The Symptom-Sign Inventory (SSI) consists of 80 questions presented orally. The administration and part of the scoring have already been described in some detail (Foulds, 1962); but, since then, a continuum has been suggested from neurosis through integrated psychosis to non-integrated psychosis. This continuum is considered to represent increasing degrees of failure to maintain or establish mutual personal relationships (Foulds, 1965). Measurement of this continuum, which has only been completed for women, involves three scales.

A ten-year follow-up study of 74 opiate (most heroin) addicts referred to the Drug Dependence Clinic in Southampton showed that overall, little use was made of the treatment facilities available. Half of the patients on whom we were able to obtain follow-up data appeared to be no longer abusing drugs. An appreciable number of subjects had committed offences prior to abusing drugs and a large proportion offended during the follow-up period, adding support to the view that most addicts are not driven to crime because they are unable to obtain the help they need. The death rate of 15% is that expected in a long-term follow-up study. The results suggest that the natural history of many heroin addicts is uninfluenced by therapeutic intervention.

When discussing some of the problems associated with chlorpromazine (Largactil) therapy, Denber and Travis (2) point out that it is desirable that the drug be given as infrequently as is compatible with therapeutic efficacy. They found this to be twice a day. Haden (5) and Tibbits (10) report that satisfactory results can be obtained with single daily doses. While studying the single daily dose administration of drugs in a psychiatric hospital, Lara and Wells (7) found that phenothiazine compounds could reasonably be given in this way. In order to explore these reports the medication of 17 chronic, well stabilized, male schizophrenic patients was changed by giving their chlorpromazine once instead of three times a day. These patients had been on an average dosage of 200 mg. of chlorpromazine t.d.s. The dosage was altered by giving the total daily dose at one time, limiting the maximum dose to 600 mg. In some cases this resulted in a small reduction in the total dosage. The main side-effects complained of before the change were photo-sensitivity from 8 patients and drowsiness during the day from 9 patients. Because of this latter complaint the single dose was given at 9 p.m. Three weeks after the change to the single dose no alteration in symptoms or behaviour had been noted except that there were now no complaints of drowsiness during the day. Two patients complained that they disliked taking 6 large tablets at one time.

Childhood adversities are major preventable risk factors for poor mental and physical health. Scientific advances in this area are not matched by clinical gains for affected individuals. We reflect on novel research directions that could accelerate clinical impact.

Mr. President, Ladies and Gentlemen,—Last year I had the honour of delivering the Maudsley Lecture, and I brought forward a certain amount of evidence in favour of the genetic causation of dementia præcox. I have continued these investigations and published the results in papers entitled “Further Pathological Studies in Dementia Præcox, especially in Relation to the Interstitial Cells of Leydig,” Proc. Roy. Soc. Med., 1922, vol. xv (Section of Psychiatry), pp. 1–30; also “The Reproductive Organs in Relation to Mental Disorders,” Brit. Med. Journ., March 25, 1922. The former investigation included 27 cases of dementia præcox, the onset occurring in adolescence; also the results obtained in 9 cases of psychoses other than dementia præcox occurring in post-adolescence, and 4 cases of primary dementia, in which the demential symptoms came on in post-adolescence. From these investigations, and from others which I have been pursuing, I have come to the conclusion that it is better to speak of primary dementia, which may occur either in the pre-adolescent period, adolescence, or post-adolescence; moreover, I am of opinion that all the psychoses belong to one group and are genetic in origin. In those forms of psychoses in which recovery takes place—for example, confusional insanity or exhaustion psychosis, benign stupor, periodic insanity, or manic-depressive insanity—we may assume there is a suspension of neuronic function in the highest psychic level; but all these conditions I have found may end in a terminal dementia, in which the changes in the reproductive organs and in the brain do not differ from those met with in the primary dementia of adolescence, the dementia indicative of a suppression of function. In the primary dementias, naturally, the symptoms may be partially due to a suspension, and partially to a suppression of function, and I would explain partial remission of symptoms by a partial restoration of function in neurones in which the nuclear change was either not present or not advanced.

In 23 acute, unmedicated, schizophrenic patients, psychotic behaviour and β-endorphin serum level were measured before and during four weeks of neuroleptic therapy. Prior to drug treatment, β-endorphin level of all patients was within the normal range. Neuroleptic therapy induced marked elevations of β-endorphin in eight subjects; statistical analysis revealed a slight but significant increase for the whole group. This endocrine effect was not correlated with therapeutic efficacy of neuroleptic treatment.

