In the course of a study of families containing children of primary school age, we have collected detailed social and medical histories of the parents. In earlier papers (Ryle and Hamilton, 1962; Hamilton et al., 1962) based upon part of the population studied here, we have confirmed the reliability of the Cornell Medical Index (C.M.I.) as an indicator of neurosis. The aim of the present paper is to investigate whether social factors within a relatively homogeneous, largely working-class population, are related to neuroticism. While differences in the rate of neurosis between the social classes have often been described, interpretations of these differences are difficult because they may be due not only to variations in the rate of illness but also to differences in the mode of presentation, in symptomatology or in attitudes to medical treatment or to research enquiry. On the other hand, in studying a population such as ours, with small social class differences, the range of social factors available for measurement is reduced.

The present paper continues our study of the parents of children of primary school age, in a sample taken from one of the authors' N.H.S. list. The details of the selection of this population, the methods of data collection, and the absence of any relationship between various social factors and neuroticism, were described in a previous paper (Pond et al., 1963) and are not repeated here. In this paper we report upon the marital history and adjustment of the parents of these 100 families, and investigate the relationship between neuroticism and these factors.

Legal adoption has gained enormously in popularity over the last thirty-five years. Beginning in 1927 with under 3,000 cases, a peak was reached in the early post-war years with over 21,000 orders granted in 1946, while over the last decade this figure has stabilized at an annual average of 13,500. Something like a third of these adoption orders are for mothers wishing to confer legitimate status on their own children born before or out of wedlock, while in a small proportion of other cases children are adopted by relatives acting in loco parentis. We are left with a clear majority of cases (probably about 60 per cent.) in which the purpose of adoption is to create or complete a family where fertility is known or believed to be impaired. Only rarely will a couple adopt in preference to reproducing, although there are certain circumstances in which such a decision would be justified, for example where pregnancy carries serious risks for a woman healthy in all other respects or where there is a likelihood of inherited abnormality in her child.

Attempted suicide has been described as the prime emergency of general practice. Although this may represent a slightly exaggerated claim, the present writers have certainly found attempted suicide to be a frequent reason for the referral of patients to the psychiatric department of a general hospital. The expression “attempted suicide” is usually taken to refer to an unsuccessful attempt to kill oneself: yet such a description is often somewhat inappropriate to describe a dramatic episode of behaviour, during which an assault upon the self occurs as the result of a mood of despair or rage. Death may not be consciously sought and it is more satisfactory to define attempted suicide as a non-fatal act of self-damage.

Many experiments have been reported suggesting that the serum of schizophrenic patients differs in some way from the serum of non-schizophrenic subjects, either in respect of some specific constituent or of the alterations in function which it can produce when added to various biological systems (Heath, 1957; Walaszek, 1960; Bergen, Koella, Czicman and Hoagland, 1961). These reports suggest that schizophrenia is a pathological mental condition resulting from some disorder of metabolism or of biochemical processes, and it would be logical to expect that this disorder would be most manifest as a disturbance of the neurological activity in the cerebrum—perhaps more specifically in the cerebral cortex—since the clinical picture in schizophrenia is primarily one of gross derangement of the processes of perception, attention and thinking.

Penrose (1935), in describing the first British patients with phenylketonuria, noted in their unaffected relatives a high incidence of paranoid illness in later life, and suggested that the heterozygous state might predispose to such breakdown. The 47 phenylketonuric families reported by Munro (1947) showed in unaffected relatives a similar high incidence of psychotic illness, which he (Munro, 1957) categorized as endogenous depression with paranoid features.

Various authors have reported that alterations in urine volume are associated with alterations in urinary adrenaline and noradrenaline output. (Perman 1961 and Leroy and de Schaepdryver 1961. Weil-Malherbe and Ström-Olsen (1958) reported alterations in urinary adrenaline and noradrenaline excretion associated with mood changes in a group of patients with manic-depressive psychosis. In three of the patients studied, there was also during the manic phase an increased urine volume.

Clements (1962) has shown that atropine given intravenously has a vagal blockage effect superior to that achieved by subcutaneous injection. Electroconvulsive therapy is such a frequent reason for inducing general anaesthesia that a knowledge of the best premedication technique to use seemed to us important. Clearly the cardiovascular protective effect of the atropine is more important than the suppression of salivation. Maclay (1953) reported that in 62 deaths after E.C.T., 19 (30.6 per cent.) were attributable to the respiratory system. Clement's findings (1962) suggest that vagal blockade is adequate in protecting against cardiovascular disturbance 75 seconds after the injection of 1 mg. of atropine intravenously, but he mentions that the antisialogogic action is reputed to take longer to develop, and his paper did not include an assessment of this action.

Definition of Medical Rehabilitation

A full definition of medical rehabilitation should contain three parts. The first is a statement of aim: ideally, to settle or resettle an individual in his normal domestic setting, and in work appropriate to his talents. Most patients and doctors can measure their success against these two practical indices, although what is regarded as socially desirable varies widely and some individuals prefer a highly idiosyncratic way of life.

