In the past few years many papers have appeared both in Europe and the United States of America demonstrating the value of Chlorpromazine and Reserpine in the treatment of mental illness. In the United States of America Kinross-Wright (1954) has reported on Chlorpromazine in the treatment of schizophrenia and claimed very satisfactory results; in this country Lomas (1955) and his collaborators have in several papers confirmed these results. With regard to Reserpine in the United States of America Kline (1954) has used the drug extensively with good results; in Europe, hopeful reports by Foote (1955) and McGrath et al. (1956) confirmed the value of this drug in psychiatric practice.

The cases reviewed in this paper were treated in Three Counties Hospital during the last seventeen years. The ages of the patients ranged between 15 and 44 years. Of the total 1,009 cases, 563 had insulin coma and convulsion therapies, while 446 received no such special treatment. Some had prefrontal leucotomy after failing to respond to insulin and convulsion treatments, but their number is small and they are not included here.

Owing to the increase in the expectancy of life, there is an increase in the incidence of aged people suffering from mental illness who are admitted to hospital. This has stimulated the paying of special attention to the problems of differential diagnosis in order to avoid lengthy hospitalization wherever possible. Recent studies have tended to emphasize the frequency of affective disorders as well as senile dementia in aged patients. It is consequently important to distinguish the former group because of the greater possibilities of treatment there than in senile dementia. A recent paper (O'Connell, 1954) has been concerned with the study of case material of patients over the age of sixty admitted to this hospital. The present study is largely based on material obtained from patients drawn from O'Connell's sample, but also includes cases with longer hospitalization.

That great criminals are wholly without the moral sense, that violent and habitual criminals are, as a class, moral imbeciles—are startling propositions; but, nevertheless, they have been adopted and advocated with singular show of truth and much ability of late years. Such views are quite opposed to all the doctrines of divines, and philosophers, speculative and practical. That any man, however wicked, is utterly deprived of the moral sense, sounds very new and very strange to us. Our own consciousness tells us all, what Sir Thomas Brown has so finely told us in eloquent words—“Surely there is a piece of Divinity in us; something that was before the elements, and owes no homage unto the sun. Nature tells me I am the image of God, as well as the Scripture. He that understands not this much is yet to begin the alphabet of man.”

There are conflicting psychiatric opinions about the value of separating depressive illnesses into several syndromes on clinical grounds, and so far experimental attempts to reach a classification of depression by distinguishing physiological or biochemical features which characterize one group rather than another have had only limited success. One interesting series of experiments in this area has been that of Shagass and his colleagues on the sedation threshold (Shagass et al., 1956, Shagass and Naiman, 1956, Shagass, 1954); they report that neurotic and psychotic depressions can be differentiated by means of EEG and other reactions to sodium amytal (amylobarbitone sodium) neurotics requiring greater amounts of the drug to reach the sedation threshold.

The significance of the electro-encephalographic variations found in old age is not well defined and hence the value of this form of investigation as a prognostic measure is doubtful. Apart from a few papers such as Mengoli (1952), Mundy-Castle et al. (1954) and Obrist (1954), most of the published work contains no reference to findings obtained from a control series of persons of similar age and not suffering from a definite disability. This absence of definite criteria in respect of the EEG findings in records taken from apparently healthy elderly persons is important both as regards clear-cut abnormalities and also in reference to minor variations of doubtful significance.

In the early phenothiazine literature the ataractic properties of Thorazine in the control of disturbed, hyperactive schizophrenics were described (Kurland, 1955; Hall and Dunlap, 1955; Lehmann, 1955). Kurland (1955) gives an excellent description of the powerful activity of Thorazine in this sphere, namely the control of hyperkinesis and hostile, aggressive behaviour; however, he found that there was little basic change in delusional thought disorder other than to divorce the abnormal thinking from its affective attachment. It was noted that the clinical improvement was most dramatic when the affective component of the illness was most marked. Hall and Dunlap (1955) felt that there was significant reduction in delusional ideation but noted that the schizophrenic process was not affected by Thorazine medication.

