Doctors have climbed mountains with explorers and travelled the world with kings and statesmen; they have gone on humble journeys with sick folk, voyaged for money, fled from their enemies, sought new knowledge. We have travelled to learn about psychiatric opinion and practice abroad, and have greatly profited thereby.

The last twenty years have seen great changes in British administrative psychiatry. Jones (1955, 1960) has described how the mentally ill began to be assembled into special institutions for their own good (and society's protection) some 150 years ago. The humanitarian revolution associated with the names of Pinel and Tuke and the philanthropic enthusiasm of Shaftesbury and the other early Commissioners in Lunacy led to the widespread building of asylums, especially after the Acts of 1845 and 1853. This was a period of great interest in administrative psychiatry, or asylum management, as the writings of Conolly (1847, 1856) and others show. During the latter half of the nineteenth century the enthusiasm was lost and the asylums became custodial. The consolidated Lunacy Acts of 1890 and 1891 fixed a pattern of humane custody scrutinized by Lunacy Commissioners which persisted little changed for 50 years. Custodial decline was also seen in the United States and some causes of it have been discussed by Bockoven (1956) and Ozarin (1954). In the last 20 years, however, and especially since the end of the 1939–45 War, there has been a marked change in the conditions of the mentally ill.

The wording of the Mental Health Act, 1959 makes it clear that an application under Section 29 replaces both the old Urgency Order and the D.A.O.'s three-day order as a means of compulsory admission to a mental hospital or the psychiatric ward of a general hospital. It was intended to be limited to cases where the patient's mind is so acutely deranged as to make him a grave and immediate danger to himself or others, so that the delay in obtaining a second medical recommendation required for admission under Section 25 might spell disaster.

The literature concerning this rare syndrome, alternatively known as maladie des tics, has been mainly descriptive since it was first mentioned by Itard (1825) and later by Gilles de la Tourette (1885 and 1899). Its nature remains in doubt, and until recently it has been believed to be a progressive condition inevitably ending in psychosis or pursuing a chronic course.

In 1879 Sturge described a patient with hemiparesis, epilepsy and a facial naevus. He ascribed the neurological condition to a naevus of the brain similar to that on the patient's face. Weber gained the distinction of providing the other half of the eponym by describing the radiological appearances of a similar case. In 1955, however, he advanced the self-effacing descriptive term “encephalofacial angiomatosis”. The essential pathological features of the disorder are facial naevus and leptomeningeal angiomatosis. It is generally agreed that buphthalmos (present in Sturge's original case) is not a necessary component.

Depressive states have long been classified by various dichotomies into reactive versus endogenous, agitated versus retarded and neurotic versus psychotic. The reactive-endogenous dichotomy is an aetiological classification, whereas the agitated-retarded and neurotic-psychotic divisions are symptomatological ones. It is generally considered that there is much correlation between these different classifications, although it is agreed that there may be some overlapping and various points of difference.

The use of amphetamine and its analogues as stimulants and for the control of appetite in the obese is well known. It is not so widely appreciated that they can produce both acute psychiatric disturbances and addiction. In spite of various publications drawing attention to amphetamine psychoses, the frequency of such states does not yet seem to be widely recognized, even among psychiatrists. Scant attention has been paid to the less alarming effects of these drugs, yet they cause a con siderable amount of ill-health. Addiction occurs and patients will go to great lengths to maintain their supplies.

In 98 depressives of various diagnostic categories, Anderson and Dawson (1962) found that a raised fasting blood acetyl methyl carbinol (AMC) level was associated with marked verbal retardation and depressive preoccupation. They also found that raised fasting blood AMC levels fluctuated more than normal ones. It was suggested that the increases in amount and in fluctuation were best regarded as signs of impaired metabolic homeostasis because there was no reason to attribute any signs or symptoms to the effect of AMC itself.

Frohman et al. (1960a, 1960b, 1961, 1962) have investigated the effect of plasma of schizophrenic patients on carbohydrate metabolism. They measured the production of lactate and pyruvate by the nucleated red cells of the chicken after incubation with patients' plasma. After incubation with plasma from schizophrenic patients, the lactate/pyruvate ratio was raised significantly above the ratio found after incubation with plasma from normal subjects. This observation was interpreted as evidence of an inhibition of aerobic metabolism induced by the plasma of schizophrenic patients. We report here an attempt to confirm these findings.

Delayed Auditory Feedback (D.A.F.), sometimes known as delayed side-tone, is the name given to the technical process in which a subject's speech is recorded, delayed, amplified and returned to his ears through a headphone at such power as to prevent him hearing it through the normal channels of direct air and bone conduction. This process has been found to produce marked disturbance of speech, the main changes found being the production of an artificial stutter, marked slowing of speech, increase in loudness of speech and development of a flatness of intonation or decrease in vocal intensity variation (Lee, 1950/1951). The slowing and increase in intensity have been found by Black (1951) to be related to the variation in delay and amplification, but even when these factors are held constant there is considerable individual variation in the response to D.A.F.

When speech processes are interfered with by the technique known as Delayed Auditory Feedback (D.A.F.) various disturbances result (Lee, 1950, 1951). These have been intensively investigated and have been found to depend upon the delay and amplification of the feedback (Black, 1951) and upon personality factors (Beaumont and Foss, 1957; Spilka, 1954). These differences have been shown to extend into psychiatric diagnoses (Goldfarb and Braunstein, 1958; Spear, 1963) and it has been possible to demonstrate that schizophrenic patients show less increase in vocal intensity under conditions of D.A.F. than do other psychiatric patients and normal subjects. It was thought worth while to investigate this difference further, using a slightly more refined method of measurement of the parameter under consideration and to seek clinical correlations with the findings.

