It has been known for over a century that abnormalities of glucose metabolism are more common in those suffering from certain forms of mental illness (Kasanin, 1926), but only in the past few years has there been any serious attempt to establish the exact nature of the association. We are now in a situation where a great deal of data and opinions have surfaced in a short space of time. In order to bring this body of data into a single forum to debate its significance and – more importantly – to examine how it should influence practice, it was felt appropriate to convene a consensus meeting on diabetes and schizophrenia. The aims of the meeting were to bring a group of interested and informed clinicians and pharmacologists together to present and debate all the currently available data, opinions and practices from around the world that relate to the association between schizophrenia and glucose abnormalities. In order to do this we felt it crucial to involve experts not only in psychiatry but also in diabetology. One of the major roles of the convened group was to give some sort of hierarchical basis to the many types of data that have been published. The prime focus of the group was to agree a consensus statement that would give practising psychiatrists and diabetologists a clear message as to the current state of knowledge, beliefs and potential best practices.

“The T.A.T. draws forth no more than twenty small samples of the subject's thought. To suppose these will invariably provide a skeleton of total personality is unduly optimistic” (6). With this warning no experienced clinical psychologist is likely to disagree. The present aim has been to provide a method of analysing and quantifying the content of the responses which minimizes dependence on hypotheses derived from outside the test situation and to relate the results to the amount produced and, more particularly, to the rate of production.

In July, 1927, at a British Medical Association meeting, in the Obstetrics and Gynæcology Section, G. I. Strachan dealt with the mental side of the hygiene of menstruation. He made the statements that in cases where menstruation was influenced in mental disease it was usually in the direction of excess, and moreover he had found no justification for the text-book statement that insanity was usually accompanied by amenorrhœa. A study of the more important text-books of psychiatry reveals a paucity of information on the subject, and this has stimulated me to collect any facts which have bearing on this interesting problem.

Tashiro (1922) showed that the isolated frog nerve liberates ammonia on stimulation, and Richter and Dawson (1948) have recently found that ammonia is liberated on stimulation by the brain. Ammonia is very toxic to the brain, on which it has an irritant action; but the brain may be protected to some extent by the enzyme system described by Krebs (1935), which can detoxicate ammonia by combination with glutamic acid to form glutamine. Sapirstein (1943) obtained evidence that this system is active in vivo by showing that glutamic acid increases the resistance of animals to convulsions produced by injecting ammonium chloride. The toxic action of ammonia on the brain is also of interest in connection with the view that it may be concerned in certain forms of epilepsy (Harris, 1945). This view is supported by the observations of Price, Waelsch and Putnam (1943) on the inhibitory action of glutamic acid on petit mal attacks.

I have lately been engaged on a research into the normal and morbid histology of the choroid plexuses of the lateral ventricles.

Parnell (1951) reported that 76 men undergraduates at Oxford had lost a full term's residence on account of psychological ill health in the period of three years from 1 January, 1947 to 31 December, 1949. Psychological ill health had caused 52·5 per cent. of all prolonged absence through illness, a fact which emphasized the need for more detailed study of the causes and possibility of prevention of psychological disturbance. As an indication of minimal current prevalence of such disturbance, it may be reported that 59 Oxford students in need of psychiatric help were referred by their general practitioners to the Warneford and Park Hospitals in twelve months from 1 April, 1953 to 31 March, 1954: these figures take no account of the numbers treated elsewhere; but the evidence as a whole shows that, as found in 1951, mental upset is still the most important cause of ill health in Oxford students.

Information derived from a comparison of somatotype, electroencephalographic, psychological and psychiatric findings upon patients and healthy controls is summarized in this paper. It shows that, despite a probable bias in the controls, significant differences can be detected between the two samples. Some of these differences were sufficiently marked to form the basis for a simple heuristic method of detecting vulnerability.

In 1939 an inquiry was begun into the late results of the type of head injury which results from collisions on the roads, from accidents in industry and from falls in the home. Since penetrating injuries resulting from civilian accidents are extremely rare, the examples that were encountered have been eliminated from the final reckonings and so the following account is concerned entirely with the so-called closed type of injury. It must, of course, be realized that compounding and infection are common even in this type of injury, because cranial fractures frequently run across and open into the paranasal air sinuses.

