Chemically, trimipramine has an imino-benzyl nucleus and a side-chain resembling that of methotrimeprazine [5-(3-dimethyl-amino-2-methyl-propyl)-10, 11-dihydrodibenz (b, f,) azepine]. In “double blind” controlled comparisons of trimipramine and imipramine, Salzmann (1965) in 27 hospitalized depressed patients who did not require ECT, found the two drugs not significantly different in effect. Blumenthal and Seppala (1965) obtained similar results. Burns (1965), however, in 44 patients suffering from psychotic depression, found trimipramine to be significantly superior at the 5 per cent. level to imipramine in ratings of recovery from depression, anxiety and insomnia. No difference was found in the latency interval between the drugs.

Recent investigations of cognitive disorder in schizophrenia (Payne and Hewlett, 1960; Payne, Caird and Laverty, 1964) have indicated that schizophrenic performance in cognitive tests is characterized by a tendency to use very loose, “overinclusive” concepts. This phenomenon which Cameron (1944) termed “overinclusive thinking”, has been re-interpreted by Payne (1961) in terms of an impairment of a hypothetical filter mechanism which normally excludes irrelevant stimuli from consciousness and so allows attention to be directed towards the task in hand. McGhie and Chapman (1961) and Chapman (1966) have presented clinical evidence based on the subjective reports of schizophrenic patients supporting the hypothesis that a primary disorder in this disease is an impairment in the selective and inhibitory functions of attention. Chapman and McGhie (1962) and McGhie, Chapman and Lawson (1965a and b) have substantiated and elaborated this clinically derived hypothesis in an experimental setting where the subjects were required to perform various psychomotor and short-term memory tasks with and without distracting stimuli. The results of these investigations, while supporting the hypothesis in a general way, were nevertheless equivocal. The distraction effect in schizophrenia appeared to be confined to those situations where adequate performance involved the processing of a substantial amount of information. This finding was explained in terms of Broadbent's (1958) theory of the human operator as a limited capacity information channel. It appeared that distraction affected the performance of schizophrenic patients only in situations where the limited information channel was fully occupied in handling relevant aspects of the task—for example, in tracking and short term memory tests. Under these conditions the assimilation of irrelevant information produces overloading of the information channel and a consequent breakdown of performance. On the other hand, in those tasks requiring little information processing—for example, in repetitive psychomotor tasks—the channel is operating well below capacity, the assimilation of irrelevant information does not lead to overloading, and consequently does not have any detrimental effect on performance. An analogue of this situation occurs in normal subjects, in whom division of attention between two sources does not necessarily lead to impairment of performance if the informational requirements of each source are small and total information load does not exceed the critical limit (Broadbent and Herron, 1962). For the schizophrenic patient attention tends to be divided between the relevant and the irrelevant, yet impairment in performance need not occur if the informational requirements of the task are kept small.

In view of the important implications of the subject, it is surprising that there have been so few studies of psychiatric illness within the medical profession, except specifically in regard to drug addiction. Indeed, we could find only two papers on the overall psychiatric morbidity in the profession published during the last decade (Duffy and Litin, 1964; Pearson and Streker, 1960). In Great Britain there have been no published studies of this kind as far as we can discover.

As a result of three decades of painstaking work, R. Gjessing (1932–1960) published ten classical Beiträge zur Somatologie der periodischen Katatonie. These studies are being continued by L. R. Gjessing (1956, 1958, 1964, 1965) on some of the original patients and on additional subjects.

Richter (1960) reviewing knowledge about biological “clocks” in medicine and psychiatry, emphasized the incidence of 48-hour cycles of physical and mental symptoms. He considers that the mental symptoms are not specific and can be manic depressive or schizophrenic. Menninger-Lerchenthal (1960), in his book on periodicity in psychopathology, devoted a section to 48-hour rhythms and lists references to 48-hour cycles in the literature.

Individual variations in drug metabolism are important factors affecting both toxicity and clinical effectiveness (Brodie, 1964; Kalow, 1965; Price Evans, 1965). In most cases the best available index of the drug concentration at the site of action is the plasma level. An estimate of this will show whether the optimal concentration is present and in some cases may indicate whether new symptoms can be attributed to toxic side reactions.

The study of the form and content of hallucinations remains a fascinating and intriguing one to all who are interested in psychopathology. In our present state of knowledge it provides the basis for experimental approaches to the aetiology of hallucinations. This paper is a brief review of the relationship between experimental and phenomenological approaches to the problem of hallucinations associated with organic cerebral lesions.

In 1957 Krantz, Truitt, Ling and Speers found that the inhalation of small amounts of hexafluorodiethyl ether (Indoklon) produced convulsions in animals, and it was later used as a therapeutic convulsant for the treatment of psychiatric patients (Krantz, Truitt, Speers and Ling, 1957).

