There are conflicting psychiatric opinions about the value of separating depressive illnesses into several syndromes on clinical grounds, and so far experimental attempts to reach a classification of depression by distinguishing physiological or biochemical features which characterize one group rather than another have had only limited success. One interesting series of experiments in this area has been that of Shagass and his colleagues on the sedation threshold (Shagass et al., 1956, Shagass and Naiman, 1956, Shagass, 1954); they report that neurotic and psychotic depressions can be differentiated by means of EEG and other reactions to sodium amytal (amylobarbitone sodium) neurotics requiring greater amounts of the drug to reach the sedation threshold.

The common ground between neurology and psychiatry is regrettably slight, but in either field there have been men who sought to bring about a rapprochement between them by evolving broad conceptions of the structure of mind. For example, Hughlings Jackson's concept of “levels” and Freud's description of the mind in terms of Ego, Super-Ego and Id are both essentially attempts to define and classify the intellectual and behavioural functions of the brain, so as to form a coherent basis for the study of the interactions and disorders of these functions.

Schizophrenic patients given LSD-25 show an increase of psychopathological phenomena and a regression to the prime stage of their psychosis, the manifestations of which seem to be more directly related to the life history of the patients.∗ It has also been observed that some “normal” experimental subjects show various paranoid symptoms with the same drug, but whether these are in any way determined by heredity is not known.

It has been suggested (Foulds, 1961b) that a double classificatory scheme, which takes account of both the more unstable symptom variables and the rather more enduring and stable personality variables, should increase the reliability of the psychiatric diagnosis.

The treatment of mentally subnormal patients is often complicated by abnormal behaviour, usually consisting of a mixture of aggression towards either themselves or others, extreme noisiness, hyperkinesis and general anti-social conduct. Because this presents great difficulties, particularly from the nursing point of view, the aim of all whose task it is to care for these patients has been to improve this behaviour pattern. However, until recently the treatment has been largely custodial, coupled with large and frequent doses of sedatives, usually of the barbiturate group. The advent of “tranquillizing” drugs, particularly the phenothiazines, seems to offer the possibility of controlling these disorders without reducing the patient to a vegetative state.

The argument to be put forward in this paper is that the way in which psychometric tests are often employed in geriatric problems may be less useful and, indeed, less sensible than is generally supposed. This applies to straightforward “intelligence testing” as well as to so-called “diagnostic testing”. It is recommended that the principles and practices of experimental psychology should be applied to these problems instead.

This paper represents an attempt to measure the reliability of the clinical assessment of the reaction to pain and further to estimate the significance of this reaction in a group of chronic schizophrenic patients.

The possibility that schizophrenia is associated with a relative deficiency of neuraminic acid in the cerebrospinal fluid has been suggested by Bogoch (1) and confirmed by Chistoni and Zappoli (5).

In the introduction to his Chairman's address in 1959, Warren (24) reminded us that both Cameron (6) from this country and Kanner (17) from the United States, had, in recent years, surveyed the historical background of child psychiatry. Chairmen of this Section may thus deem themselves exempted from repeating that task for some years to come. Warren took as his theme some relationships between the psychiatry of childhood and that of adulthood. It seemed to me appropriate to follow his lead and to carry our thoughts a step further by considering the child and adult as members of the family group, and to study how far it would be useful to accept the nuclear family, rather than the individual patient, as the functional unit in psychiatry.

Psychotomimetic drugs have been used increasingly in the past decade for facilitating psychotherapy, most experience being with lysergic acid diethylamide (LSD-25) (Sandison, 3; Savage, 4; Abramson, 1; Cohen, 2). Few attempts have been made to study experimentally their effects on therapeutic interviews, largely because of technical difficulties.

In recent years there has been increasing experimental evidence that specific disturbances of perception occur in schizophrenia. Reduced size constancy in schizophrenic patients has been reported in studies by Raush (13), Crookes (6), and Weckowicz (16). Further investigations by Weckowicz and his colleagues (17), have also demonstrated reduced distance constancy in schizophrenia. (The retinal image of an object alters proportionately with the distance at which it is perceived. Size and distance constancy refer to our normal ability to compensate for changes in the stimulus and thereby to retain a stable perception of the object.) Brengelmann (3) and Angyal (1) have shown that schizophrenic patients have difficulty in reproducing briefly exposed visual stimuli. Penrose (12) has shown that schizophrenics perform poorly in a variety of tests involving visual discrimination.

