It is generally accepted that any appreciable lack of intelligence precludes the possibility of successful psychological treatment along verbal lines. It is also widely believed that individuals with a lifelong character disorder, commonly described as “psychopathic”, whatever their degree of intelligence, are relatively inaccessible or unresponsive to group or individual psychotherapy. It follows that in individuals where intellectual defect is coupled with psychopathic character, the difficulties of psychotherapy are multiplied. A review of the literature supports this general impression.

Peripheral neuro-effector sites within and outside the autonomic nervous system form useful reference points for the study of the central effects of some agents. Nevertheless, ready analogies between peripheral neurohumoral mediation, and central synaptic transmission may be grossly misleading, and reliance must solely be placed on data derived from within the central nervous system itself.

In the outpatient department of the Maudsley Hospital, patients are seen in the first instance by members of the medical staff of consultant status at the diagnostic clinics, to which they are referred from a variety of sources, by far the greater number coming from general practitioners. From the diagnostic clinics there are several possible disposals, one of which is referral for outpatient treatment of a more prolonged and elaborate type, as opposed to treatment at a purely supportive level with brief interviews concerned with environmental factors and immediate practical problems. The more prolonged and elaborate outpatient treatment is under the supervision of a physician of consultant status with a Freudian analytical training and strong interest in psychotherapeutic methods. It is carried out by registrars under his guidance and may consist either of individual or group sessions, or of a mixture of the two, as he directs. His general outlook is well known (Foulkes, 1948). It has been a constant source of difficulty that the number of patients referred for this type of outpatient treatment has been greater than the resources of the hospital could manage, with the consequent development of long waiting lists and of the necessity for making awkward decisions with regard to priorities.

In her sociological study of suicide Cavan (1928) commented that “up to date no adequate studies have been made of the relation of the habit of drinking to suicidal tendencies”. Ten years later, Merrill Moore (1939) makes a similar complaint: “What relation, if any, is there between alcoholism and suicide? This question has never been definitely answered and little has been written about it… In the entire literature of medicine hardly more than twenty acceptable articles on this subject are recorded.” Little has been written on the topic since then.

Since Meduna published his monograph on carbon dioxide therapy of nervous disorders (Meduna, 1950) the method has been widely employed. This paper discusses the results obtained by the strict application of the methods described by Meduna to 42 psychoneurotic out-patients at the Maudsley Hospital, and the bearing these results have on his claim that it is an effective and safe method of treating psychoneurosis, such as could be applied by practitioners with little psychiatric experience.

D-Lysergic acid diethylamide (L.S.D.-25) was first prepared by Stoll and Hoffmann in 1938 (35) as a derivative of rye ergot. Its profound effects in minute doses were discovered accidentally by Hoffmann and reported by Stoll (34) along with additional observations by the latter on 16 healthy controls and six schizophrenic patients. With a dose of 30–130 γ (0.03–0.13 mgm.) Stoll (34) noted motor inco-ordination, disturbances of visual perception with illusions and hallucinations, clouding of consciousness, and affective changes principally in the direction of euphoria and distractibility. Subsequent clinical reports have confirmed these findings (6, 38). Becker (1) using doses of 30–40 γ in healthy controls attempted to predict the quality of the resulting psychosis from the constitutional somatotype of the subject; he contrasted maniacal hyperkinetic states with those showing inhibition and depersonalization and drew attention to the pattern of the visual perceptual disturbances, which were principally those of differences in size, clarity and perspective. Becker's attempts at somatotypological correlation were less successful than those of Condreau (4) who used mentally ill patients as well as healthy subjects and found that L.S.D.-25 did tend to reinforce pre-existing personality characteristics, especially with regard to mood changes. Rinkel and others (30, 7) with doses of 20–90 γ in mixed healthy and psychiatrically disturbed populations stressed the scotopic nature of the hallucinations and the greater frequency of illusions of rippling or wavy lines evolving at times into geometrical designs. Affective blunting with a lack of spontaneity was commoner than the production of major delusions. In epilepsy apparently visual hallucinations are more frequently concomitants of L.S.D.-25 administration than in other mental disorders (31).

