In a previous study of the efficacy of a vitamin-preparation (Krawiecki, Couper and Walton, 1957), the Wechsler Memory Scale Form I (1945) was administered on four occasions to each senile psychotic patient in the trial. Although the experiment produced interesting therapeutic results the present paper is not concerned with these but rather with the diagnostic and predictive implications of the Memory Scale changes.

Abnormalities in the vestibular reactions in schizophrenics have been reported in the literature. Pekelsky (1921) observed transitory lack of caloric response in two cases of catatonic stupor. Rosenfeld (1926) described four cases of acute catatonia in which on calorization a slow deviation appeared instead of the physiological response. Claude, Baruk and Aubry (1927) examined four cases of catatonia, eight of hebephrenia and one of dementia paranoides. In one of the catatonic cases no caloric or galvanic response could be elicited, and in the three others the reactions were diminished. The other cases showed normal reactions. The authors stated that a diminution of the responses could sometimes be observed in hysteria. Claude, Bourguignon and Baruk (1932) found the Chronaxie of the vestibular nerves greatly increased in patients with catalepsy, but normal after the disappearance of that symptom. Joo and Meduna (1935) stated that in old-standing cases of schizophrenia a lack or a considerable diminution of the vestibular responses could nearly always be found. Sercl and Vinar (1937) examined the vestibular reactivity in twelve cases of hebephrenia and thirteen cases of paranoid schizophrenia. The responses to rotation were normal in all cases. The caloric responses were found to be diminished or lacking. Lack of caloric response was more frequent in the hebephrenic than in the paranoid cases. Löwenbach (1936), working on Gjessing's cases of periodic catatonia, carried out quantitative investigations taking into account the latency period of nystagmus, its duration and the number of oscillations. He examined thirty cases, each of them repeatedly, and attempted to correlate the results of the tests with the periodical changes in the clinical picture. He found that shortly before and during periods of stupor the vestibular reactivity dropped, and that sometimes only a slow deviation could be elicited. The lowering of the frequency was due to the prolongation of the slow phase. The abnormalities were independent of the duration of the illness, and in some old-standing cases the response was normal. Sometimes a temporarily diminished reactivity was noticed which did not coincide with a change in the clinical picture. Löwenbach noted frequent and often abrupt changes in individual cases, and in some he observed transitory complete loss of reaction. Angyal and Blackman (1940) studied vestibular reactivity to caloric and rotatory stimulation in 58 unselected male schizophrenics and in 20 normal controls. The response to caloric stimulation was found to be considerably lowered, the rotatory response only slightly reduced. There was no correlation to the duration of hospitalization or to the conventional subtypes of schizophrenia. However, in a group of five patients with extreme apathy, indifference and poverty of mental contents the reactivity was particularly low. In cases with a periodical course the vestibular reactivity was distinctly lower during the catatonic periods than during the intervals. The same authors (1941) investigated the nystagmic reactions to caloric stimulation under the influence of alcohol, hyperpnoea and CO-inhalation in schizophrenics and normal persons. While in normals alcohol intake results in an increase in the frequency of the nystagmus, in schizophrenics a decrease was observed. CO, which normally has a depressing effect on the nystagmic reaction, produced an increase in schizophrenics. Hyperpnoea, while causing an increase in normals, had the opposite effect in schizophrenics. Freeman and Rodnick (1942) studied the amount of sway induced by rotation in thirty schizophrenics and in an equal number of normal controls. The patients were found to be significantly less reactive than the normal subjects.

Fifty years ago in a discussion on the pharmacology of cannabis indica, Dixon (1899) said, “Hemp therefore exerts its effect differently according to the preparation used … In fits of depression, mental fatigue, nervous headache, and exhaustion a few inhalations produce an almost immediate effect, the sense of depression, headache, feeling of fatigue disappear and the subject is able to continue his work feeling refreshed and soothed. I am further convinced that its results are marvellous in giving staying power and altering the feelings of muscular fatigue which follow hard physical labour … It is to be feared, however, that cannabis indica can never become popular until its active principle has been isolated, that is, the isolation of a compound of fixed strength.”

