The Capgras syndrome, first described by Capgras and Rebould-Lachaux (1923), is the name applied to a peculiar delusional system in which the patients come to believe that persons well known to them—usually close relatives—are impostors who have assumed the exact appearances of those whom they have supplanted. The majority of examples of this condition have been observed in schizophrenic patients but, like most eponymous titles in medicine, the term was applied to a disease pattern that failed to fit conveniently into existing classification. Most branches of medicine, with the gradual accumulation of new information, pass through an ‘identification’ phase when new syndromes are being discovered. A further 'synthesizing’ phase is eventually reached when researchers, equipped with greater knowledge regarding likely aetiology, pattern of symptoms and treatment, are able to appreciate the wider implications and ramifications of the problem, as well as uncertainties surrounding the initially identified disease pattern. In psychiatry, titles that emphasize specific patterns of symptomatology tend to be the rule rather than the exception, but advances in psychopathology, neuropsychology and neuropathology imply a need for reassessing the contribution of a purely phenomenological approach to the problem. Such an approach may well be overdue as far as the Capgras and other syndromes are concerned. The following case is presented in the hope that the condition, when it is recognized, will be evaluated in terms of its aetiology, and that attention will be paid to the more fundamental questions of psychopathology and related patterns of neuropsychological function.

In depression alteration in mood is accompanied by pronounced physical and behavioural changes. Characteristically there is a decline in appetite, weight and libido, insomnia and a disturbance of diurnal rhythm. A slowing of thought and movement to the point of severe retardation or even stupor may occur. Anxiety is often present and in agitated depression is accompanied by restless psychomotor activity. As lesions in the hypothalamus may produce disturbances in appetite, weight, libido and sleep, it has been suggested that hypothalamic dysfunction may play a part in the aetiology of those depressions in which physical symptoms predominate (Pollitt, 1965).

The neuroleptics which are very effective in chronic schizophrenia, such as fluphenazine, thiothixene and haloperidol, have both central ‘inhibitory’ and 'stimulatory’ properties (Itil et al., 1969, 1970). When chronically administered in low dosages, these compounds decrease Stage 4 of the sleep process and produce insomnia, while in high dosages they produce deeper sleep stages. Based on these observations and the fact that extrapyramidal symptoms usually do not occur during deep sleep, we hypothesized that high oral doses of trifluoperazine given at night would produce fewer sleep disturbances and extrapyramidal symptoms than the same dosages of this compound administered during the morning.

Although a number of papers have been written emphasizing the need for conservative dentistry and describing various ways of dealing with patients fearful of dental treatment, little systematic attention has been paid to understanding the basis of this impediment. A fear of dental treatment is, indeed, so common that it can almost be considered normal unless of such a degree as to interfere with much needed dental care. Thus, in the U.S.A. Freidson and Feldman (1958) reported that 51 per cent of a large and representative sample did not visit a dentist regularly. Out of these 9 per cent reported that their reluctance to do so was based on fear. Similarly, Kegeles (1963) reported that fear of dental treatment significantly reduced the number of preventive dental care visits, independent of social class. Shoben and Borland (1954) found that unfavourable family dental experience and unfavourable family attitudes towards dentistry were the only factors which discriminated between fearful and non-fearful dental patients.

The classification of affective disorders has been a topic of controversy for years. The literature is filled with tentative attempts to order this large group of patients. Such attempts have brought surprisingly little resolution of the issues involved. There are those who would make numerous subdivisions within the affective disorders, and others who see affective illness as a unitary disorder.

There are well over 50 published reports since 1949 on the use of lithium salts in psychiatric disorders, most of them in the decade since 1960. Considering only those studies reported in acute manic states, it is difficult to arrive at a reliable assessment of the specific therapeutic effect of lithium because quantitative evaluations were seldom employed, so that comparisons of outcome have to be based on statements of degree of improvement which are subject to varying interpretations. Furthermore most of the studies were not adequately controlled, and the diagnostic criteria used were not always clear.

