Trifluoperazine, which is 2-trifluoromethyl-10-(3′-[1″-methylpiperazinyl-4″]-propyl)-phenothiazine dihydrochloride—a preparation manufactured by Smith, Kline and French Laboratories Limited under the description SKF5019—is the most recent phenothiazine derivative reported to have a beneficial effect on certain types of mental illness. On the basis of animal tests trifluoperazine is described as having nine times the potency of chlorpromazine in blocking the conditioned response, and its specificity is greater than that of chlorpromazine.

It is often of importance in a psychiatric department to ascertain whether a patient has consumed the Largactil prescribed, e.g. on occasions when a patient appears only to be slightly affected by Largactil. Dubost and Pascal demonstrated that a Largactil solution mixed with equal quantities of concentrated sulphuric acid gives a marked carmine red colour which is so stable that the intensity of the colour may be measured in a spectrophotometer. In biological fluids, Largactil must first be extracted with ether and then transferred to the aqueous phase before the determination can be undertaken. By experiments on rabbits and dogs, these authors found that up to 5 per cent. of the Largactil administered is excreted in the urine in the course of 24 hours and a total of up to 8 per cent. is excreted in the course of the first few days.

In spite of the enthusiasm with which schizophrenic patients have been treated by physical methods over the past twenty years, there is surprisingly little evidence enabling us to compare the results of one physical treatment with another, or the physical treatments themselves with the treatments they replaced. Some writers (Polonio and Slater, 1954; Rees, 1949) point out a significant improvement over the spontaneous recovery rate with the use of insulin, while others (Jensen, 1952) find no such improvement. Bourne (1953) and Notkin et al. (1939) go so far as to claim that any improvements of insulin-treated patients are due to the extra care and attention they receive, and the work of Ackner and his colleagues (1957) may support this conclusion. Linford Rees (1949) comparing electrical treatment with insulin concluded that electro-shock therapy was far less effective than deep insulin therapy in the treatment of schizophrenia—a conclusion in line with that of Finiefs (1948). On the other hand Impastato and Almansi found very little difference between E.C.T. and insulin treatment in this respect.

It is not only the directly observable therapeutic effects of treatment which will determine the value of that treatment—in many cases the accompanying side effects are equally, if not more important, depending upon their nature and severity.

Promazine hydrochloride (“Sparine”) is a phenothiazine derivative which has recently been introduced to this country with claims to be a “tranquillizing” drug. It is closely related chemically to chlorpromazine but does not contain the chlorine atom which has been thought to cause the undesirable side effects of the promazine group. The structural formula of Sparine compares with that of chlorpromazine as follows:

That chorea may sometimes occur as a result of cerebral syphilis has been accepted for some years (Kinnier Wilson 1940) and it has often previously been reported in association with G.P.I. The literature on the topic is dealt with by Lowrey and Smith (1918), Stone and Falstein (1938) and Weickhardt (1945). In all the reports however I can find only three previous instances where clinical and serological evidence of G.P.I. in a patient was associated with a family history and clinical syndrome of Huntington's chorea. These cases were reported by Pagliano and Aviennos (1922), Urechia and Rusdea (1922) and Stone and Falstein (1938) and the case here described appears to be only the fourth similar example to be reported. It has a practical as well as an academic interest since the differential diagnosis of the early stages of Huntington's chorea from those of G.P.I. is still sometimes necessary.

MC4703 is a new phenothiazine derivative which contains a trifluoromethyl group and which was made available in the form of 10 mg. and 50 mg. tablets by E. R. Squibb & Sons for clinical evaluation as an ataractic or “tranquillizing” agent. The interesting results obtained with the drug justify the presentation of this brief, preliminary report, but a more detailed account of the investigation will be supplied in due course.

The preparation of the men to staff the psychiatric centres and services, the laboratories and installations which have come into existence in such numbers and within so short a period in almost every country has been a task of the first magnitude.

Phenothiazine derivatives have been widely employed in the management of schizophrenia over the past few years. Possibly the most commonly used has been chlorpromazine under its trade name “Largactil”.

Head injuries in children have been studied less extensively than those in adults, in particular, their psychiatric aspects. Ssouchareva and Einhorn (1935), Blau (1936), Riggenbach (1946), Fabian and Bender (1947), Lutz (1951) and others have given special attention to such aspects. However, there are still marked discrepancies in the assessment of the various aetiological factors and their prognostic importance in determining prolonged psychiatric sequelae.

For the past twenty years we have been studying methods of teaching and their effectiveness in changing the behaviour of medical students and doctors. At the Massachusetts General Hospital our work was concerned primarily with teaching psychotherapy to medical students, residents and younger physicians. During these years we have practised and taught many kinds of psychotherapy, including situational therapy, relationship therapy such as catharsis, support, reassurance, suggestion and persuasion, and the various types of insight therapy from the verbalization and understanding of simple correlations to more extensive Freudian psychoanalysis. The patients we treated in Boston were primarily those with psychoneuroses and psychosomatic disturbances. In these groups of patients insight therapy was the method of choice. It was only when insight therapy was impracticable or too disturbing to the patient that other methods such as relationship therapy were used. During these years we used insight therapy whenever possible, often with limited effectiveness. The treatment for any given hospital admission required from 20 to 40 interviews, occasionally more. It was our practice to use the vis-à-vis interview method.

Cyclizine hydrochloride (1-benzhydryl-4-methylpiperazine monohydrochloride) is a popular remedy for motion-sickness. The success which is reputed to attend the use of the drug in this condition may be a function of of two distinct effects: (a) a direct, specific inhibition of the vestibular mechanism; (b) a general, central inhibition or sedation. A consideration of the latter, rather than the former, suggested the possibility that cyclizine might prove to be of value as a potential “tranquillizer”. A controlled clinical trial was carried out in order to establish whether any tranquillizing effects might be associated with the use of the drug in a number of chronic psychotics, all of whom manifested some gross disturbance of behaviour. This paper describes the experimental method which was used; the results which were obtained; and a general comment upon the possible implications of the results in relation to other drugs used in psychiatry.

Benda (1947) has reported values falling within the normal range for the serum calcium, phosphate and alkaline phosphatase in mongolism. More recently however Sobel et al. (1956) have stated that, while the inorganic phosphate and phosphatase are normal, the serum calcium is low in mongolism. The data on which this report was based do not appear to have been published to date. Further information on this point therefore seemed desirable.

A series of studies published since 1951 attempted to clarify what is meant by the neurotic in human nature. In returning to this problem today, I must beg your indulgence for repeating myself at some points. Apart from the kindness of your chairman in inviting me to discuss the Neurotic Process as my contribution to this symposium, my further justification is the opportunity which it gives me to add a few considerations which may round out the hypothesis and make it more useful, and also to indicate that the neurotic process is the meeting place for the organic and psychological approaches to problems of human behaviour (4, 5, 7, 10).