A revival of interest in psychiatric classification has led to the use of statistical techniques such as factor analysis to help describe the depressive population. Several recent factor analytic studies rating symptoms in depressed patients have had results which portray a common clinical pattern (Hamilton and White, 1959; Kiloh and Garside, 1963; Rosenthal and Klerman, 1966b; Rosenthal and Gudeman, 1967). In each of these studies the first or primary factor has suggested the endogenous depressive pattern. In the most recent of these papers we presented the first factor in our study of 100 depressed women (Rosenthal and Gudeman, 1967). This factor was shown to be similar to the principal factors of the other studies, and to suggest the “endogenous” or “autonomous” pattern. This replication has been an encouraging indication that studies carried out in different patient populations may indeed give reproducible symptom patterns.

It is now widely accepted that abreaction as a technique can most usefully be applied in the field of psychoneurotic reactions arising from exceptionally traumatic experiences. During the last world war, ether and intravenous barbiturates were extensively used in the treatment of battle neuroses, often with dramatic results (Sargant and Slater, 1940; Shorvon and Sargant, 1947). For the less spectacular syndromes of peace-time, such methods are probably best applied to investigation and elimination of resistances encountered in the therapeutic situation (Horsley, 1943).

The recent proliferation in mental hospitals of industrial units has created a need for some system of reporting on the work done by patients undergoing treatment in them. This paper is based upon four years experience of using a particular report form, provides some data about the validity and reliability of the form, discusses its shortcomings and concludes with a recently amended version of the form which it is hoped will be superior.

The effect that childhood experience may have upon the individual's adult life has always been a subject of great interest.

Since the publication of Freud's essay on “Mourning and Melancholia” (1917), much thought has been devoted to the influence of bereavement in childhood, more especially as an antecedent to depressive illness in the adult. Bereavement is peculiarsluyitable for such an investigation since the death of a parent is one of the few reasonably frequent events which are largely independent of the behavioural pattern of the family.

A number of factors are recognized as being of importance in the prognosis of “Myxoedematous Madness” (Asher, 2), and these are discussed in some detail below.

The purpose of this paper is to publicize another factor, namely accidental hypothermia, which, by causing a super-added confusional state, can greatly increase mental disturbance. That this additional psychiatric disorder may be rapidly reversible is demonstrated by the following case report.

There have been a number of studies attempting to quantify anxiety under stress, using biochemical measures such as plasma Cortisol concentration and urinary catecholamine excretion as concomitants of the emotional response. A limitation of some of this work has been the lack of predictable and adequate stresses studied, which have included disturbing interviews (Bliss et al., 1956), admission to hospital and anticipation of operation (Mason, 1959), stressful films (Levi, 1965) and hypnotically induced anxiety (Persky et at., 1959).

Steroid hormones may produce a wide variety of psychiatric syndromes (1), (2), and the progestational steroids are no exception. We were alerted to this by the occurrence of an acute schizophrenic psychosis following the withdrawal of 30 mg. Enovid (Enavid) daily, which was being used to control endometriosis (3). The patient's psychotic symptoms showed remission with drug replacement and relapse on placebo.

The Renal Unit of the Queen Elizabeth Hospital, Adelaide, South Australia, provides the only specialized renal service for the State's population of one million. Established two years ago, it has developed a programme of recurrent haemodialysis and has used recurrent peritoneal dialysis for a period. It is associated with a renal homotransplantation programme. The Unit staff consists of a full time Director, one Senior Medical Registrar, a Senior House Physician, nurses and technicians. There is a close liaison with the University of Adelaide Department of Surgery which has been responsible for establishing and running the homotransplantation programme with a staff of a Senior Lecturer and the assistance of two Honorary Assistant Surgeons. The psychiatrist works closely with the group and interviews all patients entering the programme. His role has been that of an observer and adviser on the management of patients in chronic renal failure, and in the psychological screening of potential kidney donors.

The effect of loss of parents during childhood has been the subject of many studies. Although most reports agree that some emotional disturbance occurs in the child, it is not yet clear what are the late effects of such separations in adult psychiatric health and behaviour. Brown (1961) and Munro (1965) pointed out that childhood bereavement before the age of 15 is not a rare experience: both studies report an incidence of over 19 per cent, in non-psychiatric populations. While some studies (e.g. Brown, 1961) reported an increased frequency of bereavement in childhood in depressed patients, other studies (e.g. Hopkinson and Reed, 1966) failed to confirm this. Furthermore, as Ainsworth (1962) pointed out, the term “parental deprivation” requires careful definition. It can refer to insufficiency of parent-child interaction (which cannot be assumed to follow automatically in every separation, because of the presence of parent substitutes), to grief reactions which may be supposed to follow parental loss and predispose to depression (Bowlby, 1961) and to distortions of parent-child relationships. The psychological consequences of parental loss could be expected to differ according to the degree of pre-separation distortions of relationships.

It has been routine psychiatric practice in recent years to prescribe vitamins in alcoholism and confusional states and sometimes in other organic psychoses. The doses given are massive, varying from about ten to twenty times those strictly necessary in deficiency states. This empirical therapy is supported neither by controlled trials nor by direct evidence of vitamin deficiency.

Working in a rehabilitation hospital (Morgan et al., 1965) for long-term psychiatric patients, many of them chronic schizophrenics, the author has been struck by the extent to which some of them are ignorant of the names of other people. This ignorance has been observed in formal therapeutic group situations, at formal interview, and in informal conversation. Whatever the situation may be, such ignorance hampers communication and causes socially incompetent behaviour on the part of the patient.

