Nitrazepam (Mogadon), a benzodiazepine compound, chemically related to diazepam (Valium) and chlordiazepoxide (Librium) is a recently introduced sleep-inducing agent. Other studies (Baum et al., 1965; Fraser and Shepherd, 1966), found it to be both safe and effective. It is thought to induce sleep by “shielding the brain centre responsible for waking from emotioned stimuli”, and is therefore of particular interest for psychiatric illness. This study is a clinical comparison with sodium amylobarbitone, using a double-blind cross-over technique.

In several previous studies it has been shown that the mean tremor amplitude displayed by morbidly anxious patients is greater than that of normal control subjects. The most detailed experiments were those carried out by Redfearn (1957). He compared the findings obtained in groups of male morbidly anxious patients and controls, and in addition to confirming the existence of a difference in tremor amplitude, he reported that the tremor of male anxious patients showed a greater degree of accentuation of the 8–10 c/sec. components than the tremor of a matched control group. Halliday and Redfearn (1956) compared the tremor spectra obtained from normal male and female subjects, and found that the curve for men was similar to that for women.

Recent years have seen increase of interest in problems relating to the health of the aged. One of the major difficulties has been the practical problem of assessment, whether it be of physical, social or mental health. It is essential that any measures employed are appropriate to the aged population, should be easy and brief to administer, as well as being reliable and valid. Some advances have been made in tests of cognitive functioning developed or derived for use with the aged (Dixon, 1965; Britton and Savage, 1966). As yet, however, no simple psychometric test has been proposed for aiding the psychologist, psychiatrist, general practitioner, social scientist or those concerned with the care of the community aged in the early recognition of possible psychiatric abnormality. This report aims to remedy this omission to a certain extent. We have derived from an extensively used psychometric measure, the Minnesota Multiphasic Personality Inventory (MMPI, Hathaway and McKinley, 1951), a short scale of fifteen questions which has been shown to be a valid, easily usable measure of mental illness in the aged.

The increasing demand for the institutional care of elderly psychiatric patients has been a growing concern in England and especially in Essex, which has an unusually large number of old people (21 per cent. over 65 compared to a national average of 12 per cent.) (2).

An ecological study by Philip and McCulloch (1966) demonstrated very high correlations between the incidence of attempted suicide and the rates of incidence for repeated attempted suicide, overcrowding, having been taken into care by the local authority, having had contact as a child with the Royal Scottish Society for the Prevention of Cruelty to Children, and juvenile delinquency. McCulloch and Philip (1968) showed that persons admitted to hospital following a suicidal attempt manifested these variables to a high degree. In this latter study “juvenile delinquency” was replaced by “all offences” as a variable. The present paper reports on the relationships between a scale based on these variables and a number of psychological measures gathered from 84 of the 95 patients in the latter study.

One current classification of depression divides the syndrome into psychotic and non-psychotic varieties. It is interesting that a similar classification developed over a thousand years ago out of some words of St. Paul. In his Second Epistle to the Corinthians, Ch. 7, v. 10, Paul wrote: “For godly sorrow worketh repentance to salvation not to be repented of, but the sorrow of the world worketh death.” The word sorrow used in English translations of the Bible stood for the tristitia of Latin versions (Greek λνπη); connoting sadness, sorrow, despondency, depression. Paul's distinction between the two kinds of tristitia, the one “from God” and the other “of the world”, led mediaeval theologians to enlarge on differences between the two kinds of depression.

This paper describes and attempts to evaluate an alcoholism treatment programme in two Caribbean islands with a multi-racial population of just under a million. The programme, initiated by the author in 1956, combined emetine aversion treatment in a group setting, with milieu therapy and group psychotherapy of a didactic kind aimed at producing conversion (rather than aversion) to uncritical belief in the tenets of Alcoholics Anonymous.

Bene (1965) in a previous issue of this Journal, has summarized the main evidence for the view that homosexuality is a product of defective role training and is not a result of any direct genetic mechanism. It is becoming apparent that once a child has been pronounced as a boy or a girl it has to learn the forms of behaviour appropriate to its ascribed sex. The learning or conditioning mechanism by which the child learns to make its role performance congruent with its' ascribed sex is not understood. Comfort (1964) has suggested that sex-typing may be some form of imprinting. Hampson (1965) investigating several types of hermaphroditism has found evidence that if the gender role has to be changed after about the third year of life, increasing psychological difficulties are encountered. He also points out that the development of the gender role coincides with that of language.

The sub-speciality of geriatric psychiatry is coming to be known as “psycho-geriatrics”, an abbreviation which is not a very happy one, but which seems to be becoming generally accepted.

This investigation is part of a larger comparative study of Edinburgh primary school children referred to a psychiatric department with behaviour disorders and of a matched control group of non-referred children.

It has been found that a significant progressive reduction in the amplitude of physiological tremor in the 4–12 c/sec. range occurs when relatively unpractised subjects carry out a series of trials in a motor task involving a controlled muscle effort (Carrie, in press.

Desipramine (Pertofran) is the monomethyl analogue of imipramine (Tofranil) and is marketed as a potent anti-depressant agent. The literature on this drug has already been adequately reviewed by Rose et al. (1964) and Waldron et al. (1965). It is therefore sufficient to note that earlier reports claiming a more rapid action than imipramine have not been supported by more recent investigations. This paper reports a double-blind controlled comparison of imipramine and desipramine, designed to investigate the relative effectiveness, speed of action and side-effects of these two drugs.

