Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequency was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.

Various authors have reported that alterations in urine volume are associated with alterations in urinary adrenaline and noradrenaline output. (Perman 1961 and Leroy and de Schaepdryver 1961. Weil-Malherbe and Ström-Olsen (1958) reported alterations in urinary adrenaline and noradrenaline excretion associated with mood changes in a group of patients with manic-depressive psychosis. In three of the patients studied, there was also during the manic phase an increased urine volume.

The question of the long-stay mental hospital population has recently received a great deal of attention. Proposals, based on the statistics of mental hospital admissions and discharges over the last few years, the increasing development of day hospitals, out-patient clinics, psychiatric units attached to general hospitals, and community services for the mentally ill within the general framework of new and improved methods of treatment, have led to considerable thought as to how best to reintegrate former mental hospital patients into the community. The process of discharging long-stay patients has, of course, been continuous, but the numbers involved have been comparatively small in the past. A policy of reducing considerably the number of mental hospital beds depends partly on aiming at the highest possible maintenance capacity of discharged patients. For long-stay female patients this would involve, among other aims, the re-training in domestic skills to adequate levels, while in male patients the aim would have to be some form of industrial resettlement. The general aim of increasing the activity and skill level of long-stay mental patients has found its expression in the establishment of industrial workshops. From its early beginnings (Baker, 1956) this form of therapy has developed into the establishment of production workshops or factories both inside and outside the walls of mental hospitals. (Wadsworth, Scott and Tonge, 1958; Early, 1960; Cooper and Early, 1961; Wadsworth et al 1961, 1962.)

The effects on outcome of research into the course of psychiatric illness are controversial. This study examines a cohort of research patients involved in an outcome study in which the research and clinical teams were kept separate. While research intervention of this nature would not be expected to influence outcome, the research cohort had fewer readmissions than non-research controls. This occurred despite the presence of factors which would be expected to be associated with a contrary result. It is stressed that the confounding effects of research need to be taken into account when designing follow-up studies and evaluating outcome results.

For this purpose average normal values were studied in 40 normal cases, and 40 mental cases were selected from amongst those who were suffering from various mental disorders who were given electric convulsive therapy.

In a previous paper in this series, a brief discussion has been given of the theoretical reasons for anticipating that depressant drugs would shorten the perceptual after-effects of visual stimuli, and stimulant drugs would lengthen these effects. The present paper is concerned with a related type of prediction, also concerned with certain visual after-effects. The phenomenon in question was first observed by Bidwell; it has not received much study, unfortunately, in spite of its great theoretical interest. The phenomenon is simply this. If a beam of red light (the primary stimulus, or Sp) is thrown into the eye of a person having normal colour vision, that person will report a red sensation, followed after the extinction of the light source by a series of after-images, usually in the complementary colour. The theory governing the appearance of the after-image is conventionally a photochemical one; the Sp produces certain effects in the retina which are opposite in direction for complementary colours and which are reversed when the Sp ceases to act on the retina. This reversal is perceived as the complementary after-image. Bidwell discovered that when the Sp is shown only for a relatively short period of time, say 20 milliseconds, and is immediately followed by a neutral stimulus, such as a beam of white light, then the S is not perceived at all, but only the complementary after-image. In other words, a red stimulus is perceived as green, a green stimulus as red. It is this perception of a non-existent stimulus which caused the phenomenon to be of such interest to psychologists.

The prognosis as to life in cases of mongoloidism is universally recognized as being notoriously bad. It would appear that the majority die in infancy and that many of those surviving this period succumb during the second decade. A small proportion reach the third decade, and a still smaller one survive till middle age. Brousseau in 1928 stated that few mongols reach the age of maturity, and that no mongol had reached old age. She stated that the oldest case found in medical literature at that time was a mongoloid female aged 57 reported by Langdon Down. In 1937 Tredgold stated that Langdon Down had then in his training institution at Normansfield 16 mongols over 21 years of age. Three of these were between 40 and 50, two between 50 and 60 and one male aged 63.

Projective identification is a psychoanalytic concept encompassing functions of defence and communication. It is invaluable in a variety of settings in general psychiatry, including patient assessment, ward management and work with families.

In recent years the introduction of neuroleptic drugs into large overcrowded mental hospitals has been accompanied by a striking improvement in their atmospheres which have become more therapeutic and less custodial (W.H.O., 42). Accordingly it has become possible, often for the first time, to organize effective programmes of rehabilitation for the chronic schizophrenics who still constitute a high proportion of mental hospital populations (Brill and Patton, 7). The new programmes have usually included group nursing, planned activities, and graded incentives for patients to strive to regain their positions in society. This approach has placed emphasis on the patient as an individual, having rights and responsibilities, safe, trustworthy, and, with assistance, often able to help himself and others (W.H.O., 41). Because of these changes in the State Hospital, it is not surprising that the literature has been flooded with enthusiastic reports and wholehearted endorsement of the merits of a variety of neuroleptic agents.

The present investigation was carried out in order to check on the reliability of the findings reported in a previous publication by Hamilton and Salmon (1962). In this first experiment objective assessments were made of the effects on male chronic schizophrenic patients of three activity programmes: Industrial Workshop Therapy, Occupational Therapy and a control situation in which patients did not receive any specific activity therapy. The effects of these therapeutic approaches were assessed in terms of test scores and ratings, as well as output and earnings for those patients receiving Workshop Therapy. For patients undergoing Workshop Therapy a separate assessment was made of the effects of payment by result compared with flat-rate payment, and of co-operative work compared with working as individuals. The major findings of this study were that Industrial Workshop Therapy led to greater improvement than Occupational Therapy, that the greatest changes in behaviour occurred while patients were working individually and receiving a weekly flat-rate payment, that the behavioural changes in the Workshop group continued in the second, piecework, phase of the investigation, that piecework payments did not result in greater output than flat-rate payment, and that patients working in small teams compared with patients working as individuals, both under piecework conditions, showed greater all-round improvement on the indices used to measure it.

The Asylum Journal, first published in 1853, is now, as the British Journal of Psychiatry, in its 200th volume. It has changed greatly in its breadth and scope, but its core values and concerns – professional respect, removal of stigma, delivery of care, understanding of pathology, and informed treatment – have remained at its heart throughout. We predict some changes for the future, but not dramatic ones, and conclude that the impinging advances of science will elucidate and refine, but not remove, the need for a journal that is proud to represent psychiatry or, in the words of John Bucknill, its first editor, ‘to render prominent its characteristics and to stamp it as a specialty’.