The scores of 269 depressed patients on the Depressive Category-Type Scale were analysed. The distributions of component and total scores were found to be bimodal, indicating that most depressed patients can be divided into an endogenous group and another characterized by the presence of neurotic features and the absence of endogenous ones. These findings were discussed in relation to those of other investigators. The relationship between the differentiation of syndromes and the classification of patients into corresponding diagnostic groups was considered. Finally, it was suggested that it should be interesting to try to estimate, from published data, the correlation between endogenous and neurotic depression in the general population.

A one-day census was made (from the Camberwell Register) of children excluded from education in school, children in ESN schools with IQs of 49 or below, and pre-school children suspected of being severely retarded. Their service placements were again recorded 26 months later. Comparison with other prevalence studies suggests that the ‘true’ prevalence of severe retardation (IQ 49 or below) for school-age children in the United Kingdom at the present time is approximately 3·6 to 4·0 per 1,000 (age-specific rate). About 40% of these children are also non-ambulant, or severely incontinent or have severe behaviour disorders. Early identification and plentiful provision of day places alone do not necessarily reduce the demand for residential accommodation. Detailed studies are needed to determine the factors which exacerbate or minimize the problems faced by families with severely retarded children.

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.

As part of a study of various aspects of differential development between the sexes, the series of patients with epileptic psychoses published by Slater, Beard, and Glithero (1963) was reanalysed in the light of a hypothesis of differential cerebral maturation. As predicted by the hypothesis, females had an earlier onset of epilepsy and of psychosis than males. Whereas the sex ratio in epilepsy normally shows an excess of males, the sex ratio in epileptic psychoses is almost equal. Unlike most chronic temporal lobe epilepsies, the epilepsies which were later associated with psychosis arose largely within a specific developmental epoch around the pubertal growth spurt. Some of the clinical and biological implications of this finding are discussed.

A stratified sample of 404 prisoners and ex-prisoners from three contrasted London prisons were interviewed: 40% were found to be excessive drinkers, although drunken offenders with very short sentences were excluded. The significant differences between heavy drinkers and the rest are considered in relation to history and social status.

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.

The use of a technique of Declining-dose Drug Desensitization (DDDD) in phobic patients is described. An anti-anxiety drug is used (diazepam), the blood level declining during each treatment session and the starting dose for each treatment session being gradually reduced. Some relevant animal work on state-dependent learaing in the drugged-state is briefly reviewed. Despite the multiplicity of other treatments available this method would appear to have some advantages.

An attempt has been made to explain the changes in uric acid levels observed in the phase of manic depressive illness by suggesting that they may be a reflection of changes in brain RNA metabolism. The effect of prolonged lithium administration on RNA synthesis in rat brain and liver has been studied. Differences in the rate of turnover of brain RNA between the lithium-treated and saline control animals have been observed.

Problems arising from the categories used in the Eighth Revision of the International Classification of Diseases, and from some of the definitions included in the British Glossary, are discussed. Suggestions are made for changes which would facilitate the use of the I.C.D., firstly for furnishing quantitative data to answer questions about groups of cases, and secondly for retrieval of information about patients with particular syndromes for purposes of research studies. Finally, a multi-axial system for diagnostic coding is described.

Published drug trials with neurotic patients are surveyed and rating scales and other improvement criteria are tabulated and related to outcome. These findings are compared with the results of studies which were designed to evaluate the effectiveness of various improvement criteria. The principles of the construction of distress scales and the method of testing reliability and validity of scales which purport to measure changes are discussed.

A questionnaire concerned with dependency, mainly in the mother–child relationship, and intended for use in child psychiatry, is described. It was administered to the mothers of 116 randomly selected junior and secondary school children in the general population, stratified into age, sex, social class, and school groupings. Two meaningful dimensions were revealed by principal component factor analyses: one concerned with reliance on mother and the other reflecting sociability. Reliability and validity were found to be satisfactory.

Patients with ‘secondary’ affective disorder differ from those with ‘primary’ affective disorder in that there are additional symptoms of their pre-existing illness among the former. Hysteria, anxiety neurosis, antisocial personality, alcoholism, and drug dependency are the psychiatric conditions most frequently associated with ‘secondary’ affective disorders. There are other differences which may also be related to the presence of pre-existing illness. These differences include the findings that patients with ‘secondary’ affective disorder are younger, more often male, and are rarely manic; they suggest that it is appropriate to distinguish between ‘primary’ and ‘secondary’ affective disorder for research purposes.

A case of acute schizophrenic psychosis developing during the treatment of hyper-thyroidism with carbimazole is described. The patient was clinically and biochemically euthyroid at the time the psychosis developed. It is suggested that an acute alteration in thyroid status, without necessarily producing hyper- or hypothyroidism, may be sufficient to induce a psychotic reaction.

This paper, an abbreviation of the first Aubrey Lewis Lecture, concerns itself initially with the evolution of the institute concept as a part of western institutional development. The growth of the concept of the institutes of psychiatry as organizations in medicine, initially bringing together the biological, psychosocial, and clinical sciences as they relate to the field, is documented briefly in the history of the beginnings of the New York State Psychiatric Institute, the earliest established institute in the specialty. Later sections of the paper concern themselves with the conflicts between the goals of these institutes, those of related universities, the supporting governmental agencies, and private supportres. The author discusses the problems inherent in bridging the gap between the formation of a multidisciplinary institution and one which may come to function effectively in an interdisciplinary fashion. Consideration is given to the theoretical and administrative measures potentially valuable in bridging this gap. This abbreviated version of the lecture deletes the evaluation of those factors which have led to the widespread development of the institutes of psychiatry.

The Clinical Research Department was started at Graylingwell Hospital, Chichester, Sussex, by Dr. J. Carse in 1947, when the hospital was administered by Sussex County Council. The first director was Dr. (now Professor) E. Stengel, and he undertook the first systematic follow-up of leucotomized patients. From 1950 to 1955 the director was Dr. Martin Roth; his studies on the psychoses of old age, and especially those delineating depressive psychoses, are now a landmark in clinical research. At about this time, the means by which clinical research in the National Health Service hospitals should be administered was reviewed and a policy evolved whereby departments in which clinical research was prospering and whose further development would make financial demands beyond those available to the regional hospital boards would be considered for support by the Medical Research Council.