Dr. Scott has outlined the varieties of treatment which have been suggested for psychopaths and some of the varieties which may be suitable for certain methods.

The Day Hospital approach in adult psychiatry appears to have begun with the original conception of Cameron in Montreal. He stated (Cameron, 1958) that both the original concept and its further development sprang from growing appreciation of the possibilities of new methods of treatment and diagnosis: at this time the rapid rise of the cost of in-patient treatment took place and there was increasing realization of the importance of the treatment milieu. At the same time as Cameron was setting up his Day Hospital in Montreal, Bierer was setting up the Marlborough Day Hospital in London (Bierer, 1951) and he discussed the theory and practice of Psychiatric Day Hospitals later (Bierer, 1959). Harris (1957) also discussed the implications of Day Hospitals and Night Hospitals in psychiatry with regard to the adult patient.

In psychiatry we often use different kinds of psychology without being aware of doing so. Before we consider existentialist psychiatry in detail we must discuss the three different kinds of psychology, namely, explanatory psychology, understanding psychology and interpretive psychology.

The discovery by Kuhn (1957) that an iminodibenzyl derivative (imipramine) was therapeutically successful in depressive illnesses aroused great interest and stimulated clinical trials with the drug in many parts of the world. The results of some of the published reports are given in summarized form in Table I.

The pharmacological treatment of depression was quite limited in efficacy before the discovery of iproniazid and imipramine (Rees, 1960).

A number of synthetic drugs have recently been introduced as specific antidepressants in psychiatry. Isocarboxazid (Marplan) is an analogue of iproniazid (Marsilid). Both belong to the monoamine oxidase inhibitor group of antidepressants. Isocarboxazid is said to be less toxic but of equal potency for a lesser dose than iproniazid. A controlled clinical trial of isocarboxazid was therefore undertaken to assess this drug in the treatment of depression. The results of this trial are reported in this paper together with the results of an uncontrolled trial in a further group of patients (group M) who received isocarboxazid only.

Nialamide is claimed to inhibit the activity of the enzyme monoamine oxidase which is known to be responsible for the breakdown by catalytic oxidation of various amines, e.g. serotonin and norepinephrine. It has been suggested that depression may be associated with inadequate levels of serotonin and/or norepinephrine and that the administration of a monoamine oxidase inhibitor should rationally help to relieve depression. No serious side-effects have been reported in the available literature except that agitated patients might become somewhat more agitated and overactive.