A family doctor's wife, aged 42, S.R.N., J.P., social worker and citizen of excellent character, drove her car through a nearby town at about 10.30 p.m. on an autumn night. Later a cyclist was found dead in the road along which she had just passed, parts of her car were found at the scene of the accident, and subsequently damage to her car was found to correspond with the damage to be expected had it been involved in this accident.

One of the many possible ways of obtaining information about the marital relationship is by observing the marital partners together, a procedure being increasingly used in clinical practice. Little is established, however, for either clinical or research purposes, about how such observations may be ordered, with what reliability they can be made, or how they relate to other aspects of marital function and to the psychological health of the partners. This paper is concerned with just such issues.

Variations in clinical features associated with unemployment among a sample of male parasuicides were examined. Employed and unemployed persons did not differ in mean scores on the Suicidal Intent Scale, but the unemployed were rated significantly worse on measures of depression (Beck Depression Inventory) and hopelessness (Hopelessness Scale). A covariance analysis showed that hopelessness, rather than depression, is the important discriminator. Different patterns of relationships between the three clinical measures were observed in the two groups. Hopelessness may be a key social-psychological variable for inclusion in any model of the pathways which link unemployment with parasuicide.

A patient who resumed sleep-walking as an adult is described. The failure to diagnose his disturbed nocturnal behaviour as sleep-walking kept him from his work for over 8 months, and led to a treatment which exacerbated the behaviour. The diagnosis was made when the patient attempted to strangle his wife.

In a double-blind study of 38 chronic schizophrenic in-patients, haloperidol decanoate was compared with fluphenazine decanoate as maintenance therapy over 60 weeks. Both drugs were given by injection at 4-week intervals. Haloperidol and fluphenazine were assumed to be equipotent; the mean starting dose of the former was 127 mg and of the latter 106 mg. The number of withdrawals over 60 weeks was similar in both groups but relapses, strictly defined, were significantly more frequent in the haloperidol group. When patients were switched to haloperidol, Parkinsonism diminished more quickly than in the fluphenazine group, but after 60 weeks there was no difference in severity in the two drug groups. The higher relapse rate and the quicker reduction in Parkinsonism in the haloperidol group might be due to a misjudgement in equivalent doses of the two drugs. Plasma haloperidol steady state levels were reached in most patients by 8–12 weeks. Plasma neuroleptic and prolactin levels, week-by-week systemic drug availability and Parkinsonism showed less variation between injections with haloperidol than with fluphenazine.

This paper is a preliminary report of some investigations we are now making into the pathology of mental deficiency, mainly from the histological point of view. We have so far examined 22 cases, comprising 7 low-grade defectives showing gross neurological lesions, chiefly of extrapyramidal character, 6 microcephalics with spastic diplegia and severe mental defect, 2 able-bodied microcephalics without gross neurological signs, 1 simple able-bodied idiot and 6 mongols. In this short paper it is impossible to give even the slightest indication of the wealth of pathological material found in such a variety of widely differing conditions. A full description of our findings, together with a more detailed discussion, must be left to further papers dealing with individual groups of cases. The purpose of making a short note at this stage is to draw attention to one particular finding which struck us by its surprising constancy, i.e., a proliferation of the fibrous glia, particularly pronounced within the cerebral and often also the cerebellar white matter. In many of the cases the cortical changes were slight compared with the intense lesions of the white matter. In none of them was demyelinization a well-marked feature, nor did its severity approach that of the glial proliferation; in many it was negligible, and there were none of the fatty breakdown products, characteristic of the demyelinizing disease of the white matter called after Schilder. The gliosis was either diffused or patchy, and was often markedly perivascular; even stripe-like scars, as described by Hallervorden (10), were to be seen, although, contrary to this author's observation, there was, as a rule, no corresponding myelin defect.

I am very grateful for the invitation of the Association to speak about the work I have been doing with twins, as it is an opportunity to thank the very many members who have helped in it. Without your kindness and co-operation the work would not have been possible. Medical Superintendents have put themselves out to make it possible for me to see patients and examine records; medical officers have discussed cases with me; I have been able to see the invaluable reports on family visits by social workers, and P.S.W's. have even made special inquiries on my behalf; hospital secretaries have made visiting books and other records available, and have rummaged through dusty files for ancient case-notes, and they have added to their labours routine inquiries about twinship which have considerably enlarged my series. This help has been given not only to me personally, but also to other workers collaborating with me. For all this and more, which I have no time to mention, I want to say thank you very much.

