The present paper will deal with eye blink frequency and its relationship to scores on “personality” questionnaires and to frontalis and right forearm muscle tension measured electromyographically. This analysis forms part of a larger experiment with the main aim of investigating levels of muscle tension in four groups—(i) introverted neurotics, (ii) extraverted neurotics, (iii) extraverted normals and (iv) introverted normals—during relaxation and while responding to a series of questions about neurotic symptoms.

The senile emotional disorders are now a major problem in mental hospital practice and their incidence increases with age. It is fortunate, however, that a better understanding and recognition of these affective disorders has, in most cases, led to early treatment and recovery.

In a recent investigation the present author has shown that glucose tolerance (G.T.) was significantly lower in a group of middle-aged mental hospital patients suffering from severe depression, than in a non-psychiatric group of similar age distribution (Pryce, 1958). This observation is similar to many others reported earlier (see review by McFarland and Goldstein, 1939). The cause of this impairment of G.T. is unknown; it cannot be explained by defective absorption of glucose from the alimentary canal since an intravenous G.T. test was employed in the investigation mentioned. Again, defective dietary intake during the days before testing could have contributed to the decreased G.T. in only a few cases; there was also no correlation between G.T. and either general symptomatology or the patients' behaviour during testing. However, it was observed that the group of depressions weighed significantly less than the control group, though again no correlation was found between body weight and G.T. among the depressions themselves. McCowan and Quastel (1931) and others have reported a close parallel between decreased G.T. and “emotional tension”, evidence which favours an emotional cause for the phenomenon, in line with the theories of W. B. Cannon (1911).

The purpose of the present study was to evaluate the effects of hypophysectomy, the surgical removal of the pituitary gland, on the intellectual functioning of the individuals undergoing this particular form of surgery.

Beneficial results with procaine amide in the treatment of Huntington's Chorea were first reported by Goldman (1952). He was led to make an oral trial of the drug after having noticed a patient in the dentist's chair improve following an injection. He found improvement in six cases with the typical syndrome of Huntington's Chorea, of whom four had a positive family history of the disease. The evidence of improvement in these cases was partly based upon clinical observation and partly upon the patient's account of changes in his daily experience, for example, his first case had difficulty in eating, which had led to protests from other customers at a restaurant he had frequented, and this disability is said to have been satisfactorily reduced with the help of the drug.

The discovery of chlorpromazine in the Rhône-Poulenc-Spécia laboratories in France, and the subsequent early clinical studies which were carried out in that country, for example in 1952 by Hamon et al. (5) and in 1953 by Delay and Deniker (1), eventually resulted in the enthusiastic and widespread application of this compound in the field of clinical psychiatry. Chemists and pharmacologists, in many countries, have been actively engaged during the ensuing years in the search for new compounds which might prove to be more potent therapeutic agents than chlorpromazine in the treatment of mental illness. One of the tangible manifestations of their labours is the present crop of “tranquillizers” which are being extensively used in the treatment of neurosis and psychosis. Whereas opinion may be divided with regard to the real or specific value of any one of these new drugs, few would disagree with the contention that none of them is ideal. Despite the considerable number and variety of phenothiazine derivatives and other new substances which have been developed as a result of extensive research, chlorpromazine has retained much of its original therapeutic reputation, in open competition with its rivals, down the years, and is still probably the most widely used tranquillizer today. This would seem to imply that no outstanding advance has been made since the early days of the new biochemical era in psychiatry. Valuable knowledge may have been obtained as a result of the application of scientific theory and empirical methods in this field, but in terms of effective therapeutic agents the results have been meagre, with the accent on quantity rather than quality. Nevertheless, a continued search is justifiable, and any new compound which holds forth promise must be put to a clinical test if final success is to be assured and if valuable therapeutic potential is not to be summarily dismissed or heedlessly cast aside.

This contribution towards the subject is limited to three of its aspects—namely, the possible aetiological role of inherited predisposition and psychogenic factors (mainly environmental to which the patient is still exposed), the relationship between late endogenous depression and the symptoms of cerebrovascular changes, and prognosis. On the face of it, prognosis of course must ultimately depend on that of the cerebrovascular disorder but apparently hereditary and environmental factors play a more significant role. Inherited predisposition is here assessed in terms of constitutional and personality factors.

In a previous study (Kornetsky, Humphries and Evarts, 1957) it was found that the impairment of a variety of psychological processes caused by 200 mg. of chlorpromazine was not significantly less than the impairment produced by 200 mg. of secobarbital. It was also shown that the effects of drugs on psychological performance in man are related not only to the specific pharmacological activity of the drug, but also to the specific reactivity of the subject. It appeared that there was something unique to the individual which accounted for a significant portion of the effect of a drug. The present study was designed to extend these observations by reducing the number of drugs tested (in the previous study four drugs were used) and increasing the number of times a subject received each drug. It was hoped that this would give a better estimate of the effect of a specific dose of a specific drug and thus decrease the error of measurement and increase the reliability of the correlation between drugs.

In the course of time the term “porencephaly” has come to mean a condition characterized by any large circumscribed defect in the substance of the brain. Because of the unmyelinated state of the centrum semiovale in early life traumatic, vascular, anoxic or infective processes are likely to lead to a much more massive resorption of the tissues than occurs in the adult. Parts of the wall of the hemisphere may be converted into a semi-translucent membrane separating the lateral ventricle from the sub-arachnoid space. This thin sheet of neuroglial tissue usually represents the residual stretched out molecular layer of the cortex, and is a finding common to many varieties of infantile and foetal encephalomalacia (Wolf and Cowan, 1956).

