The experience of 82 demented female patients, admitted to Crichton Royal in the period 1957–59, is compared with 107 similar female patients from 1974–76. All finally died in the hospital, or at the closure of the study in November 1981 were long-stay patients there. Results show that on average, each patient in the more recent group spent 24 per cent longer in hospital; the results, however, were only statistically significant in the very elderly—over 85. Further study of the 1970s failed to demonstrate that day care and intermittent holiday admissions had any effect on the length of time the patient spent in hospital on final admission. Using the study data, models of future needs are worked out on the basis of bed requirements for patients admitted without prospect of discharge.

This study attempted to use feedback from the Model Standards Questionnaires (a series designed to measure the quality of care) to improve care on a psychiatric hospital's rehabilitation wards. Both a controlled and quasi-experimental design were used. The controlled design provided evidence that feedback from the Questionnaire concerned with the Individual Programmes of Treatment and Care led to improvements in these practices but not for the remaining three questionnaires. The quasi-experimental design indicated that the significant generalised improvement in care, over all questionnaires, was most likely due to the feedback.

Few psychiatric controversies have been as persistent as the disagreement surrounding the nosology of depression. The conflict centres on the question of whether depression is a single illness, with its many faces manifestations of individual idiosyncrasy and severity, or whether it constitutes two or more separate conditions. The 1926 debate at the British Medical Association Meetings, with Edward Mapother (11) propounding the case for a single illness and Buzzard and Ross advancing claims for a dichotomy, has in one form or the other continued until today. The issue is complicated by the fact that few terms in psychiatry are used with as many different meanings as depression. Unfortunately the use of the term is seldom clearly defined. As Humpty Dumpty said in Through the Looking-Glass, “it means just what I choose it to mean—neither more nor less”.

Since the interviewing process, or the process of two people talking to each other is an extremely complex phenomenon, it seemed advisable to begin its analysis at the elementary and quantitative level, by first of all measuring the duration both of periods of continuous speech, and of the pauses and then after investigating their various relations and rhythmic alternation, to work up through grammatical analysis to the more complex phenomena.

The World Health Organization's World Mental Health Report is a call for action and reminds all of the huge personal and societal impact of mental illnesses. Significant effort is required to engage, inform and motivate policymakers to act. We must develop more effective, context-sensitive and structurally competent care models.

The mechanism of action of electroconvulsive therapy (ECT) in treating major depression is unknown. We studied two candidate mechanisms through inhibiting simultaneously the synthesis of noradrenaline and serotonin in patients immediately after successful treatment with ECT using a randomised, placebo-controlled, double-blind crossover design. There were no significant changes in depression scores under any experimental conditions, or between the amine-depleted and placebo groups despite reductions of 61% in serum homovanillic acid, 47% in 3-methoxy-4-hydroxyenylethyleneglycol, and 89% in serum tryptophan. Catecholamine and serotonin availability may not be necessary for maintaining the initial antidepressant response to ECT.

We describe the case of a 33-year-old man with Down's syndrome and severe eating disorders. The clinical symptoms, and their difference from those of anorexia nervosa, are discussed. The patient responded well to a strict behavioural programme after long, in-patient treatment and was still well at a 2-year follow-up examination.

There are many clinical reports on psychotherapy with depressed patients, and an enormous effort has been devoted to psychotherapy research (10, 23, 24, 27, 28). However, there is little quantitative description of the content of psychotherapy—what patients discuss during sessions and how much time is spent reflecting on problems. This situation is partially understandable given the technical difficulties in obtaining psychotherapy process data. Content analysis of transcribed tapes, process records, video-tapes and the coding of words have been among the methods used (7, 9, 12, 14). These methods are inclusive and precise but impracticable in lengthy psychotherapy or with large samples.

This paper is a preliminary report of some investigations we are now making into the pathology of mental deficiency, mainly from the histological point of view. We have so far examined 22 cases, comprising 7 low-grade defectives showing gross neurological lesions, chiefly of extrapyramidal character, 6 microcephalics with spastic diplegia and severe mental defect, 2 able-bodied microcephalics without gross neurological signs, 1 simple able-bodied idiot and 6 mongols. In this short paper it is impossible to give even the slightest indication of the wealth of pathological material found in such a variety of widely differing conditions. A full description of our findings, together with a more detailed discussion, must be left to further papers dealing with individual groups of cases. The purpose of making a short note at this stage is to draw attention to one particular finding which struck us by its surprising constancy, i.e., a proliferation of the fibrous glia, particularly pronounced within the cerebral and often also the cerebellar white matter. In many of the cases the cortical changes were slight compared with the intense lesions of the white matter. In none of them was demyelinization a well-marked feature, nor did its severity approach that of the glial proliferation; in many it was negligible, and there were none of the fatty breakdown products, characteristic of the demyelinizing disease of the white matter called after Schilder. The gliosis was either diffused or patchy, and was often markedly perivascular; even stripe-like scars, as described by Hallervorden (10), were to be seen, although, contrary to this author's observation, there was, as a rule, no corresponding myelin defect.

Plasma levels of antidepressant drugs were measured in 17 depressed patients at roughly monthly intervals over follow-up periods of three to 26 months. Good results in seven were associated with small fluctuations in level from visit to visit, while big fluctuations were associated with poor outcome. Such fluctuations were probably from poor compliance or drug interaction from self-medication. Severe side effects and cardiotoxicity were associated with high levels.

I am very grateful for the invitation of the Association to speak about the work I have been doing with twins, as it is an opportunity to thank the very many members who have helped in it. Without your kindness and co-operation the work would not have been possible. Medical Superintendents have put themselves out to make it possible for me to see patients and examine records; medical officers have discussed cases with me; I have been able to see the invaluable reports on family visits by social workers, and P.S.W's. have even made special inquiries on my behalf; hospital secretaries have made visiting books and other records available, and have rummaged through dusty files for ancient case-notes, and they have added to their labours routine inquiries about twinship which have considerably enlarged my series. This help has been given not only to me personally, but also to other workers collaborating with me. For all this and more, which I have no time to mention, I want to say thank you very much.

The present investigation deals with the effects of two lengths of exposure time in neurotic and schizophrenic subjects, and with the relations between these effects and measures of extraversion, neuroticism and rigidity. A consideration of previous work, discussed in the following paragraphs, led to three main predictions concerning varying exposure times.

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).

Protagonists of mental tests in clinical practice have hitherto shown a decided preference for methods of examination adapted to study capacities already developed or knowledge already acquired. Relatively little attention has been given to the study of learning, despite the fact that this function is so obviously affected in many and various neuropsychiatric conditions. One need only recall the widespread loss of plasticity so characteristic of the dementias and the more specific defects of learning associated with various types of focal lesion, e.g. of the language centres or the visual-association areas (cf. Cobb, 1944, pp. 214–5; Zangwill, 1945). It may therefore be urged that any technique of studying learning that is objective in character and easily adapted to the needs of routine clinical examination is worthy of attention. One technique which meets these demands will be described in the present paper, together with a small selection of the results obtained on routine psychological testing at the Brain Injuries Centre in Edinburgh.