The question of the long-stay mental hospital population has recently received a great deal of attention. Proposals, based on the statistics of mental hospital admissions and discharges over the last few years, the increasing development of day hospitals, out-patient clinics, psychiatric units attached to general hospitals, and community services for the mentally ill within the general framework of new and improved methods of treatment, have led to considerable thought as to how best to reintegrate former mental hospital patients into the community. The process of discharging long-stay patients has, of course, been continuous, but the numbers involved have been comparatively small in the past. A policy of reducing considerably the number of mental hospital beds depends partly on aiming at the highest possible maintenance capacity of discharged patients. For long-stay female patients this would involve, among other aims, the re-training in domestic skills to adequate levels, while in male patients the aim would have to be some form of industrial resettlement. The general aim of increasing the activity and skill level of long-stay mental patients has found its expression in the establishment of industrial workshops. From its early beginnings (Baker, 1956) this form of therapy has developed into the establishment of production workshops or factories both inside and outside the walls of mental hospitals. (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al 1961, 1962.)

Although the literature is sparse on the subject, the perversions have been successfully treated by behaviour therapy. The treatment is based on the hypothesis that aberrant sexual behaviour has been acquired as a learned response and can be abolished along the lines indicated by learning theory. Raymond (1956) and James (1962) employing aversion techniques, successfully treated cases of glove fetishism and homosexuality respectively. Raymond's patient has since partially relapsed and has been readmitted for further treatment.

The present paper describes a case of fetishism and impotence treated by a combination of aversion therapy and therapy based on reciprocal inhibition (Wolpe, 1958). This case is thought to be of special interest in that to some extent the patient acted as his own control, since previous methods of treatment had been unsuccessful.

There have been few published reports of the use of E.C.T. in delirious states complicating organic illness. Most psychiatric textbooks with adequate accounts of modern physical treatments allude only briefly to its use in these states, and few medical textbooks mention it at all. Yet the problem of the management of the acutely disturbed delirious patient is not a rarity in medical and surgical wards; in varying degrees delirium may accompany most serious illnesses and prognosis worsens with its persistence. For these reasons it is thought worth placing on record the following cases.

The case records of patients with organic delirium admitted in the past fifteen years to the psychiatric unit of St. George's Hospital were examined. Those cases receiving E.C.T., all seriously disturbed and otherwise unmanageable, are reported in this paper.

The psychiatric aspects of mitral valvotomy have received relatively little detailed study, and this is all the more surprising since clinicians have commented on the frequency with which mental disturbance appears to follow the operation. This investigation was undertaken in an attempt to establish more precisely than heretofore the extent and nature of the relationship.

It has been suggested in a previous paper (Sedman and Reed, 1963) that depersonalization phenomena were most likely to occur in patients with premorbid insecure personalities during a phase of depressive mood. Schneider (1958), includes under the term Insecure Personalities both Anankasts (obsessionals) and Sensitives. In such individuals there is “… a nagging inner uncertainty under various forms of compensatory or over-compensatory activity, especially where the inferiority feelings are of a physical or social character”. The purpose of this paper is to examine further the suggested linking of depersonalization, insecure personality and mood change in schizophrenia.

This paper reports an investigation in which it was found that, by dividing “paranoids” on a scale of “non-integrated psychosis”, two groups were formed which differed significantly from each other on several independent measures. When the same division was made within non-paranoid schizophrenics and within melancholics, very few such differences were disclosed.

The evidence suggests that integrated and non-integrated “paranoids” can usefully be regarded as differentiable groups, the latter being more closely related to other forms of schizophrenia.

The study to be reported was carried out within the framework of Personal Construct Theory as put forward by Kelly (1955). This theoretical background is summarized and discussed in Bruner (1956) and Bannister (1962).

Previous studies from this laboratory have shown that loading with large doses of certain amino-acids and Marsilid produced marked behavioural change in some chronic schizophrenic patients (Pollin, Cardon and Kety, 1961). Methionine and tryptophane produced qualitatively different effects and there was no overlap between marked methionine and tryptophane reactors. The changes with tryptophane were characterized by mood elevation and increased involvement with the environment and extra-version, in several instances to a dramatic degree.

Amitriptyline (Tryptizol) is an antidepressant drug which is related structurally to imipramine (Fig. 1). Its full name chemically is 5-(d-dimethylaminopropylidene)-dibenzo (a,d) (1,4) cycloheptadiene hydrochloride. Numerous uncontrolled trials to date (Ayd, Bennett) have reported success with this drug in the treatment of both endogenous and reactive depressions. Several reports (Ayd, Dorfman, Dunlop) have stressed the fact that agitation as a manifestation of depressive illness is frequently relieved. The purpose of this study was to assess the effect of the drug on depression in a controlled trial.