Taking the needle and being needled are contemporary colloquialisms which have some significance to those who administer injections for psychological purposes. They suggest that the experience of receiving hypodermic injections must be a relatively common one in our society, and also that such an experience is generally considered to be unpleasant. The corollary of these conclusions is that such a public attitude of mind is likely to foster preconceptions in relations to injections so that, whether or not the pain threshold itself is actually exceeded, the individual receiving an injection will be predisposed to regard the experience as a stressful one.

In reviewing controlled trials using mono-amine oxidase inhibitors in the treatment of depression it is soon obvious that workers vary as to whether they consider “depression” as a symptomatic mood change in diverse conditions or as a disease entity. Where the latter occurs, a variety of classifications of depressive illnesses appear, and that most widely used is the broad separation between endogenous and reactive depressions. Other points to note are the authors' definition of improvement, and particularly whether this refers to one aspect of the mental state only and whether the patient left hospital before receiving any treatment other than the drug.

One of the obvious requirements of a clinical test which purports to assess any aspect of the impairment of behaviour is that of cross-validation; it should be able to discriminate between different groups of patients similar to those on which it was first standardized. This paper reports such cross-validation of a paired-associate learning test which Inglis (1959) has shown to discriminate between groups of elderly psychiatric patients with and without memory disorder.

Recent interest in the problems of long-stay mental hospital populations has led to a number of studies which have been concerned with rehabilitation and particularly the re-activation of chronic, deteriorated patients by deliberate and systematic modification of their environment. In some of these studies, attention has been focused on the hospital ward itself, both as the background against which personal and social deterioration may be assessed, and as the means of re-building desirable patterns of behaviour (Cameron, Laing and McGhie, 1955; May, 1956). Another group of rehabilitation studies has been concerned with the value of specific work programmes. Industrial-type workshops in Dutch mental hospitals have been discussed by Carstairs et al. (1955), and the value of industrial and productive work in hospitals in this country, as well as some of its therapeutic effects, have been described in other publications (Baker, 1956; Stern, 1959; Collins, Fynn, Manners and Morgan, 1959). Considerable developments in the rationale and organization of sheltered as well as financially viable industrial workshops or factories for chronic mental patients have been made more recently (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al., 1961).

Most patients with endogenous depression who receive electroconvulsive treatment (E.C.T.) recover completely or improve considerably. However, it is evident that the effect of E.C.T. varies in different individuals. In some cases more treatments are necessary than in others and sometimes the final result is unsatisfactory even after a great number of treatments. Many attempts have been made to explain these variations.

Haloperidol is a comparatively new tranquillizing drug synthesized by Janssen et al. (1959). It is chemically unrelated to other drugs acting on the nervous system. It is a substituted butyrophenone whose formula is 4-fluro-4(1-[4-hydroxy-4-(4-chloro)-phenyl-piperidino]) butyrophenone.

Amitriptyline hydrochloride is 5–(3 dimethylaminopropylidine)–dibenzo (a,d) (1,4) cycloheptadiene hydrochloride. Structurally it is not related to the hydrazines and is not a monoamine oxidase inhibitor. It bears some resemblance to the phenothiazines and its chemical structure is related to imipramine, in which the central seven numbered ring is azepine, nitrogen replacing the partially unsaturated carbon of the amitriptyline cycloheptadiene ring (Dorfman, 1960; Vernier, 1961).

SKF 7261 is a low dosage phenothiazine derivative belonging to the piperazine group, other members of which include trifluoperazine (“Stelazine”), prochlorperazine (“Stemetil”) and perphenazine (“Fentazin”, “Trilafon”).

Former attempts to restore weight loss in psychiatric patients have included hyperalimentation (Weir Mitchell, 8) and sub-coma insulin therapy (Debenham et al., 2; Sargant and Craske, 5; Sullivan, 7). The aim of the present trial was to compare weight gains in a group of patients given repeated small doses of insulin with two other groups to whom oral hypoglycaemic agents were administered, and with a control group. The drugs used were tolbutamide and chlorpropamide, both of which are sulphonylureas used in the management of diabetes mellitus, and known to induce hypoglycaemia in non-diabetic subjects (Hoenig and Gittleson, 4; Cardonnet et al., 1; Garcia Reyes et al., 3). Pharmacologically there are no qualitative differences in their mode of action. Stowers et al., (6) found the half-life of tolbutamide to be 3·5 hours and that of chlorpropamide 34·5 hours. The prolonged action of chlorpropamide permits once daily dosage, but tolbutamide, being a shorter acting drug, was given in divided doses to maintain depression of blood sugar over the 24 hours.

Since the introduction of anti-depressant drugs into general use in the psychiatric field, there have been several statements to the effect that such a drug administered concurrently with electrical treatment reduces the number of shocks required to achieve a satisfactory response. This has been claimed by Sargant (1961) but without experimental support. Dunlop (1960) has published a comparison between the number of electrical treatments given with the anti-depressant drug during a particular attack, and the number of treatments without the aid of a drug in an earlier attack in the same patient: however, comparison of treatments in the same group of patients at different times is unreliable because there may be other factors to account for the differences noted. A controlled trial is necessary to ensure that all factors are constant other than the one under consideration.

The mono-amine oxidase inhibitors, of which phenelzine (“Nardil”) is one example, were introduced for the treatment of depressive illness as a result of the observation that iproniazid, which is a mono-amine oxidase inhibitor, produced euphoria and increased mental alertness in some tuberculous patients to whom it was given. Trials of iproniazid in mental illness were carried out (Loomer et al., 1957; Cesarman, 1959), but it was found to be very liable to give rise to side-effects, being particularly toxic to the liver. Other less toxic mono-amine oxidase inhibitors such as phenelzine, which is chemically related to iproniazid, were later developed.

Frank Fish's paper, published in The Journal of Mental Science in September 1961, pp. 978–985, deals with issues which are fundamental for psychiatry. He examines the different approaches used in existential psychology and especially the philosophical basis of existential psychiatry. In his conclusion, he denies its value. His paper demands a reply, since it contains misrepresentations.

In view of the reports of Mendigutia et al. (6), Delay et al. (3), Kamphausen (5), Harenko et al. (4), Alleva (1), that haloperidol was very effective in controlling manic states, it was decided to treat a number of cases with this diagnosis using this new preparation.

Thioproperazine is a phenothiazine compound with a piperazine nucleus in the side chain. The pharmacological investigations of Courvoisier et al. (1958) indicate that it is much less sedative than other phenothiazines and that it has weak anti-adrenaline, anti-histamine and anti-serotonin activity. Clinical reports by Delay et al. (1958), Perrin et al. (1958), Denber et al. (1959), Levy and Maarek (1960) and Perret et al. (1961) indicate improvement in schizophrenic patients, but their papers described trials of this drug in which both recent and long-term cases or other diagnostic groups were included. Denham and Carrick (1961) reported the total remission of symptoms in 32 of 58 chronic schizophrenics treated by the discontinuous method with significant improvement in a further 25. Their acceptance of the view that improvement was correlated with the occurrence of hypertonic syndromes and that failure of treatment was likely if anti-parkinsonism drugs were used to suppress the hypertonicity, excludes the possibility of the type of continuous treatment employed with other phenothiazines. Denber et al., however, advocated the suppression of these drug effects and Perret et al. reported 47% improvement using the continuous method in another mixed group of chronic patients.