This paper reports the result of an investigation into the hypothesis that severity of personality disturbance is positively related to the frequency of certain early adverse childhood influences.

Although the number of anti-depressant drugs available has grown rapidly in recent years, they are still broadly classified into three main groups. First are the general nervous system stimulants, exemplified by amphetamine, second the group derived from the phenothiazines exemplified by imipramine and third, the monoamineoxidase inhibitors—the first example of which was iproniazid. The general stimulants have many disadvantages, their place in treatment is limited, but fairly well defined. Many monoamineoxidase inhibitors have been found to have serious toxic effects, but some, including tranylcypromine appear to be reasonably safe and effective (Agin, 1960).

In the previous paper (Burch, 1964), I discussed the possible significance of certain statistical features of manic depressive psychosis; in this one I shall consider corresponding statistics relating to schizophrenia.

Despite the advent of the stimulant phenothiazines—effective, sometimes, when older dimethyl compounds fail—a proportion of chronic schizophrenics continue to resist treatment with both types of drug, and also fail to respond to intensive nursing regimes designed to combat the effects of institutionalization. These patients constitute a major therapeutic problem.

Attempted suicide has been described as “one of the most disturbing and costly abnormal behaviour patterns in our society” (29). Various suspected predisposing factors have been extensively studied, including physical and mental illness (e.g. 24, 17, 11, 25, 6), alcoholism (e.g. 19, 8, 3, 12), interpersonal conflicts (e.g. 10, 30, 14), old age (e.g. 15, 34, 23), and social isolation and degeneration (e.g. 7, 28, 33).

This study was undertaken to learn more about a group of patients, married women, who had become housebound by their phobic anxiety symptoms. It was felt that it would be of some value to discover to what extent they formed a homogeneous group, what the outcome of their illness was in general terms, and specifically what proportion remained housebound and what data there had been available on admission to hospital that might in retrospect be seen to have had prognostic significance.

Haloperidol is a drug that fulfils Delay's criteria of a neuroleptic in that:

1. 1. It inhibits psychomotor agitation without producing sleep.

2. 2. Alleviates psychomotor manifestations.

3. 3. Produces with increasing dosage characteristic extrapyramidal signs.

Common observation indicates that some chronic schizophrenics are more extraverted than others. According to Eysenck (1960, p. 11) neuroticism is a distinct factor from psychoticism; one would therefore expect it to manifest itself to a varying extent in different chronic schizophrenics. These considerations suggested that it would be of interest to discover whether extraversion and neuroticism in a sample of chronic schizophrenics, as measured by their extraversion and neuroticism scores on the Eysenck Personality Inventory (Eysenck and Eysenck, 1963), a modified form of the Maudsley Personality Inventory (Eysenck, 1956), were significantly related to their psychiatric symptoms and to other characteristics such as sex, age and work efficiency.

The conjunction of hypothyroidism and mental illness has been of great interest to psychiatrists for almost a century. Sir William Gull (1873) noted mental changes in his original description of hypothyroidism, as did Ord (1878) when he coined the term myxoedema. Savage (1880) reported the first patient with myxoedema to be found in a mental hospital population.

Ataractic drugs have been the mainstay of treatment in schizophrenia for the last eight years. Since their introduction, mental hospitals, in various areas of the United States and in every country, have been able to discharge more patients than they admit. Despite this fact there remains much divergent opinion about the value of these drugs, doubt arising from inconsistent therapeutic results and the relapse rate. Also, some double-blind studies have cast some doubt upon the efficiency of these drugs. We are reporting this relatively small study because we feel that it opens an insight and possibly suggests a method of standardizing treatment in the near future.

Despite the important place occupied by delusional thinking in psychiatric theory, comparatively little experimental work has been undertaken on this particular form of thought disorder. This is perhaps surprising considering its relevance to reasoning and belief as a social process, the role of the delusion in differential diagnosis, and the number of deluded patients available for investigation. Most investigators have been concerned with the content of delusions rather than their force, for the type of delusion has an undoubted influence on behaviour—quite clearly the patient with grandiose delusions acts differently from the paranoid individual; nevertheless, the available evidence suggests that the type of delusion reflects the individual's social history rather than the nature or degree of his psychopathology. More relevant to the latter is the degree of belief expressed by the patient in his delusions, the transitory (and malleable) ideas of an early depressive illness often contrasting with the implacable beliefs found in a condition of chronic melancholia. Some longitudinal studies have been undertaken recently in which the degree of delusional belief has been examined in terms of its resistance to manipulation, and this avenue of approach offers an extremely valuable scale of assessment of the individual psychiatric patient.

In this paper age- and sex-specific first admission rates to hospital for involutional psychoses (Malzberg, 1955), are submitted to the same type of mathematical analysis as that used in the two preceding papers. To judge from the nature of the fit between the observed rates (for both sexes) and a highly restrictive mathematical function it seems probable that this diagnostic category—as used in New York State, 1949 to 1951, and by Kallmann (1953)—corresponds to a definite organic disease. Its relationship to the so-called involutional phase of life would appear to be coincidental. The disease is confined to a genetically specific sub-population and the phenotypic expression apparently requires the accumulation of 12 random events. Certain statistical properties of the system affected by these random events are closely similar to those of the “lymphoid system” in autoimmunity. The hypothesis can therefore be entertained that involutional psychosis—together with manic depressive psychosis and schizophrenia—is fundamentally an autoimmune disorder. However the primary pathogenic agent and its “target” organ have not yet been identified and the disease could equally well arise from stochastic disturbances in some other, hitherto unidentified, system, certain statistical characteristics of which are similar to those of the lymphoid system.

