To make a comparative study of the fatiguability of chronic schizophrenics and non-psychotic depressives and to test Kraepelin's hypothesis that schizophrenia is typified by rapid and acute fall-off in work performance (Kraepelin, 1910). Kraepelin's explanation of the cause of this fall-off was in terms of constriction of volition. However, on the basis of operational definitions, there appears to be little justification for regarding the phenomenon as other than a special case of fatiguability.

Some of the earliest objective approaches to the removal of specific anxieties and fears in children were based on the fact that neurotic (learned, unadaptive) responses can be eliminated by the repeated and simultaneous evocation of stronger incompatible responses. An early and well-known example of this approach was the experiment of Jones (1) in which a child's fear of rabbits was gradually eliminated by introducing a “pleasant stimulus” i.e., food (thus evoking the anxiety-inhibiting response of eating) in the presence of the rabbit. The general method of “gradual habituation” was advocated by Jersild and Holmes (2) as being superior to all others in the elimination of children's fears. This rationale was crystallized in Wolpe's (3) formulation of the Reciprocal inhibition Principle, which deserves the closest possible study:

In recent years interest has attached to the fact that experiences allied to those described by patients during acute schizophrenic illnesses can be induced in normal people by the use of certain drugs, sometimes called “hallucinogens”. In so far as these drugs have caused hallucinations, however, they have induced predominantly visual hallucinations, whereas in schizophrenia the outstanding hallucinations are auditory ones, of voices—often making remarks in the third person singular, sometimes making apparently senseless or absurd remarks. In this paper, attention is drawn to means whereby non-schizophrenic persons can be caused to experience hallucinatory and illusory voices by primarily psychological and not pharmacological techniques. These techniques are also applicable to normal volunteers, but this paper will deal with first experiences of them during the treatment of some sexual deviants and alcohol addicts.

In Great Britain systematic population studies of treated mental illness have received little attention. In exception Carstairs and Brown (5) have carried out a retrospective psychiatric census of two small communities in South Wales, to include admissions to mental hospitals, attendances at out-patient clinics and all cases of suicide and attempted suicide over a five and a half year period. Martin et al. (18) have explored the incidence of neurosis on a new housing estate. More extensive programmes have been undertaken in the U.S.A., particularly that of Hollingshead and Redlich (15) in their detailed study of New Haven, Connecticut, and in Scandinavia as exemplified by Larsson and Sjögren's (16) study of a rural population in Sweden.

Pick's disease most commonly begins in the midlife period. Sjogren, Sjogren and Lindgren (1952) in their series of 18 anatomically verified cases of Pick's disease found that the average age of onset was 54·5±2·7 years. Escourolle (1956) segregated from the literature 184 cases in which he considered the diagnosis of Pick's disease to be “indisputable” and demonstrated therefrom that the sixth decade is the period of highest incidence. Pick's disease, however, has frequently been reported to erupt in the seventh decade and occasionally in the eighth, ninth and tenth decades. (Bonfiglio, 1926; von Braunmühl, 1928; Moyano, 1932; Sjogren, Sjogren and Lindgren, 1952.)

This study is intended to yield information about the type of task that a chronic schizophrenic might be expected to succeed at and, conversely, the conditions under which their disabilities are magnified. The primary purpose is to obtain data to act as a guide in the design of work for such patients, and secondly to produce more general information about the differences between the normal person and the chronic schizophrenic on sequential operations. The task studied involved primarily both long and short-term memory functions, together with the associated processes of attention.

In 1948, Funkenstein, Greenblatt and Solomon reported on a test of autonomic function which is clearly a combination of tests used by earlier workers (McWilliam, 1925; Sachs, 1936; Myerson et al., 1937; Gold, 1943; Altman, 1943). They reported a relationship between the changes in systolic blood pressure induced by injected adrenaline and methacholine and the clinical course, after electro-convulsive treatment in a group of psychiatric patients. This was followed by a considerable volume of work, published by Funkenstein and his colleagues, on the prognostic, diagnostic and other aspects of a test (the adrenaline-methacholine or Funkenstein test) which has aroused steadily increasing interest. The number of papers published has grown continually, and great variation exists in the techniques adopted and the scoring methods used. Some workers have confirmed the original findings whilst others have not. Thus the subsequent literature on the test has shown a pattern not unfamiliar in medicine; enthusiastic first publications followed by reports less satisfactory and more critical, and attempts to carry out a proper evaluation, producing many contradictory results.

