Is leucotomy “one of the best treatments we have” or is it “sheer unadulterated barbarism”? These are two of the many points of view expressed to me whilst I was collecting material for this paper.

The task now arises to indicate the significance which should be given to the findings described in earlier pages. There are three possible theories by which the combination of a schizophrenia-like psychosis with a pre-existing epilepsy might be accounted for. First the combination might be co-incidental, due purely to chance, in which case there would be no medical problem of any consequence. Secondly the occurrence of epileptic fits might tend to precipitate the psychosis in individuals genetically predisposed, who otherwise would have had better chances of escaping such a development. Thirdly the psychosis might be the direct consequence of the epilepsy, and therefore to be regarded as an epileptic and not a schizophrenic disorder in the aetiological sense. Fourthly it would be possible to suppose that in any given collection of cases representatives of more than one of these causal chains could be found. These theories may be discussed in turn.

The number of illegal internet pharmacies selling prescription-only medicines without a prescription is increasing. Large quantities of drugs are dispensed, making drugs of abuse readily available, and further risks are posed by counterfeit medication. Urgent national and international action is required to stop further proliferation of illegal pharmacies.

Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.

A patient with major depression who did not respond to treatment with fluoxetine alone responded to thyroid hormone augmentation of fluoxetine.

Immune dysfunction has been proposed as a mechanism for the pathophysiology of autistic-spectrum disorders. The selectin family of adhesion molecules plays a prominent role in immune/inflammatory responses. We determined the serum levels of three types of soluble-form selectin (sP, sL and sE) in 15 men with high-functioning autism and 22 age-matched healthy controls by enzyme-linked immunosorbent assay. Levels of sP-selectin and sL-selectin were significantly lower in patients than in controls. Furthermore, sP-selectin levels were negatively correlated with impaired social development during early childhood.

A purported association between creativity and psychopathology is ancient, persistent and controversial. Biographical research, studies of living artists and writers, and investigations into the cognitive and temperamental factors linked to both creativity and mood disorders suggest a more specific link to bipolar illness. A new, large and well-designed population-based study adds further support to this connection.

It has been hypothesised that community cases of depression compared with clinic cases: (a) have fewer symptoms; (b) have milder symptoms; (c) have different symptoms; (d) are of shorter duration; (e) are less incapacitating; (f) are more environmentally and less biologically caused; and (g) respond better to psychological than pharmacological intervention. A review of the literature indicates that some of these hypotheses have not been tested, others have not been adequately tested, and none has been unequivocally confirmed. Further investigations of these important issues are required.

The annual World Development Report which the World Bank produces has for the first time focused upon health issues. Central to its 1993 report Investing in Health was an analysis of the “global burden of disease”, addressing both mortality and morbidity. Previous attempts to prioritise health problems on a worldwide scale have focused on mortality, so common mental disorders have not appeared to be significant. The method of measuring the burden of disease described here has highlighted neuropsychiatric disorders, particularly depression, which accounts for around 30% of neuropsychiatric disorders. Neuropsychiatric diseases account for 5.7% of the total burden of disease for women in the developing world, and rank fifth in this respect. In the rest of the world, they account for 13.3% of the total burden of disease for women, and rank third. Prioritising health interventions is crucial given the scarce resources available. Sufficient evidence now exists to warrant greater emphasis on common mental disorders.

Despite evidence for their comparable efficacy, psychotherapy faces a dramatic decline relative to pharmacotherapy in psychiatry. A deep ideological reason for this decline centres on the belief that psychotherapy is a psychosocial treatment whereas pharmacotherapy is a biological treatment. Modern cognitive neuroscience demonstrates that this distinction is a myth.

The problem of drug addiction is numerically a relatively minor one in this country at the present time, although the effects on the patients concerned, particularly as a considerable proportion belong to the medical and allied professions, are profound. The Interdepartmental Committee on Drug Addiction in its Report (1961) attributed our relative freedom from the problem largely to the present attitude of the public towards drugs and to the systematic enforcement of the current Dangerous Drugs legislation. In the U.S.A., on the other hand, drug addiction is a matter of national concern and there the hand of the physician treating drug addiction is controlled by Federal legislation. Tremendous efforts have been made, with only a limited degree of success, to diminish its incidence particularly during the past twenty years. Legislative measures, notably the Harrison Act of 1914, have been introduced; national committees have been set up to discuss the problem; and two hospitals (Lexington, in Kentucky, and Fort Worth) both entirely devoted to the treatment of drug addiction, have been established. As a direct result of these efforts a considerable amount of valuable information concerning drug addiction has become available, particularly as a result of the work of Isbell and his colleagues at Lexington Hospital. The addictive properties of new preparations have been assessed; the metabolic, pharmacological and biochemical aspects of drug addiction have been investigated, and research into the psychological mechanisms underlying drug addiction has been carried out.

Of fundamental importance in the problem of symptom-formation in schizophrenia is the question of the relationship of given symptoms to specific aspects of the personality. The present paper bears on this question in that it is concerned with the investigation of the imagery of the schizophrenic, and the relationship of certain symptoms to specific imagery characteristics. More specifically stated, interest here is in the questions of (1) whether or not the imagery of schizophrenics is different from that of normal individuals, and of (2) the relationships of the imagery of schizophrenics to such symptoms as hallucinations, delusions, and activity disturbances. It is believed that these observations may serve the psychiatrist in understanding the nature of the schizophrenic process by its indication of the importance of imagery in schizophrenic symptom-formation.

The value of electro-encephalography as an aid to the study and diagnosis of nervous diseases is now accepted. The most valuable results have been obtained in cases of organic disease of the brain, particularly in space-occupying lesions and in epilepsy, but considerable attention has also been paid to the changes occurring in cases suffering only from mental disorder. The chief contributors to this subject are listed in the bibliography.