There have been numerous reports in recent years of prolonged apnoea resulting from the use of suxamethonium (succinylcholine, “Scoline”) in general anaesthesia and for electroplexy. For example, Grant (16) described a case of respiratory paralysis lasting 2 to 3 post-operative days following an intravenous dose of 80 mg. of suxamethonium, and Cowan (7) reported a patient who underwent a partial gastrectomy and exhibited complete apnoea for 9 hours duration after only 25 mg. of suxamethonium had been given, and who subsequently died. Hurley and Monro (22) reported apnoea lasting for 10 minutes following 20 mg. of suxamethonium used as a relaxant for electroplexy, and for 20 minutes after decamethonium iodide.

Vespral, chemically designated as 10-(3-dimethylaminopropyl-2-trifluoro-methyl)-phenothiazine hydrochloride, or trifluopromazine hydrochloride is a new ataractic drug which has only recently become available in this country. A clinical field trial with Vespral has been reported in a previous issue of this journal (1). It was then suggested that the drug was most effective in the treatment of psychotic disorders, schizophrenia in particular. The aim of this study was to evaluate, with some claim to objectivity, the effectiveness of the administration of trifluopromazine hydrochloride on the behaviour of a small population of chronic schizophrenic patients.

The Maudsley Personality Inventory (MPI) that purports to assess the two personality dimensions, extraversion-introversion (E-I) and neuroticism-normality (N-N), has been used extensively in recent research work and a number of published papers in somewhat different spheres bear witness to the use made of the questionnaire (Eysenck, 1956a; Coppen, 1958; Franks, 1957; Bartholomew, Franks and Marley, 1958). A clear description of its construction and use has been presented by Eysenck (1956b) and a comparison between it and other personality scales, as well as some criticisms of its construction, has been set out by Jensen (1958). The particular interest this questionnaire has evoked is due in part to the fact that it is one of the few personality inventories constructed and standardized this side of the Atlantic. The importance of a reliable questionnaire of this type is noted by Eysenck (1958) in his attempt to produce a shortened version of the MPI that will be of value in such work as market research.

Experimental studies by O'Connor (2) and O'Connor and Rawnsley (3) have indicated the value of separating chronic schizophrenics into those who exhibit and those who do not exhibit paranoid symptoms. Other work by O'Connor and Venables (4) and Venables and O'Connor (6) has shown that performance of schizophrenic patients on experimental laboratory tasks may be clarified by dividing them into active or withdrawn groups by means of a rating scale (Venables, 5) in addition to a division on the basis of the presence of paranoid symptoms.

It is a well-known fact that patients dislike E.C.T. and that part of this dislike is based on the unpleasant period of waiting which occurs before all operative procedures. There may be indeed other features involved in E.C.T. as patients seem to have a fear and dislike of this treatment out of proportion to what would be expected. That this dislike of E.C.T. is an important matter is brought out by the difficulty in persuading patients who have suffered a recurrence of a depressive illness to undergo this treatment once again, and if any means could be devised to increase their readiness to accept medical advice on this subject then an advance would be made.

In a recent paper Walton (3) has described the diagnostic and predictive accuracy of the Modified Word Learning Test (Walton and Black (4)) in relation to psychiatric disorders of the senium. Walton assessed the predictive value of the test in terms of changes in diagnosis over a two-year period. However, as Payne (2) has pointed out, a diagnosis, as such, can only be regarded as a kind of label, of interest not in its own right, but because of its implications. These, Payne has argued, are commonly fourfold, being related to (a) aetiology, (b) description, (c) the effects of treatment and (d) prognosis.

Diphenhydramine hydrochloride has been found to have a sedative effect, and various modifications of it have been prepared in order to enhance its effect. A promising variant is Covatin, which is p-butylthiodiphenylmethyl-2-dimethyl-aminoethyl sulphide hydrochloride; or, structurally:

A double-blind study of chlorpromazine and promazine was conducted to measure their comparative therapeutic effectiveness on a short-term basis at medium dosage levels, such as might be used for out-patient purposes. The patients chosen, however, represented a more therapeutically challenging group of hospitalized acute schizophrenics in whom a dramatic and convincing effect might offer an evaluation of comparative response.

There is a considerable literature dealing with the relation of anxiety to conditioning performance in human subjects. When compared with normal subjects, those with marked anxiety have been observed to show more rapid conditioning and slower extinction of certain responses. Typical observations have been those of Taylor (17) concerning conditioned eyelid responses, and of Welch (20), and Bitterman and Holtzman (3), concerning the galvanic skin response. In contrast, Bindra et al. (2) found no difference in the conditioning of salivary responses between anxious and non-anxious subjects.

