Frenquel, α-(4-piperidyl) benzhydrol hydrochloride, generically known as Azacyclonal hydrochloride was introduced commercially into this country in the early part of 1957 although it had already been available in the United States of America for several months previously. Sargant (1956) obtained a supply of Azacyclonal from America and in his paper on Chemical Tranquillizers he refers to Azacyclonal as “an interesting drug”. Azacyclonal was thought to be the first drug to possess a specific anti-hallucinatory effect.

A review of the literature which is accumulating on the so-called tranquillizing drugs shows:

1. A relatively small number of adequately controlled trials with, in general, more conservative conclusions than those of the much greater number of uncontrolled trials (Foulds, 1958).

2. Diffuseness in patient selection, with subjects often being chosen for behavioural qualities (e.g. overactivity) or general characteristics (e.g. chronicity) rather than for diagnosis.

It is natural for psychiatrists and others dealing with mental patients to enquire what the prognosis is for a patient showing certain symptoms or syndromes of symptoms—taking age and the history of the patient's illness into account. The very fact that the symptoms generally form syndromes points to their interdependence to a greater or lesser degree, but this interdependence may not be a straightforward linear relationship such as is revealed by an ordinary correlation coefficient for the symptoms may interact with each other in a complicated way. When this is the case the problem of prediction is difficult from a statistical as well as from a psychiatric point of view. In this paper an effort is made to clarify the statistical problem by describing briefly and by comparing two statistical models which may be used for predictive purposes. The models are introduced by means of an example using data for patients who have attended this hospital. For reasons of clarity the number of variables included in the study is a bare minimum.

In a previous investigation (Foulds and Caine, 1958) a series of consecutive admissions (women) admitted to Runwell Hospital and diagnosed as psychoneurotic were found to divide into four groups in terms of presenting syndrome (hysteria or dysthymia) and of personality type (hysteroid or obsessive). When psychological tests were administered to these groups it was found that some measurements were related to diagnostic category whilst others were related to personality type.

A case closely comparable with that reported below does not appear to have been described, possibly because of the ethical problems involved. Watkins (1947, 1951), in the description of two cases, has made the most nearly related contribution to the old debate as to whether an unwilling subject can be hypnotized. His cases were both trained subjects who were offered money rewards to attempt to resist the formal induction of hypnosis before an audience. They were both successfully hypnotized. The fear-inspired unwillingness of the patient to be described would appear to have been in a rather different category.

The use of tranquillizers in mental deficiency has shown a divergency of effects. Noce, Williams and Rapaport (1) claimed that reserpine produced some improvement in all their thirteen adult hyperactive low-grades, and Rettig (2) reported that chlorpromazine produced decreased hyperactivity in twenty-three of his twenty-seven adult defectives of all grades. Blair and Herold (3), using ten “matched-pairs” of hyperactive defective children, found behaviour improvements in nine of them on chlorpromazine, with an average I.Q. gain of 10.4. Using six different tranquillizers on twenty-five adult defectives of all grades, Rudy, Himwich and Rinaldi (4), found that all gave some benefit, with chlorpromazine the most effective. Fischer (5) showed that twenty out of his twenty-two low-grade adult defectives (many with psychotic overlay) were improved in behaviour on reserpine. Using sixteen “matched-pairs” of E.S.N. children, Segal and Tansley (6) claimed that hydroxyzine produced improved scholastic performance in fourteen of them, and Bergin and Bergin (7) stated that the epileptics in particular in their thirty-four low-grades were improved by promazine hydrochloride.

Perivascular cysts visible to the naked eye have been described in the brain of several cases of gargoylism (Lindsay et al., 1948; Henderson et al., 1952; Naidoo, 1953). In most instances they were small, not exceeding 1 mm. in diameter and confined to the white matter of the cerebral hemispheres. The present case is remarkable for the exceptional size of the perivascular cysts which had led to gross bilateral cavitation of the thalamus and putamen.

Prochlorperazine (Compazine, Stemetil) and chlorpromazine (Thorazine, Largactil) frequently produce tremor and rigidity. Less well known are the severe tonic spasms of the muscles of the head and neck which can result from these phenothiazine derivatives. This paper directs attention to these spasms and their similarity with “extrapyramidal seizures” and oculogyric crises.