It is a fact that there is, within the National Health Service, a gradually increasing demand for psycho-analytical psychotherapy. This demand is reflected in the large number of patients referred and in many articles dealing with the treatment of psychiatric and physical illnesses. Such satisfaction gained by this recognition is offset by the knowledge that both inside and outside the medical profession there is an abysmal ignorance of what psycho-analytical psychotherapy is, what it can or cannot achieve and what it involves in that most precious commodity—doctor time.

Since human electroencephalography was first introduced by Berger in 1929, there have been many attempts to correlate the alpha rhythm with various aspects of personality. Lemere (1936) first reported a relationship between “good” and “poor” alpha rhythms and cyclothymic and schizoid personalities respectively. Gottlober (1938) found a correlation between a high alpha index (per cent. time alpha) and extraversion. However, Henry and Knott (1941) pointed out that the group studied by Gottlober was loaded both with high alpha indices and extraverts, and with additional data were unable to find a significant relationship between extraversion-introversion and alpha index.

Consistent decrements in schizophrenic performance on a reaction time (RT) task obtained by a number of investigators indicate that RT procedures yield reliable indices of schizophrenic deficits in attention (1, 2, 10), motivation (3), preparatory set (8), and psychomotor function (4). In previous studies (6, 7), the writer has presented evidence that these deficits may be attributable to impaired social motivation, in that these RT disturbances can be eliminated in most schizophrenics by activating biological motivation through shocks to the reacting finger. Older, more disorganized patients were unable to improve, however, even with shock motivation. Systematic comparisons of older and younger schizophrenic patients with and without ground privilege status, resulted in the finding that reduced social motivation, lessened reactivity to shock stimulation, and inability to cope with unpredictable anxiety cues constituted relatively independent dimensions of schizophrenic deficit in RT.

In recent years the mental health of British university undergraduates has aroused considerable interest. The findings of Parnell (1951) at Oxford, Davy (1957 and 1960) at Cambridge, Malleson (1958) at University College, London, and Juel-Jensen (1962) at Oxford indicate that up to 20 per cent. of students suffer psychiatric disturbances of sufficient degree to constitute a handicap in their daily life. Furthermore, mental ill-health is one of the most important reasons why undergraduates lose time from their studies or withdraw from university altogether. Read (1954) stressed the advantages of the psychiatric service for students at the London School for Economics.

This paper describes a “double-blind” trial comparing ‘Triptafen’ tablets—each containing amitriptyline hydrochloride 25 mg. and perphenazine 2 mg.—with a matching placebo in the treatment of depressive illness.

Observations have been made on the stereotyped behaviours of a group of autistic children by means of one-way mirrors; Hutt and Hutt (1965) systematically varied the complexity of the situations in which the children were placed and noted the incidence and severity of the stereotyped behaviours exhibited. Jones (1965) also attempted the quantification and classification of stereotyped behaviours in a group of adult schizophrenic patients. In this experiment the observer was present in the same room. In both experiments the stereotyped behaviours were shown to be responsive to social influences.

Since it was first described by Mannheimer, Pakesch, Reimer and Vetter in 1952 megaloblastic anaemia has come to be recognized as an occasional complication of anticonvulsant drug therapy. More recently a disturbance in folic acid and vitamin B12 metabolism has been observed in many non-anaemic drug-treated epileptic patients (Hawkins and Meynell, 1958; Klipstein, 1964; Malpas, Spray and Witts, 1966; Reynolds, Milner, Matthews and Chanarin, 1966a). Reynolds et al. (1966a) found megaloblastic haemopoiesis in 38 per cent. and subnormal serum folates in over 75 per cent. of a series of 54 out-patient epileptics. In addition, serum vitamin B12 levels, though still within the normal range, were significantly lower in the megaloblastic group of patients than in controls. They suggested (1) that the anti-folate effects of phenobarbitone, phenytoin and primidone may be related to their therapeutic actions, and (2) that prolonged drug-induced disturbances of folate and vitamin B12 metabolism may be responsible for certain side-effects, particularly mental symptoms. The latter possibility is supported by the increasing recognition of psychiatric illness due to vitamin B12 deficiency in the absence of anaemia or subacute combined degeneration of the cord. (Langdon, 1905; McAlpine, 1929; Holmes, 1956; Smith, 1960; Edwin, Holten, Norum, Schrumpf and Skaug, 1965; Strachan and Henderson, 1965).

In 1876 the Danish physician, Julius Thomas Thomsen, described the disease entity of myotonia congenita, from which he himself and some members of his family suffered. This muscular disorder is now accepted as a clinical and genetic entity, distinct from other forms of myotonia, viz. dystrophia myotonica and paramyotonia (De Jong, 1955).