There is very little experimental evidence about the combined effects of alcohol and phenobarbitone, administered at or about the same time. Similarities in their actions suggest that the effects of the drugs are likely at least to summate in some respects (for example, in depressing the respiratory centre); and there are experimental and forensic observations which suggest that death has sometimes occurred after a dose of ethanol and phenobarbitone, neither of which would have been fatal by itself (Jetter and Maclean, 1943; Fisher, Walker and Plummer, 1948). Phenobarbitone and other barbiturates are widely prescribed (Dunlop, Henderson and Inch, 1952), usually without reference to the habitual alcohol consumption of the patient, and potentiation as well as summation has been reported to occur between some barbiturates and alcohol (Rachek, 1944; Sandberg, 1950).

Reserpine is one of the active alkaloids extracted from the root of the plant Rauwolfia Serpentina. The physiological changes resulting from the use of the drug in animals—such as hypotension, bradycardia, sedation, increased peristalsis, meiosis, etc.—are probably the result of a central action. The precise sites are not known although it seems likely that one of them is the midbrain reticular formation. There is no evidence of any peripheral action, nor of any direct effect on the cortex. The reason for the long latent period, before the drug begins to show an action is still obscure (Lancet Leader, 1955; Mover, 1955; Plummer et al., 1954). The recent work on the pharmacological relationships between Reserpine, Serotonin and the hallucinogens suggests interesting possibilities (Pletscher et al., 1955; Shore et al., 1955).

There is already a considerable literature on the toxic effects of Reserpine, the most serious of which are Parkinsonism, of a post-encephalitic type, and severe depression (Achor et al., 1955; Barsa and Kline, in press; Locket, 1955; Schroeder and Perry, 1955; Stead and Wing, 1955).

The endocrine system is one of the foremost links in the psychosomatic relationship, and its special significance in the study of mental disease needs no emphasis. Compared with our knowledge of the chemistry and basic functions of the hormones very little is known about their more intimate mechanisms of action. It has been possible to assign to some hormones the function of controlling the rate of specific metabolic processes, but whether they do so by a direct reaction with a component of one or more enzyme systems or indirectly by influencing the mutual accessibility of enzyme and substrate is still a matter of discussion. The latter mechanism would depend on a spatial organization involving membrane barriers, phase boundaries or similar discontinuities and, in fact, many hormonal effects which can be demonstrated in vitro with the aid of intact or sliced tissues disappear when the structural organization of the cell is destroyed. It is, however, well to remember that synthetic and other energy-consuming reactions were believed until recently to depend on the integrity of the cellular organization, but when some insight was gained into the mechanism of biological energy transformation and the function of labile phosphate bonds in these processes, it was possible to demonstrate many such reactions in homogeneous systems. Similarly, the interactions of hormones and enzymes may require the intervention of unstable mediators, and control of these factors might allow their reconstruction in cell-free extracts. In any case, it is more satisfying to account for the great specificity of hormonal action on the basis of a chemical reaction with specific enzymes than by a mechanism leading to predominantly physical changes.

The importance and relevance of reaction to colour in the interpretation of Rorschach protocols has been so often and so vigorously stressed by proponents of the test that few psychologists can have remained unaffected by their views. It is the purpose of this paper to examine the validity of these views. Already the evidence pertinent to the hypothesis that certain reactions to the blots depend upon the indirect effect of colour, the so-called “colour-shock” signs, has been examined (Keehn, 14). Beyond repeating the general conclusion that such signs seem not to be dependent upon presence or absence of colour this topic will not be discussed, so restricting this paper solely to a consideration of the validity of the hypotheses concerning the direct reaction to colour on the cards. No better or succinct and documented statement of these hypotheses can be made than that of Hertz and Baker (10), who, after summarising numerous studies relating to the topic, conclude that— “There is general agreement that colour factors give a measure of the stability of the emotional life. They show the externally directed or expressed emotionality of an individual. FC represents emotional stability and adaptability, CF, emotional lability, excitability and lack of control, and C, lack of restraint and impulsiveness.”

Concerns about violent conduct of service users towards healthcare staff have prompted a ‘zero tolerance’ policy within the National Health Service. This policy specifically excludes users of mental health services. We attempt to challenge artificial distinctions between users of mental health and other services, and propose an ethical underpinning to the implementation of this policy.

The condition termed ‘delusional atmosphere‘ belongs to the ‘precursor phenomena‘ of delusion and has always attracted special attention because its peculiarities evoke the hope of obtaining better insight into the conditions governing the emergence and formation of delusion. The following considerations represent a review of the most important topical hypotheses about the nature of the delusional atmosphere and its progression into finalised delusional elaborations as seen in the perspective of the psychopathology of German-speaking countries.