be used increasingly by psychiatrists.

A sociological study of hospital-treated psychiatric disorder, designed to discover what social groups make use of a particular service, and for what reasons, adds another dimension to the understanding of clinician and administrator. Such a study must also reflect the changes in mental hospital practice which have followed the Mental Health Acts of 1959 and (Scotland) 1960, and the effect of these changes on individual attitudes towards in-patient care. The recent opening in Edinburgh of a completely new psychiatric admission hospital provided appropriate stimulus and setting for the present inquiry.

Maternal age at parturition, birth order, and parental loss have all been extensively investigated as possible causal or concomitant factors in a wide variety of mental disorders. Thus, to take an extreme example, the influence of maternal age on one of the two main kinds of mongolism is well known and can hardly have other than a biological explanation, as is also true of a number of other causes of mental defect whose incidence is known to increase with maternal age (Penrose, 1963); and similarly much is now known of the biological effects of maternal age in animals (for a survey see Parsons, 1964).

It is well known that there is a definite march of events from onset to ending in the epileptic seizure. The sequence of symptoms differs in the different forms. “Idiopathic” epilepsies have a march through aura, tonus, clonus, and recovery, while Jacksonian organic epilepsies show a characteristic march directly related to their brain anatomical location. Electrically induced therapeutic epilepsy likewise has a march of events which is fairly constant though deviations from the normal pattern do occur, and it is our purpose in what follows to establish and quantitate the normal sequence of events.

Metronidazole (‘Flagyl’) has recently been said to be of value in treating alcoholism (Taylor, 1964). The drug is, of course, better known for its use against trichomoniasis. Three main claims have been made about it: (a) that it has an effect like disulfiram (Taylor, 1964; Bonfiglio and Donadio, 1966; Lehman, Ban and Nalchayan, 1966); (b) that it cuts short withdrawal symptoms (Lehman et al., 1966); (c) that it reduces craving and thereby allows return to normal drinking (Lehman, et al., 1966; Elosuo, 1966; Bonfiglio and Donadio, 1966). It is this last claim that is particularly important, since other well-tried preparations are in use for the first two purposes. We report a double-blind controlled trial directed to the possible disulfiram-like effects of the drug, and to its ability to reduce craving.

The present paper reviews six years of operation of I.T.O. (Bristol) Limited, during which there were 605 referrals. The majority came from Glenside Hospital, 374 patients (62 per cent.), and approximately 8 per cent. were referred from each of the following sources—Local Authority, Day Hospitals, Hospitals for the Subnormal, other psychiatric sources and non-psychiatric sources. Male admissions totalled 326 (54 per cent.) and female 279 (46 per cent.): of these only 84 (14 per cent.) were married with a surviving partner and 492 (81 per cent.) had never been married.

Considerable evidence has accumulated that alterations in the direct current fields of the brain can produce alterations in function (O'Leary and Goldring, 1964). In view of this a group of investigators instituted a clinical trial of the possible usefulness of transcranial polarization (Lippold and Redfearn, 1964; Redfearn et al., 1964; Costain et al., 1964). In the approach used a current was passed between electrodes attached just superior to the eyebrows and an electrode on the leg. The principal changes reported consisted of an elevation of mood and an increase in involvement with the environment when the head was positive relatively to the leg and a withdrawal and quietness when the head was negative relatively to the leg. The current level reported as effective was generally of the order of 250 microamperes. Among Lippold and Redfearn's subjects were seven schizophrenics, in six of whom brief D.C. polarization produced the expected effects. Among the subjects of Redfearn et al. were four schizophrenics, in all of whom some favourable effect from D.C. head positive polarization was reported. This study was uncontrolled. In a blind controlled trial, Costain et al. found head-positive polarization to be of therapeutic efficacy in a group of 24 depressed patients. Their interpretation of results was challenged by Dawson and Montagu (1965). In view of these reports, we decided that a pilot study of the possible efficacy of transcranial polarization in altering the non-responsive state of chronic schizophrenic patients was warranted. It was decided that a more longitudinal study would be of greater value in determining possible therapeutic usefulness than a shorter trial on a larger number of patients. The experiment was conducted on one of the research wards of Rockland State Hospital.

So far there has been a failure in psychiatry to establish any really adequate and universally accepted classificatory systems. This failure has proved a stumbling block to effective research, it has often frustrated communication and has held back the development of scientifically based treatment methods. Even now there still lingers some controversy over the appropriateness of the use of any classification in psychiatry (Kessell, 1964).

The literature on involutional psychiatric disorder, as on depressive diagnoses in general, is quite controversial. Since middle-aged women form a significant proportion of medical as well as psychiatric patients, it would seem useful to examine diagnoses within this group.

Metronidazole (Flagyl) is an established and effective treatment of urogenital trichomoniasis. J. A. T. Taylor (1964) was using metronidazole to treat a husband and wife for this condition, when she observed the following. The husband, who was a chronic alcoholic, seemed to lose his craving for alcoholic drinks. Sometimes he experienced flushing of the face and shoulders and epigastric discomfort when he took metronidazole soon after alcohol, i.e. he experienced a disulfiram type reaction. The wife reported that alcohol drinks tasted unpleasant to her during therapy. Taylor then studied 53 alcoholic patients and concluded that metronidazole (i) decreased tolerance for alcohol, (ii) diminished craving for alcohol and (iii) produced an uncomfortable reaction to alcohol.

The validation of personality questionnaires presents the psychologist with knotty problems. His reaction all too often is to plead that, as it is difficult to find criteria for validating measures of personality, he is justified in relying on face validity alone. Fortunately, this has not been true of the Maudsley Personality Inventory (MPI), nor even of its more recent successor, the Eysenck Personality Inventory (EPI). Serious attempts have been made to validate these questionnaires, and the problem has been tackled from a number of different angles. S. B. G. Eysenck (1962) and Eysenck and Eysenck (1963) found that subjects nominated by judges as extraverted, introverted, stable and neurotic scored significantly differently on scales measuring these dimensions. A further study (Eysenck and Eysenck, 1964), in which larger numbers of both judges and subjects were used, confirmed these findings. Vingoe (1966) found that subjects who rated themselves extraverted on a seven-point scale of extraversion–introversion differed significantly on the extraversion scale of the EPI from those who rated themselves introverted.

In a random sample of 500 British women Coppen and Kessel (1963) found that certain menstrual symptoms—those of the premenstrual syndrome—i.e. depression, irritability, swelling, as well as menstrual irregularity, were positively correlated with Neuroticism on the Maudsley Personality Inventory. In a further study on the prevalence of menstrual symptoms in psychiatric patients (Coppen, 1965), a high incidence of menstrual symptoms was found in all groups, particularly neurotic women. Both these surveys were conducted by means of a menstrual questionnaire completed by each woman. This approach allows different groups to be investigated and compared, using a standardized measuring instrument. The purpose of this investigation was to see if cultural factors have any influence on the prevalence or severity of menstrual symptoms by administering a translation of the menstrual questionnaire to a sample of Spanish college students.