Amitriptyline hydrochloride (“Tryptizol”) is a new antidepressant with a predominant action on the central nervous system. It is 5-(3-di-methylaminopropylidene) - dibenzo (a,d) (1,4) cycloheptadiene hydrochloride, and is related chemically to imipramine.

Early workers studying children because of persistent delinquency concluded that the child's inability to make relationships was the central core from which all other behaviour disturbances arose. The long term effects of institutionalization and repeated moves from foster mother to foster mother, it was asserted, were basic in any consideration of aetiology. The difficulty of treating these patients and the permanency of ill-effects was emphasized. In his well-known World Health Organization Bulletin, Bowlby (1951) concluded ‘on the basis of this varied evidence it appears that there is a very strong case indeed for believing that prolonged separation of a child from his mother (or mother substitute) during the first five years of life stands foremost amongst the causes of delinquent character development’. Whilst the practical conclusions of this publication led to a remarkable change in outlook and improvement in the institutional care of children, his theoretical conclusions have drawn heavy fire. Andry (1960) directed attention to the ‘defective role frequently played by the father and not only that of the all-too-often mentioned mother’. Wootton (1959, 1962) regards as an unproven hypothesis ‘that maternal deprivation leads to life-long damage and is a major factor in criminal behaviour’. She argues that Bowlby has overstated the case for the separation experience itself, without due regard to the conditions the child has come from or goes to, and has given scant recognition to hereditary factors. Wootton notes that relatively few investigations have traced the fortunes of the maternally deprived after adolescence, let alone throughout life, and hence there is no definitive proof that the damaging effects of the separation experience are irreversible. Further, the maternal separation hypothesis relates to only a minority of the delinquent population (the ‘affectless psychopath’) and there is no experience of the general population at large of comparable infantile experiences. A review of the recent literature (Lancet, 1966, British Medical Journal, 1967), indicates that various investigations into the long term effects of childhood parental deprivation and bereavement in the causation of adult mental ill health and behaviour disturbance have yielded inconclusive results. Whilst this state of affairs suggests that further studies are necessary to detect consistent patterns of parental deprivation, these patterns by themselves may not indicate precise modes of aetiology, but when taken into consideration with other objective data of family background may yield the development or refutation of hypotheses regarding various determinants of psychiatric disorder. In the light of these contemporary uncertainties we have re-examined the hypothesis that early adverse experiences are related to subsequent delinquency and criminality. By statistical procedures we examined two prison populations, one consisting of short term male first offenders of less serious crime, and the other of male recidivists and those convicted of serious crime. Various groups from the general population at large have been incorporated to act as the control group.

There is doubt whether schizophrenia, the most common and most devastating serious mental illness, existed much more than 200 years ago. Many authors who have written recently on the history of schizophrenia suggest that it is a disease that first appeared towards the end of the eighteenth century and rapidly increased in prevalence throughout the nineteenth. Cooper & Sartorius (1977) ask “Why are good descriptions of what can now be recognized as chronic schizophrenia so scarce in European medieval and earlier literature?” and they associate schizophrenia with industrialisation. Torrey (1980) argues that although descriptions of madness, including hallucinations and delusions, date to ancient times, schizophrenia as we know it with an onset in early adulthood and progressive deterioration, is not described. He associates schizophrenia with civilisation, and proposes an infectious cause. Hare (1979, 1982) supports this hypothesis, providing detailed evidence for a real increase in hospitalised psychiatric patients who most probably had schizophrenia in the last century (Hare, 1983), and also states that there are no good earlier descriptions of schizophrenia.

There is concern regarding the quality of information about mental health problems on the internet. A trial was carried out to see whether sending feedback to website administrators about the quality of information on their website would lead to an improvement (ACTRN12609000449235). Fifty-two suicide prevention websites were identified by means of an online search. The quality of information about how to help someone who is suicidal was scored against expert consensus guidelines. Websites were randomised to receive feedback or serve as controls. The information on the websites varied greatly in quality. However, feedback did not lead to an improvement.

Electroplexy is now a widely accepted and used treatment in psychiatric practice. Primarily it is by far the most reliable means of terminating or resolving depressive attacks, months or indeed years before the anticipated remission of these illnesses on their own accord. Less commonly it is also regarded as an effective treatment in some schizophrenic states, particularly the acute type, or schizophreniform illness, “but actually most schizophrenics are treated at some stage of their illness with electrically induced convulsions” (Kalinowsky and Hoch, 1952). Neither depressive nor schizophrenic syndromes are infrequent in pregnancy and the question must therefore be posed in some of these complications whether electroplexy is justified; whether it can be used safely either alone or with relaxants; and what, if any, deleterious effects may be imposed on the mother and/or foetus.

Psychologists are frequently asked to say whether, in the case of a particular patient, there is evidence of organic dementia. At first sight this would not appear to be an unreasonable request. A considerable amount is known about the performance of normal people on tests of cognitive function and it might be supposed that people who work with tests of human ability should be able to modify their procedures to the purpose of diagnosing intellectual deterioration when this is not obvious on routine neurological or psychiatric examination. Moreover, it might seem that the frequent presence of independent criteria of brain damage provided by neurological and neurosurgical investigations should facilitate the development of competent diagnostic clinical psychology in the neurological field.

