For many years, cases of pernicious anaemia associated with mental symptoms have been described, and interest in these symptoms was renewed following the introduction of liver therapy (Richardson, 1929; Phillips, 1931). Interest later appeared to decline, so that MacDonald Holmes (1956), almost 20 years after the last important clinical review of the subject, could comment with justification that although the cerebral lesions of pernicious anaemia had been recognized for more than a century they were still much less familiar than the lesions which occurred in the spinal cord and peripheral nerves. Since then vitamin B12 deficiency as a cause of mental symptoms has given rise to increasing interest, and this is reflected in recent suggestions that serum vitamin B12 assays should be carried out routinely in psychiatric patients and might be more informative nowadays than the routine Wassermann reaction (Strachan and Henderson, 1965; Hunter and Matthews, 1965).

Many psychiatric symptoms have been described in pernicious anaemia, including depression, manic excitement, paranoid states, confusional episodes, and dementia. Although vitamin B12 deficiency is known to produce neurological symptoms there is much less certainty about its role in producing mental symptoms. Despite this uncertainty, it has been asserted that carrying out vitamin B12 assays on psychiatric patients will enable doctors to cure for good severe disabling disease which otherwise may end in chronicity (Edwin et al., 1966). Routine examinations to exclude pernicious anaemia have been advocated for all psychiatric patients (Strachan and Henderson, 1965; Hunter and Matthews, 1965). A prudent preliminary is a critical evaluation of the causal relationship between vitamin B12 deficiency and individual psychiatric syndromes.

Anorexia nervosa is a disorder characterized by loss of weight occurring as a result of a reduced intake of food; it may be aggravated by vomiting, excessive exercise or purgation. Females are affected much more commonly than males; the illness often begins during adolescence and one of its early manifestations is the cessation of menstruation.

Steroid hormones may produce a wide variety of psychiatric syndromes (1), (2), and the progestational steroids are no exception. We were alerted to this by the occurrence of an acute schizophrenic psychosis following the withdrawal of 30 mg. Enovid (Enavid) daily, which was being used to control endometriosis (3). The patient's psychotic symptoms showed remission with drug replacement and relapse on placebo.

Although abnormalities in physique in mental patients have been reported many times (see review by Rees, 1960) their cause and significance are obscure. Rey and Coppen (1959) reported the results of an investigation into the physique of mental patients using a measure of sexual maturation known as the androgyny score (Tanner, 1951, 1962).

In carrying out short term therapy involving one to six sessions with doses of 75 μg. to 200 μg. of LSD, the author gained a definite clinical impression that suggestibility was influenced by LSD, although there is little mention of such a parameter in the classification of LSD effects. Remarks meant to be helpful sometimes proved much more effective whilst patients were influenced by LSD than when they had been given in ordinary interview. Classification of the phenomena of LSD intoxication may have therapeutic orientation and dynamic concepts or it may draw on purely descriptive terms with symptomatic significance.

It is known that peptic ulcer patients have an increased incidence of blood group O, (1) and that peptic ulcer patients have above average scores for Neuroticism on the Maudsley Personality Inventory (3). In view of this it seemed worthwhile to see if there is any relationship between blood group O and Neuroticism (2).

The present study is concerned with what is inherited in mental disorder. Is it an unspecific tendency to mental disorder, is it specific symptoms or features such as age of onset, course or outcome, or is it psychiatric diagnosis?

The study of pairs of relatives with mental disorder is certainly the best approach to investigating the problem of what is inherited. Unfortunately there has been a paucity of studies primarily dealing with this particular problem.

Since the inception of the use of artificially induced convulsions as a therapeutic agent in 1935 by Meduna and the modification of this method of treatment by the use of electric currents by Cerletti and Bini in 1938, a vast literature has accumulated on this form of psychiatric treatment. Yet, despite this vast literature and the passage of over 30 years of experimental opportunity, no predominant or convincing rationale for the use of electroconvulsive therapy (E.C.T.) has emerged; Meduna's (53) original theory of the incompatibility of schizophrenia and epilepsy having been long discredited. E.C.T. remains, therefore, an empirical form of treatment.

For over a decade the Maudsley Monograph Suicide in London (Sainsbury, 1955) has been the most authoritative source of information about the contribution of certain social factors to the incidence of suicide in a British urban population. Sainsbury's investigation tested the hypothesis “that where social mobility and social isolation are pronounced, community life will be unstable, without order or purpose, and that this will be reflected to a greater or less degree in the suicide rates”. Much of his work stems from the pioneer work of Durkheim (1897). Using a combination of sociological and psychiatric methods he correlated rates of suicide and indices of social characteristics for London Boroughs derived from a social survey, the 1931 Census and other studies (Burt, 1944). He found significant differences in suicide rates among the boroughs, which remained consistent over 30 years despite considerable changes in the composition of their populations. Comparing suicide rates with other social factors he found significant correlations with social isolation, social mobility, divorce and illegitimacy. He suggested that suicide tended to be higher in the middle class and to diminish with poverty, but found no correlation with unemployment and overcrowding. He stated that suicide rates increased with age, particularly among males, there being a preponderance of over 55 year olds in his sample. A seasonal variation was observed, with the peak incidence in May. In his sample there were twice as many men as women. Six per cent. of his group were definitely alcoholic. Nine per cent. had made a previous attempt at suicide. Almost half of the group were seen to be psychiatrically ill or abnormal in personality.

It is a fact that there is, within the National Health Service, a gradually increasing demand for psycho-analytical psychotherapy. This demand is reflected in the large number of patients referred and in many articles dealing with the treatment of psychiatric and physical illnesses. Such satisfaction gained by this recognition is offset by the knowledge that both inside and outside the medical profession there is an abysmal ignorance of what psycho-analytical psychotherapy is, what it can or cannot achieve and what it involves in that most precious commodity—doctor time.

In recent years the mental health of British university undergraduates has aroused considerable interest. The findings of Parnell (1951) at Oxford, Davy (1957 and 1960) at Cambridge, Malleson (1958) at University College, London, and Juel-Jensen (1962) at Oxford indicate that up to 20 per cent. of students suffer psychiatric disturbances of sufficient degree to constitute a handicap in their daily life. Furthermore, mental ill-health is one of the most important reasons why undergraduates lose time from their studies or withdraw from university altogether. Read (1954) stressed the advantages of the psychiatric service for students at the London School for Economics.