Nortriptyline (Allegron, Aventyl) is the demethylated metabolite of amitriptyline. Preliminary trials by Bennett (1962), Oltman et al. (1963) and Leahy et al. (1964) indicated that it might be an effective anti-depressant. Forrest et al. (1964) found that it compared favourably with amitriptyline, a widely used anti-depressant of established efficacy. This investigation also compares nortriptyline with amitriptyline.

This paper describes the preliminary clinical testing of a new sedative drug, and also explores the feasibility of using a single-patient, self-controlled and recorded design in psychiatric drug trials. Hogben and Sim (1953) demonstrated a form of drug trial which emphasized intra-subject fluctuations and their control. Recently, Shapiro (1963) has argued the usefulness of a similar approach in fundamental, clinical research. However, the single-patient drug trial appears not to have been widely used in psychiatry, although several writers, e.g. Shepherd (1963), have indicated its possible advantages.

This study examines the quality of residential care in non-psychiatric nursing homes and psychiatric group homes for a representative epidemiologically-based sample of patients discharged from a psychiatric hospital in West Germany. There were twice as many chronically ill patients in sheltered accommodation as in hospital, 85% of them in nursing homes, which scored badly on all measures of therapeutic environment. This poverty of social environment was correlated with severity of symptoms for schizophrenics, especially with flatness of affect and poverty of speech. Nursing homes were just as likely as hospitals to promote chronic illness and hinder rehabilitation.

A 59-year-old woman with Turner's syndrome developed epilepsy, diabetes mellitus, chronic psychosis, and subsequently pre-senile dementia. This would endorse the view that psychosis in Turner's syndrome arises through brain damage.

A 35-year-old Arab lady and her mother, both with bipolar manic-depressive illness and 46,XX,21p-(pcenåpter), are reported. The clinical significance of this association is considered.

The sub-speciality of geriatric psychiatry is coming to be known as “psycho-geriatrics”, an abbreviation which is not a very happy one, but which seems to be becoming generally accepted.

The effects of a series of six ECT treatments were observed on the CSF concentrations of HVA, MHPG, and 5-HIAA in 12 patients suffering from schizophrenia. Four patients were previously neuroleptic drug-free, and eight had received only oral neuroleptic drugs at the same dose for more than 4 weeks. A significant increase in the concentration of HVA was observed after the first ECT treatment but not after the final treatment. No significant changes were observed in the concentrations of MHPG and 5-HIAA. The patients improved clinically, and the results suggest that ECT has important effects on dopaminergic systems.

In their review of the schizophrenia-like psychoses of epilepsy, Slater et al. (1963) document the belief that although epilepsy (especially that of the temporal lobe) often precedes schizophrenia-like reactions, schizophrenia rarely precedes epilepsy. In their review of literature on the co-existence of schizophrenia and epilepsy, Slater et al. found but one reported case where temporal lobe epilepsy developed in a patient already psychotic. Their own series of 69 cases contained no instance of psychosis occurring prior to definite onset of epilepsy.

In a comparative study (Vinoda, 1966) of personality characteristics of 50 female attempted suicides and an individually matched group of 50 psychiatric controls and 50 normals, it was observed that the attempted suicides differed from the psychiatric and normal controls on measures of hostility, guilt, rigidity and neuroticism. Attempted suicides (AS) were significantly more hostile and rigid than both psychiatric controls (PC) and normal controls (NC), and they were significantly more personally ill (neurotic) than normal controls but not more than psychiatric controls. On the basis of previous researches it was hypothesized that the group of attempted suicides would be more hysteroid in their personality and intropunitive in the direction of their punitiveness than the control groups. The first study (Vinoda, 1966) did not reveal such differences. The scrutiny of results showed that there were more or less equal numbers of hysteroid and obsessoid personalities among attempted suicides and similarly a more or less equal number of persons who were intropunitive or extrapunitive in the direction of their aggression. This led the author to hypothesize that these variables might be more related to the nature of suicidal attempts in terms of seriousness of the attempts made.

The term “Group-Therapy” can have two meanings, and it is well to keep the distinctions clearly in mind. It can refer to the treatment of a number of individuals assembled for therapeutic sessions, or it can refer to a planned endeavour to discover (and so make accessible to the understanding, and thus control) the forces which operate in the participating group.

In the course of urine-testing with Phenistix in a survey∗ of the inmates of remand homes, classifying schools and approved schools, only one positive result has been obtained from 2,300 boys and 541 girls tested so far in the London area. This was obtained with the urine of a boy who proved not to be Phenylketonuric, and further investigations were carried out in his case and with members of his family.

May I begin by qualifying the title of this paper? I can only illustrate some broad principles and a few of the methods that are used in epidemiology today—there is no attempt to be comprehensive.

Gelineau (1880) introduced the term “narcolepsy” and suggested that it constituted a disease sui generis. A careful perusal of the literature, however, shows that the condition had been described previously. Precedence has been claimed for Bright, Thomas Willis and even for Galen! At any rate, Notkin and Jelliffe (1934) were able to unearth 270 cases of narcolepsy and allied conditions in a literature survey covering the years 1813–1931.

Serum cholesterol levels were estimated in 313 mentally handicapped patients who subsequently died from various causes. Although cholesterol levels in the mentally handicapped are lower than those in the general population, it was found that there was still an association between relatively low serum cholesterol values and mortality due to cancer of the colon. Similarly, patients who died from myocardial infarction had relatively high serum cholesterol levels. The mechanism of the relationship between hypocholesterolaemia and cancer of the colon is unclear, but the increasing longevity of the mentally handicapped is an important factor which has contributed to a rising incidence of cancers, particularly gastrointestinal forms, in this group.

Until recently, research on borderline disorder in children has sought the common denominator of the symptoms. In recent years there have been attempts to circumscribe the definition with the help of DSM–III criteria and the DIB. This approach appears fruitful. The scanty data on schizotypal children suggest that the validity of this diagnosis in childhood should be investigated. In adolescence it is possible to discern those with borderline and schizotypal disorders whose symptoms meet both DIB and DSM–III–R criteria respectively. No data exist, however, concerning the predictive validity of such disorders in adolescents. Classification on an empirical basis is advocated in order to refine the diagnosis of these and related disorders in children and adolescents.

A student of chemistry was treated for thallium poisoning. Seven months after his ingestion of thallium, intelligence tests were performed on the patient and his non-identical twin brother, who was of similar educational background. These indicated severe deterioration in intellectual function of the patient, particularly in memory and performance abilities. Tests 13 months after ingestion showed little general improvement.

Shortly after the introduction of therapeutic malaria into this country, the Ministry of Health and the Board of Control, in consultation with the London County Council Mental Hospitals Department, established a special centre for this treatment at Horton Mental Hospital. A separate villa in the hospital grounds was set apart for the work, and, through the interest, advice and help of Col. S. P. James, M.D., F.R.S., of the Ministry of Health, a laboratory was equipped and arrangements were made for the supply of malarial infective material to all parts of Great Britain. The work was begun in April, 1925, and during the seven years that have elapsed since then, 200 cases have been treated. These cases are all women, drawn from the various London County Mental Hospitals; recently, however, an annexe has been added to the centre, and facilities are now available for treating men also.