The problem we are concerned with is the relationship between neurosis and psychosis. It is well known psychiatrically that many patients tend to be what are called “mixed” states, meaning that the diagnostic classification is doubtful. Patients complaining of physical symptoms, such as sleeplessness, heart palpitations, and other signs of autonomic imbalance, accompanied by anxiety or phobias, and who seem well reality-oriented, are not hallucinated or deluded and do not show any cognitive deterioration, are classed as neurotics. Psychotics, on the other hand, are generally deluded and hallucinated, are poorly reality-oriented, tend to show signs of cognitive deterioration, but have an absence of the physical symptoms so characteristic of neurotic disorders.

In recent controlled trials, conducted by the authors (1956), we were interested to note the proportion of patients improving with the administration of placebos. A placebo is defined in the Shorter Oxford Dictionary (1944) as “A medicine given more to please than to benefit the patient”. It is presumed that, implicit in this definition, is the qualification that the doctor is aware of the relatively inert qualities of the substance, whilst the patient is not. There is, of course, a type of patient who derives considerable benefit mainly by virtue of the fact that he has been pleased. In spite of the discovery of increasing numbers of drugs with specific properties, the prescription of placebos is still common practice. Dunlop et al. (1952) analysed over 17,000 prescriptions of which about one-third were tonics, stomachics or sedatives; although barbiturates cannot strictly be called placebos, the spirit in which they are prescribed frequently puts them near to this category.

The fugue has received little recognition in the literature in recent years. Stengel (1941, 1943) defines the fugue state as consisting of “transitory abnormal behaviour characterized by aimless wandering, and more or less marked alteration of consciousness, usually, but not necessarily, followed by amnesia”, According to Henderson and Gillespie (1944) the patient in a true fugue suddenly leaves his previous activity and goes on a journey which has no apparent relation to what he has just been doing, and for which he has complete amnesia afterwards. William McDougall (1926) states: “Fugue is the name given to those instances in which a person suddenly disappears from his accustomed haunts and re-appears at some distant place, astonished and puzzled to find himself there, and unable to give any account of himself in the period between his disappearance and his re-appearance.” In a footnote McDougall adds: “This word is sometimes used in a wider sense to include wandering of a seemingly aimless kind for which the subject (generally a psychopath) can assign no adequate reason or motive, but of which, nevertheless, he can give some description.” In our cases the criteria for a fugue have been sudden onset of wandering with clouding of consciousness and a more or less complete amnesia for the event.

Over the past 3 years we have collected 37 cases, either from the hospital records or from cases personally seen by us. Interesting features have emerged which, as far as we can ascertain, have not previously been described. A control group matched for sex, age and clinical diagnosis has been studied to exclude fortuitous associations. In the 37 cases of fugue under review, 31 are men and only 6 women. This incidence in favour of males is in accordance with the findings of other workers who have dealt with mixed groups, but differs from Stengel (1941), who picked his cases mainly from the female wards of Bristol Mental Hospital.

The phenomenon to which Lasègue and Falret in 1873 applied the term “folie à deux”, had many times previously been recognized and described. William Harvey (1651) noted a case, and his contemporary, Sir Kenelm Digby (1658) not only recorded an excellent clinical description but suggested a psychopathology (Greenberg et al., 1956). For Lasègue and Falret, folie à deux was a social rather than a psychiatric phenomenon: the second “passive” subject, they believed, was not truly psychotic but simply “absurdly credulous”. As they saw it, the more authoritative and intelligent “active” partner created the delusions and imposed them on the “passive” subject. This was more likely to occur in a setting of prolonged and isolated intimacy. The delusions were more likely to be accepted if they were plausible and played on the hopes and fears of the second subject. Heredity, they pointed out, offered no overall explanation, for this process frequently involved unrelated individuals. The second subject often accepted the first's delusions only after a fruitless and exhausting struggle to restore his sanity: “the indifferent escape both this useless travail and its consequences.” They held the prognosis for the “passive” subject to be invariably good, providing that the pair were separated. As early as 1563 Wier, writing on the cure of nuns afflicted en masse by demoniacal possession, had advised this course.