The mono-amine oxidase inhibitors, of which phenelzine (“Nardil”) is one example, were introduced for the treatment of depressive illness as a result of the observation that iproniazid, which is a mono-amine oxidase inhibitor, produced euphoria and increased mental alertness in some tuberculous patients to whom it was given. Trials of iproniazid in mental illness were carried out (Loomer et al., 1957; Cesarman, 1959), but it was found to be very liable to give rise to side-effects, being particularly toxic to the liver. Other less toxic mono-amine oxidase inhibitors such as phenelzine, which is chemically related to iproniazid, were later developed.

Seven hundred Progressive Matrices records of male neurotic military patients admitted to Sutton Emergency Hospital between April and November, 1942, were compared with a control group (1). The distribution of the patients' scores shows a negatively skewed curve with a clustering of scores below the control median (Fig. 1).

Depression is a serious illness in Western Europe and the United States of America. It is estimated that in 1957 the combined total of suicides in the United States, Britain, France and Western Germany was approximately 30, 000 (1). The attempted suicide rate is considered to be six or seven times as great, which could give a grand total of 200, 000 suicide attempts in that year in these countries. Many of these patients are depressives, as stated in a recent British Medical Journal leading article (2).

Mr. President and Fellowsof the College,—Permit me first to thank you for the great honour you have done me by inviting me again to deliver the Morison Lectures in this great seat of medical progress and learning.

To research workers in personality measurement the advance of routine testing procedures in clinical psychology has seemed peculiarly sluggish. Whereas solid theoretical foundations have been found for an account of the normal personality structure in factor analytic terms (5, 6, 7) and a rich variety of new tests has been created (8, 9, 14), the clinicians have confined themselves to one or two “gadget” tests, conceived with no more explicit relation to personality structure than a patent medicine has to modern physiological principles. The present research aims to bring factor structure measurement in a clinical population into relation with that found in normals and to provide a first, reproducible, test battery covering at least a dozen factors for use in clinics able to give sufficient time for valid and reliable measures of the primary personality dimensions.

Thiothixene and thioridazine, established anti-psychotic agents (5), have been reported to possess antidepressant (4, 7, 8, 9, 17) and anxiolytic (3, 15, 16) properties. The present study is primarily concerned with the latter claim. It was initiated to assess the role of both these major tranquillizers—thiothixene, a thioxanthene derivative, and thioridazine, a phenothiazine derivative—in the symptomatic treatment of anxious neurotic out-patients.

Liaison psychiatry has been recognised in many countries as a special interest or sub-speciality of psychiatry concerned with the management of general hospital patients with psychological problems. However, despite increasing awareness of the emotional and behavioural aspects of illness, it has yet to achieve substantial influence within psychiatry and, more importantly, has had only modest effects on the delivery of medical care by physicians and other specialists. Recognition of its potential by planners and commissioners has been disappointing. Regrettably, in the UK and elsewhere, recent changes in the organisation of health care could hinder its development. This paper argues that in order to make substantial progress there is a compelling need to solve a fundamental obstacle – the separation between psychiatric and general medical care. This requires:

(a) convincing the psychiatric profession that consultation-liaison is a distinct sub-speciality;

(b) continuing efforts by liaison psychiatrists to define their special expertise and to demonstrate that their services are effective and acceptable to medical colleagues and to patients;

(c) persuading those who organise health care that liaison psychiatry services need to be provided and administered as an integral component of comprehensive medical care.

The following paper is concerned with the statistical analysis of the clinical data about nearly 500 schizophrenic patients. About half of these received insulin treatment, while the others did not. The patients were followed up for periods of between 5 and 10 years, so that the material is also classifiable by good and bad outcome. A full account of this clinical material, collected and studied at the University Psychiatric Clinic at Lisbon by one of us (P.P.), has already been published in the Portuguese language (Polonio, 1950).

Geographically, Iran is for the most part a plateau at an average altitude of about a thousand metres; the terrain—the near-jungle conditions of the Caspian littoral excepted—is arid semi-desert and the typical landscape one of limestone mountain ranges between which lie flat plains. It is bordered by Iraq, Turkey, the U.S.S.R., the Caspian Sea, Afghanistan, Pakistan and the Persian Gulf. Except during spring the vegetation in most areas is sun-shrivelled on the bare treeless earth; after five months of burning heat the winter rainfall washes off the topsoil, and river-beds, dry throughout the summer, overflow with muddy torrents. Although the soil is dry and powdery there are abundant watercourses below the surface and with irrigation the land is very productive. The country has great mineral resources; apart from the oil-fields they are un-exploited due to lack of coal and road and rail communications. The people are mainly feudal villagers or nomadic tribesfolk but Tehran is a modern city of a million population and the provincial capitals are also semi-Westernized.