Since the introduction of chlorpromazine with its troublesome side-effects, jaundice, leucopenia, agranulocytosis, photosensivity, etc., the search for safer and more therapeutically effective tranquillizers has continued unabated. Variations of the phenothiazine derivatives based on the promazine ring have been continually introduced with the aim of increased effectiveness together with greater safety.

The use of barbiturates in the treatment of insomnia carries a constant risk of habituation and of fatal poisoning from suicidal or accidental overdose. For these reasons, new non-barbiturate hypnotics deserve the closest attention. Ethinamate (“Valmidate”) and methyprylone (“Noludar”) are two such drugs. No trial comparing the hypnotic efficacy of ethinamate with a barbiturate has yet been reported, though Gruber et al. (1954) found the day-time sedative effect of 500 mg. ethinamate to be less (in duration of action) than 100 mg. of quinalbarbitone sodium. Methyprylone has been compared with barbiturate by Stewart (1956) who found 200 mg. equivalent to 100 mg. of amylo- or butobarbitone, by Lasagna (1956) who found 250 mg. equivalent to 100 mg. of pento- or quinal-barbitone, and by Thomson (1958) who found 400 mg. equivalent to 100 mg. of quinalbarbitone.

There is evidence of unduly high frequencies of alcoholism, psychopathy and criminality among the relatives of alcoholics. Åmark (1951) found a frequency of alcoholism among the brothers and fathers of 645 Swedish alcoholics to be about 25 per cent. (Fremming's estimate of alcoholism among 1,730 males from the Danish population being 3·4 per cent.). In a more recent study of family data on 1,000 patients admitted to a Canadian mental hospital that included 56 patients with alcoholism, the present author (Gregory, 1959) found a recorded history of excessive drinking among 23·2 per cent. of the fathers of the alcoholics, among 1·8 per cent. of the mothers, and among 4·2 per cent. of their siblings. Allowing for the age and sex of these siblings, it would appear that there was a lifetime expectancy of excessive drinking of at least 14 per cent. among the brothers of these alcoholic patients. These figures compare with a minimal estimated lifetime expectancy of alcoholism amounting to 1·6 per cent. of the total population, or at least 2·7 per cent of the corresponding male population of Ontario.

The authors undertook to investigate the effects of two new phenothiazine derivatives on schizophrenic patients. Over a period of two years a series of clinical trials have been carried out on approximately 260 patients, some controlled, some uncontrolled. These drugs, known as Melleril (TP21) and KS75 are chemically related. Although Melleril was ultimately selected as the drug of choice we have, for statistical reasons, included some of the findings with KS75.

4-p-Chlorophenyl-1-(3-p-fluorobenzoylpropyl)-4-hydroxypiperidine (R.1625, Haloperidol) is a new compound synthesized by Janssen et al. (1959) and reported to have biological properties similar to those of the phenothiazines at a much lower dosage level. One difference, however, was a greater tendency to potentiate pentobarbitone hypnosis. Von Eiff and Jesdinsky (1960) conducted a “double blind” trial in 28 normal subjects using 4 mg. Haloperidol 2½ or 4½ hours before the experimental period. Subjective effects included fatigue or fatigue and agitation in females. The drug did not appear to influence intellectual function as tested, but reduced self-criticism. There were minor cardio-vascular effects and a tendency to fatigue in ergometry performances. A number of clinical reports have appeared (Divry et al., 1960; Delay et al., 1960) suggesting that Haloperidol is of value in psychomotor agitation and especially in mania in doses of 2–15 mg. daily. Gerle (1960) reports favourably on the drug in schizophrenic patients. Most authors note a high incidence of pseudo-Parkinsonian side-effects (40–80 per cent. of cases) and a section of a recent symposium on the drug in Belgium was devoted to “neurodysleptic syndromes” (dystonic reactions, oculogyric crises, etc.) produced by it. Pichot (1960) at the symposium reported that these reactions can be controlled by chlorpromazine.

Studies of the effects of the repetition of statements, i.e., verbal signals, upon the behaviour of chronic psychoneurotic patients have been carried out in the Allan Memorial Institute continuously since 1953 (1).