Group therapy is one of the more recent advances in psychiatry and is a logical development which fits in well with the spirit of our time. The modern trend in psychiatry is to see the patient not only as an individual but also against his social background. This paper is a factual account of group therapy as carried out in Wormwood Scrubs Prison. The pioneer work was done by Mackwood (1949) and described by him. We should like to acknowledge our indebtedness to him.

A number of studies on reaction time (R.T.) latency to visual and auditory stimuli in psychotic patients has been reported since the first investigations on the personal equation were carried out. The general trends from the work up to 1943 are well summarized by Hunt (1944), while Granger's (1953) review of “Personality and visual perception” contains a summary of the studies on R.T. to visual stimuli.

In a previous enquiry the prognostic significance of diverse aspects of the functional psychoses was examined (Harris and Lubin, 1952; Harris and Norris, in press). Prognosis was evaluated in terms of total length of stay in a mental hospital over a follow-up period of 18 years. Each patient was assigned to one of three major diagnostic groups (schizophrenia, affective psychosis or atypical psychosis), the diagnosis being based on Kraepelinian and Bleulerian criteria. The diagnosis was made by one of the authors (A.H.) on the evidence of 20-year-old case notes written by a large number of different psychiatrists. In this investigation the same author himself examined all the patients included in the series. We felt it would be interesting to compare the predictive value of diagnoses made by the rough and ready method of the earlier survey with that of those made by a detailed examination of the patients concerned, as in the present survey. For reasons previously stated (Harris and Norris, 1954) we feel that only certified patients admitted in the second period are comparable with the types of cases admitted in 1930. If a diagnosis of schizophrenia is held to connote an unfavourable and the remaining categories a favourable outcome then in the first series 60 per cent. of the patients were correctly classified while in the second series 58 per cent. of the certified patients were assigned to their correct diagnostic group. This difference is not significant. Thus it would appear that a more sophisticated application of Bleulerian methods of diagnosis does not necessarily give rise to more reliable evaluation of prognosis. Accordingly we have attempted to dissect these three diagnostic categories to determine whether any of the components show prognostic significance. For this purpose we took the second series because for these patients there were available detailed clinical descriptions made by one of the authors (A.H.) in the observation ward of a general hospital, prior to the patient's transfer to a mental hospital. Unfortunately 13 of the case notes containing these detailed clinical descriptions had been lost, so that we could only use 187 patients out of the total of 200. They were first admitted to hospital in the period May, 1940 to May, 1942 and were followed-up for the next 10 years. The result of the analysis is set out in the table.

Certain specific disabilities following lesions of the dominant hemisphere particularly those involving the parietal region, have been recognized for many years. The syndrome of dyscalculia, dysgraphia, right-left disorientation and finger agnosia is usually known as Gerstmann's syndrome, following that author's descriptions in 1924 and 1940. It has been suggested that of these four main components of the syndrome, finger agnosia might be the fundamental disturbance, bringing the others in its train. Thus, as a result of the postulated importance of the digits for numeration, acalculia would naturally follow. Dysgraphia would result from the loss of the “schema” for the fingers—a part of the body-image—and right-left disorientation might be a consequence of the same body-image disturbance—a “hand” agnosia.

Depressive states occurring in the involutional period are among the most common syndromes encountered in psychiatric practice. Since the introduction of electroshock therapy, this has been the treatment of choice for these conditions. Unfortunately not every patient who is treated remains in good health, and every mental hospital has a certain number of chronic involutional depressions who remain refractory to further electroshock therapy.