Previous studies suggest that chronic schizophrenics differ from normal subjects in their reactions and responses to experimental “sensory deprivation” conditions, not only in that they tolerate these with no difficulty or upset for weeks at a time, but also in that they display what may be an alleviation, albeit temporary, of the degree of severity of some signs of their disorder (Smith and Lewty, 1959; Smith, Thakurdas and Lawes, 1961).

Ever since E.C.T. was introduced it has been observed that complaints of impaired memory are very common after this form of treatment, but also that the complaints vary considerably in different patients. That memory performances—as they may be measured by means of tests—are disturbed to a varying degree after E.C.T. has been established by several authors. It is thus reasonable to assume that the varying complaints of impaired memory, at least in part, reflect true disturbances of memory abilities. It is a common impression, however, that patients who have gained an obvious release from emotional distress comparatively seldom complain of memory disturbances after E.C.T. Thus, the complaints of memory impairment seem to be determined also by another factor, acting in the opposite direction, viz., improvement of disease. No investigation of the extent to which various factors have influenced the complaints of memory disturbances after E.C.T. seems to have been made.

In recent investigations of the neuroses by Foulds and Caine (1958, 1959), certain psychological tests were found to relate to diagnostic category (dysthymia or hysteria) whereas others were related to personality type (hysteroid or obsessoid) as rated by psychiatrists. The diagnostic measures included combinations of the Hypochondriasis (Hs), Depression (D) and Psychasthenia (Pt) scales of the Minnesota Multiphasic Personality Inventory (MMPI). The measures related to personality type included psychomotor and intellectual speed measures and two specially constructed extra-punitive and intropunitive attitude scales drawn from the MMPI (Foulds, Caine and Creasey, 1960). This distinction between symptoms and traits has been discussed in some detail by Foulds (1961) and no attempt will be made to review his arguments here. In a subsequent investigation, however (Foulds, 1959), he found that following treatment of approximately one month's duration symptom measures changed in psychoneurotic women relatively more than did the personality measures. It was suggested that therapists who were dissatisfied with the mere alleviation of symptoms might try to change some of the personality scores. The implication is that changes in test measures related to symptomatology are more readily accomplished than are changes in tests related to personality traits. This differential suggests a possible parameter for comparative studies of different treatment methods. Therapies directed at personality reorganization and attitude change should produce more profound and enduring changes in the personality measures than should those therapies directed at symptom relief only. These changes should be more systematic and predictable than should those to be expected simply from the passage of time.

The present study examines two psychotic groups from the point of view of personality and symptomatological dimensions. It is conceivable that illnesses as devastating and widespread in their effects as the psychoses may complicate and blur relationships which seemed rather clear-cut among neurotics. The thesis of this study is, however, that Caine's Hysteroid-Obsessoid questionnaire (Martin and Caine, 1963) will continue to behave reliably and to account for much of the variance of other measures among the partially integrated psychotics, such as the paranoid and melancholic subjects to be examined here.

Much work has been done in recent years on the use of individual anti-depressant drugs, but relatively little on comparative studies of their values. So many new drugs have appeared in such rapid succession that the psychiatrist has difficulty in knowing which to choose in the treatment of his depressed patient. The aim of this study was to compare imipramine (Tofranil) and phenelzine (Nardil), both of which had been found by personal experience to be of value in the treatment of depressive states. In the past two years there have been several well-controlled trials of both these drugs which have proved them to be of definite value in the treatment of depression. (Ball and Kiloh, 1959; Harris and Robin, 1960; Holdway, 1960; Hutchinson and Smedberg, 1960; Ashby and Collins, 1961; Rees et al., 1961.) At the time of commencement of this trial imipramine and phenelzine seemed to be the two best antidepressant agents available. It was decided to compare the remission rate or degree of improvement produced by them and the rapidity of response to each. It was hoped to determine what factors in the depressive illness were associated with a good or bad response to either drug. No similar direct comparison of these two drugs had been made, to the writer's knowledge.

A double-blind trial of special design was used to test the efficacy of imipramine hydrochloride (Tofranil) in low dosage in an outpatient setting over a relatively long period. Depressive patients were given Tofranil and placebo at different times during the trial period, and the improvement and side-effects were assessed.

Anxiety and excitement have been shown by Maas (1961) to increase the rate of breakdown of ascorbic acid, and in schizophrenics this process may be exaggerated by an abnormality of adrenaline metabolism (Briggs, 1962). Schizophrenics receiving “adequate” dietary amounts of vitamin C, as judged by the requirements of the normal population, are commonly found to have low blood ascorbate levels. Evidence of low blood ascorbate levels in most psychiatric patients has been gathered by Horwitt (1942), Leitner and Church (1956) and others. It has been debated whether such laboratory findings are associated with a state of “subscurvy”, where the individual has the complaints of excessive tiredness, depression, irritability and vague ill-health. Many authorities claim that there is no clinical evidence to justify the distinction of a state of “hypovitaminosis C”. They claim that one either absorbs sufficient ascorbic acid to maintain health, or so little that the classical condition of scurvy supervenes.

Claimed by the manufacturers as pharmacologically unique, benzquinamide (P2647) is structurally related to reserpine, and to a lesser degree, chlorpromazine (1). It has been demonstrated as markedly suppressing conditioned avoidance responses in animals without influencing the release of central amines, e.g. norepinephrine and serotonin. Animal studies have suggested that this drug is the least sedating of the benzoquinolizine derivatives, acts rapidly and is non-toxic at the recommended dosage levels.