In recent issues of The Journal of Mental Science there have appeared two critical papers (5, 7) dealing with some aspects of the dimensional analysis of personality which the writer has put forward. As replies to these papers separately would seem to require a good deal of repetition, it seemed better to frame a joint reply. This has been kept rather short on purpose, primarily because the writer does not believe that arguments are very helpful to the advancement of science, unless they are accompanied by new data of an experimental kind. In the main, therefore, this reply has restricted itself to simply pointing out that many of the points raised are factually incorrect, or, although they might be correct in themselves, are not relevant to the theory they are criticizing.

Since disulfiram (tetraethylthiuram disulphide) was first reported to cause intolerance to alcoholic beverages (Hald et al., 1948) it has been used extensively as an adjunct in the treatment of alcoholism. Impressions of most therapists have been favourable (e.g. Martensen-Larsen, 1953; Wallerstein et al., 1957). At Warlingham Park Hospital the drug has been administered over the past five years to more than 250 alcoholics (as part of a fairly comprehensive therapeutic programme—Glatt, 1955) and has been found by a great many patients very helpful after discharge from hospital.

In its classical form this peculiar disease is characterized by an irresistible compulsion to swear, together with motor tics. First recorded by Itard in 1825, it was later fully described (1885) and followed up (1899) by Gilles de la Tourette, whose name has been given to the condition. Associated with the compulsive utterances are multiple motor tics, hence Convulsive Tic is a synonym for the malady. The motor movements are more severe and widespread than those met with in simple tic, and they may involve the whole body in a violent spasm. Facial grimaces, violent jerks of the head, limbs and trunk may occur, often combined with an explosive utterance. This exclamation may consist of an unorganized sound such as a bark or a groan or a grunt. Or it may be a word—frequently of an obscene nature (coprolalia) which greatly embarrasses the patient. Other features of the condition are echolalia—the impulse to repeat sounds or words which the patient hears, and echbpraxia—the compulsion to copy the actions of others.

The Uffculme Day Hospital was opened some two and a half years ago as part of an experimental scheme to treat psychiatric patients outside the confines of a mental hospital. The plan was to admit a small number of patients and gradually to develop and organize a group therapeutic technique in the light of experience. It was hoped that a Day Hospital conveniently situated within a large industrial city would help to meet an increasing need for diagnostic and therapeutic facilities. It might find a solution for those patients who could not be adequately treated as out-patients and yet were not likely to benefit from admission to already hard-pressed and overcrowded mental hospitals. While the present Day Hospital scheme is too small to have a significant influence on the total psychiatric problems of some one million and a half people living in the vicinity, it has so far shown signs of being a welcome addition to the mental health services of the region.

This study is an attempt to assess the value of certain drugs commonly used in psychiatric practice in decreasing the hyperactivity of patients. It is one of a series investigating tranquillizers and mental disorder in mental deficiency practice (Craft 1958).

With the advent of effective physical therapies, psychiatrists have become increasingly interested in the problems posed by clinical trials. Professor Bradford Hill, in the Preface to the Sixth Edition of his Principles of Medical Statistics (1) noted that “… passage of time has … brought clinical trials into prominence and fashion …”. More recently Professor Pickering has described the clinical trial as “the most important new method introduced into clinical science in recent years” (2). Some interesting differences between controlled and uncontrolled trials are well brought out in the paper by Foulds (3) in which he found that therapeutic success was claimed in 85 per cent. of studies not using control groups. Among those studies using control groups, however, only 25 per cent. obtained a positive result. He concluded that “claims for the success of a treatment are closely associated with absence of the means whereby these claims can be scientifically substantiated”.

