Two main difficulties are met with in epidemiological studies of mental disorders. Firstly, the problem of finding all the cases occurring in a population, or a representative sample of them; and secondly, the problem of classification.

As a result of new methods of biochemical investigation an increasing although yet small number of cases of mental deficiency can be shown to be caused by congenital metabolic abnormalities. In 1958 Wright et al., reviewed and classified anomalies of this nature and since than a new syndrome has been described by Allan et al. (1958) and a syndrome closely related to, if not identical with, Maple Syrup Urine Disease by Smith and Strang (1958).

No observation can be incorporated satisfactorily in a body of knowledge unless its reliability, however defined, is also known. In psychiatry, the concept of reliability has in great measure been transplanted from clinical psychology, but its optimal application to meet psychiatric needs requires some attention.

For the purposes of psychiatry, reliability can conveniently be measured as the amount of agreement between different observers examining the same subjects (or a comparable series of subjects). The results may be expressed as the percentage of subjects in which agreement on the relevant variables is reached, or, in the case of two or more closely matched series being employed, by comparing the reported incidence of the phenomena under study. In one or other form this simple principle has been applied in a number of reliability studies, of which the majority have been concerned with the vital question of the reliability of nosological diagnosis (Ash, 1949; Mehlman, 1952; Hunt, Wittson and Hunt, 1953; Seeman, 1953; Foulds, 1955; Schmidt and Fonda, 1956; Pasamanick, Dinitz and Lefton, 1959), while Reid and Finnesinger (1952) have contributed an interesting semantic analysis of the concepts involved.

Resort to the use of phantasy in conditions of stress in individuals and in groups was a preoccupation of the author in 1944 (1). The fact that the subject was in mind occasioned the discovery of a “psychological epidemic”. The affairs to be described sound trivial, but have been thought needing of record as a factual account of group infantilisms which, although doubtless of common occurrence, are not much documented. The passage of fifteen years was thought proper to minimize chance of recognition of any people concerned, but this does not affect the validity of the observations. At the expense of some obscurity, cyphers are used to designate individuals and other clues to identity have been avoided.

A unit for adolescent psychiatric patients was opened at St. Ebba's Hospital in 1949 by the late Dr. D. E. Sands. At that time, there were few in-patient facilities for this group of patients and the unit therefore received many of the most disabled cases from all parts of the country. Sands (1953)∗ wrote of the need for such a unit. “In the juvenile period there is psychiatric breakdown to a degree which from medical and social standpoints is as much of a problem as such illness in later life. There are some who have stated that all children's and juvenile psychoses should be treated at home. Experience with these patients has shown that, however desirable this may be in theory, it is no more practical or safe for some types of juveniles than for adults. The truth of this view might have been inferred in any case from the frequency with which such cases have found their way for years into all kinds of makeshift in-patient accommodation because home for one reason or another proved impossible or practically nonexistent”. He then gave an account of the classification, aetiology and treatment of patients on the unit and the results on discharge. The present article discusses the presentation of psychiatric illness in adolescence, reviews the follow-up on patients admitted between 1949 and 1953 and compares these follow-up results with those of Sands on discharge.

In St. Crispin Hospital, Northampton, there are male identical twins (J.L. and P.L.) who for nearly a quarter of a century have suffered from an atypical psychosis. They were previously studied by Palmer (3). Their sister (B.L.) had a similar mental illness but she obtained relief from a leucotomy operation at an early stage. The mother was also affected, but the onset of illness in her case was later in life. There are two unaffected siblings.

When mongolism was first described, it was considered by some authors to be a form of cretinism (Seguin, 1866), and with the discovery of the effect of thyroid treatment in cretinism, this was tried in mongolism also. The disappointing results diverted attention to other endocrines. Tredgold, in 1929, was recommending a mixture of thyroid, pituitary, thymus, suprarenal and pineal glands, though he did not believe that such treatment was curative.

The change in time perception produced by the administration of drugs has received a fair amount of attention. Frankenhaeuser (6) has reviewed the work on the effects of hashish and mescaline intoxication on the estimation of time. She concludes that “there seems to be some agreement in that time seems longer than usual in passing but shorter when regarded in retrospect”. But this work dealt with introspective reports regarding the passage of time rather than with quantitative changes and will not be discussed further here.

The value of medical and social services in the domiciliary care of the mentally subnormal child has been under considerable discussion during recent years. The mentally subnormal child is known to show many of the same traits as the normal child when removed from the type of personal relationship between mother and child, which is normal within the ordinary home. It is generally agreed that hospitalization of the normal child under five should be avoided if possible, but it must be remembered that this attitude is equally important in the case of the mentally abnormal or psychotic child. Indeed such children have great difficulty in coming to terms with their environment, and as a result are even more vulnerable to the breakdown of the mother/child relationship than the normal child. It is important, therefore, to look critically at the reasons given for applying for admission to a hospital for mental subnormality, and this study attempts to analyse the reasons put forward in a sample of patients admitted during the years 1955–59, and to discuss possible methods of improving the existing mechanisms.