The purpose of this survey was to assess the abilities and present status of all the adult women classed as feebleminded who have been discharged from the Fountain Hospital. This paper is not a comprehensive assessment, but a survey of these patients' past history, together with an interim report on their rehabilitation. In the majority of cases, the present whereabouts and occupation are known by the social worker and have been re-checked over the past eighteen months in the course of normal follow-up contacts.

Many chemical substances have been used to assist psychotherapeutic treatment. Abreactive procedures, using either depressant substances like sodium amytal, or excitatory substances like methedrine, or sometimes a combination of these substances, are standard procedures though, in everyday psychiatric practice, their use is limited.

The possibilities of therapy in cases of male transvestism are very limited. There are a few references in the literature to the use of synthetic oestrogens and in these papers the aim has been to feminize the patient by hormonal castration. Benjamin (1) recommends the use of oestrogens for milder cases and Hamburger (2) has used them prior to surgical castration.

There can hardly be a psychiatrist in this country who has not produced parkinsonism in his schizophrenics with reserpine or phenothiazines: Moore, who was among the first in the field in the use of reserpine, spoke of the parkinsonian syndrome, but there was one observation of his that received only passing attention, This was that a small number of his chronic schizophrenics lost their florid schizophrenic symptoms, to be replaced by a clinical picture that he found closely akin to retarded endogenous depression, to the point of contemplated or attempted suicide.

The use of drugs in order to calm excited mental patients dates back to the 5th Century B.C. or earlier.

The employment of extracts of the mandrake, Mandragora, in states of motor excitement is attributed to Hippocrates (Belloni, 1957). One disadvantage of such extracts was that reduction of agitation and anxiety could only be achieved at a cost of clouding of consciousness. This is also the case with many modern sedatives.

Although some years have passed since the end of the period under consideration, the subject matter is not altogether inappropriate. Neurosyphilis is now rare, though by no means completely abolished in the Western countries, and it is necessary to bear it in mind, for long-forgotten and undiagnosed cases are still liable to confront busy practitioners or specialists. In many parts of the world the situation is different and neurosyphilis is still frequently seen. Its global incidence may be waning but it is not yet a historical curiosity.

The tranquillizing drugs are used so extensively in the control of psychotic states that the wave of enthusiasm threatens to swamp the entire therapeutic field. Yet, until the scope and limitations of these drugs have been established it would be unwise to neglect advances in other methods of treatment. Prefrontal leucotomy has long since passed the crest of its wave, and in recent years conservative operative techniques and a more selective field of clinical application have rendered it a valuable treatment for certain groups of patients.

Attention is perhaps insufficiently focused in psychiatry on the “constitutional psychic inferior”. It may therefore be of interest to describe prisoners who have been thus affected at Camp Hill Prison in the Isle of Wight.

The assessment of sex responsiveness is a recurring problem in the field of conduct disorders and psychopathy, particularly when it is desirable to determine the effectiveness of therapy on the behaviour of the sex offender. Previous studies have indicated certain test differences in emotional disturbance and stress reactivity in subjects of known delinquent history, but it has been observed that sex responsiveness may be an additional (separate) factor to consider for the patient who is a known sex offender (19, 20, 21, 22).

In the six years that have elapsed since the tranquillizing drugs have been introduced for the treatment of mental illness, psychiatrists have been overwhelmed by the multiplicity of drugs, each claimed by its manufacturer to be more effective and less toxic than all the others. Contemporaneously, there has been a demand for the better assessment of the value of therapy in psychiatry with less reliance on clinical impression and more on the controlled trial (Eysenck, 1957; Foulds, 1958). It is quite impossible for each clinician to familiarize himself with each new drug, and it is difficult to carry out a fully-controlled double-blind trial on more than a small proportion of them. Moore (1959) has suggested a centrally-controlled trial of the tranquillizing drugs in schizophrenia by a body such as the Medical Research Council (1954) similar to the study on aspirin and cortisone in rheumatoid arthritis. Difficulties concerning diagnosis, and, probably more important, variations in the environment of the treatment situation which are of so much importance in determining the outcome of a mental illness, militate against the successful pursuance of such a scheme, and do not appear to have been overcome so far.