In order to test whether a drug is an inhibitor of monoamine oxidase in the human subject, three main measures are available:

1. We can measure an increased excretion of the normal substrates of the enzyme, e.g. tryptamine (Sjoerdsma, et al., 1959b).

2. We can measure a decreased excretion of the metabolites resulting from the enzyme's action, e.g. 5-hydroxyindoleacetic acid (5-HIAA).

3. We can administer a loading dose of an enzyme substrate and observe how the subject deals with it before and after the drug, e.g. 5-hydroxytryptamine (Sjoerdsma et al., 1958), and epinephrine (N-methyl-C14) (Resnick et al., 1958).

The following study was designed to compare the effectiveness of imipramine (Tofranil) and pheniprazine (Cavodil) in the treatment of endogenous depression. Controlled trials have shown the value of imipramine (Holdway, 1960) and therefore no placebo group was included. The theoretical advantages of a cross-over technique were considered to be outweighed by such disadvantages as the tendency for the effects of the first therapeutic agent to continue into the second phase of the experiment; and the tendency for rapid remissions to occur with anti-depressive drugs and to persist for a period despite withdrawal. Thus two similar groups of patients, each treated with full dosage of their respective drugs, were compared. The selection of patients was randomized, and the trial was blind throughout.

Weckowicz, Sommer and Hall (14) in a paper on the size and distance perception of schizophrenic patients relate their results to a theory of the normal perception of size and distance. This paper analyses more fully some aspects of their results, since they provide evidence against the theory of perception which Weckowicz et al. accept.

This work was originally started because attention had been drawn to the high suicide rate in Hampstead. Geffen and Warren (1) originally reported this high rate. During the last ten years it has varied between 20 and 30 per 100,000 inhabitants (see Table I). It also compares with the suicide death rate of 10 per 100,000 for the whole community.

It may be recalled that the Recommendations adopted by the General Medical Council in 1957 refrained from specifying the period of time to be allotted to particular subjects, or the sequence in which they should be taught. They considered the primary task to be that of finding means to reduce the congestion in the curriculum: to instruct less and to educate more: and they trusted that the licensing bodies and schools would not feel limited in their right, even their duty, to experiment with different courses and various methods of teaching.

So many new compounds are now being introduced for the treatment of psychiatric disorders that it is difficult for the clinician to assess the accuracy of the claims made for them. If a form of therapy is one hundred per cent. effective in a disease which was previously one hundred per cent. fatal, for example vitamin B12 in pernicious anaemia, the question of a controlled trial does not arise. But even the manufacturers do not claim such a degree of effectiveness for drugs advocated for the treatment of mental illnesses, and in addition the natural course of such illnesses is very variable, so that it is essential that clinical trials of these drugs should be controlled. Foulds (1958) has reviewed British and American clinical trials of drugs in psychiatry during the years 1951 to 1956, and has shown that the less controlled a trial, the more likely it is to result in a favourable report on the drug being tested, presumably because of bias on the part of the clinician. Forrester (1958), however, on the basis of a completely uncontrolled trial of Stelazine on only twenty-five patients, concluded that “the amount of improvement in a few cases was not sufficient to encourage the further use of the drug”.

Four experiments were carried out on chronic female schizophrenic patients in order to determine the differential effects of colour upon their behaviour. The three primary colours, red, blue and green, were used. The patients, who fell into Arieti's second or third stages of schizophrenia, had a mean age of 45 years (range 38-50), and a mean duration of hospitalization of 19 years (range 9-30). All experiments were carried out in a small side room painted white, the colour of which could be changed by the use of coloured lights hanging centrally from the ceiling. The colours used had a fixed intensity of 2 foot candles at a distance of 2 feet.

It is the custom of our times to explain neurological, and, to some extent, psychiatric disorders by reference to a static or diagrammatic conception of the physiology of the nervous system, linked with the findings of morbid anatomy. But, in the words of Riese (1950), expressed in his Principles of Neurology:

“Can the behaviour of a living organism be interpreted as purely mechanical? Though the organism remains submitted to the law of mechanics and physics, and though it is to the benefit of a steady improvement of our factual knowledge to explore the mechanics to the maximum possible, we must recognize that in a living organism mechanics are not left to themselves (which means to chance), but that they are at the service of a directing agency best described as the organism's welfare. The reflex must be conceived as an instrument of this agent. All disorders analysed and described in terms of reflex action are only instrumental ones. Neither the physician's task nor his possibilities extend beyond this limit. The directing forces of the organism will be withheld forever from the physician's acting power, if only for the reason that these forces are just ideas or principles of interpretation, but not perceptible realities.”

There are many reports referring to incidence of agranulocytosis in patients receiving phenothiazines. This and the potential hepatotoxic effect of this group of drugs have been the greatest drawback in their usage.

Consideration of the aetiology of behaviour disorders in epileptic children has been something of a test case in psychiatry: it divides sharply the “organicists” from the “environmentalists”, while those absorbed in psychopathological theory are given free scope to describe the complexity of dynamic mechanisms without committing themselves as to the ultimate aetiological factors.

Circulars on Child Guidance were issued by the Ministries of Health and Education (Circulars H.M. (59) 23, 3/59 and 347) in March, 1959 (1). Observations on these circulars while still in draft form had been invited from the Royal MedicoPsychological Association (2) and were submitted to the appropriate authorities.

The R.M.P.A. does not wish to comment again in detail on these circulars, but it is noted that Circular 347 states as its object the laying of a sound basis for the present organization of the Child Psychiatry (Guidance) Service and for the planning of future developments as and when this becomes possible. This being so, it is noted that it is now laid down that the clinic “will be under the medical direction of the psychiatrist”. In order to be of help in the re-organization of present child psychiatric (guidance) clinics and in the planning of future clinics, it is considered that it would be helpful to define the functions of the medical director of a clinic.