Reserpine was first used extensively in psychiatric practice in the U.S.A. where many favourable reports on its use were published in 1954 and 1955. Subsequently a series of reports appeared in the U.K. These reports were more critical and sought to establish more precise indications for the use of the drug. It soon became apparent that the drug was of most value in schizophrenia and the organic hyperkinetic states. The value of reserpine in psychoneuroses is limited but that it is going to have a more than temporary place in the treatment of schizophrenia is suggested by the continued appearance of favourable reports. These last authors emphasize that not only is the drug an effective sedative but also that it does appear, in some places, to induce genuine remissions. The present difficulty is to predict which patients will respond in this way.

There have been many new types of sedatives and hypnotics evolved in recent years. The term “tranquillizing drug” is a recent innovation which suggests a calming effect without a hypnotic effect. Methylpentynol (“Oblivon”) is one such drug which has little hypnotic action, but is said specifically to relieve anxiety. This action was noted by the relief of apprehension observed in patients prior to dental treatment (Trotter, 1953). Methylpentynol is a higher alcohol which in high dosage has a hypnotic effect in animals (Margolin et al., 1951). No toxic effects have been reported. It is made up in rather large, blue-green capsules containing 250 mg. of methylpentynol, and also as an elixir.

Some workers have claimed that nalorphine is as potent an analgesic as morphine and does not lead to addiction.

In recent years electrophoretic methods for the analysis of the serum proteins have been extensively and fruitfully applied to studies of diseases of the nervous system (Volk, Saifer, Rabiner and Oreskes, 1955; Volk, Saifer, Rabiner and Hinterbuchner, 1956; Press, 1956).

It is the aim ofthis paper to present some ideas for a new and practical approach to some of the problems of assessment and placing of mental defectives with respect to motor abilities. Attention will be drawn to some theoretical confusion about the relationship between mental and motor abilities in the mentally deficient population and finally some experiments illustrating the possibility of a new approach will be described.

This paper reports a double-blind type of clinical trial with hyperactive low-grade mental defectives. Chlorpromazine has previously been used with this group but a high incidence of toxic effects has been noted (McColl (1)). Reports on reserpine have been conflicting but a careful trial by Kirk and Bauer (2) reports the action of this drug if anything to be detrimental.

While Visiting Psychiatrist to a convict prison, the author used the M.M.P.I. as an aid to clinical diagnosis. The test did not prove helpful in that respect. Impressive, however, was a profile recurring so often as to appear typical of the recidivist in prison.

The following paper describes the psychological part of a psychiatric and EEG study of psychiatric illness occurring for the first time in women of the involutional age range. The origins of the investigation and the clinical results are fully discussed elsewhere (Tait et al., 1957). They include such matters as the psychiatric observation that classical forms of melancholia seem to have become relatively infrequent. One possible explanation for this may be thought to be in the earlier recognition, hospitalization and treatment of psychiatric illness. It was decided that an appropriate study would pay attention only to women who are admitted to a mental hospital for the first time. In practice this has included all such women admitted to amenity beds in the hospital over a given period of time. This modified selection of admissions was made in order to ensure as wide a range of illness as possible, giving a higher proportion of neurotic illness without excluding psychotic material. The age range studied was that usually considered to encompass the normal range of the biological involution, 40–55. Such a study thus avoids the bias (apart from age) of any preconceived mode of selection. By including only first admissions, some assurance was given that up till then, the patients had been reasonably free from psychiatric illness.

The safety of electro-convulsive therapy (E.C.T.) has been greatly increased since muscle relaxants were first introduced for this purpose. Short-acting relaxants such as suxamethonium and suxethonium reduce the usual strong tonic and clonic contractions to faint muscle twitchings, and fractures do not occur. Respiration can be maintained throughout by positive pressure inflation so that cyanosis and stertorous breathing are avoided. This may ensure that material from small pulmonary lesions is not disseminated to other areas. It is disappointing that the cardiovascular commotion is only slightly reduced, and deaths still occur, albeit rarely.