In this country reserpine is not used extensively as a tranquillizer for disturbed mentally subnormal patients, and a phenothiazine is usually the first drug of choice. This is probably due to the undesirable side-effects of reserpine, of which lethargy, depression, hypotension and Parkinsonism are the most important. However, a number of hyperactive and disturbed patients have in our experience responded better to reserpine than to a phenothiazine. Consequently, when a compound said to have an essentially similar action but to be free of these side-effects became available, we felt that a clinical evaluation should be undertaken.

While anomalies of sensory and perceptual responses characterize many mental disorders it is only recently that any serious attempt has been made to investigate them experimentally.

The work to be reported is a replication and refinement of a previous study (Bannister, 1960). As preface to the previous study, four traditional approaches to the problem of schizophrenic thought disorder were briefly reviewed, namely “dissociation” (Kretschmer 1936), “deterioration in mental efficiency” (Babcock, 1933), “concretism” (Kasanin 1946) and “overinclusion” (Payne, Matussek and George, 1959). These explanations and the experimental work arising from them were not utilized in the current research since it is argued that they suffer from three major defects.

In order to explore the possibility of there occurring, in accordance with the Law of Mass Action, a reversal of the deposition of the cholesterol-lipoid-lipoprotein complex (Bevans et al., 1951), in the walls of cerebral arteries of atherosclerotic dements following a reduction in serum cholesterol, a study was made in March 1959 of changes that were shown in the behaviour of six such patients compared with six senile dements and four schizophrenics following the intake of large quantities of corn oil (Keys, 1956; Anderson et al., 1957).

Eighty chronic schizophrenic women hospitalized for an average of 6·8 years received group hypnotherapy twice weekly in addition to tranquillizers. After four months, 42 per cent. were discharged on convalescent leave; by the end of a year, a total of 48 patients (60 per cent.) had been released. All discharged patients—except four who required rehospitalization —made a satisfactory adjustment to their family and social responsibilities during the one-year follow-up period.

Overinclusive thinking has been regarded by some authorities as an important aspect of the thought disorder found in schizophrenic patients (8). Norman Cameron (2, 3, 4, 5), who performed the pioneer studies in this field, defined overinclusive thinking as the inability to preserve conceptual boundaries, as a result of which distantly associated and even irrelevant ideas come to be regarded as essential parts of a concept. This abnormality necessarily makes thought more abstract and less precise. Furthermore, it can lead to overlapping concepts which share elements in common, when, normally, they should be mutually exclusive, a situation which allows the thought-disordered person to entertain two mutually incompatible ideas at the same time without recognizing the contradiction.

There are reasons for supposing that both neurotic and normal individuals are likely to react differently to questions about nervous and about physical symptoms, and that those who are readier to respond to physical than mental questions might be those who adopted a particular attitude or mental set which we shall call “defensive”.

Since it was first reported by Kuhn in 1957, the value of imipramine in the treatment of depressive illness has become generally recognized and confirmed by clinical trials (Blair, 1960; Daneman, 1961; Rees et al., 1961). It continues to hold an important place in therapy despite the introduction of many other antidepressant drugs and the occasional adverse report (Ashby & Collins 1961). Nevertheless the indications for its use are by no means established. It has been claimed that certain types of depression respond better than others: “psychotic” better than “neurotic” (Azima, 1959), “endogenous” better than “reactive” (Ball and Kiloh, 1959). Yet the difficulty of making these categorical distinctions, and of making reliable comparisons between the findings based upon them by different workers remains notorious. It is clear, however, that only a proportion of depressed patients respond well to imipramine. It is also certain that within the group which does respond well are to be found representatives of every type and degree of depressive state. There is evident need, therefore, for information that will help to indicate which characteristics of an individual will render him more or less susceptible to imipramine, and there does not appear to have been any study particularly devoted to this. In this paper we give the results of correlating certain clinical features of depression with the response to treatment by this drug.