Psychiatrists and clinical psychologists can be classified into the Big-Endians who believe in classification and the Little-Endians who do not. Each side has its derogatory stereotype of the other. According to the Little-Endians, Big-Endians are tough-minded, cold, impersonal monsters who think about the human personality in terms which are static and rigidly structural rather than fluid and dynamic. Contrary to Swift, they love people in general and hate Tom, Dick and Harry. In the field of mental health, they believe in illnesses rather than in people and believe that these illnesses all have an as yet unknown physical cause. They are reactionaries.

My aim in abstracting the material for this article from experiments with upwards of 350 subjects has been to offer a few additions to the deductions it is possible to make from the Rorschach test, and to criticize and evaluate its general aims. The number of subjects studied approached that from which Rorschach derived the conclusions embodied in his monograph Psychodiagnostik. Among these is a group of 100 normals, the investigation of which should afford an interesting combination with the findings obtained by P. E. Vernon from an equal number of similar subjects.

A decrease of glucose tolerance in mental illness has been observed for over forty years (Kooy, 1919; Mann, 1925). Although this change in carbohydrate metabolism has been described in all types of mental disorders, the majority of investigators report that it occurs most frequently in melancholia (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944). The phenomenon has usually been regarded as a secondary effect, and several theories have been suggested to explain how it is produced (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944); however, no single explanation is firmly established, and the mechanism or mechanisms are still uncertain.

The fasting blood acetyl methyl carbinol (A.M.C.) level was shown to be high at the start of the depressive phase in manic-depressives by Dawson, Hullen and Crockett (1). Such cases also showed large fluctuations of fasting blood A.M.C. level compared with normals. The findings in a manic-depressive patient investigated more recently are shown in Figure 1; those in a normal female are given also for comparison. In the manic-depressive, it can be seen that the fasting blood A.M.C. level tended to fluctuate widely, to be high before and at the start of a depressive phase. There is no evidence to suggest that A.M.C. in the quantities found could cause psychiatric manifestations (Stotz, Westerfeld and Berg, 8). It is hence possible that the alterations in A.M.C. level were merely an indication of an abnormal variability of some part of the biochemical milieu. It was decided therefore to investigate patients with other forms of depressive illness to see whether or not abnormalities of A.M.C. level and variability were present, similar to those in manic-depressives.

In a cohort of five patients from the Middle East with the Gilles de la Tourette syndrome, family history of a tic disorder or the Gilles de la Tourette syndrome was positive in three cases. In one of these there was a multiply affected pedigree spanning six generations. The phenomenology of the syndrome is the same as that described in Western reports. The familial pattern of inheritance and cross-cultural similarity emphasise the biological factors in the aetiology of the syndrome.

A case is described in which a diagnosis of paranoid schizophrenia was made using the criteria of Schneiderian first-rank symptoms. The patient showed the Capgras syndrome, with delusional misidentification of her son and other people in her environment, and also Ekbom's syndrome, with the delusion that she was infested with parasitic worms which migrated between various parts of her body. In this case, the two syndromes are descriptions of a specific delusional content, and occur as part of the psychopathology within a schizophrenic disorder, rather than as distinct disease entities.

The ‘Coping With Drinking’ questionnaire, administered to 124 A1-anon members, was factor analyzed and revealed nine identifiable styles of coping. Multiple regression analyses between three measures of sobriety and each of the nine styles of coping factors provide support for the general hypothesis that the coping styles used by wives of alcoholics are related to drinking outcome. Further, those modes of coping in which the wife communicates her feelings of distress and frustration to the drinking husband in a way which is minimally threatening for him seem to be most positively related to his attainment of sobriety.

Twenty consecutive cases of anorexia nervosa admitted to a general medical ward were found to consist of ten who reduced weight by means of dieting and ten who in addition employed self-induced vomiting. Clinical and biochemical differences between ‘dieters' and ‘vomiters' were less pronounced than those reported elsewhere. However, the ‘vomiters' had higher scores on the anxiety, somatic and depression subscales of the Crown–Crisp Experiential Index and lower serum carotene concentrations. The implications of these findings are discussed.

