Work with the tertiary amine arecoline is reported to show that this para-sympathomimetic agent can produce inhibition of conditioned avoidance responses in rats (Pfeiffer and Jenney, 1957a). When given to atropine-protected patients, the compound is said to give intervals of lucidity of an order broadly comparable to that produced by carbon dioxide or amylobarbitone (Fulcher et al., 1957).

β-Dimethylamine ethyl 2-methylbenzhydryl ether hydrochloride (Orphenadrine, “Disipal”) is a synthetic substance closely resembling in chemical structure the antihistamine dephenhydramine (“Benadryl”). It was developed in Holland (Harms, 1957) for use in parkinsonism and in this context reported upon favourably in this country by Gillhespy and Ratcliffe (1956). Claims have also been made that the drug is (i) effective in treating the pseudo-parkinsonism produced by reserpine, (ii) active in alleviating other (e.g. autonomic or vasomotor) side-effects of reserpine, (iii) has independent “psychic” activity, or (iv) enhances the tranquillizing effect of reserpine (Frieswinkel, 1957a, 1957b; Van Rhijn, 1957; Meulenbeld, 1957; Scheurle, 1957). The following trial is designed to assess some of these claims.

A clinical relationship between obsessional illness and epilepsy is unusual, but the few electroencephalographic (EEG) investigations of obsessional patients which have been published claim a high incidence of abnormal electrical activity. Records of twenty-six neurotic and five schizophrenic patients, all with obsessional symptoms, were examined by Pacella et al. (13), who found twenty-two of the thirty-one EEGs to be abnormal. Fourteen showed definite convulsive patterns with frequent 2–4 c.p.s. activity and increased high voltage waves after overbreathing. Rockwell and Simons (14) found only two abnormal records in eleven uncomplicated obsessional neurotics, using Gibb's criteria of normality, but of ten patients classified as psychopathic personalities with obsessional symptoms, all had abnormal EEGs although two were borderline. Their definition of psychopathic personality is not made explicit and the clinical distinction between their two groups is unclear. Jarvie (4) reports a case in which slow activity on hyperventilation in the EEG was associated with phobias and obsessional impulses preceded by a two-year history of episodes of rage.

During the course of an investigation of the effectiveness of various components of electric convulsive therapy in the treatment of hospitalized psychiatric patients (Brill et al., 1957, 1959) observations were made on the spinal fluid concentrations of cations and total protein before and after treatment. The possibility existed that alterations in brain function and structure (which are believed by many to occur during a course of electro-convulsive treatment, and to be responsible for improvement in patients receiving such treatment) might be associated with, or reflected by measurable changes in the cerebral spinal fluid.

In the past few years papers have appeared in the U.S.A. and in Europe which discuss the role played by 5 hydroxy-tryptamine (serotonin) in cerebral metabolism, both in health and disease. The aim of this paper is to report a trial of a benzyl analogue of serotonin, a serotonin antagonist, and to shed some light upon its possible side-effects.

To many minds there can be but little change in the treatment of depression since Johnson prescribed these remedies in 1776. Indeed the place of chemistry is now prominent, although its application is apparently more important to the patient than its study. It is believed that an enzyme, mono-amine oxidase, found in cerebral tissues, plays a part in the genesis of depression. Amphetamine inhibits the destruction of adrenaline by amine oxidase (McIlwain, 6) and amphetamine is of value in the treatment of mild depression (Guttmann and Sargant, 5). Another substance is 5-hydroxytryptamine, or serotonin, which is said to excite cerebral neurones briefly between its liberation and destruction; it is a cerebral vasoconstrictor and is destroyed rapidly by amine oxidase (McIlwain, 6). Iproniazid (Marsilid) is a drug which inhibits amine oxidase and has been used in the treatment of depression (West and Dally, 10). Its central actions are considered to be similar to those of 5-hydroxytryptamine. Recently, Chessin (3) has described yet another amine oxidase inhibitor, phenelzine, which is the study of this paper.

