In order to explore the possibility of there occurring, in accordance with the Law of Mass Action, a reversal of the deposition of the cholesterol-lipoid-lipoprotein complex (Bevans et al., 1951), in the walls of cerebral arteries of atherosclerotic dements following a reduction in serum cholesterol, a study was made in March 1959 of changes that were shown in the behaviour of six such patients compared with six senile dements and four schizophrenics following the intake of large quantities of corn oil (Keys, 1956; Anderson et al., 1957).

Eighty chronic schizophrenic women hospitalized for an average of 6·8 years received group hypnotherapy twice weekly in addition to tranquillizers. After four months, 42 per cent. were discharged on convalescent leave; by the end of a year, a total of 48 patients (60 per cent.) had been released. All discharged patients—except four who required rehospitalization —made a satisfactory adjustment to their family and social responsibilities during the one-year follow-up period.

Overinclusive thinking has been regarded by some authorities as an important aspect of the thought disorder found in schizophrenic patients (8). Norman Cameron (2, 3, 4, 5), who performed the pioneer studies in this field, defined overinclusive thinking as the inability to preserve conceptual boundaries, as a result of which distantly associated and even irrelevant ideas come to be regarded as essential parts of a concept. This abnormality necessarily makes thought more abstract and less precise. Furthermore, it can lead to overlapping concepts which share elements in common, when, normally, they should be mutually exclusive, a situation which allows the thought-disordered person to entertain two mutually incompatible ideas at the same time without recognizing the contradiction.

There are reasons for supposing that both neurotic and normal individuals are likely to react differently to questions about nervous and about physical symptoms, and that those who are readier to respond to physical than mental questions might be those who adopted a particular attitude or mental set which we shall call “defensive”.

Since it was first reported by Kuhn in 1957, the value of imipramine in the treatment of depressive illness has become generally recognized and confirmed by clinical trials (Blair, 1960; Daneman, 1961; Rees et al., 1961). It continues to hold an important place in therapy despite the introduction of many other antidepressant drugs and the occasional adverse report (Ashby & Collins 1961). Nevertheless the indications for its use are by no means established. It has been claimed that certain types of depression respond better than others: “psychotic” better than “neurotic” (Azima, 1959), “endogenous” better than “reactive” (Ball and Kiloh, 1959). Yet the difficulty of making these categorical distinctions, and of making reliable comparisons between the findings based upon them by different workers remains notorious. It is clear, however, that only a proportion of depressed patients respond well to imipramine. It is also certain that within the group which does respond well are to be found representatives of every type and degree of depressive state. There is evident need, therefore, for information that will help to indicate which characteristics of an individual will render him more or less susceptible to imipramine, and there does not appear to have been any study particularly devoted to this. In this paper we give the results of correlating certain clinical features of depression with the response to treatment by this drug.

Taking the needle and being needled are contemporary colloquialisms which have some significance to those who administer injections for psychological purposes. They suggest that the experience of receiving hypodermic injections must be a relatively common one in our society, and also that such an experience is generally considered to be unpleasant. The corollary of these conclusions is that such a public attitude of mind is likely to foster preconceptions in relations to injections so that, whether or not the pain threshold itself is actually exceeded, the individual receiving an injection will be predisposed to regard the experience as a stressful one.

In reviewing controlled trials using mono-amine oxidase inhibitors in the treatment of depression it is soon obvious that workers vary as to whether they consider “depression” as a symptomatic mood change in diverse conditions or as a disease entity. Where the latter occurs, a variety of classifications of depressive illnesses appear, and that most widely used is the broad separation between endogenous and reactive depressions. Other points to note are the authors' definition of improvement, and particularly whether this refers to one aspect of the mental state only and whether the patient left hospital before receiving any treatment other than the drug.

One of the obvious requirements of a clinical test which purports to assess any aspect of the impairment of behaviour is that of cross-validation; it should be able to discriminate between different groups of patients similar to those on which it was first standardized. This paper reports such cross-validation of a paired-associate learning test which Inglis (1959) has shown to discriminate between groups of elderly psychiatric patients with and without memory disorder.