In spite of the vast literature concerning Haemophilia, I have been unable to find any reference to the concomitant occurrence of a psychosis with this condition.

The development of megaloblastic anaemia as a complication of anticonvulsant therapy is now well recognized, and a total of thirty cases has been recorded.

Badenoch (1) reported the first detailed studies of megaloblastic anaemia developing in epileptic patients treated with phenobarbitone and epanutin, whilst Fuld and Moorhouse (6) reported the association with primidone (Mysoline) alone. In all the cases reported, the anaemia responded to folic acid therapy, whilst anticonvulsant drugs were continued.

Recent work, such as that of Moore and Martin (1957), has shown that reserpine is of value in the treatment of the chronic schizophrenic patient. Attention has however been drawn to the incidence of side-effects in this form of treatment. These side-effects have limited the application of the drug and have also led to the search for a related substance, of similar clinical effect but without the troublesome toxic effects. This present trial is of a substance, deserpidine (Harmonyl, Abbott Laboratories), which it was thought would fulfil these requirements. The isolation of this alkaloid was first reported in 1955 by Stoll and Hofman, and it has subsequently been identified as 11-desmethoxy-reserpine (Harrisson, 1955) which can be represented thus:

Blood copper had been known to be increased in pregnancy, chronic infections and neoplasms. Since the publication of Ullrich in 1942 (9), who found an increased copper level in the blood of schizophrenics, the hypercupraemia has been recognized as possibly significant and pathognomonic in this disease. Therefore during the following years a few investigators studied this aspect and also tried to prove the implications of this fact.

Changes in sympathetic nervous system responses have been noted to accompany changes in psychological states during psychiatric treatment. Funkenstein, Greenblatt and Solomon, observing the blood pressure response to epinephrine and methacholine, have reported a change in blood pressure patterns on the part of patients who benefited from electric shock treatment (1). Gellhorn has presented evidence that improvement in the psychoses is associated with heightened sympathetic reactivity (2).

In February, 1955, Howard D. Fabing described in Science (Fabing, 1955a) a clinical study using the drug azacyclonal hydrochloride (Frenquel), alpha-(4-piperidyl) benzhydrol hydrochloride. This drug is the gamma-isomer of Meratran which, although chemically similar, alpha-(2-piperidyl) benzhydrol hydrochlroide, has a rather different action. Brown and Werner (unpublished but referred to by Fabing, 1955a) reported that Frenquel prevents or diminishes central stimulation induced in the mouse by various agents, whereas Meratran has a stimulant action.

Phocomelia is a congenital malformation of the osseous system characterized by the absence or extreme smallness of the arms, forearms, thighs and legs, producing a pronounced shortening of limbs. The hands and feet, which may be fairly normal in appearance and development, seem inserted more or less directly into the shoulders or pelvis of the patient. As the micromelic appendages resemble the physical outlines of a seal's flippers, the condition is known as phocomelia.

In the last few years a number of new pharmacological agents have been introduced into psychiatry and reserpine has been one of the most controversial of these. Reports have varied from the over-enthusiastic (Noce, Williams and Rapaport, 1954), to the cautiously optimistic (Moore, 1956) and even the frankly sceptical (Cutler, Monroe and Anderson, 1957). It would be true to say, however, that all mental hospitals use reserpine now to some extent and nearly all psychiatrists are agreed that some remarkable recoveries have occurred. However, many questions remain to be answered—What kind of case improves?—What is the nature of the improvement qualitatively?—How lasting is the effect? Time alone gives the answer to some of these questions which are constantly recurring phenomena in therapeutics.

Phillipson's Object Relations Technique (Phillipson, 1955) is roughly described as possessing features to be found in the T.A.T. and Rorschach methods. It consists of 13 cards, including a blank card. The design of the test and the order of card presentation are depicted in Table I.

The autonomic nervous system activity that has been observed to accompany grand mal epilepsy does not occur consistently with the seizures produced by electric convulsive treatment. The dilated pupils, flushing, lacrimation and gooseflesh which appear during the tonic spasm of the electrically induced seizure, and which are the outward manifestations of the autonomic storm within, are often not readily observed because of their transience; they begin to fade almost as soon as they appear and may be gone with the onset of the clonic spasm. Different patients exhibit them in different degrees and the same individual may show changes in the amount of autonomic response over a course of treatments.