Frontal leucotomy has been used in the treatment of psychiatric illness for over twenty years. Its popularity has undergone the usual fluctuations of a newly-introduced form of empirical therapy, and at present there are many different opinions about its value (Lancet, 1962; Pippard, 1962). For a critical review of the clinical and psychological literature, see Willett (1960). The standard operation has fallen out of favour, not because it was thought to be ineffective, but because it had undesirable side-effects on the personality. Various “modified” operations have, therefore, been introduced. Using one of these—the “orbital undercutting” technique—Knight (1960) has reported excellent results in 129 cases of long-standing depression. Robin (1958, 1959), however, has reported no difference between the outcome for 198 patients who had a standard leucotomy for functional psychoses, fifty-two of them affective, and an equal number of carefully but retrospectively matched controls.

It is widely recognized that somatic complaints are frequently encountered in depressive illness and in some instances these may predominate in the clinical presentation. Studies relating to the occurrence of such symptoms in depression have been reviewed by Cleghorn and Curtis (1959), who point out that in a number of patients mood disturbance may not be readily apparent. It is not unusual for these patients to be referred initially to a general medical or surgical clinic, where after investigation it is concluded that their complaints cannot be understood in terms of physical disease (Stoeckle and Davidson, 1962).

A fundamental area, if not the fundamental area, of psychological disturbance, according to classical Freudian psychoanalysis, as is well known, is the fear of being castrated. According to Freud (10; 11, p. 267) this is a fear of being castrated by the father as a reprisal for incestuous desires toward the mother. So closely is the fear of castration related to the father that Braatøy (4) has suggested that it be renamed “father anxiety”. None the less, the concept of the castrating mother also plays a prominent role in psychoanalytic literature. De Monchy (7) Blos (2), Fairbairn (8), Klein (18), and Bergler (1) are among those who have most emphasized the fear of the mother.

Imipramine and amitriptyline have each been tested by controlled trials and have been shown to be effective (Garry et al., 1963; Skarbek et al., 1962; Ball et al., 1959; Leyberg et al., 1959, and many others). Their uses have been discussed in articles in the “Today's Drugs” series in the British Medical Journal for 1959 and 1961 respectively. The literature has been summarized by Burt et al. (1962).

The need for the assessment of phenothiazines and other drugs used in mental conditions is increasing as new products are described. Testing these drugs on patients is cumbersome and time-consuming. It would be valuable if a preliminary test could be made on some animal in which the effect on the nervous system can be easily assessed.

In our previous paper (Humphrey and Ounsted, 1963) we found that the symptoms and behaviour problems of children adopted in early infancy resembled those of children reared by their own parents. A significant trend appeared only among children adopted after the age of 6 months, who were more prone to anti-social conduct. But the proportion of adopted children referred to the Park Hospital for Children over a four-year period (2·9 per cent.) was more than double the corresponding estimate for the general population. It is tempting to attribute at least part of this excess to the relatively large number of delayed adoptions in our sample, of whom 34 out of 80 (43 per cent.) were aged 6 months or more at the time of placement.

The only previous studies are referred to in Mental Hospitals at Work (Jones, 1962) and it is stated, “In recent years some attempts have been made, though to our knowledge none have been published, to estimate the amount of time which psychiatrists in mental hospitals actually spend in the care of patients”. In our opinion the topic of medical staffing has received little official recognition. Our own assessments are explained in this article with a view to finding some sort of base line and general agreement.

Whilst it is well known that drugs can cause behavioural changes (Trouton and Eysenck, 1960) relatively little attention has been given to the effects of drugs on complex cognitive functions. The purpose of this study was to determine the effects of two drugs frequently used in psychiatric treatment (chlorpromazine and chlordiazepoxide) on performance in problem solving situations as well as in tests involving speed and accuracy.

Though there have been many studies on the pharmacological approach to depressive illness, opinions as to the indications for anti-depressant medication and the most appropriate substance to prescribe remain far from any state of general agreement.

Cosaldon has been fairly widely used on the Continent in the treatment of dementia and toxic confusional states. Meyer (1957), Leube (1959), Sperling (1960), Schmidt (1960), and Donati (1960) consider the drug to be of particular value in the treatment of arteriosclerotic dementia, and stress that the earlier the treatment is commenced the more favourable is the response.

E.C.T. is rightly regarded as a highly safe procedure and, although several thousands of treatments are given annually at this hospital, the occurrence of any serious complication is extremely rare.

Although much effort has gone into the description and classification of schizophrenic behaviour patterns, little attempt has been made to detail the course of the disorder. The present paper is an effort to trace the effects of chronicity on perception by use of a cross-sectional method. The specific tasks were selected to maximize autochthonous factors in perception. At the same time a demonstrable sensitivity to emotional states was desired, since changes in the schizophrenic condition are often considered reflections of reaction to stress. A wide enough area of behaviour was encompassed so that a general pattern, if one emerged, could be considered typical of perception as a whole.

A comparison of imipramine and electroplexy in 31 depressed patients selected for the latter treatment has already been reported (Robin and Harris, 1962). The following study concerns depressed patients chosen for conservative measures.

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)).

Extra-pyramidal reactions following on the administration of the major tranquillizers have been frequently reported on (May and Voegele, 1956; Druckman, Seelinger and Thulin, 1962; Freyhan, 1957).

The diagnostic classificatory system in use in modern psychiatry appears to be the product of countless acts of “subjective factor analysis”. Psychiatrists have observed that particular symptoms tend to occur in clusters, and these clusters have been labelled and given a status akin to that of disease entities in general medicine. It is a continually developing empirical system, and it is customary to reexamine such systems periodically to assess the state of current practice and its validity.

In studies of the incidence and prognosis of disease in the elderly it is valuable to have an objective measure of the patient's mental state. In a previous paper (Isaacs, 1962) a paired-associate verbal learning test devised by Inglis (1959) was applied to a group of 50 normal and 100 hospitalized old people, and was found to give useful information on the relationship between test performance and such factors as incontinence of urine and prognosis for rehabilitation. In the present study a simplified version of this test was performed on a larger number of elderly hospital patients. The test proved valuable in determining the characteristics of patients with varying degrees of mental impairment.

The literature contains only a few reports on plasma 17-hydroxycorticosteroids (17-OHCS) in mental patients (Bliss, Migeon, Branch and Samuels, 1955; Freeman, Steed, Hoegemeier, Wheeler, Savage and Wadeson, 1956; Board, Wadeson and Persky, 1957; Hoagland and Freeman, 1959). According to these investigators the mean values in schizophrenic patients do not differ significantly from values found in normal subjects.

Early in our clinical studies with the phrenotropic drugs, reserpine and chlorpromazine, we observed that psychotic patients receiving them were more resistant to treat for infectious processes that occurred during their hospitalization (Saunders, 1961). We also observed that in experimental animals, the LD50 of a standardized dose of bacteria was significantly increased if the rats had been previously treated with a phenothiazine. Preliminary observations led us to consider the role of these drugs in protein synthesis, with specific interest in the gamma globulin, since antibodies are associated almost exclusively with this fraction. Further interest in the problem of protein synthesis was stimulated by the reduced albumin and increased globulin levels found in most chronic psychoses, as the phrenotropic drugs are capable of significantly shifting this ratio toward normal. The question of phrenotropic drug action on antibody synthesis was asked at the Second International Congress of Psychiatry in September, 1957, and no specific information was known to the participants (Saunders, 1958). With this background, the question warranted further study in man. We designed our experiment to measure antibody response to oral poliovirus vaccine, Cox strains types 1 and 3, during phenothiazine therapy.