Recent interest in the problems of long-stay mental hospital populations has led to a number of studies which have been concerned with rehabilitation and particularly the re-activation of chronic, deteriorated patients by deliberate and systematic modification of their environment. In some of these studies, attention has been focused on the hospital ward itself, both as the background against which personal and social deterioration may be assessed, and as the means of re-building desirable patterns of behaviour (Cameron, Laing and McGhie, 1955; May, 1956). Another group of rehabilitation studies has been concerned with the value of specific work programmes. Industrial-type workshops in Dutch mental hospitals have been discussed by Carstairs et al. (1955), and the value of industrial and productive work in hospitals in this country, as well as some of its therapeutic effects, have been described in other publications (Baker, 1956; Stern, 1959; Collins, Fynn, Manners and Morgan, 1959). Considerable developments in the rationale and organization of sheltered as well as financially viable industrial workshops or factories for chronic mental patients have been made more recently (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al., 1961).

Most patients with endogenous depression who receive electroconvulsive treatment (E.C.T.) recover completely or improve considerably. However, it is evident that the effect of E.C.T. varies in different individuals. In some cases more treatments are necessary than in others and sometimes the final result is unsatisfactory even after a great number of treatments. Many attempts have been made to explain these variations.

Haloperidol is a comparatively new tranquillizing drug synthesized by Janssen et al. (1959). It is chemically unrelated to other drugs acting on the nervous system. It is a substituted butyrophenone whose formula is 4-fluro-4(1-[4-hydroxy-4-(4-chloro)-phenyl-piperidino]) butyrophenone.

Amitriptyline hydrochloride is 5–(3 dimethylaminopropylidine)–dibenzo (a,d) (1,4) cycloheptadiene hydrochloride. Structurally it is not related to the hydrazines and is not a monoamine oxidase inhibitor. It bears some resemblance to the phenothiazines and its chemical structure is related to imipramine, in which the central seven numbered ring is azepine, nitrogen replacing the partially unsaturated carbon of the amitriptyline cycloheptadiene ring (Dorfman, 1960; Vernier, 1961).

Former attempts to restore weight loss in psychiatric patients have included hyperalimentation (Weir Mitchell, 8) and sub-coma insulin therapy (Debenham et al., 2; Sargant and Craske, 5; Sullivan, 7). The aim of the present trial was to compare weight gains in a group of patients given repeated small doses of insulin with two other groups to whom oral hypoglycaemic agents were administered, and with a control group. The drugs used were tolbutamide and chlorpropamide, both of which are sulphonylureas used in the management of diabetes mellitus, and known to induce hypoglycaemia in non-diabetic subjects (Hoenig and Gittleson, 4; Cardonnet et al., 1; Garcia Reyes et al., 3). Pharmacologically there are no qualitative differences in their mode of action. Stowers et al., (6) found the half-life of tolbutamide to be 3·5 hours and that of chlorpropamide 34·5 hours. The prolonged action of chlorpropamide permits once daily dosage, but tolbutamide, being a shorter acting drug, was given in divided doses to maintain depression of blood sugar over the 24 hours.

Since the introduction of anti-depressant drugs into general use in the psychiatric field, there have been several statements to the effect that such a drug administered concurrently with electrical treatment reduces the number of shocks required to achieve a satisfactory response. This has been claimed by Sargant (1961) but without experimental support. Dunlop (1960) has published a comparison between the number of electrical treatments given with the anti-depressant drug during a particular attack, and the number of treatments without the aid of a drug in an earlier attack in the same patient: however, comparison of treatments in the same group of patients at different times is unreliable because there may be other factors to account for the differences noted. A controlled trial is necessary to ensure that all factors are constant other than the one under consideration.

SKF 7261 is a low dosage phenothiazine derivative belonging to the piperazine group, other members of which include trifluoperazine (“Stelazine”), prochlorperazine (“Stemetil”) and perphenazine (“Fentazin”, “Trilafon”).

The mono-amine oxidase inhibitors, of which phenelzine (“Nardil”) is one example, were introduced for the treatment of depressive illness as a result of the observation that iproniazid, which is a mono-amine oxidase inhibitor, produced euphoria and increased mental alertness in some tuberculous patients to whom it was given. Trials of iproniazid in mental illness were carried out (Loomer et al., 1957; Cesarman, 1959), but it was found to be very liable to give rise to side-effects, being particularly toxic to the liver. Other less toxic mono-amine oxidase inhibitors such as phenelzine, which is chemically related to iproniazid, were later developed.