In recent years an ever-increasing interest has been taken in the possible use of serum enzyme investigations in clinical diagnosis, prognosis and therapy control. That clinical abnormalities are accompanied or even induced by biochemical aberrations is accepted. That the serum enzyme pattern may show consequent abnormality before the signs and symptoms familiar to the physician appear, has been also demonstrated in several disease states, such as caeruloplasmin in Wilson's disease (Scheinberg and Gitlin, 1952) and the transaminases in infective hepatitis (Wroblewski, 1957).

In the course of the past few years, a series of related studies (Aserinsky and Kleitman, 1955; Goodenough et al., 1959; Wolpert and Trosman, 1958) has demonstrated beyond doubt the association of normal dreaming with the appearance of rapid, binocularly synchronous eye-movements. It has also been claimed that the rapid eye-movements (REMs) represent scanning movements made by the dreamer as he “watches” the visual events of the dream (Dement and Kleitman, 1957a; Dement and Wolpert, 1958). The REMs are absent during dreaming among those with life-long blindness, but are retained for some years by those whose blindness arises later than childhood (Berger et al., 1962a). In a study of undisturbed nocturnal sleep by Dement and Kleitman (1957b) periods of eye-movements were observed to occur fairly regularly at about 90-minute intervals throughout the night in association with the lightest phases of cyclic variation in depth of sleep, as indicated by the electroencephalogram (EEG). These REM periods had a mean duration of about 20 minutes, and 4–6 occurred per night.

Recent time estimation studies (e.g. Loehlin 1959, Frankenhaeuser 1959, Wallace and Rabin, 1960) although carrying on studies dating back to the time of Vierodt and Wundt, suggest that time experiments merit more attention in modern psychology and psychiatry. Two omissions are (a) the time estimation of periods longer than one or two minutes and (b) the possible relation of individual variations of these estimates with individual personalty variations of a normal and abnormal kind. Everyday anecdote and observation in fact, do suggest a relationship in stressing how the passage of time varies with differing emotional states, even in normal people. In clinical groups striking variations of time experience have been recorded (see e.g. Dubois, 1954).

Over the past few years, workers in many diverse fields have become interested in the framework of the psychiatrist-patient relationship as a matter for study in its own right. Yet the pattern of professional opinions, conveniently subsumed under the term “orientation”, which the psychiatrist brings with him to the clinical situation, has received very little attention. In this paper an attempt will be described to measure certain aspects of psychiatric orientation, and to explore how these may be correlated with other variables.

Recently there has been a resurgence of interest in the subject of hypoparathyroidism and it has become increasingly clear that psychiatric symptoms may frequently be found in patients with hypoparathyroidism, even where no evidence of tetany is present. It is significant that in a survey, in the Cardiff area, of 82 patients who had had a thyroidectomy, Davis et al. (1961) found that mental symptoms (defined as a feeling of uneasiness, tension and anxiety, sometimes with attacks of panic, often with depression) occurred in 66 per cent. of 26 patients whose plasma calcium was below 9·3 mgms/cent, in 51 per cent. of 31 patients whose plasma calcium lay between 9·3 and 9·8 mgms./cent. and in 35 per cent. of 23 patients whose plasma calcium was above 9 · 8 mgms./cent. They estimated that at least 24 per cent. of the patients showed partial parathyroid insufficiency, and that this apparently accounted for many minor but disabling symptoms, particularly depression and lassitude. They found that often these symptoms could be cured by the administration of calcium.

