The classification system of atypical and typical antipsychotics has created a lot of confusion and might be abandoned. Nevertheless, to say that all drugs are the same and that therefore it does not matter which drug is given is wrong. Both typical and atypical antipsychotics differ in side-effects, mechanisms of action, cost and efficacy. The available choice of antipsychotics should be adapted to individual patients in a shared decision-making process.

Between 1975 and 1985, 3.8% of patients referred to the Maudsley Hospital with anorexia and bulimia were adoptees. This exceeds the rate of adoption (1.5%) in the general population matched for year of birth. The 18 adoptees with eating disorders had significantly more associated behavioural disturbance and lower academic achievement than the 18 matched controls, and different precipitating factors.

The prevailing picture in both the scientific literature and mass media is that the increase in unemployment acts as a generic risk factor on the entire population and increases the rate of suicide, suggesting that the socioeconomic environment is the determining factor and measures to improve it are the most suitable in the struggle to reduce the number of suicides. As a result, ‘horizontal’ actions targeting the general population are proposed rather than ‘vertical’ actions that target specific vulnerable groups. This is not only a mistake but it also constitutes a kind of ‘reverse’ stigma which deprives mental health patients of their right to receive special and targeted benefits, interventions and care, and deprives mental healthcare of valuable resources.

The Concept of the Body Image and the Perception of the Human Body

The consideration of our awareness of our own bodies ceased to be wholly a philosophical problem when Pick (1908) and Head and Holmes (1911), having observed neurological disturbances of body awareness, first suggested the concept of a Body Image or Body Schema. The concept, has in its slow growth, become at times confused and has always resisted satisfactory definition. Pick himself made no attempt to define it, while for Head and Holmes it was a “postural model of the body” being constantly built up and changed by every new posture and movement and forming a “plastic schema” which was “the fundamental standard against which all postural changes are measured“. Schilder (1935) greatly enriched the concept by emphasizing not only its physiological and neuropathological basis but its psychological aspect. He defined it thus: “The image of the human body means the picture of our own body which we form in our mind, that is to say the way in which the body appears to ourselves.” This was a comprehensive “body image”; more than a perception or mere representation and including even Head and Holmes's “Body Schema“. The Body Schema concept has been more recently defined by Clifford Scott (1948) as “that conscious or unconscious integration of sensations, perceptions, conceptions, affects, memories or images of the body from the surface to its depths and from its surfaces to the limits of space and time”.

In a previous paper, Davies and Beech (4) presented data obtained from both clinical observations and psychological tests on normal subjects under the influence of Sernyl. In that paper an account was given of the chemical constitution and action of the drug. It is not necessary to say more here than that this compound is a synthetic cyclohexylamine derivative that was introduced into anaesthetic practice because of its ability to produce analgesia without loss of consciousness. It appears to act mainly at the thalamic level and produces changes in the reception of sensory stimuli. Post-operatively, however, psychiatric disturbances were common and the use of the drug in anaesthetic practice was curtailed. Our interest in Sernyl has centred upon its psychotomimetic effects and its possible mode of action. It has, in fact, been suggested that normal individuals under the influence of Sernyl behave, in some respects, like schizophrenic patients and that this similarity is most striking in the case of thinking processes. In the further investigation of the effects of this drug it was therefore decided to test the hypothesis that Sernyl produces mental disturbances which are characteristic of thought-disordered schizophrenics.

The estimation of the amount of neutral 17-ketosteroids excreted in the urine has attracted considerable attention, since the level of excretion (usually expressed as mgm./24 hours) can be fairly well correlated with the output of androgenic substances determined biologically (Callow et al., 1939a, b). What constitutes the normal range of daily output is still somewhat uncertain; 1.7 to 12.6 mgm. for females, 3.5 to 15 mgm. for males (Callow, 1939), 40 to 15 for normal women (Friedgood and Whidden, 1939), 4.3 to 21 mgm. (Chou and Wang, 1939), 3.5 to 14.6 mgm. for females, 9.4 to 20.4 for males (Patterson, McPhee, Greenwood, 1942) have been quoted. We have conducted investigations in a large number of cases of each sex in the last two years, and have come to regard 6 to 15 mgm. daily as the range for normal adults, females as a rule being lower in the scale than males; after middle age a somewhat reduced output is to be expected. It has been suggested (Patterson et al., 1942) that among normals higher values are related to larger body size, but we are unable to confirm this.