There have been many evaluations of the use of chlordiazepoxide in mental illnesses, most of these concerned with its use in the reduction of anxiety. The majority of the papers have emanated from North America and have reported in “open” investigations that the drug is of value in reducing anxiety. Other papers from Britain, Australia and the European Continent have also described the results of similar treatment. Of the British contributions, only two of eight (Jenner et al., 1961; Gore and McComisky, 1961) describe results of placebo-controlled trials. A recent annotation concerning chlordiazepoxide (1961) observed that most of the trials had not involved the use of placebo. Furthermore, as chlordiazepoxide is a drug very much more expensive than a barbiturate, it was considered that more placebo-controlled investigations were desirable.

Two hundred years ago “griefe” was officially regarded as a cause of death. It is doubtful if the Registrar-General would accept such a diagnosis today but the loss of a loved person continues to be seen as a cause of a wide variety of physical and mental ailments.

The nervous origin of paroxysmal tachycardia was stressed by many German-speaking authors (Hering, 1911; Rothberger and Winterberg, 1911a; Rothberger and Winterberg, 1911b; Schlesinger, 1906) at the beginning of the century. Thus Schlesinger (1906) pointed out that many patients who suffered from this disorder had neurasthenic or hysterical personalities. He postulated that there was a mechanism responsible for the attacks of tachycardia which could be set in motion by a stimulus in the nervous system. Somewhat later a French cardiologist (Gallavardin, 1922) described a type of paroxysmal tachycardia which he believed was of nervous origin. In more recent times Stokvis (1947) has given an account of a Jewish patient who was taught to think himself into an attack in order to avoid deportation by the German occupation authorities in Holland. There is some pharmacological support for the central origin of paroxysmal tachycardia. Thus Klein (1940) described a schizophrenic patient who when treated with pentamethylene tetrazol developed supraventricular paroxysmal tachycardia four minutes after the injection of the drug. He suggested that the delay between the injection and the onset of the attack indicated that the attack was due to an effect of the drug on the central nervous system. Several different workers (Evans, 1940; Peters and Penner, 1946) have claimed that intravenous injection of ergotamine tartrate will relieve an attack of supraventricular paroxysmal tachycardia within a few minutes. Rothlin and Cerletti (1949) have shown that the effect of adrenaline on the heart is not altered by ergot alkaloids, so that the effect of ergotamine in paroxysmal tachycardia cannot be due to an unopposed vagal effect and must therefore be due to a direct action on the brain centres which regulate cardiac activity.

This contribution is based on observations made in the course of the psycho-analytic treatment of thirty-six adolescents, 24 boys and 12 girls. These are pardy cases I have treated and supervised myself; but to a greater extent relate to material brought together over the past three years by many colleagues and students co-operating in the study of adolescents in treatment at the Hampstead Child Therapy Clinic. The study includes young people between puberty and late adolescence with neurotic or borderline psychotic disturbances. Cases are not included which presented a clear picture of delinquent personalities from the outset, though this does not mean that in the course of treatment such features have not appeared. The appearance of impulsive and delinquent features in clinical pictures where we would not expect them in other age groups belongs to the typical experiences and problems of treatment during this phase.

This study is concerned with the relationships between TAT measures of Organization and Hostility and scores on Progressive Matrices (PM), Age and Stay (time in hospital) in a schizophrenic sample.

Complaints about lack of sleep are frequently made by patients diagnosed as depressed, and various recent studies have examined this symptom by attempting to measure sleep either objectively or subjectively. In the former approach bed movements have been recorded by Cox and Marley (1959), Hinton and Marley (1959), and Hinton (1961, 1962), while Oswald et al. (1963) have based their work on EEG changes during sleep. Since lack of sleep is essentially a personal experience, most of the objective data have been combined with subjective records, such as patients' descriptions of sleep, patients' and nurses' ratings of sleep, patients' estimates of length of sleep and nurses' observations of length of sleep. Isaacs (1957) comments that no one method used alone provides a satisfactory estimate of the hypnotic properties of drugs.

The entire population of Tristan da Cunha (264 islanders and 29 temporary inhabitants) was evacuated in October, 1961, after a volcanic eruption which, although it occurred in close proximity to the settlement, only damaged one out of the 70 buildings and caused no casualties. The evacuees were taken first of all to Capetown and thence by sea to England, where they arrived in November, 1961. Temporary hutted accommodation was found for them at Pendell Camp, an army establishment near Redhill, Surrey, where they spent the first eight weeks of their first English winter in conditions of some discomfort. In January, 1961 they were transferred to more permanent homes in R.A.F. married quarters at Calshot, a small place situated on the western bank of Southampton Water near its junction with the Solent.

The social adjustment of individuals is studied from different viewpoints by psychiatrists and sociologists. The psychiatrist is concerned with the malfunctioning personality (and with normal function toward which patients must be assisted); the sociologist is concerned with the functioning social system. The basic reference of both disciplines is to the individual and the individual's adaptation in his social group.