The creation, in DSM-III, of the category ‘major depression’ can be linked to the launch, and success, of Prozac. The consequences of creating this broad diagnostic category are of concern in relation to the treatment of individuals with a diverse variety of depressive disorders.

In the previous contribution to this series of studies∗ we reported the scores obtained by women patients in a mental hospital when submitted to certain p-tests. Facts emerged of the kind that, relative to the scores obtained by normal non-psychotic women, maniacs obtained low p-scores, melancholic and depressive and dementing psychotics high p-scores, and that certain præcox patients obtained extremely high-p scores indeed.

Pavlov's theory of hypnosis is, perhaps, the first theory of hypnosis to be essentially derived from physiological experiments. Arising out of his experiments with dogs, the theory hopes to explain the hypnotic phenomena in human beings.

In some of our earliest investigations into the effect of leucotomy we used the Rorschach test, hoping thereby to obtain a fairly full and clear-cut picture of the personality changes produced by the operation, but it was found that this test had the disadvantage that, when repeated, memory of the previous test or tests to some extent minimizes the validity of the later interpretations.

Psychiatry made a great advance when it began to recognize the psychological meaning of mental symptoms—when it took the stand that it is not enough to establish that a patient has, say, delusions, but that one must relate the content of the delusions to the patient's life experience. Another stride has yet to be made, and that is the recognition of the physiological meaning of symptoms. Mental activity being the manifestation of cerebral activity, mental aberration must signify some aberration in the function of the brain, however normal this organ may appear to the eye. In a case of mental disorder, therefore, just as much as in hemiplegia, one must inquire how the laws of physiology reveal themselves in the signs and symptoms of the disease. To return to the example, it is not enough to show that the content of a delusion represents the patient's thoughts and strivings, but there remains the question: What has happened to his brain to cause his thoughts and strivings to assume the guise of delusions, when in a normal man they merely take the form of fancies? When a deluded patient says he is a very rich man, a certain psychological cause is at work. A healthy man, too, may be worried about money, but, in response to this cause, he merely fancies himself a rich man. The demonstration of a psychological cause, therefore, does not explain the sick man's delusion. All it explains is the content of the delusion; since the patient is worried about money, his delusion deals with wealth rather than some other topic. But it does not explain why the patient has delusions. The explanation of this must lie in some cerebral defect which permits inferior modes of thought to occur in response to certain situations. Psychiatry will not reach its full stature as a science until it regards each mentally sick person and each of his symptoms as a problem in cerebral physiology.

It is a common clinical observation that schizophrenic subjects often exhibit abnormalities of verbal behaviour in both the spoken and the written modes. Such abnormalities may range from minor idiosyncrasy to gross linguistic deviance. Where the linguistic deviance is very obvious, this of itself may carry considerable diagnostic weight in the overall schizophrenic symptomatology. In general, two main questions have been asked concerning this phenomenon: (a) why do schizophrenics produce abnormal language?; (b) what precisely is the linguistic characteristic of the abnormality? For mainly historical reasons it has been the first question which until relatively recently has received the most attention. The past twenty years or so have seen a remarkable advance in linguistics and its vigorous hybrid, psycholinguistics, without which present attempts to analyse and quantify language deviance would have been impossible. All of this is relevant to question (b). Since the beginning of this century, however, psychodynamic models and theories have afforded sufficient frameworks for speculation over question (a).

Eleven schizophrenic and three manic patients were randomly administered 0.3 mg/Kg b.wt. of naloxone or placebo in a drug-free state using a double blind procedure. BPRS and CGI were employed for making periodic assessment of mental status; the MRS was additionally used for manic patients. The authors discuss their findings, which are essentially negative.

The potential difference across the rectal mucosa (rectal p.d.) is generated by the active transport of sodium across the mucosa, and it is sensitive to the action of aldosterone. The rectal p.d. values of depressive patients on no treatment, tested whilst depressed or after recovery, were found to be similar to those of control subjects, indicating that sodium transport across the rectal mucosa and the activity of aldosterone were normal in these patients. This contrasts with previous reports of abnormalities of sodium transport and of aldosterone levels in manic-depressive patients. Manic-depressive patients taking lithium carbonate as a prophylactic agent were found to have significantly elevated rectal p.d. values when normothymic. Patients who had become depressed whilst taking lithium, and in whom prophylaxis had therefore failed, were found to have normal rectal p.d. values. Lack of elevation of rectal p.d. in response to lithium administration may be a characteristic of patients who fail to respond to lithium prophylaxis.