Quick (1931) first reported on the conjugation of benzoic acid in man and recorded the hippuric acid excretion rate as a test for liver function. Quastel and Wales (1938) found faulty detoxication in catatonic schizophrenic patients and later (1940) a return to normal values after clinical remission. A number of other workers, particularly Georgi, Fischer, Weber and Weiss (1948–49) described this disturbed benzoic acid detoxication as a general syndrome in all schizophrenics. When giving glycine simultaneously with the benzoic acid they noticed a normalized and increased hippuric acid excretion rate in patients who originally showed decreased hippuric acid excretion. The Quick test, modified in this way, was used in order to prove that the decreased hippuric acid excretion rate is not the expression of a disturbance in the coupling mechanism between benzoic acid and glycine but rather a disturbed ability of the organism to mobilize glycine. Mall and Jünemann (1952) have lately confirmed the results of Georgi et al. in extensive investigations. They reached the conclusion that variations in the hippuric acid excretion rate are mainly due to a disturbance of the ability to dispose of glycine in the schizophrenic organism. They confirmed previous results of Georgi according to whom treatment of the patients, which was carried out partly from the point of view of disturbed liver function only, partly combined with insulin and electroshock, leads to improvement of the detoxication rate. Persky, Gamm, and Grinker (1952) have also recently seen decreased hippuric acid excretion values in catatonic schizophrenic subjects, and have reported a return of the hippuric acid excretion to normal after successful psychiatric treatment. In their series patients who manifested free anxiety symptoms, excreted elevated amounts of hippuric acid; the excretion rate returning to normal levels after successful psychiatric treatment.

D-lysergic acid diethylamide (LSD 25) was first prepared in 1938 by Stoll and Hofmann. It is the synthetic amide of d-lysergic acid with a secondary amine, diethylamine and belongs to the ergonovine group of ergot alkaloids all of which have lysergic acid as a base. After its ingestion in minute doses, it induces psychic states in which the subject becomes aware of repressed memories and other unconscious material in a setting of clear consciousness. This preliminary paper describes the results obtained from the use of the drug in 36 psychoneurotic patients over a period of one year. We consider that the drug will find a significant place in the treatment of the psychoneuroses and allied mental illnesses.

The relationship of neuro-psychiatric disorders to electro-physiology and biochemistry has a vast literature, review of which is not within the scope of this preliminary report. The report itself concerns a study of an aspect of this relationship based on 30 unselected neuro-psychiatric cases. Each case had an electroencephalographic (E.E.G.) and a cerebrospinal fluid (C.S.F.) investigation, the latter with reference to the presence of amino-acids.

Hypnoanalysis is becoming more and more a recognized psychotherapeutic procedure. It is an analytical type of therapy which utilizes the hypnotic state to reduce the great time and cost of formal psychoanalysis. As with any new form of treatment, there is great variation in the techniques used by different authors (1, 2, 3, 4, 5, 6, 7). This variation ranges from such extremes as attempts to imitate formal psychoanalysis with a hypnotized patient, to mere question and answer interviews interspersed with hypnotic suggestion.

Most spontaneous movements are considered to be motor expressions of the feelings and emotions (Stagner, 1948). Many movements of this kind are referred to as “nervous” habits or mannerisms, a description in which this assumption is also implicit. It is surprising, therefore, that so readily available and objective a guide to the affective organization of the personality has been studied relatively little: the difficulties of definition, description and measurement may account for this. Olson (1929), however, devised a useful time-sampling technique for measuring nervous habits, but I know of no investigations in which it has been used to compare the spontaneous movements made by healthy and “nervous” subjects.

This is the fourth of a series of articles reporting an investigation into the Block Design Rotation Effect. This effect was first observed in some patients while they were doing the Goldstein Block Design Test, in which the subject has to reproduce patterns with the aid of coloured cubes. Some patients, while completing the designs correctly, would leave the completed pattern in a rotated position without apparently being aware of this (2). Such rotation frequently reached 45° (Illustration 1) but rarely exceeded this amount.

To research workers in personality measurement the advance of routine testing procedures in clinical psychology has seemed peculiarly sluggish. Whereas solid theoretical foundations have been found for an account of the normal personality structure in factor analytic terms (5, 6, 7) and a rich variety of new tests has been created (8, 9, 14), the clinicians have confined themselves to one or two “gadget” tests, conceived with no more explicit relation to personality structure than a patent medicine has to modern physiological principles. The present research aims to bring factor structure measurement in a clinical population into relation with that found in normals and to provide a first, reproducible, test battery covering at least a dozen factors for use in clinics able to give sufficient time for valid and reliable measures of the primary personality dimensions.

In the course of planning a research into spontaneous movements (expressive movements and disorders of involuntary movement, such as tics), it was essential to devise some means whereby these forms of motor behaviour might be objectively measured. The purpose of this paper is to describe one of our methods of doing this by the use of motion pictures, and to demonstrate experimentally the reliability and validity of a method which, it is believed, may prove to have a wider application.