Although abnormalities in physique in mental patients have been reported many times (see review by Rees, 1960) their cause and significance are obscure. Rey and Coppen (1959) reported the results of an investigation into the physique of mental patients using a measure of sexual maturation known as the androgyny score (Tanner, 1951, 1962).

There is still much disagreement about the best way to treat patients with phobic states. Until recently, drugs and various forms of psychotherapy have mainly been used. Lately, behaviour therapy has also come into use, as graded retraining in practice (Meyer and Gelder, 1963), or as desensitization in imagination (Rachman, 1959; Wolpe, 1961). Since few investigations have included adequate control groups, results such as those of Wolpe (1961) cannot indicate whether behaviour therapy is an advance on existing forms of treatment.

Symptoms of depression as a clinical entity have been the object of factor analyses by Hamilton (1960) and by Overall (1962). In each of these studies data consisted of observations of male in-patients whose hospital diagnosis was depression. Subjects were rated on the basis of interview behaviour in sets of items considered relevant to clinical concepts of the disorder. Dimensions obtained in Overall's analysis agreed very closely with factors which had previously been identified in psychiatric ratings of schizophrenic patients (Lorr, 1953; Lorr, McNair, Klett, and Lasky, 1962; Overall and Gorham, 1962). This finding was interpreted as evidence that “certain basic factor dimensions appear in various different types of patients” (Overall, 1962). Hamilton felt that a single word-label might describe qualitatively different behaviours, depending on diagnosis; he therefore insisted on the importance of context (nosological category) in assessing the significance of any given symptom.

A previous study of the incidence of subjective ideas of sexual change in male schizophrenics has briefly noted the lack of precise quantified data in the literature and the standard English language teaching texts (Gittleson and Levine, 1966). There are no controlled studies of these ideas in female schizophrenics. The studies of Klaf and Davis (1960), Planansky and Johnston (1962) and Lukianowicz (1963) refer only to males.

The first human renal homotransplantation was performed in 1936. Recently, with the introduction of improved immuno-suppressive techniques, this operation has been carried out on an increasing number of occasions. The first renal homotransplantation in South Australia was performed in February, 1965. The donor was related by marriage to the patient and was not consanguineous. The patient is still alive and at work sixteen months later (June, 1966).

It is becoming increasingly important, in the administration of psychiatric units, to single out the likely absconder from the rest of the hospital community. The following study has been embarked upon partly to outline a sketch of a hypothetical absconder, and partly to lay down a method of study which could be applied to other institutions with similar problems. The problem of absconding is of comparatively recent origin, as the “open door policy” has become generally adopted in British mental hospitals.

The syndrome of multiple motor tics accompanied by explosive utterances was originally described by Itard (1825) and later differentiated as a syndrome by Gilles de la Tourette (1885). Koster (1899) discovered two cases among 2,500 patients admitted to a hospital for nervous diseases in Leipzig and found only 50 recorded cases in the literature available to him. Since then, cases have been reported from Germany (Strauss, 1927), Switzerland (Heuscher, 1950), Poland (Dolmierski and Klossowna, 1958), France (Seignot, 1961), Finland, (Salmi, 1961) and Canada (Baker, 1962), in addition to several from the United States and Great Britain (see below). Mahler et al. (1945) found that 18 out of 541 children admitted to a children's ward in a New York psychiatric hospital had tics, but only 11 of them suffered from “the tic syndrome” (Mahler and Luke, 1946)—a synonym for Gilles de la Tourette's syndrome. Ascher (1948) found four cases of this condition among 9,000 in-patients and 50,000 out-patients at a psychiatric centre in Baltimore. There was only one case detected among 5,300 children attending an education guidance centre in Turku, Finland (Salmi, 1961). Creak and Guttman (1935) found 14 cases in which tics were noted in the diagnosis among in-patients of the Maudsley Hospital, London, between 1932 and 1935. The rarity of Gilles de la Tourette's syndrome is such that a review of published case reports is the only feasible method of surveying the broad aspects of the condition. Three cases treated at Runwell Hospital, Wickford, Essex, and a fourth case treated personally in London are presented and published case reports reviewed.

Several workers have suggested that important differences exist in the cognitive disorders shown by patients in the various sub-groups of schizophrenia (Shakow, 1962, Lothrop, 1961). In this report the cognitive disorders investigated are those measured by the following tests: the Bannister-Fransella test (1966), which aims to measure “looseness and inconsistency in the use of constructs (concepts)” and two tests from the Payne-Friedlander (1962) battery intended to measure “over-inclusive thinking”—the Payne Object Classification test (Payne, 1962) and a modification of Benjamin's Proverbs (Benjamin, 1944). The differences among the schizophrenics which are considered are those between the acute and chronic stages of the illness and between paranoid schizophrenia and the non-paranoid varieties of the illness—hebephrenia, catatonia and simple schizophrenia.

Leucotomy has been used to treat many patients with schizophrenia. Although some patients seem to have derived considerable benefit from the operation, a number have shown little or no improvement (Board of Control, 1947, Tooth et al., 1961). An appreciable number of schizophrenic patients who have had a leucotomy remain long-stay patients in mental hospitals. In the last few years there has been an increased emphasis on the rehabilitation of chronically disabled psychiatric patients and the purpose of this paper is to assess the response to rehabilitation of long-stay schizophrenic patients several years after a leucotomy operation.