This paper describes a group of female patients admitted to mental hospital who in the past had undergone thyroidectomy for thyrotoxicosis. It was thought that a group of this kind who had been admitted might show, possibly in an exaggerated form, the personality features said to be common to individuals predisposed to thyrotoxicosis. The series does not include any toxic psychosis attributable to the disease itself and the title may possibly be misleading in this respect. Most psychiatric studies have dealt with the patient at the time of the illness and the emphasis has tended to be on precipitating factors. A much quoted study is that of Conrad (1) (1934). As a psychiatrist working in a thyroid clinic she described 57 cases referred for psychiatric opinion and used 48 cases not so referred as controls. She concluded from a careful study that the onset of the illness was due to two main patterns of emotional disturbance: (1) fear of loss of shelter and affection equivalent to deprivation of mother, (2) fear of dangers of the mother role. She found a large number of cases where there had been loss of the mother at an early age. Ham, Alexander and Carmichael (1951) (2) remind us that the disease occurs spontaneously only in man, not animals, and rarely in primitive communities. They describe a “specific dynamic pattern” in thyrotoxicosis, viz., Frustration of dependent longings and persistent threat to security (exposure to death and other threatening experiences in early life, causing unsuccessful premature attempts to identify with the object of the dependent cravings. There is a continued effort toward premature self sufficiency and to help others. These strivings for self sufficiency and taking care of others fail causing thyrotoxicosis. Lidz and Whitehorn (1949) (3) also regard thyrotoxicosis as following in almost every case a somewhat similar pattern. They regard these patients as a group less wanted than their sibs but eventually achieving parental affection by being “good children” (in the exaggerated sense) and persist in this pattern of behaviour in adult life. They expect the same unswerving fidelity they gave to their parents in return for excess of affection that they give to a parental figure. These authors claim that this almost invariable pattern provides short cuts in therapy, e.g., when the illness arises soon after marriage, problems are apt to revolve about difficulties in leaving the parental home. Working on different and more objective lines Ruesch (4) and his colleagues at the Thyroid Clinic of the University of California studied 43 patients carefully selected to give a fair representation of patients treated by thyroidectomy. They verified thyrotoxicosis by histological reports on the excised portion of the gland. Each patient had 5 interviews and abbreviated Wechsler and Minnesota Multiphasic Personality Inventory Tests. Their main interest was the prolonged psychological invalidism which had been noted to immediately follow operation. They found that patients with delayed recovery tended to have a long record of previous hospitalization, and a high frequency of major and minor operations. In the M.M.P.I. the most common pattern was “undifferentiated normal”. They concluded that patients with thyroid disease are not entirely normal sociopsychologically, but the group could be subdivided into two entities: (1) normal or almost normal, (2) hysterical or anxious type in female patients, or dependent personalities in male patients.

A patient in a state of stupor presents one of the most remarkable phenomena seen in medicine. The term “stupor” itself is in widespread use in general medicine and usually refers to partial or near coma. Its precise use in psychiatric practice implies a condition of immobility and muteness without loss of consciousness or organic paralysis. The term “akinetic mutism” is sometimes used to describe such states, particularly by neurologists. The actual clinical appearance or syndrome is too well known to warrant a detailed description. Essentially, for the purposes of this paper, it is equated with akinesis and mutism.

Psychologists are frequently asked to say whether, in the case of a particular patient, there is evidence of organic dementia. At first sight this would not appear to be an unreasonable request. A considerable amount is known about the performance of normal people on tests of cognitive function and it might be supposed that people who work with tests of human ability should be able to modify their procedures to the purpose of diagnosing intellectual deterioration when this is not obvious on routine neurological or psychiatric examination. Moreover, it might seem that the frequent presence of independent criteria of brain damage provided by neurological and neurosurgical investigations should facilitate the development of competent diagnostic clinical psychology in the neurological field.

Much interest has been displayed in the past few years in the effect on human subjects of reduction, or as far as possible, abolition of sensory stimulation, so that virtual isolation from the environment is produced. Recent comprehensive reviews have appeared, dealing with experimental work (Solomon et al. 1957) and conditions arising incidentally in the course of various therapeutic procedures (Grünthal 1957), and it is therefore unnecessary to deal with the topic at length here.

A psychological test of brain-damage, shown to be valid in discriminating between unequivocal brain-damaged and non-brain-damaged psychiatric patients, is limited in its diagnostic role until studies can demonstrate its independent diagnostic contribution in the clinically doubtful case of brain-damage.

Stoll, in 1947, reported on the effects of LSD-25, an ergot alkaloid which can produce striking mental changes in normal persons, when given in microgram quantities. Since this original report, many papers and provocative ideas on the subject have appeared.