Reserpine is one of the active alkaloids extracted from the root of the plant Rauwolfia Serpentina. The physiological changes resulting from the use of the drug in animals—such as hypotension, bradycardia, sedation, increased peristalsis, meiosis, etc.—are probably the result of a central action. The precise sites are not known although it seems likely that one of them is the midbrain reticular formation. There is no evidence of any peripheral action, nor of any direct effect on the cortex. The reason for the long latent period, before the drug begins to show an action is still obscure (Lancet Leader, 1955; Mover, 1955; Plummer et al., 1954). The recent work on the pharmacological relationships between Reserpine, Serotonin and the hallucinogens suggests interesting possibilities (Pletscher et al., 1955; Shore et al., 1955).

There is already a considerable literature on the toxic effects of Reserpine, the most serious of which are Parkinsonism, of a post-encephalitic type, and severe depression (Achor et al., 1955; Barsa and Kline, in press; Locket, 1955; Schroeder and Perry, 1955; Stead and Wing, 1955).

Developmental defects of the cerebellum may take various forms: agenesis of the entire cerebellum; aplasia of one or both hemispheres, or aplasia limited to the vermis. It is the purpose of this communication to review the first two groups and to place on record the clinical and pathological features of a case in which but for one small fragment the cerebellum was wholly absent.

The problem of long-stay patients in mental hospitals is assuming increasing importance. At present, in most large mental hospitals the long-stay patients occupy 80 to 90 per cent. of the beds. The investigation by Freyhan (1955) suggested that although the new methods of treatment of the last 30 years have greatly increased the speed of recovery in the case with the good prognosis, they have not altered the outlook for the deteriorating case. This is in general confirmed by May (1956). Now these patients may have a yet longer stay because of the increased life span.

In previous work (8, 9) the writer has found that measures of breathing activity during speech, and of output of speech per breath are related to the emotional intensity and to the extent to which emotions are restrained or given free expression in the exchanges during psychiatric interviews. A high level of ventilation, i.e. high breathing activity with low output of speech per breath was shown to belong to content implying outgoing affect (jealousy, appetite, sex, aggression, wishes and hopes), and a low level of ventilation in speech to be associated with topics of restricted emotionality, such as fear, inhibition, deprivation, as well as to reasoning.

Tension states as rated by physicians or as experienced subjectively, as well as anxiety states and other emotional disturbances have been shown to be associated with physiological changes in the muscular system as measured by the electromyograph (15, 19, 21). Increased muscular tension was also found to accompany hyperventilation (1, 6) and increased muscular tension as well as inhibited breathing have been reported to accompany intellectual effort (11, 22, 23). Rising gradients of tension from forehead and chin have recently been shown to accompany sustained attention when listening to read material (26).

The therapeutic problems confronting those of us engaged in mental deficiency practice are manifold. This is due to the varied and mixed population inhabiting our hospitals.

There is the group known as “high grade” with intelligence quotients of 75 per cent. upwards who are admitted on account of their social inadequacy due to emotional maladjustment, sexual deviations and other psychopathic behaviour problems. The “low” and “medium grade” with intelligence quotients of 25 to 60 per cent., in addition to their deviant behaviour are intellectually so low that they could not cope outside an institution.

It is the aim of the psychiatrist to rehabilitate the former group and here in our hospital we have a very active programme to accomplish this end. The latter group are, however, an ever-pressing therapeutic problem on account of the frequency of psychomotor excitement, noisiness and destructiveness.

The present study was designed to assess the effectiveness of the new drug Reserpine in controlling deviant behaviour in such mentally defective patients.

In 1928 Symonds (1928) recorded a case of Schilder's encephalitis, the disease being remarkable for its familial incidence and the presence of a progressive double hemiplegia. Since this date other writers have fully confirmed his observations.