In attacking the problem of the relationship of endocrine function to the schizophrenias and other mental diseases, we have avoided the elementary conception that certain hormones are responsible for special psychological traits and have reached the following conclusions. First, the quality of the mental disturbance depends mainly on a genetically conditioned personality pattern, various individuals reacting in different ways to the precipitating causes. Second, the hormones come into the whole picture only in so far as the hormone equilibrium of the body determines how far the individual can adjust himself to the increased demands arising out of the occurrence of various precipitating causes (Reiss, 1955). It is therefore understandable that very many, or even the majority of people suffering from severe endocrine disturbance, need not necessarily show any psychopathological changes, since their personality pattern is not so conditioned and no increased demands for adjustment are made by the occurrence of precipitating causes. On the other hand, it is equally understandable that certain disturbances in hormone production and equilibrium, even when clinically obscure, can be decisive for mental breakdown in individuals with the appropriate personality pattern, at the occurrence of precipitating causes.

In recent years a number of new drugs have appeared, grouped together as so-called tranquillizing agents. The publication of three very encouraging papers describing the use of meprobamate prompted the present trial. Selling (1955) prescribed one 400 mg. tablet daily after each meal and one at bedtime in 187 cases, combined with psychotherapy, and found its use in anxiety and tension states was of considerable value (90 per cent and 95 per cent respectively improved or recovered). Borrus (1955) used one to six 400 mg. tablets daily in 104 cases. In 68 per cent of all cases, and 78 per cent of the anxiety states, there were favourable results. Lemere (1955) contrasting chlorpromazine and reserpine, found meprobamate (used in over 250 patients with at least 70 per cent good results) to be relatively uniform in its action, remarkably free from side reaction and more effective in the relief of insomnia. All three authors stressed the absence of toxicity.

For this purpose average normal values were studied in 40 normal cases, and 40 mental cases were selected from amongst those who were suffering from various mental disorders who were given electric convulsive therapy.

In a previous paper one of us (4) has elaborated a theory relating drug action to personality. According to this theory, depressant drugs increase cortical inhibition (Pavlov) or reactive inhibition (Hull), thus producing an extraverting effect on personality, while stimulant drugs decrease inhibition and produce an introverting effect in behaviour. It was also suggested in this paper that a direct proof of the hypothesis might be obtained by making predictions regard ing the effects of stimulant and depressant drugs on a variety of experimental laboratory situations connected with the general theory of inhibition and excitation.

It is a well-known principle in psychology that the effects of sensory stimulation do not cease when the stimulus itself ceases. The so-called visual after-images are probably the best known of these after-effects, but almost equally well known are those induced by a rotating spiral. If a normal person fixates the centre of the rotating spiral for a period of time, and if then the motion of this spiral is suddenly stopped, an after-sensation of movement is well nigh universal. This after-sensation is opposite to the original motion in direction, just as the after-image produced by the fixation of a colour is usually the complementary colour to that which caused the original perception. There is little doubt that while peripheral factors play some part in these after-effects, central features also play a part, and it becomes tempting, therefore, to use phenomena of this type in attempts to verify or disprove the drug action hypotheses advanced by one of us in a previous paper. This hypothesis stated that stimulant drugs increased excitatory potential and decreased inhibitory potential, while depressant drugs decreased excitatory potential and increased inhibitory potential. The question now arises as to how this general postulate can be applied to the phenomena under discussion.

During the last few years the use of electroconvulsive therapy in the treatment of out-patients has greatly increased. For example, in 1951, one hundred and forty-one treatments were given in the out-patient department of Freedom Fields Hospital, Plymouth, while in 1955, four hundred and sixty-four were given. There is no doubt that the number of treatments given to out-patients has increased even more in the country as a whole, as many hospitals did not start giving E.C.T. on an out-patient basis until well after 1951.

In the first paper of this series, it was pointed out that one of the reasons why McDougall's theory of drug action and personality was not accepted at all widely was connected with the fact that he failed to provide an objective, experimental test which could be used to diagnose extraversion-introversion, and to assess drug effects. This argument is not entirely correct; McDougall did in fact suggest one such test, namely the rate of fluctuation of so-called reversible perspective figures. Many varieties of these are known, and have been used experimentally; the Necker cube, the staircase, the vase-face, and the windmill patterns being probably the best known. In all of these, there is an ambiguity in the drawing which makes it possible to perceive two distinct patterns in the stimulus; on prolonged inspection these patterns alternate, and it is the rate of alternation, signalled verbally or by suitable mechanical arrangement, which constitutes the score on this test. It is known that different types of pattern give reasonably reliable scores, and also that rates of alternation on different patterns correlate quite highly together, thus demonstrating that one and the same tendency is being measured. That this tendency is of central rather than peripheral character is indicated by the fact that changes in the rate of reversal due to fatigue and other causes can be transferred from one eye to the other.