A decrease of glucose tolerance in mental illness has been observed for over forty years (Kooy, 1919; Mann, 1925). Although this change in carbohydrate metabolism has been described in all types of mental disorders, the majority of investigators report that it occurs most frequently in melancholia (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944). The phenomenon has usually been regarded as a secondary effect, and several theories have been suggested to explain how it is produced (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944); however, no single explanation is firmly established, and the mechanism or mechanisms are still uncertain.

There is hardly any field of natural science where development is so erratic as that of the physiology of the brain. It is true that perhaps no branch of science develops quite evenly. Very often the domination of old and deeply-rooted theories is so strong that they cannot easily be removed under the pressure of new facts, and consequently they may hamper the progress of science in the given field for many years. But generally the development of natural science is straightforward in the sense that its every stage is a logical consequence of the previous stages, and that particular lines of investigation tend to complement each other and eventually to merge into a single whole.

This investigation deals with relationships of sodium amytal and lysergic acid (LSD) to measures of immediate memory and expressive movement as a function of exposure time. Significant differences in learning and expressive movement had been obtained previously between neurotics and schizophrenics (3, 4). The extent of these differences posed the problem why memory disturbance, as in the test, is clinically not more obvious in schizophrenics than in neurotics. It was thought that accidentally favourable conditions had been used, either in difficulty of task or in exposure time, to produce the results. The decision was taken to vary the exposure time in a pilot experiment, using LSD in normals to represent schizophrenic-like symptoms.

My first duty is to thank you for having elected me President of this Section. I am conscious that this is one of the greatest honours which can come to a psychiatrist and I shall do my very best, within my limitations, to prove worthy of it. It is customary for the presidential address to deal with a topical problem of common concern, and one on which the President can speak with authority based on personal experience. I have chosen to talk about the teaching of psychiatry. I have called my address “Reflections” in order to make it clear that I cannot offer you more than some personal observations on a subject on which I feel deeply.

“We would predict that any test which has been shown to differentiate reliably and validly between introverts and extraverts will, when applied to subjects who have been administered an excitant (or depressant) drug, show shifts in scores in the direction characteristic of greater introversion (or extraversion).” “… the effects of depressant drugs are similar to those of brain damage as far as objective psychological tests are concerned. Conversely, the effects of excitant drugs are opposite to those of brain damage.” These predictions by Eysenck (7) were tested using measures of immediate memory and expressive movement which had previously been validated against extraversion and brain damage. The measures discussed are derived from the Figure Reconstruction Test (immediate recall version).

The part played by the endocrine system in psychiatric illness is still controversial. Mental disorders may occur at the menopause or in the Puerperium, accompany thyroid or pituitary dysfunctions, or appear in adrenocortical diseases. Castration in men and women may be followed by marked personality changes. But often there are little or no mental changes, and there is certainly no clear-cut mental accompaniment of specific endocrine diseases. It is probable that mental symptoms, when they do occur, are dependent upon the basic personality structure, not upon a particular diseased gland. It is also likely that glandular dysfunction in turn can be brought about by mental stress or disorder. In other words, the two systems function together and should not be artificially separated.

In a previous study of the efficacy of a vitamin-preparation (Krawiecki, Couper and Walton, 1957), the Wechsler Memory Scale Form I (1945) was administered on four occasions to each senile psychotic patient in the trial. Although the experiment produced interesting therapeutic results the present paper is not concerned with these but rather with the diagnostic and predictive implications of the Memory Scale changes.

In an earlier study (Stengel et al., 1955), reactions of various types of mental patients to eleven different painful and noxious stimuli were described. Two groups of 54 females and 43 male low-grade defectives were included in the original investigation, but it was felt at that time that the results needed further amplification before they could be usefully commented upon. In this earlier investigation only one of us actually carried out the tests, the reliability of which, therefore, was not clearly established. Furthermore, in the original testing of low-grade defectives no assessment of “Overt Reactivity” was made. As the relationship between this factor and pain reactivity in the other patient groups constituted an important finding of the study, we came to the conclusion that it would be necessary to retest some of the low-grade defective patients with these points in mind. This seemed all the more desirable as it is widely assumed that mental defectives in general, and especially low-grade mental defectives, are grossly deficient in sensitivity to pain.

In a previous paper the results of a two-year follow-up study were reported (Walton, 1958). This study showed that when the Wechsler Memory Scale was administered four times to each patient of a series suffering from a memory defect, significant differences emerged between those patients subsequently diagnosed as brain-damaged or as non-brain-damaged, in respect of the degree of improvement in their performance. The results were of considerable diagnostic and predictive importance. In spite of this, however, the method would be an uneconomical method for routine diagnosis. A shorter test involving the same principle of successive opportunities to learn appeared necessary. Additional analysis of the final Memory Scale results also showed that present learning ability was more impaired in the organic group than in the non-brain-damaged group, whilst scores based on retentivity questions produced many misclassifications. The results strongly suggested that a test of dementia should consist of a measure of present learning ability and that opportunities to learn could best be provided by successive repetitions of the particular test.

Measurement of the residual abilities in patients suffering from senile dementia is difficult to carry out with the present techniques which, having been standardized on younger people, tend to miss many of the characteristics of mental decline through ageing.

In the present experiment measures of certainty and adequacy of certainty, derived from a test of immediate recall and recognition, were investigated in relation to d-amphetamine and amytal.