Familial forms of Schilder's Encephalitis have been described by Ferraro (1928) and Van Bogaert and Nyssen (1936) while Bouman (1934) has emphasized that in children quadriplegia is the usual clinical finding.

The present report deals with the clinical and pathological findings in a girl who was the second of thirteen children in the family studied by Symonds. Clinically, the case was remarkable for the very long period of survival and pathologically, by reason of the extensive degree of spinal cord degeneration with but little evidence of sclerosis in the cerebral hemispheres.

Disorientation in a new place (e.g. a hospital ward) and inability to remember a route after having been shown and having walked it several times, is a well known feature of senile dementia. These disturbances are a frequent practical cause of difficulty, since such patients are not uncommonly physically fit and active and unless allowed to wander about during some of their waking hours become irritable and unhappy. Yet their supervision and care places a great strain on those responsible for their welfare. If left to themselves they have a tendency to fall downstairs or to wander on to roads which renders them a menace both to themselves and to others. Some insight into the causes of spatial disorientation in the elderly, and ways in which it might to some extent be compensated for, would therefore be of considerable practical assistance. It may not lead to a cure of the defects, any more than a study of the reasons for getting lost in a fog will help to relieve the meteorological conditions. What it may do, however, is to discover the equivalent to senile patients of “cats' eyes” to the motorist, and help to relieve labour and prevent accidents.

A number of new tranquillizing drugs have recently become available. We report a method of assessment for one of these—“Pacatal”. In this experiment the new drug was compared with (i) no treatment at all, (ii) treatment using dummy tablets of the same size and appearance as the Pacatal tablets, and (iii) Largactil. A group of patients suffering from schizophrenia were selected, all being deteriorated. These patients can be found in considerable numbers with a reasonably similar clinical picture which is relatively stationary without treatment.

When we commenced using reserpine in our disturbed male ward we were impressed by the calming effect which this produced in many of the patients and by the fact that the ward as a whole became quieter. In order to confirm these impressions we created a method which enabled us to express the behaviour of the patients in a graph. We thus had a simple means of comparing one clinical state with another and of assessing the influence of the therapeutic measures used.

I believe that it is customary for an address from the chair not to direct attention to some particular enquiry that has engaged the speaker, but to make a general survey of the broad issues of a society and its discipline, to take a bird's-eye view of the development of the subject, or to take up some fundamental issue or issues which at the moment have reached something in the nature of a turning point.

Behaviour disorders resulting from localized lesions of the brain have attracted increasing attention recently. With the rapid progress being made in neurosurgical treatment there is a prospect that their accurate diagnosis may become more than an academic exercise. In the present paper a description will be presented of characteristic overactive behaviour which appears, in the majority of cases, to be due to cortical damage, frequently involving the temporal lobe, and sustained either at the time of birth or in later childhood.

The behaviour symptoms exhibited were remarkably constant throughout the series of twenty-five children studied. There was marked restlessness, distractibility and an inability to concentrate for more than a few seconds at a time. The affected children showed an apparent compulsive need to touch every object which they saw, and to suck or chew them. Outbursts of aggressive and irresponsible behaviour occurred frequently, and the patients seemed to be incapable of responding to reprimand or chastisement for longer than a few minutes. The majority suffered from epilepsy or showed other evidence suggesting the presence of cerebral damage on examination.

Electroplexy is now a widely accepted and used treatment in psychiatric practice. Primarily it is by far the most reliable means of terminating or resolving depressive attacks, months or indeed years before the anticipated remission of these illnesses on their own accord. Less commonly it is also regarded as an effective treatment in some schizophrenic states, particularly the acute type, or schizophreniform illness, “but actually most schizophrenics are treated at some stage of their illness with electrically induced convulsions” (Kalinowsky and Hoch, 1952). Neither depressive nor schizophrenic syndromes are infrequent in pregnancy and the question must therefore be posed in some of these complications whether electroplexy is justified; whether it can be used safely either alone or with relaxants; and what, if any, deleterious effects may be imposed on the mother and/or foetus.