During the last twenty years countless attempts have been made to refine, replace or validate our intuitive clinical classifications of mental illness by the statistical analysis of symptom ratings. By and large these attempts have been unsuccessful. In spite of all the elegant and complex manipulations to which innumerable sets of data have been subjected, the classifications used by psychiatrists remain much as they were before the computer was invented. The reasons for this failure—for as such it must be seen at least by clinicians—are complex, but we would attribute it mainly to two factors: a failure to appreciate how unreliable and open to bias are the clinical ratings on which most analyses have been based, and too exclusive a reliance on factor analysis at the expense of other forms of multivariate analysis.

Stutter, tic and the Gilles de la Tourette syndrome have many features in common. Haloperidol has been found of value in the treatment of the last-named syndrome (1) and also of tic (2). Our study was intended to evaluate its use, combined with orphenadrine, in stutterers. We used it both with and without speech therapy, as shown in Table I. The trial was controlled, and double blind. Our 36 patients, aged 15 to 60, were of both sexes and neither psychotic nor subnormal. They were not on other therapy. They were randomly divided by an independent third party equally into the following groups, and treated as indicated.

This paper describes a retrospective study of the influence of personal variables and treatment methods on the prognosis for a return to flying of service aircrew suffering from anxiety states precipitated by flying stress. The study was made preparatory to a prospective investigation of treatment of anxiety states in aircrew.

Most chromosome studies of criminal males have been made on groups selected on account of tall stature with the main purpose of finding the frequency of patients with extra Y or X chromosomes.

A Glossary of Mental Disorders was published in 1968, prepared by the Registrar-General's Advisory Committee on Medical Nomenclature and Statistics. The document used as a basis the Eighth Edition of the World Health Organization's International Classification of Diseases (I.C.D.), Section V, which deals with mental disorders and mental subnormality. For the first time in this country the meaning of the categories listed in the I.D.C. are described, and the new Glossary stands beside the Second Edition of the American Diagnostic and Statistical Manual (D.S.M. II) which was also published in 1968. The psychiatrists working on the United States-United Kingdom Diagnostic Project at the Institute of Psychiatry, Maudsley Hospital, London, and the Psychiatric Institute, New York, made diagnoses according to the new Glossary descriptions on 820 hospital in-patients drawn from both sides of the Atlantic and interviewed using a standardized interview. The comments contained in this article are based on their experience.

In this study, 42 school phobic youngsters aged 11 to 15 were investigated to find out if they were exceptionally dependent, particularly on their mothers, as had repeatedly been asserted in connection with similar cases, often without adequate supporting evidence of an objective nature (Berg, 1970). The Highlands Dependency Questionnaire (H.D.Q.) was administered to their mothers around the time they were accepted for admission to an adolescent psychiatric in-patient unit. The Questionnaire had previously been found to measure at least two unrelated sorts of dependency, represented by a sociability factor (I) and an immaturity factor (III) with satisfactory reliability and validity; this emerged when a principal component factor analysis was performed on the results of applying it to the mothers of a randomly selected sample of 68 secondary school children from the general population, stratified for age, sex and social class (Berg et al., 1971). Data on 14 variables was processed on the University of Leeds English Electric KDF9 computer, using a system of standard programmes (Hamilton et al., 1965). In addition to the two sets of factor scores which were calculated using actual raw score weights, two corresponding sets of subscale scores were calculated using approximate raw score weights; correlations between factor and subscale scores in the control group had been found to be: r = ·87 for sociability and r = ·84 for immaturity (Berg et al., 1971), whereas in 19 youngsters out of the school phobic group, looked at in another context, they were: r = ·51 for sociability (perhaps explained by a divergence between at least two tendencies which have different emphasis in the factor and subscale scores) and r = ·95 for immaturity. The criteria adopted for the diagnosis of school phobia had been given previously when 29 school phobic cases with similar clinical features were reported in some detail (Berg et al., 1969).

Breathlessness is a difficult symptom to define (Howell and Campbell, 1966). Comroe (1966) spoke of the value of obtaining detailed accounts, in the patients' own words, of how they experience their breathlessness. Olsen (1964), who wrote that, ‘the problem of defining dyspnoea becomes a little easier if it is considered as a complex of completely subjective symptoms,’ also stated ‘it is recognized that difficult breathing may be observed by the physician without the patient being aware of respiratory embarrassment’.

