The common territory shared by anxiety and depression has always been a contentious subject. Research in favour of anxious depression as a potentially treatment-relevant subtype has been limited by diagnostic dilemmas and crude measurement. The most recent evidence from genetics, neuropeptide systems and functional neuroimaging suggests a valid diagnostic construct.

Until recently, the main targets of pharmaceutical advertisements were clinicians and the major vehicles for ‘educational promotion’ were advertisements in academic and professional journals and visits and gifts from pharmaceutical representatives. All is now changed and patients have become legitimate targets of advertising. Direct-to-consumer advertising represents a new and expanding area of pharmaceutical promotion that harnesses the mass media.

The Madrid Declaration is being promoted by representatives from seven nationally funded mental health research networks, along with leaders of ongoing European Union-funded mental health projects. It advocates the creation of a Network of Excellent Networks, based on a dynamic and adaptive cross-European network of distinctly qualified research centres.

Pernicious anaemia can present with psychiatric symptoms before haematological or neurological manifestations appear. We describe a young woman who presented with insidious onset catatonia without evidence of psychosis or depression. Blood count and mean cell volume were normal and neurological findings were equivocal. Low B12 levels and intrinsic factor antibodies were found only by chance when they were included in a battery of further investigations. B12 replacement was followed by prompt improvement. This case provides an argument for wider screening for B12 deficiency in certain individuals with psychiatric disorders.

While the treatment alliance (Sandler, Holder and Dare, 1970a) and some aspects of transference (Sandler, Dare and Holder, 1970b) relate to tendencies within the patient which act to maintain the treatment relationship, the concept of resistance is concerned with elements and forces in the patient which oppose the treatment process. Although resistance is a clinical rather than a psychological concept (Sandler, Dare and Holder, 1970a), originally described in connection with psychoanalytic treatment, it is one which can readily be extended, without substantial revision, to other clinical situations.

Gentlemen,—My first duty, which is also a pleasure, is that of thanking you, as I do most warmly, for the honour you have conferred upon me in electing me to preside for a season over this great Association, a position which may well be called the blue ribbon of our department of medicine, rendered illustrious as it is by the names of great men who have held the office in the past. My only regret has been that in accepting it I replace one whom we should all gladly have seen in this chair, one whose enforced retirement cannot be alluded to without a feeling of loss, though we rejoice that his health is so far restored as to enable him to be amongst us to-day. For the rest, I am happy to echo the sentiment expressed by Dr. Macpherson a year ago, and to welcome my election as a token that the interests, aims and aspirations of the departments which preside over the lunacy administration of these countries are recognised as identical with those of all the other members of this Association—that, in fact, we all form one great body, united by devotion to as lofty an object as can animate the members of any merely human society.

In a previous paper the results of a two-year follow-up study were reported (Walton, 1958). This study showed that when the Wechsler Memory Scale was administered four times to each patient of a series suffering from a memory defect, significant differences emerged between those patients subsequently diagnosed as brain-damaged or as non-brain-damaged, in respect of the degree of improvement in their performance. The results were of considerable diagnostic and predictive importance. In spite of this, however, the method would be an uneconomical method for routine diagnosis. A shorter test involving the same principle of successive opportunities to learn appeared necessary. Additional analysis of the final Memory Scale results also showed that present learning ability was more impaired in the organic group than in the non-brain-damaged group, whilst scores based on retentivity questions produced many misclassifications. The results strongly suggested that a test of dementia should consist of a measure of present learning ability and that opportunities to learn could best be provided by successive repetitions of the particular test.

Vespral, or triflupromazine Squibb, is a new phenothiazine derivative. Chemically the compound is 10-(3-dimethylaminopropyl)-2-(trifluoro methyl) phenothiazine hydrochloride. Its structural formula compares with that of chlorpromazine as follows:

Until recently “Vespral” has been available in this country only for clinical trials, but its supposed therapeutic effects have been investigated fairly extensively in the United States and Canada (Goldman; Gallagher and Pfeiffer; Niswander, Lind and Schlesinger; Freed; Azima; Pennington; Saunders; Freyhan; Cahn and Levy).

One of the ways in which the psychiatrist differs from others who work with delinquents is in the importance attached to the sexual history of the offender. The contribution of psychiatrists in this respect has been mainly confined to a description of the emotional and dynamic aspects of sexual adjustment. But it is reasonable to suppose that if these emotional differences are as important as they seem to be from a study of individual cases, they would be reflected in differences in objective sexual behaviour, which are sufficiently definite to be used by criminologists in their more systematic studies. In the case of emotional relationships within the family, for example, psychiatric emphasis has induced criminologists to consider “broken homes” or “maternal separation” in a systematic way, but very few attempts have been made to relate the objective aspects of sexual behaviour and development with criminal behaviour. Even in the Gluecks' exhaustive study of five hundred delinquents and controls, which included psychiatric examination, sexual behaviour was not recorded, but only the presence or absence of sexual conflicts.

The operation of prefrontal leucotomy or, as some call it, prefrontal lobotomy, is one of the most startling of modern therapeutic procedures. It was introduced in Portugal by Moniz (1936)—the actual operation being performed by Lima—and was subsequently developed in Italy and in America. In this country it was first carried out at the Burden Neurological Institute in Bristol on December 11, 1940. At the time of writing (May, 1943) some 350 leucotomies have been performed in Great Britain. In 1942 Freeman published his book, Psychosurgery, dealing with the work done up to the end of 1941. Most of the work dealt with in the present review has been published since then, although for the sake of completeness Freeman's book will be referred to.

Attention was first drawn to the importance of this topic by Schneider (1957) when he proposed that some of his first-rank symptoms could be grouped together under the concept of ‘permeability’ of the barrier between the individual and his/her environment — the ‘loss of ego boundaries’. Similarly, in a recent series of papers (Strauss et al, 1987), the essence of schizophrenia was conceptualised in the processes of interaction between biology, behaviour, and environment. The two main syndromes — acute and chronic — can each be precipitated or made worse by environmental factors, and although most patients with the negative syndrome appear to show some irreducible impairment, poverty of the social environment has been found to worsen their condition, while on the other hand, a moderate degree of social stimulation promotes relative improvement (Wing, 1987).

Neurosyphilis continues to present in atypical forms, leading to erroneous diagnoses by physicians and psychiatrists. This patient, with a previous history of psychosis, presented in a catatonic state with rhabdomyolysis and renal failure. A subsequent breakdown was thought to be schizophrenic until unusual features led to a reassessment and discovery of neurosyphilis which was treated with penicillin and resulted in a remarkable clinical recovery.