Hypertensive attacks during treatment with amine oxidase inhibitors were first described in tuberculous patients, and were “rediscovered'’ when these drugs were introduced into psychiatry. In an assessment of iproniazid for tuberculosis (Ogilvie, 1955), 4 out of 42 patients experienced “attacks of a most distressing nature”, with severe throbbing occipital headache and high blood pressure. Six years later, similar attacks were observed in 5 out of 212 patients treated for depression with nialamide (Davies, 1959), but it was not until the introduction of tranylcypromine that reports again appeared (Lurie and Salzer, 1961; Clark, 1961). By the beginning of 1963, over 40 such cases had been reported, including several complicated by intracerebral haemorrhage or cardiac failure due to the rise in blood pressure (Songco, 1961; McClure, 1962; Dorrell, 1963).

The literature on female alcoholism is relatively scanty. The few reports that have been published suggest that the female alcoholic is different from the male alcoholic: for example, Lysansky (1957) stated that American female alcoholics start to drink later, lose control later, drink alone, prefer wine and have fewer arrests or admissions. Perhaps her illness is also more severe: Fort and Porterfield (1961) discovered in their sample that the women required a much shorter length of time to become alcoholic than did the men; the phases of the process were less distinct and nearly all the women had serious personality difficulties or had experienced strong emotional stress. Another American author, Rosenbaum (1958), thought that female alcoholism was an expression of personality misdevelopment, and produced some evidence to support this view. However, he also demonstrated that in married female alcoholics the husband's own heavy drinking, as well as his non-constructive attitude towards his wife's drinking, contributed to the wife's illness.

Various forms of treatment have been recommended for multiple tics, including psychotherapy (Zausmer, 1954), behaviour therapy (Yates, 1958) and phenothiazines and other tranquillizers (Lucas, 1964; Kelman, 1965), but there have been no reports of an adequate controlled trial of any particular therapy.

It is now widely accepted that abreaction as a technique can most usefully be applied in the field of psychoneurotic reactions arising from exceptionally traumatic experiences. During the last world war, ether and intravenous barbiturates were extensively used in the treatment of battle neuroses, often with dramatic results (Sargant and Slater, 1940; Shorvon and Sargant, 1947). For the less spectacular syndromes of peace-time, such methods are probably best applied to investigation and elimination of resistances encountered in the therapeutic situation (Horsley, 1943).

It has been routine psychiatric practice in recent years to prescribe vitamins in alcoholism and confusional states and sometimes in other organic psychoses. The doses given are massive, varying from about ten to twenty times those strictly necessary in deficiency states. This empirical therapy is supported neither by controlled trials nor by direct evidence of vitamin deficiency.

From diverse physiological and psychological studies in animals and in man, it is generally concluded that increased secretion of adrenocortical steroids accompanies emotional stress. The relationship between mood, especially the pathological changes of mood found in a depressive illness, and adrenocortical hormones is not so clearly defined.

A raised incidence of neurotic personality traits and mental illness has been reported among the first-degree relatives of obsessional neurotics. It has been suggested that genetical factors are involved in determining a predisposition to this condition, but some authors have postulated that similarities in aspects of the environment such as early upbringing and family traditions may account for similarities shown by relatives.

The classification and nature of psychoses with both schizophrenic and manic-depressive symptoms is still highly controversial. The original view based on the Kraepelinian dichotomy of endogenous psychoses was that the “mixed” or “schizo-affective” psychoses were mixed also in a genetic sense. This would mean that some individuals inherit both schizophrenic and manic-depressive Anlage. This view has not been confirmed. One alternative is that proposed by Kleist and Leonhard, namely, that atypical forms of endogenous psychoses exist, which are genetically independent of both schizophrenia and manic-depressive psychosis. It seems, however, that Leonhard's concept has attracted little attention. Slater (1953) stated that Leonhard's work was “most interesting”, but hardly mentions it in his text-book of psychiatry (Mayer-Gross, Slater and Roth, 1960). An account of Leonhard's views on schizophrenia has however, been given by Fish (1958).

In recent years a number of studies on attempted suicide in various cities in England and Scotland have been published (Batchelor, 1954a and b; Stengel and Cook, 1958; Harrington and Cross, 1959; Middleton et al., 1961; Kessel and Lee, 1962; Sclare and Hamilton, 1963). Direct comparison between these suicides is difficult, not only because they differ in presentation but also because regional and cultural differences contribute to varying clinical and epidemiological data. There is, however, general agreement that cases of attempted suicide have become depressingly common problems in the casualty departments and wards of most general hospitals in larger cities. The Ministry of Health Circular H.M. (61) 94 estimates that the annual incidence of attempted suicide in England and Wales is around 30,000 cases. The present writers agree with Stengel (1963) that this is likely to be an underestimate.

To keep psychiatric patients as much as possible in the community rather than have them admitted to mental hospital is a policy which has become more and more favoured and has been shown to work (Leyberg, 1959; Silverman, 1961; Sainsbury et al., 1963 and Hoenig et al., 1965, etc.). This type of management cannot be expected to be equally successful with all groups of patients and is perhaps most open to question as regards the illnesses that affect the elderly.