The fasting blood acetyl methyl carbinol (A.M.C.) level was shown to be high at the start of the depressive phase in manic-depressives by Dawson, Hullen and Crockett (1). Such cases also showed large fluctuations of fasting blood A.M.C. level compared with normals. The findings in a manic-depressive patient investigated more recently are shown in Figure 1; those in a normal female are given also for comparison. In the manic-depressive, it can be seen that the fasting blood A.M.C. level tended to fluctuate widely, to be high before and at the start of a depressive phase. There is no evidence to suggest that A.M.C. in the quantities found could cause psychiatric manifestations (Stotz, Westerfeld and Berg, 8). It is hence possible that the alterations in A.M.C. level were merely an indication of an abnormal variability of some part of the biochemical milieu. It was decided therefore to investigate patients with other forms of depressive illness to see whether or not abnormalities of A.M.C. level and variability were present, similar to those in manic-depressives.

“When we consider the immense human significance of sleep, the absolute necessity for us to spend a considerable part of our lives in abject mental annihilation, it is remarkable how little we know about it. …” In these words, Sir John Eccles introduced the recently published Ciba Foundation Symposium on “The Nature of Sleep” (3), in which are described many of the advances which have been made in recent years in our attempts to understand the phenomena which are involved in the state of sleep. In one of the papers included in this Symposium, Bremer (2) reviews the work which has been reported since 1954 on the neurophysiological mechanisms involved in sleep. The relationship of dreaming to the depth of sleep has been investigated by such workers as Kleitman (5), Dement (4) and Wolpert (11). These studies have been made possible by the application of modern techniques of measuring mental activity. The use of electroencephalographic methods has allowed an approximate classification of the different levels of sleep which enables different workers to adopt a standard frame of reference. Measurements of rapid eye movements and of changes in muscle potential during sleep have provided more objective methods of assessing dream activity. Other recent studies have attempted to make an objective assessment of the physical and mental effects of sleep deprivation (Morris et al., 7, Bliss et al., 1, Murray et al., 8, Wilkinson, 9, Williams et al., 10).

The role of phenothiazine derivatives in controlling the symptoms of mental diseases has been investigated by many workers by determining its site of action in the central nervous system.

In the treatment of depression “in all comparisons it is necessary to bear in mind that electroplexy carries a negligible mortality rate and that there are relatively few physical contraindications to its application” (Shepherd, 1959). Bruce et al. (1960) compared electroplexy and imipramine in 50 consecutive admissions and at one month the former is shown to give better results. Rees et al. (1961), whose cases were suitable for electroplexy, show only 35 per cent. with total remission or marked improvement after three weeks treatment with imipramine—a much lower figure than one would expect with E.C.T.

Previous papers in this series (Shapiro, 2, 3, 4; Shapiro and Tizard, 6; Yates, 13 and 16) have been concerned with the investigation of an aspect of the reproduction of designs called the rotation effect. Rotation is the term used to describe the fact that subjects often, when copying a design, make their reproductions in an orientation which is different from that of the model (see Figure 1).

Patients in the care of the Department of Psychological Medicine, Guy's Hospital, who are receiving moderate and large doses of phenothiazine drugs are regularly tested for evidence of hepatic or haematological disturbance. In the course of such an investigation, when the urine of a schizophrenic patient was tested with modified Ehrlich's reagent for urobilinogen, it was remarked that a deep blue colour was produced. The patient had been receiving 600 mg. of chloropromazine daily in divided doses for the previous 10 days, and as no other cause for this unusual result could be found, the phenothiazine was considered to be responsible.

The common ground between neurology and psychiatry is regrettably slight, but in either field there have been men who sought to bring about a rapprochement between them by evolving broad conceptions of the structure of mind. For example, Hughlings Jackson's concept of “levels” and Freud's description of the mind in terms of Ego, Super-Ego and Id are both essentially attempts to define and classify the intellectual and behavioural functions of the brain, so as to form a coherent basis for the study of the interactions and disorders of these functions.

There are conflicting psychiatric opinions about the value of separating depressive illnesses into several syndromes on clinical grounds, and so far experimental attempts to reach a classification of depression by distinguishing physiological or biochemical features which characterize one group rather than another have had only limited success. One interesting series of experiments in this area has been that of Shagass and his colleagues on the sedation threshold (Shagass et al., 1956, Shagass and Naiman, 1956, Shagass, 1954); they report that neurotic and psychotic depressions can be differentiated by means of EEG and other reactions to sodium amytal (amylobarbitone sodium) neurotics requiring greater amounts of the drug to reach the sedation threshold.