The management of mild depression and its concomitant associated symptoms of general debility presents a constant and widespread challenge to psychiatry both in hospital and in general practice. It is inevitable that at some stage resort will be made to drugs. This is a tempting pharmacological field and the level of interest is indicated by the available plethora of alternatives. A recently introduced drug in current use and purported to be of use specifically in this field is Deanol (Deaner) which is the p-acetamidobenzoic acid salt of 2-dimethyl-aminoethanol or Atrol which is the bitartrate of the same base.

Fifty-one years have elapsed since the Report of the Royal Commission on the Care and Control of the Feeble-minded was published and paved the way for the Mental Deficiency Act of 1913. Since that time two developments have taken place. On the one hand the administrative procedures for dealing with defectives on the basis of the Act and its amendments have been clearly defined and formalized. On the other there has been a continuous development and expansion of our social and welfare services. These developments, which should have been complementary in their aims, have in fact often proved conflicting in effect, because mental deficiency until very recently was bound to outmoded procedures which were designed to segregate the defective from the community rather than to integrate him with it, and give him the opportunities for re-socialization which our modern welfare services afford. The original belief that a hereditary neuropathic diathesis lay at the root, of most of our social ills and would sooner or later lead to national degeneracy has been replaced by scientific genetic studies, and by medical research into the aetiology of the condition, and the associated problems involved in the training and employability of the defective. Increasing professional and public recognition of the inherent faults of existing mental deficiency legislation led to the setting up of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency which published its report in May, 1957, and this in its turn has prepared the way for the Mental Health Bill which is at present in the final stages of its passage through Parliament.

Huntington's Chorea presents us with a good “model” of brain disease in that we know the extent of the contribution of heredity, in contrast to a condition such as schizophrenia regarding which many authors (cf. Alanen, 1958) would be prepared to defend the concept of pseudo-heredity. Secondly the disease carries a fairly uniform prognosis, and finally it results in a distinctive disturbance of motor function which permits of some accuracy in diagnosis and some criterion for objective measurement.

In this paper the effect of chlorpromazine is compared with that of pecazinet on the schizophrenic population of three chronic psychiatric wards.

Delay, Deniker and Harl (1952) introduced chlorpromazine into psychiatry. Pecazine was first used by Kline and Jacob (1955) and Hiob and Hippius (1955). Thorpe and Baker (1956), in a double-blind, controlled trial, found that both drugs reduced tension significantly in deteriorated, female, schizophrenic patients. Baker and Thorpe (1957) found that pecazine did not significantly reduce daytime incontinence in deteriorated psychotic patients. The trial was controlled and blind. Jones (unpublished), in a double-blind, controlled trial on disturbed psychotic patients, found chlorpromazine to be effective but could find no evidence that pecazine had any effect.

The authors undertook to investigate the effects of two new phenothiazine derivatives on schizophrenic patients. Over a period of two years a series of clinical trials have been carried out on approximately 260 patients, some controlled, some uncontrolled. These drugs, known as Melleril (TP21) and KS75 are chemically related. Although Melleril was ultimately selected as the drug of choice we have, for statistical reasons, included some of the findings with KS75.

Studies of the effects of the repetition of statements, i.e., verbal signals, upon the behaviour of chronic psychoneurotic patients have been carried out in the Allan Memorial Institute continuously since 1953 (1).

The use of drugs in order to calm excited mental patients dates back to the 5th Century B.C. or earlier.

The employment of extracts of the mandrake, Mandragora, in states of motor excitement is attributed to Hippocrates (Belloni, 1957). One disadvantage of such extracts was that reduction of agitation and anxiety could only be achieved at a cost of clouding of consciousness. This is also the case with many modern sedatives.

The tranquillizing drugs are used so extensively in the control of psychotic states that the wave of enthusiasm threatens to swamp the entire therapeutic field. Yet, until the scope and limitations of these drugs have been established it would be unwise to neglect advances in other methods of treatment. Prefrontal leucotomy has long since passed the crest of its wave, and in recent years conservative operative techniques and a more selective field of clinical application have rendered it a valuable treatment for certain groups of patients.