In a previous communication (1951) it was shown that the hyperglycaemic factor described by Meduna and Vaichulis (1948) in the urine of psychotics consisted of two fractions, and that the more active and specific of these was of a protein nature. Morgan and Pilgrim (1952) have prepared concentrates of this factor from the urine of male and female schizophrenics, and have produced further evidence that it is a protein or a substance strongly bound to a protein. In normal male urine they did not find a measurable quantity of the factor.

Dr. Tómasson's interesting remarks on the therapeutic effect of adrenergic and cholinergic drugs lead me to mention some experiments with benzedrine recently carried out at the Maudsley Hospital. These experiments primarily originated from different considerations. They were part of more extensive investigations into the connection between mental phenomena and blood-pressure and its fluctuations. Benzedrine seemed to be suitable for experimental alterations of the blood-pressure because its effect on arterial tension lies between that of adrenaline and ephedrine with regard to rapidity and intensity of action. Experiments on normal persons demonstrated a peculiar stimulating and euphorizing effect of the drug. The experimental subjects were selected as normal in regard to blood-pressure. They included several cases of mild depression. These also showed either a slight elation, or at least a decrease of their depression after the administration of the drug. This result encouraged further experiments on depressives of various kinds. These were always carried out in the following way: Patients whose mental state was well known and who had been constant for a period with regard to their blood-pressure were given at first small, and later slowly increasing doses of the drug. There were intervals without medication in which the subjects received inert tablets of the same appearance and taste as the benzedrine. The blood-pressure was taken several times daily.

The authors have independently used drug-aided psychotherapeutic techniques. Some good results were being obtained but we were not entirely satisfied with existing agents. The first few applications of parenteral “Ritalin” appeared promising and prompted the work on which this paper is based.

Although described as far back as 1898, the Ganser state is still a subject of controversy and causes discussions regarding its existence as a clinical entity, its psychopathology and its incidence. Lately, Goldin and Macdonald (1955) endeavoured to clarify the meaning of the Ganser state after a critical review of the literature. They provided an illustrative case report with some hitherto unreported features and psychological test results. Although their paper presents a wealth of valuable material, there are still some points which need further discussion and elucidation.

Prefrontal leucotomy as an operative method of treatment for mental disease greatly stimulated research into the functions of the frontal lobes. The operation was a direct result of the observation of Fulton and Jacobsen (1935) that rage reactions seen in monkeys in the course of increasingly difficult experimental tasks do not occur after extirpation of the frontal lobes.

Sleep as a method of controlling mental derangements dates to antiquity. According to Celsus sleep restores mental equilibrium: “but certainly for all so affected sleep is both difficult and especially necessary; for under it many get well …” (13). Griesinger in 1861 was the first to use chloroform as a sleep-inducing agent in mania and melancholia (21). The advent of bromides and barbiturates enhanced further investigation, and early in this century sleep treatment was relatively well systematized by Wolfin 1901 (40), Trend in 1903 (39), and by Kläsi in 1922 (25). This paper will not attempt to review the literature on sleep, for these findings have been outlined in papers by Palmer (32, 33), Baer (7), Ey (18), and recently in a documented book by Angel (2). The purpose of this paper is to present (1) a method of prolonged sleep treatment using the new inhibitory substance chlorpromazine (Largactil), in combination with different barbiturates in an attempt to provoke a sleep pattern as similar as possible to normal sleep, in contrast to deep unconsciousness advocated previously (14, 32); (2) to discuss underlying theories of sleep treatment, and propose some new formulations; (3) to suggest future use and investigation of the treatment; and (4) to bring to the attention of American psychiatrists a treatment which holds an eminent position in Europe, particularly in the U.S.S.R. where sleep therapy appears to be the only officially accepted form of treatment in mental illnesses.

May I, in the first place, thank you most sincerely for the honour you have done me by electing me as your President during the coming year. Whilst the names of my distinguished predecessors enhance this honour in my eyes, at the same time I cannot help a feeling of humility and inadequacy at the thought of attempting to follow in the footsteps of those illustrious members of our profession whose names shine ever more brightly as the march of time reveals more clearly their contribution to our specialty and to the welfare of the mentally ill.

The idea of a relationship between respiration and mental functioning can be traced back to ancient superstition that the diaphragm is the centre of the soul as well as of emotion.

In Scotland the central collection of forms bearing details of admissions to all psychiatric hospitals was begun in January, 1962. These forms are intended to provide knowledge about the incidence of psychiatric disorders and the result of treatment. The details of this scheme and the nature of the information required were presented at a meeting of the Scottish Division of the Royal Medico-Psychological Association in 1961, and in the discussion which followed the reliability of data which depended on clinical diagnosis was questioned.