An initial report on this study (Sheldon, 1964) demonstrated a significant positive relationship between psychiatric after-care and reduction of readmissions to mental hospital in the six months following hospital discharge when patients were randomly allocated to psychiatric after-care or to the general practitioner. The present paper demonstrates that this effect, although diminished, is still apparent for a similar group of patients allocated to after-care by their discharging psychiatrist and followed up for three years. It attempts to clarify the factors operating in psychiatric selection for after-care, and to explore the relative importance of after-care and of the nature and severity of illness in determining outcome, at least as measured by the number, duration, and time after discharge of rehospitalizations.

Juvenile delinquency is generally considered to be one of present-day society's most serious problems. Indeed, more than half of all serious crimes in the United States are committed by youths under 18 years of age (3). Despite its magnitude and prevalence, juvenile delinquency is still inadequately defined, much less understood, partly because of its having only lately been recognized as a distinct practical problem and thus a fit matter for investigation. Over the past four decades, however, there has been an increasingly active study of the problem, focusing on the delinquent youths themselves and, more recently, on the environment in which they have developed. Methodological approaches to the question of definition and causality of delinquency have been diverse, but can be considered as being of two general types: the deductive-theoretical, in which a stated hypothesis is critically examined in the light of clinical experience as illustrated by clinical material; and, the inductive-empirical approach, in which a body of data, e.g., the environmental factors found in delinquents, is analysed, and conesions are drawn, based on the results of that aysis.

For over a decade the Maudsley Monograph Suicide in London (Sainsbury, 1955) has been the most authoritative source of information about the contribution of certain social factors to the incidence of suicide in a British urban population. Sainsbury's investigation tested the hypothesis “that where social mobility and social isolation are pronounced, community life will be unstable, without order or purpose, and that this will be reflected to a greater or less degree in the suicide rates”. Much of his work stems from the pioneer work of Durkheim (1897). Using a combination of sociological and psychiatric methods he correlated rates of suicide and indices of social characteristics for London Boroughs derived from a social survey, the 1931 Census and other studies (Burt, 1944). He found significant differences in suicide rates among the boroughs, which remained consistent over 30 years despite considerable changes in the composition of their populations. Comparing suicide rates with other social factors he found significant correlations with social isolation, social mobility, divorce and illegitimacy. He suggested that suicide tended to be higher in the middle class and to diminish with poverty, but found no correlation with unemployment and overcrowding. He stated that suicide rates increased with age, particularly among males, there being a preponderance of over 55 year olds in his sample. A seasonal variation was observed, with the peak incidence in May. In his sample there were twice as many men as women. Six per cent. of his group were definitely alcoholic. Nine per cent. had made a previous attempt at suicide. Almost half of the group were seen to be psychiatrically ill or abnormal in personality.

The past decade has seen many new drugs. With use, serious side-effects have become apparent. The need for rapid assessment and advertisement of such effects led to the formation of the ‘Dunlop Committee‘.

To keep psychiatric patients as much as possible in the community rather than have them admitted to mental hospital is a policy which has become more and more favoured and has been shown to work (Leyberg, 1959; Silverman, 1961; Sainsbury et al., 1963 and Hoenig et al., 1965, etc.). This type of management cannot be expected to be equally successful with all groups of patients and is perhaps most open to question as regards the illnesses that affect the elderly.

The Symptom Rating Test (S.R.T.) was designed to assess changes in symptoms in non-psychotic patients. Previous studies suggest that the test is a measure of recently experienced neurotic distress. Scores were found to change markedly with changes in the clinical state of patients during treatment, and in anxious neurotics the scores were found to be correlated with psychiatrists' rating of anxiety.

There is growing evidence of a connection between the metabolism of monoamines and severe depressive illness, but the exact role of these substances in affective disorders has yet to be defined. We know that reserpine depletes the brain of monoamines and that a proportion of patients treated with this compound develop a depressive illness. Conversely a number of compounds which raise the levels of amines in the brain by blocking the enzyme monoamine oxidase have been used in antidepressant therapy. The knowledge that loss of amines may be associated with depression, and that their replenishment in the brain may induce recovery, immediately leads to the question as to which of the biogenic amines is responsible for the affective changes. Pollin, Cardon and Kety (1961) observed the effect of giving various amino acids together with a monoamine oxidase inhibitor (M.A.O.I.) to patients suffering from chronic schizophrenia. They found that only tryptophan, the precursor of the monoamine 5-hydroxytryptamine (5HT), produced an elevation of mood. On the basis of their results, Coppen, Shaw and Farrell (1963) treated a number of patients suffering from severe depressive illness with M.A.O.I. and half of this group also received an oral dose of a suspension of D L-tryptophan (214 mg./kg. body weight) for one week. The patients taking tryptophan and M.A.O.I. recovered more rapidly than those receiving M.A.O.I. alone both while they were on tryptophan and also subsequently. One explanation for these findings was that the combination of M.A.O.I. and tryptophan increased the amount of amines derived from tryptophan in the brain, and that it was this which was responsible for the therapeutic effect. If this were so, then there were several possibilities. The first was that the level of 5HT in the brain was low in depression and the combination of amine precursor and enzyme inhibitor brought it back to normal. Alternatively it may be that recovery occurred as a result of the presence of abnormally large quantities of 5HT in the central nervous system or even following the production of tryptamine, another amine derived from tryptophan.