A search was made for statistical studies of the remission rate in cases of schizophrenia which had received no specialized treatment such as hypo-glycæmia. The search was confined to the period since 1918, as the period influenced by broader and more hopeful views of the nature and prognosis of “dementia præcox”. It was also confined to studies in which the remitted cases had been followed up for some time after discharge to avoid errors due to early relapses. The results of all these statistical follow-upstudies aie given in Table I. The various writers have classed their results in somewhat different ways, and it has been necessary, in constructing the Table, to fit all the results under standard headings.

During the first half of 1049 a battery of cognitive and personality tests was given to a sample of 104 adolescent and adult high-grade male defectives resident in Darenth Park, Dartford. The testing was carried out by N. O'Connor and the writer, in collaboration with Dr. J. M. Crawford, Deputy Superintendent of Darenth Park. The following report presents a summary of the cognitive and motor test findings, and discusses some of their implications.

The present investigation deals with the effects of two lengths of exposure time in neurotic and schizophrenic subjects, and with the relations between these effects and measures of extraversion, neuroticism and rigidity. A consideration of previous work, discussed in the following paragraphs, led to three main predictions concerning varying exposure times.

Protagonists of mental tests in clinical practice have hitherto shown a decided preference for methods of examination adapted to study capacities already developed or knowledge already acquired. Relatively little attention has been given to the study of learning, despite the fact that this function is so obviously affected in many and various neuropsychiatric conditions. One need only recall the widespread loss of plasticity so characteristic of the dementias and the more specific defects of learning associated with various types of focal lesion, e.g. of the language centres or the visual-association areas (cf. Cobb, 1944, pp. 214–5; Zangwill, 1945). It may therefore be urged that any technique of studying learning that is objective in character and easily adapted to the needs of routine clinical examination is worthy of attention. One technique which meets these demands will be described in the present paper, together with a small selection of the results obtained on routine psychological testing at the Brain Injuries Centre in Edinburgh.

This study attempted to use feedback from the Model Standards Questionnaires (a series designed to measure the quality of care) to improve care on a psychiatric hospital's rehabilitation wards. Both a controlled and quasi-experimental design were used. The controlled design provided evidence that feedback from the Questionnaire concerned with the Individual Programmes of Treatment and Care led to improvements in these practices but not for the remaining three questionnaires. The quasi-experimental design indicated that the significant generalised improvement in care, over all questionnaires, was most likely due to the feedback.

There are many clinical reports on psychotherapy with depressed patients, and an enormous effort has been devoted to psychotherapy research (10, 23, 24, 27, 28). However, there is little quantitative description of the content of psychotherapy—what patients discuss during sessions and how much time is spent reflecting on problems. This situation is partially understandable given the technical difficulties in obtaining psychotherapy process data. Content analysis of transcribed tapes, process records, video-tapes and the coding of words have been among the methods used (7, 9, 12, 14). These methods are inclusive and precise but impracticable in lengthy psychotherapy or with large samples.

In Personal Construct Theory (Kelly, 1955), a person is considered to describe and predict his perception of the world by using bi-polar constructs which form an integrated system. In clinical practice it is possible to elicit from a patient not only a description of his environment in his own constructs but also an account of how he uses his construct system to predict future events. The following study shows how an assessment of the patient's construct system is useful in evaluating the outcome by therapy.

Few psychiatric controversies have been as persistent as the disagreement surrounding the nosology of depression. The conflict centres on the question of whether depression is a single illness, with its many faces manifestations of individual idiosyncrasy and severity, or whether it constitutes two or more separate conditions. The 1926 debate at the British Medical Association Meetings, with Edward Mapother (11) propounding the case for a single illness and Buzzard and Ross advancing claims for a dichotomy, has in one form or the other continued until today. The issue is complicated by the fact that few terms in psychiatry are used with as many different meanings as depression. Unfortunately the use of the term is seldom clearly defined. As Humpty Dumpty said in Through the Looking-Glass, “it means just what I choose it to mean—neither more nor less”.