In a previous study hyperkinetic circulation was found in alcoholics in the abstinence phase. Normal conditions were restored by 40 mg. propranolol. Even tension symptoms decreased (Carlsson, 1971).

A diagnosis of Turner's Syndrome is given to female patients who have small stature, primary amenorrhoea and a number of other variable stigmata. The ovaries are absent and the genital ducts and external genitalia do not develop spontaneously beyond the pre-pubertal stage. Chromosome analysis shows that the majority have a 45, X karyotype, in which one of the pair of sex chromosomes is missing. Others have a structural abnormality of one of the two X chromosomes resulting in loss of short-arm material.

The reports on the good effect of L-DOPA on Parkinson's syndrome and on some forms of depression have prompted us to investigate if it might alleviate mental disorders not responding to conventional methods. Pare et al. (1962) suggested distinguishing between types of depression according to how they respond to antidepressant drugs. If L-DOPA were shown to be effective, it would provide another means of differentiating between obscurely defined mental states. We present five cases of psychic disorders in which depression was a prominent symptom. All were treated with L-DOPA after a wide range of conventional treatments over many years had proved of little use.

Since the classic report in 1888 by the Committee on Myxoedema of the Clinical Society of London, there has been a wide interest in the psychiatric aspects of hypothyroidism. Despite many reports which followed, Asher (who in 1949 coined the term ‘myxoedematous madness’) had this to say: ‘Myxoedema is one of the most important, one of the least known and one of the most frequently missed causes of organic psychosis'. Most studies have been clinical descriptions with no correlation of the degree of affective disturbance with the severity of disease process.

Psychoanalysis is not regarded as having a significant part to play in the treatment of the psychoses. This view has been strengthened by the ease with which the phenothiazine and other drugs may bring many psychotic symptoms under control. Nevertheless, there are psychiatrists who believe that psychoanalysis, in its classical form or suitably modified, can benefit patients suffering from psychoses. The issues which have been raised by these claims are still the subject of controversy among psychiatrists and psychoanalysts. This paper is not concerned with details of the different kinds of analytical treatment which may be recommended for patients. Such an account would be inappropriate in the circumstances of current psychiatric practice in the United Kingdom. Instead attention will be focused on the way in which psychoanalysis can be integrated into therapeutic regimes presently employed in mental hospitals.

Although the suicide rate in England and Wales is declining (Fox, 1970), the rate of parasuicide is increasing rapidly (Aitken et al., 1969; Stanley, 1969; Bagley, 1970). There is an obvious clinical interest in knowing the extent to which medical and other agencies can prevent such behaviour, or its repetition, and in being able to predict high risk individuals. Progress in the evaluation of the prevention agencies has been reviewed by Bagley (1971), and in the field of prediction a number of studies have been published using British material. These studies usually take the form of an examination of the traits and characteristics of a group of completed or attempted suicides, and follow-up studies are less common (W.H.O. 1968). The present study, so far as we can discover, is the first follow-up study which includes patients who were not seen by a psychiatrist at the time of their key attempt.

In a well-known, very influential and frequently quoted paper, ‘On the Characteristics of Total Institutions,’ Goffman (1961) calls attention to ideological disputes which are centred on total institutions. As he puts it: ‘It is widely appreciated that total institutions typically fall considerably short of their official aims. It is less well appreciated that each of these official goals or charters seems admirably suited to provide a key of meaning—a language of explanation that the staff, and sometimes the inmates, can bring to every crevice of action in the institution. Thus, a medical frame of reference is not merely a perspective through which a decision concerning dosage can be determined and made meaningful; it is a perspective ready to account for all manner of decisions, such as the hours when hospital meals are served or the manner in which hospital linen is folded…. Paradoxically, then, while total institutions seem the least intellectual of places, it is nevertheless here, at least recently, that concern about words and verbalized perspectives has come to play a central and often feverish role.’ (pp. 83–84.)