The nature of the episodes of severe mental disorder which Strindberg suffered after the age of 45 has led to considerable discussion, much of which must remain inconclusive until all the relevant documents, some still awaiting publication, can be assessed. On the basis of present evidence, the diagnosis of an affective, schizophrenic, or toxic state is considered, and the views of earlier psychiatrists are discussed.

A carefully controlled comparison of communication defects and deviances in parents of schizophrenics and neurotics was undertaken using the 41-category Rorschach manual of Singer and Wynne. Subjects were tested and scored blindly and scoring was shown to be reliable. Although a statistically significant difference was found between the two groups, the marked overlap of the distribution of scores found in this study is not compatible with theories advanced by other authors concerning communication abnormality in parents of schizophrenics. Evidence is presented which provides a more parsimonious explanation of the difference between groups and leads to a hypothesis which would explain the failure of this study to confirm the striking differences between groups reported by previous workers.

A cohort of patients from Camberwell, who had been in psychiatric hospital for one year or more on 31 December 1964, is described. The attrition rate for this group, and the accumulation of ‘new’ long-stay patients from the area since that date, are analysed, and compared with published data from other studies. In the light of the resulting overall decrease in the long-stay population with time, possible trends in the future can be considered.

A self-assessment inventory for measuring severity of depressive illness is described, Its chief merits are brevity and simplicity. The correlation with the Hamilton Rating Scale is +0·87. At a cut-off level of 14–15 points 3% of patients and 7·5% of ‘Normals’ are misclassified. The mean scores for male and female patients do not differ significantly and the small positive correlation of score with age is of little practical significance. The limitations in this inventory are discussed but, despite them, it has practical value and merits further development.

Some current problems in clinical psychopharmacology are examined and pharmacological approaches towards their elucidation outlined and discussed. Particular topics reviewed include the concepts of potency and maximum effect, the balance between wanted and unwanted effects, and the problems of heterogeneity and variability as they apply to patients and their responses to psychotropic drugs. Types of methods for the assessment of drug effects are listed and the growing importance and relevance of pharmacokinetic studies stressed. A more general and intensive use of the pharmacological approach is urged in order to acquire much-needed basic data on psychotropic drug action in man.

Specific cortical somatosensory evoked responses were recorded in nine patients suffering from senile dementia and eight elderly depressed patients. The results were as follows. (1) The latencies of each peak were longer in the demented than in the depressed group but this difference was significant only for peak 3 (the second negative deviation). (2) The late negative deviation (peak 5) was either absent or very flat in demented patients. The ratio of the amplitude of this late wave to that of the first peak discriminated between demented and non-demented patients at the 0·5% level. (3) The value of this ratio combined with that of the latency of peak 3 could be used to classify all but one patient into the correct diagnostic group. The results are discussed in the light of the relevant literature. It is suggested that slowing of conduction in the nervous system may be a very basic disturbance associated with cognitive impairment in old age and that measurements of this kind may come to assist in the diagnosis of dementia.

Folate (RBC, serum, CSF) and B12 (serum and CSF) and 5-HIAA and HVA (CSF) concentrations were measured in patients with senile dementia. Those with RBC folate < 130 ng/ml. were given folate/B12 in a double-blind crossover trial. (1) Amine metabolites and folate were unrelated. (2) CSF folate levels rose significantly but slowly on ward diet only independently of the period of intensive replacement. (3) There was no clinical improvement over the 24 weeks of observation but in view of the biochemical findings the period of study may have been too short.

A 27-year-old man developed signs of personality change after exposure to carbon monoxide. One month later a second exposure was followed by an akinetic mute state with unusual motor seizures, probably associated with tentorial herniation and brain-stem compression. Elimination of carbon monoxide was unduly prolonged after the second exposure. The patient showed clinical evidence of dementia, but there has been a gradual improvement in cognitive and social functioning over two years.

In a barbiturate dependent patient, the blood barbiturate was less than 0·2 mg% two and a half hours after an oral dose of 200 mg amylobarbitone sodium. Amylobarbitone was withdrawn, and the patient was maintained on phenobarbitone, with a blood barbiturate level that remained at about 4·0 mg% over several weeks. Themost likelyexplanation of the findings is that the oxidation of amylobarbitone, but not phenobarbitone, is accelerated in patients dependent on the former drug.