Two critically important areas of research are the long-term course of illness and predictors of outcome in chronic schizophrenia. Although these two areas have been actively investigated throughout the 20th century, there is still a lack of agreement about even basic features of the long-term outcome of schizophrenia as well as a lack of validating evidence for putative predictors of outcome. Determining the long-term outcome of schizophrenia has implications for the pathophysiology and public health policy of this illness. For example, a course of illness that is marked by progressive deterioration may suggest a degenerative disease process, whereas a course that remains stable or improves over time may be more consistent with non-degenerative hypotheses such as neurodevelopmental, infectious, or toxic processes. In terms of public health policy, the allocation of resources related to issues such as community-based versus hospital-based care will be heavily influenced by knowledge of the level of chronicity and impairment associated with schizophrenia throughout the lifetime of affected individuals. Validation of predictors of outcome will have immediate clinical relevance, as well as providing support for pathophysiological hypotheses.

Changes in appetite and weight were recorded in mild to moderately depressed out-patients during the course of clinical trials of various antidepressant drugs. After six weeks, differences due to treatment regimes were minimal. Patients who on becoming depressed experienced severe changes in appetite and weight in either direction, tended to return to normal. The significant associations of appetite and weight change during treatment were with weight, appetite, and carbohydrate preference at presentation, and also with the ‘appetite history’ and ‘weight history’. The associations with the degree of depression were relatively minor.

Sex chromatin studies of the mentally defective have revealed a higher than average prevalence of positive sex chromatin among retarded males, and of double Barr bodies among retarded females (Prader et al., 1958; Israelsohn and Taylor, 1961; Maclean et al., 1962; Anderson et al., 1964; and others). It is not yet clear whether mentally defective women also contain an unusually large number with the XO constitution. That mild mental deficiency is a common accompaniment of an XYY constitution in males has been shown recently (Jacobs et al., 1965; Casey et al., 1966; Price et al., 1966). As yet no epidemiological studies have been reported on the XYY constitution.

The Family Interpersonal Perception Test (FIPT) was used to explore the relationships between schizophrenic patients and their parents, and how these related both to relapse in the year after discharge and to improvement in social functioning. Forty schizophrenic patients and their parents were tested during their first ever admission to hospital and again two years later. Parents' and patient's views of each other were more negative in those with worse outcome, but what most significantly distinguished groups with different outcomes was how patients expected their parents to see them. The FIPT, therefore, reveals patterns of interaction in which the patient's role in outcome is at least as important as that of the parents, and can aid the identification of specific features with which to work in therapy.

Forty-three depressed patients in hospital were studied with weekly dexamethasone suppression tests (DSTs) and were followed as out-patients for at least three months after discharge. The detection rate of patients with LHPA axis dysfunction increased from 41% with a single DST to 59% with serial DSTs. There was a poor correlation between weekly post-dexamethasone cortisol levels and Hamilton depression rating scores. In patients with evidence of LHPA axis dysfunction, a DST at discharge discriminated effectively between a good and a poor outcome group; persistent non-suppression was strongly linked with a relapse of depression in the first three months after discharge. In general, our results support previous claims that the DST is a state marker for depressive illness.

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness had been made. DSM–III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a ‘schizodepressive continuum’, but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.

An increasing number of psychiatric services have non-seclusion policies. Evaluation of a policy of using specified observation levels instead of seclusion was made over a two-year period. The number of violent incidents recorded in health service facilities was low (exactly 50). Community responses elicited from police, probation, and prison services were not generally critical of the policy. Medication levels used were not excessive as determined by peak levels of major tranquilliser and anti-Parkinsonian drugs used. No patient was excluded from the unit because of his or her level of actual or potential aggression, but two were transferred from it for this reason.

It probably goes without dispute at the present time that the precise content of a schizophrenic's thought, like that of anyone else, is derived from experience. Even the remarkable mélange of Schreber's memoirs could in large part be traced to his childhood experiences (Niederland, 1959). There is generally little doubt that the exact form and the course may be determined by age and experience; the effects of genetically determined intellectual endowment are uncertain (Elsässer, 1952; Rosenthal, 1963). The very occurrence of schizophrenia as a clinical phenomenon challenges the investigator, and there are many who question whether experience alone could result in schizophrenia in any and all human beings. They ask rather to what extent and by what mechanisms is the occurrence of schizophrenia determined by genetic factors.