This study arose out of another enquiry currently in progress (Sainsbury and Grad) into the relative merits of community and hospital care of the mentally sick as practised in the Chichester and District Mental Health Service. For this purpose it was clearly important to know how reliable were the psychiatric assessments made on patients referred to the Service. The occasion was seized to carry out a detailed investigation into the reliability of diagnosis and other psychiatric assessments under N.H.S. conditions, with particular reference to why disagreement between psychiatrists sometimes occurs. As described elsewhere (Carse, 1958; Morrissey and Sainsbury, 1959), the Service supplies all the psychiatric requirements of Chichester and district, and thus provides a wide range of patients treated in a variety of settings.

Witchcraft, the extra-natural interference in the welfare of the community by women, has long since ceased to be a source of major concern in Western society. In many other areas of the world, however, the witch remains a very active and vital image in the consciousness of the people, This is certainly true for the Yoruba*—a negro group occupying large areas of Nigeria, Dahomey and Togoland along the north-west coast of Africa. With the Yoruba (irrespective of his social level, religion or education), belief in the witch and in her powers is all but universal.

Since the preliminary studies in imipramine (Tofranil) (1, 2, 3, 4) demonstrated the potent anti-depressant activity of this substance, attempts have been made to pin-point the differential effects of the drug on psychodynamic structure. These were reported in two previous studies (5, 6). The purpose of the present communication is to elaborate on the information gained in the latter experiments, and their consequent application to the psychotherapy of depressions and other mental syndromes.

The late Dr. Vera Norris (5), in a study of London mental hospital admissions, found that a London woman, at birth, has 0 · 8 chances in 1,000 of being admitted at some time in her life with a puerperal psychosis. This figure, based upon hospital admissions, must be compared with Kline's (4) estimate that 5 per cent. of pregnant women have an associated emotional disturbance. Clearly, hospital admissions represent a small proportion of all cases occurring and it is likely that socio-economic and cultural as well as medical factors play a part in determining whether admission takes place. Estimates of the incidence of psychiatric disorders associated with childbearing must vary according to the age structure of the population, the facilities for psychiatric care available in the community and the criteria adopted for attributing illness to the effects of childbearing.

At the present time only two groups of drugs have an established place in the treatment of chronic schizophrenia, the phenothiazine derivatives and the rauwolfia group of alkaloids. Of these two groups the phenothiazines are in more general use, and, although not free from side-effects, are safer drugs for the long-term management of schizophrenic patients. They also have a wider range of effectiveness in the different schizophrenic syndromes. Many observers, however, have been impressed by the dramatic results obtained in a proportion of cases of long-term schizophrenia treated with the rauwolfia alkaloids and these may be effective in cases not responding to the phenothiazines (Kline, 2).

Only 16 cases of folie à trois have been reported in the English literature (Wolff, 1957). The present case seems worth recording because of the rarity with which this condition is described and the problems it raises.

There are some 23,000 long-stay epileptic in-patients in Britain. Most of these patients are in hospitals for the mentally ill or subnormal or in independent colonies. There are, however, only two hospitals within the National Health Service which cater specifically for the long-term treatment of epilepsy, St. Faith's Hospital, Brentwood, for females, and St. David's, Edmonton, for males. This communication is concerned with the incidence of temporal lobe epilepsy among the long-stay female epileptics at St. Faith's.

Brandström (1957) in Sweden, has recently resolved certain problems in the synthesis of barbiturates with a neopentyl group as one of the ring substituents and the resulting compound 5-allyl-5-neopentyl-barbituric acid∗ has been subjected to experimental studies which show it to be less hypnotic and anaesthetic than amylobarbitone or pentobarbitone sodium and yet protective to rats subjected to a stress situation after the technique of Jacobsen and Sonné (1955). The drug is rapidly absorbed after oral administration, and has a duration of action between that of amylobarbitone and phenobarbitone.

The term “stressor agent” was first introduced to medicine by Selye (1950). Stressors really referred to patho-physiological phenomena associated with shock-like mechanisms, but psychiatrists have made use of the concept and to them stress implies mental conflict, anxiety-tension and defensive re-organization in relation to unpleasant psychic events. This re-organization might be maladaptive and lead to neurotic or deviant behaviour. It is always difficult to isolate a distressing event and attach prime importance to it in the aetiology of psychiatric disorders. What is minor discomfort for one, calling for minor adjustment, may represent severe pain for another by touching on some specially sensitive aspect of the personality, causing drastic emotional and behavioural changes. With these reservations in mind it is possible to extend the psychological concept of stressors to include the field of juvenile delinquency.