In conjunction with a longitudinal study of ageing twins (Jarvik, 1967) the opportunity arose to examine the postulated relationship between increasing aneuploidy and age (Jacobs et al., 1961, Hamerton et al. 1965, Court Brown et al., 1966). Chromosome analyses have been completed for 59 subjects, ranging in age from 77 to 93 years with a mean age of 84.5 years for the 23 men and 84.6 years for the 36 women.

Symptoms of post-traumatic stress disorder (PTSD), anxiety and depression are prevalent among post-conflict populations worldwide but controversy about the cultural meaning of these symptoms, particularly in relation to PTSD, adds to the challenge for psychiatry in mounting appropriate intervention programmes. Accumulating scientific evidence assists in guiding the focus and scope of emergency mental health programmes, initiatives that can become the vanguard of mental health development and reform for countries recovering from conflict.

Advanced maternal and paternal age were investigated as putative risk factors for AD in 198 clinically diagnosed Alzheimer patients and in 198 randomly selected healthy controls. No significant differences in average age of fathers and of mothers at birth of the subject were observed. The risk of AD was not significantly different across categories of maternal and paternal age. The association with parental age was not different for sporadic and familial AD. These findings do not support the view of a maternal or paternal age effect on AD.

Various benefits claimed for methadone maintenance in the treatment of opioid drug takers are reviewed. It is said to stop illicit drug use, maintain treatment contact, reduce morbidity, mortality and crime, and improve social adjustment. Little firm evidence is found to support these claims. Results are reported comparing 26 drug takers on methadone prescriptions with 16 illicit opioid takers. The measures used are Stimson's (1972) ‘Patterns of Behaviour’ questionnaire, and direct behavioural measures of social functioning. The groups are found not to differ in terms of treatment contact, work status and involvement with other drug takers. There is some evidence that the methadone group is involved in less criminal activity. However, no association is found between amounts of drugs prescribed and numbers of local pharmacy thefts. It is concluded that the benefits of methadone maintenance have been exaggerated.

The purpose of this survey was to assess the abilities and present status of all the adult women classed as feebleminded who have been discharged from the Fountain Hospital. This paper is not a comprehensive assessment, but a survey of these patients' past history, together with an interim report on their rehabilitation. In the majority of cases, the present whereabouts and occupation are known by the social worker and have been re-checked over the past eighteen months in the course of normal follow-up contacts.

Hoenig (1967) has recently and comprehensively summarized the extensive literature on the prognosis of schizophrenia. In a section on existing prognostic tests he criticizes the vagueness of the items to be scored, the variety of prognostic criteria and the low validity of the resulting scales. The present paper describes an attempt to devise a new prognostic test, using material which was originally collected in order to study the cost of rehabilitation.

This paper reports the result of an investigation into the hypothesis that severity of personality disturbance is positively related to the frequency of certain early adverse childhood influences.

The concept of transference, as developed by Freud, arose within the context of the psychoanalytic treatment of neurotic patients. The extension of the techniques of psychoanalysis to a wider range of patients, including psychotics, has led to the introduction of a number of terms to describe special and additional forms of transference. This paper is concerned with aspects of the relationship between patient and doctor which are discussed in the literature under such headings as erotic transference (Saul, 1962), erotized transference (E. Rappaport, 1956; Greenson, 1967), transference psychosis (Rosenfeld, 1952, 1954, 1969; Searles, 1961, 1963; Wallerstein, 1967) and delusional transference (Little, 1958, 1960, 1966; Hammett, 1961).

It is widely recognized that somatic complaints are frequently encountered in depressive illness and in some instances these may predominate in the clinical presentation. Studies relating to the occurrence of such symptoms in depression have been reviewed by Cleghorn and Curtis (1959), who point out that in a number of patients mood disturbance may not be readily apparent. It is not unusual for these patients to be referred initially to a general medical or surgical clinic, where after investigation it is concluded that their complaints cannot be understood in terms of physical disease (Stoeckle and Davidson, 1962).