The evidence for an association between hostility and deliberate self-poisoning is reviewed. Although the concept of hostility is poorly defined and different measuring instruments may not measure the same entity, self-poisoning subjects as a group appear to have very high levels of hostility. However, depression is also associated with hostility and when studies have taken into account the psychiatric diagnosis of overdose patients it is outwardly-directed hostility which distinguishes these individuals from other psychiatric patients or normals. A model is proposed to show the inter-relationships of hostility, depression and self-poisoning.

Forty alcoholics and 40 controls were compared on tests of frontal lobe functions, abstracting ability, and verbal and picture memory. Alcoholics were inferior to controls, and heavy drinkers poorer than moderate ones (life-time alcohol consumption) on picture memory and a verbal fluency test of frontal lobe functions. Verbal memory and abstracting ability were not significantly impaired. Although this pattern may indicate that frontal and right temporal areas of the brain are particularly vulnerable to the effects of chronic alcoholism, the possibility that it may merely reflect general sensitivity of the tests to brain damage cannot be ruled out.

Disturbance of functions controlled by the autonomic nervous system may be due to changes in the emotional state, and are part of normal reactions to stress. Their general occurrence is reflected in phrases like “it makes me sick” and “to sweat with fear”. In some groups of people these autonomic disturbances are not confined to stressful situations but become more general and frequent and so more disabling. For instance, in patients with affective illnesses, symptoms of autonomic origin are common and are relieved by successful treatment of the underlying illness. Again, there is a group of patients who complain of these symptoms but who show little affective disorder. In these patients the autonomic symptoms are provoked by specific situations which are not particularly stressful to normal people, e.g. nausea occurs when eating in company or diarrhoea when travelling; outside these specific situations symptoms do not occur. Although these patients may complain of some anxiety, the physical symptom is the major complaint and the anxiety is often attributed to this.

Charcot's term ‘hysteroepilepsy’ implies brain mechanisms in common between epilepsy and hysteria. No such direct link between these two conditions exists. Nevertheless, there are a number of indirect associations between epilepsy and hysteria that can lead to confusion in the differential diagnosis and management of the patient with seizures.

Catechol O-methyltransferase of lysed human red blood cells was assayed under optimal conditions, using saturating concentrations of the substrates, S-adenosyl-L-methionine and 3,4-dihydroxybenzoic acid. The mean enzyme activity found in 24 normal subjects was 29.2 nmol/hr/ml RBC. The mean activity in blood of 33 female unipolar depressives was not significantly different from normal. However, higher enzyme activities were observed in the blood of 11 schizophrenic patients (38.9 nmol/hr/ml RBC). Partially purified enzyme preparations from blood of normal and schizophrenic individuals were indistinguishable with respect to substrate specificities, isoelectric pH values, and ratios of the two O-methylated products. Therefore it is unlikely that any defect in O-methylation which may occur in schizophrenia can be attributed to a change in the intrinsic properties of erythrocyte catechol O-methyltransferase.

This paper presents a replication of a study by Kiloh and Garside (1963). These workers carried out a factor analysis of 35 clinical features of 143 depressed patients. They demonstrated the presence of a factor which showed strong positive loadings with the clinical features classically accepted as characterizing neurotic depression and strong negative loadings with the clinical features characterizing endogenous depression. Of the 143 patients, 92 were diagnosed as more definitely suffering from endogenous or neurotic depression. Correlation coefficients were calculated between the diagnosis in these 92 cases and each clinical feature.

A major problem in the affective disorders is what constitutes an homogeneous illness. A recent study enabled us to separate depressive illnesses into two types (1). The first we have called ‘depression spectrum disease’; its prototype is a female with an onset of a depressive illness before the age of 40, in whose family more depression is seen in female relatives than in male relatives, the deficit in males being made up by alcoholism and sociopathy. The second illness we have called ‘pure depressive disease’, the prototype of which is a male whose depression starts after age 40 and in whom there are equal amounts of depression in both male and female relatives and no large amount of alcoholism or sociopathy in the males. First degree relatives of depression spectrum disease are more likely to be psychiatrically ill (depression, sociopathy or alcoholism) than first degree relatives of pure depressive disease probands. Data of Hopkinson and Ley support this concept in part (2); they found that early-onset affective probands (< 40) had higher morbid risks for affective illness in relatives than late-onset probands (onset after 40). Further confirmation comes from a study of 259 alcoholics and their first degree relatives (3). Most of the psychiatrically ill male relatives had alcoholism; most of the psychiatrically ill female relatives had depression. As of the present the differentiation of the two kinds of depressive illness is made on the basis of a specific familial predisposition. Major clinical differences in the two groups have eluded us.

The results described are based on data from 47 male and 83 female patients randomly assigned to treatment with imipramine or phenelzine in an open trial. All were fresh (untreated) cases diagnosed as suffering from depressive illness (melancholia). They were rated before treatment and 2 and four months later. Imipramine did not give results which were significantly better than phenelzine. With both drugs it was found that patients had done either very well or very poorly at follow-up, i.e. the distribution of scores was U-shaped (or bimodal at the least).

The 55 men and 90 women who were unsuitable for treatment with drugs or who had failed to respond to such treatment were given a course of ECT and followed-up at corresponding intervals. The improvement after ECT was better than with drugs and the distribution of scores is quite different. An earlier series of male patients treated with ECT in the pre-drug days did not show as good a response to the treatment.

Twenty patients with panic attacks and ten controls were given a standardised interview about thoughts occurring during times of anxiety or panic attacks. The interviewer was blind to the subject's diagnosis. The 20 panic patients underwent a psychophysiological test battery which included a cold pressor test, mental arithmetic task, and 5.5% CO2 inhalation. More patients than controls reported thoughts centred on fears of losing control and shame when anxious. Panic patients rated their thoughts as stronger and clearer than did controls and they had more difficulty excluding them from their minds. A feeling of anxiety preceded anxious thoughts in patients. This suggests that ‘faulty cognitions' are not the initial event in a panic attack, although anxious thoughts may exacerbate or maintain them. Significant correlations were found between the intensity of anxiety-related thoughts in anticipation of mental arithmetic and changes in diastolic blood pressure and heart rate during mental arithmetic.

An analysis of the drug regimes prescribed to two separate groups of unselected schizophrenic patients indicates certain trends of clinical importance. The results demonstrate a need for the adoption of a personalized dose regime. The scatter of dose regimes found effective is too great to recommend a standardized approach to the prescription of L.A.P. injections.

Two other results of particular significance are that the dose of drug required to control symptoms can be gradually reduced in nearly half of patients, and that helpful trends in prescribing were identified that will help the clinician to abolish side-effects.

Attention was first drawn to this syndrome by Kleine (1925), who described five patients with periodic somnolence, two of whom also had an excessive appetite. Levin (1929) described a youth aged 19 who had suffered from nine attacks of sleepiness and pathological hunger from the age of 16. The attacks lasted from one to six weeks and recurred at intervals of up to twenty-eight weeks, but he eventually recovered spontaneously.

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness Is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations, Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.