The following experiments on glutamic acid were carried out in view of the conflicting reports of Price, Waelsch and Putnam (1943), Waelsch and Price (1944), and Goodman et al. (1948) on its effect in epilepsy. A number of preliminary experiments were made which suggested that there was an apparent difference between the effects of glutamic acid and sodium glutamate. Such a difference does not appear to have been considered by most other investigators. It was decided therefore to try to determine whether a possible reason for the difference was the effect of the sodium ion on water balance, since this is known to be related to the tendency to seizures (McQuarrie et al., 1932, Swinyard et al., 1946, and Weinland, 1949). For comparison potassium glutamate was given in a way to be described below. The experiments will be reported under the following headings:

1. 1. The acute E.E.G. and clinical effects of intravenous sodium glutamate.

2. 2. The short term (one week) E.E.G. and clinical effects of glutamic acid, its sodium and potassium salts and a placebo.

3. 3. Longer term clinical effects in out-patients.

4. 4. Biochemical studies of the blood and urine levels of glutamic acid by paper chromatography of 7 epileptic patients and 5 non-epileptic control subjects, including salt and water balance studies of patients and controls.

Fashion is more deep-rooted than contemporary custom will allow, and the current enthusiasm for drug treatment in psychiatry is no evanescent fad. The Greeks made good use of the pharmacopœia, prescribing borage, buglosse, marigold, polypodie and epithyme for melancholy, more specifically recommending wormwood, centaury and pennyroll for the hypochondriac malady. Burton (a) discussing black hellebor, relates that its virtues were extolled by Galen, Pliny and Coelius Aurelianus, the mentally afflicted being sent to the Anticyrae, or to Phocis in Achaia to be purged, the plant growing there in abundance. Burton (b) describes how the Melangoga, or melancholy purging medicines, were classified as simple or compound, purging upwards or downwards. Asarum, brassivola, laurel, scilla, white hellebor, and antimony purged upwards, whereas polypodie, epithyme, black hellebor, lapis lazuli and aloes purged downwards. Sceptics throve then, no doubt, as they do now. Meryon (1861) mentions Asclepiades—dismissed by Pliny as an impudent quack, who contended that drugs injured the stomach and induced complaints more dangerous than those which they were intended to cure.

Studies examining comparative outcomes of schizophrenia in high-income countries with those in low- and middle-income countries remain of interest to researchers and may be of value in understanding some environmental factors that influence the course and outcome of the disorder. The view that the disorder has a better outcome in low- and middle-income countries compared with high-income countries, even though widespread and supported by a set of World Health Organization (WHO) studies, requires further testing and exploration. Unfortunately, although not insurmountable, the obstacles for such studies both in terms of implementation and interpretation are considerable.

Since there are several excellent accounts of the technique of insulin therapy (1, 2, 3, etc.), and since our method is based largely on the recommendations of Sakel, we do not intend to describe this in detail, but to discuss such variations and points of interest as have developed at Hatton during the completion of treatment in 59 cases.

The development and use of a new psychiatric symptom change scale based on the Present State Examination (PSE) - the PSE Change Rating Scale - is described. The advantages of the PSE are retained (the extensive glossary, the diagnostic facility and the standardised interview technique) while improving its sensitivity to change and decreasing its administration time. The scale has been designed to prevent feedback of results and ‘halo’ effects: it has proved highly reliable in use across raters with different backgrounds and experience. The scale has been used to monitor drug effects on clinical state across a variety of diagnoses and examples of its use are given.

It is widely believed that knowledge of an adult patient's childhood is of great assistance in understanding the development of his illness. It has been thought that with advances in the understanding of psychogenesis of illnesses, where this is a major pathogenetic mechanism, it would eventually be possible to predict specifically who will develop which particular adult illness; a further hope would be that these adult illnesses could then be prevented.

Ten depressed elderly female patients in hospital (mean age 82 years) received a single oral dose of 50 mg nortriptyline prior to commencing treatment with this drug. The nortriptyline concentration in a plasma sample obtained 24 hours afterwards was used to predict the daily dose required to achieve a steady-state concentration within the range of 50–150 μg.l-1. The mean daily dose prescribed was 50 mg (range 20–100 mg). These dosage regimes provided a mean observed steady-state nortriptyline concentration of 104 μg.l-1, with a range of 76–180 μg.l-1 (S.D. 30 μg.l-1). Use of this prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success.