Symptoms attributed to dysfunction of the ductless glands have long been noticed in the group of mental disorders formerly known as dementia praecox, now included in the wider designation schizophrenia. A variety of such abnormalities has been described, but without sufficient consistency or clarity to help in formulating a pathology of the disorder. From the first, the usual onset in adolescence or early adulthood, and the symptomatology, prompted investigation of the gonads. Papers have been published by Fränkel (1919), Mott (1919), Pézard (1920), Tiffany (1921), Lewis (1923), Morse (1923), Geller (1923), Münzer (1926), McCartney (1929), in which histological changes in the testis in schizophrenia are cited and discussed. The contributions of Mott, Lewis and Morse are the most important, for their material and histology are more accurately controlled and described. It appeared as if the very extensive work done by Mott had succeeded in establishing a direct relationship between gonadal failure and dementia praecox. Subsequently his findings were heavily criticised and the conclusions to a great extent rejected, for, like others, he had obtained material at post mortem, mostly from patients who had died of tuberculosis or other diseases liable to produce the very changes he regarded as specific; very few were young adults in the early phases of the mental disease. These objections constituted an apparently insuperable difficulty, and the whole question has remained virtually in abeyance ever since.

The value of measuring changes in symptoms in a single patient has been discussed by a number of authors. (1, 3, 4.) The “self-controlled trial” (1) or the “multiple cross-over method”, i.e. the measurement of responses to repeated and systematic changes in treatment, appears to have advantages over the simple cross-over trial, but the method would be extremely time-consuming in group research with psychiatric patients if the ratings had to be carried out by research workers. The use of valid self-rating scales would make the multiple cross-over method feasible in drug trials with groups of psychiatric patients.

The primary aim of the long-term treatment of patients with schizophrenia is to prevent relapse, which is costly both in psychological and economic terms. Although with conventional antipsychotic drugs relapse may occur despite compliance with maintenance regimens, the rate of relapse is reduced in compliant patients. However, this benefit is achieved at the cost of side-effects and the risk of developing tardive dyskinesia, even among patients who have taken these drugs for only a year or two. To provide the therapeutic benefits of maintenance medication without its drawbacks, intermittent dosing and long-term therapy with reduced doses of conventional medications have been explored. The atypical antipsychotic agent, olanzapine, has been shown to be effective maintenance medication and has an improved safety profile.

Recently, the Council of the UK Royal College of Psychiatrists agreed to use the term ‘patient’ as the preferred collective noun when referring to people accessing mental health services in its official documentation. Choices regarding terminology have the power to influence those who use such terms and here, David Christmas and Angela Sweeney debate the issue of whether such a decision is appropriate or whether we need to be more careful about the terms we use.

This study examined brain activation during a cognitive inhibition task in patients with schizophrenia following changes in their positive symptoms. A Stroop task was used during functional magnetic resonance imaging in 11 patients with schizophrenia (patient group) and 9 healthy volunteers (control group). At baseline, the patient group showed significantly attenuated activation within the anterior cingulate gyrus, left pre-/postcentral gyrus and inferior frontal junction. At follow-up, there was a significant increase in activation in the left inferior frontal junction associated with a decrease in positive symptoms, suggesting this region plays a role in the development of these symptoms.

At the Annual Meeting of this Association held at Liverpool two years ago I had the pleasure of giving an account of the work which I was then doing, on the medullated nerve-fibres of the cortex cerebri, and I endeavoured to demonstrate that a comprehensive study of the form and arrangement of these constituents in the normal adult condition afforded a useful guide to precise localisation of function.

In spite of the enthusiasm with which schizophrenic patients have been treated by physical methods over the past twenty years, there is surprisingly little evidence enabling us to compare the results of one physical treatment with another, or the physical treatments themselves with the treatments they replaced. Some writers (Polonio and Slater, 1954; Rees, 1949) point out a significant improvement over the spontaneous recovery rate with the use of insulin, while others (Jensen, 1952) find no such improvement. Bourne (1953) and Notkin et al. (1939) go so far as to claim that any improvements of insulin-treated patients are due to the extra care and attention they receive, and the work of Ackner and his colleagues (1957) may support this conclusion. Linford Rees (1949) comparing electrical treatment with insulin concluded that electro-shock therapy was far less effective than deep insulin therapy in the treatment of schizophrenia—a conclusion in line with that of Finiefs (1948). On the other hand Impastato and Almansi found very little difference between E.C.T. and insulin treatment in this respect.

During the last century the fact that two people share a psychosis has been recognized as constituting a problem of psychiatry. Although quite a number of cases have been published, we were surprised at the relatively small number. The subject lends itself admirably to systematization, and the classification which has been accepted by most writers is the one evolved by French authors.

This investigation was carried out at Belsen between May 21 and June 27, 1945. As it was impossible to examine psychiatrically all the cases, only those showing evidence of psychological upset were referred for examination by the physicians. In addition, to obtain a cross-section of the population, I selected at random 60 to 70 cases in hospital and convalescent areas—ones that did not fall into the first group.

Complaints about lack of sleep are frequently made by patients diagnosed as depressed, and various recent studies have examined this symptom by attempting to measure sleep either objectively or subjectively. In the former approach bed movements have been recorded by Cox and Marley (1959), Hinton and Marley (1959), and Hinton (1961, 1962), while Oswald et al. (1963) have based their work on EEG changes during sleep. Since lack of sleep is essentially a personal experience, most of the objective data have been combined with subjective records, such as patients' descriptions of sleep, patients' and nurses' ratings of sleep, patients' estimates of length of sleep and nurses' observations of length of sleep. Isaacs (1957) comments that no one method used alone provides a satisfactory estimate of the hypnotic properties of drugs.

A system of ward support for chronic psychiatric patients in an urban community is described, which makes available ward and staff facilities throughout the 24 hours and at weekends. Details are given of a group of 41 patients using this facility over a period of six months. Two types of use of the ward were identified, based on the amount of social interaction with other staff and patients. The ‘unengaged’, with a high rate of visits, were mainly schizophrenic patients with an early first onset of illness and currently a scanty social network (small primary group and often no confidant). The ‘engaged’, with a lower rate of visits, were people with a later onset and a larger social network.

The politics of shortening hospital stays for people with psychosis has been questioned by a number of studies. Hospital practice in the meantime remains highly variable and the research evidence increasingly difficult to interpret given different conceptualisations of what constitutes effective treatment. In the absence of clearer guidelines from researchers in this area, decisions about duration of hospitalisation risk being driven by economic rather than clinical considerations.