The educational attainment of 100 school-phobic youngsters was compared to that of 100 other psychiatric patients, using the reading quotient as the main measure. Age and IQ were allowed for. RQs were, on average, higher in the school phobic group than in the other subjects, except in a small number of younger children of high IQ. Additional comparisons with another group of psychiatric patients and with the general population, using regression equations, failed to provide any evidence of poor educational attainment in school phobia.

The background, methodology, and general results of a comprehensive survey of treated psychiatric illness in Lebanon have been described in an earlier report (4). The investigation consisted of obtaining biographical and diagnostic data on all patients seen by psychiatrists in Lebanon over a six-month period (15 February 1964 to 15 August 1964) and was carried out with the collaboration of all three psychiatric hospitals in the country and twenty of the twenty-one psychiatrists practising within and outside these institutions.

A young man was followed-up over three years who had severe obsessive-compulsive rituals and ruminations, interpersonal deficits, complicating depression and a history of childhood autism. Intensive behavioural treatment was given in an operant framework, with exposure in vivo, modelling, response prevention and social skills training. Compulsive rituals improved markedly and lastingly, but ruminations and social defects persisted. When intercurrent depression occurred dothiepin facilitated behavioural treatment. Adjustment remained fragile. Minimum maintenance treatment in the community could not be adequately arranged, so that gains made in hospital were partly lost at follow-up, despite continuing improvement in rituals.

The psychotherapeutic treatment of 15 patients is described. The goals were defined in terms of target problems and target dilemmas, traps and snags, and the outcome was assessed by rating these or with a symptom questionnaire and a dyad repertory grid before and after treatment. Patients who rated dilemmas as resolved showed appropriate changes in construct correlations on the dyad grid.

A paper referred to me for statistical review has drawn my attention to the issue of appropriate evaluation of the effectiveness of treatments used in psychiatry. It has been suggested that the classical randomised controlled trial (RCT) is inappropriate to many aspects of psychiatry. I feel it is important that this issue should be looked into closely. I believe that the principle that treatment evaluation should be by RCT wherever this is feasible is certainly no less important in psychiatry than in other medical specialties. Discussion of this issue is needed, so that guidelines can be set out which will both be acceptable to researchers in psychiatry and meet scientific standards accepted in other areas of medicine.

Tardive dystonia is a rare movement disorder. We outline the development of tardive dystonia in a young schizopohrenic, and demonstrate the importance of applying a double-blind, placebo-controlled, crossover trial of any putative successful treatment.

Developmentally inappropriate degrees of hyperactivity, inattention and impulsivity are common symptoms in childhood. If of early onset (before 7 years), present in different settings and to a degree that causes functional impairment, a diagnosis of attention-deficit hyperactivity disorder (ADHD) or ‘hyperkinetic disorder’ should be considered. The age criterion is crucial to distinguish ADHD and hyperkinetic disorder from later-onset conditions such as agitated depression, adolescent-onset socialised conduct disorder (probably not linked to ADHD) or hypomania, that might appear superficially similar. Attention-deficit hyperactivity disorder and hyperkinetic disorder are commonly associated with language, learning and social impairments. Indeed, in severe cases hyperactivity could be a marker of a multifaceted developmental disorder. Hence, competent assessment usually requires a thorough history, often using a number of sources.

Each hemisphere's ability to sustain attention over extended time periods was investigated in 14 schizophrenics and 17 controls using dichotic detection tasks. Schizophrenics produced significantly higher rates of omission errors, as compared to that of commission errors. The rates of omission errors for schizophrenics fluctuated markedly, while the rates of commission errors remained fairly constant. Primarily due to the fluctuation of omission errors, the detection index decreased progressively when schizophrenics were engaged in right-ear tasks. These results suggest that schizophrenics demonstrate a deficit concerning ‘response set’, especially in the left hemisphere. It is feasible that there may be a correlation with disturbances in integration mechanisms of both hemispheres in schizophrenics.

Perhaps the earliest adumbration of modern interest in problems of old age was Quetelet's important two-volume work on Man and the Development of his Faculties in 1835 (55). In this book appeared for the first time data of a kind since become very familiar: ages when various crimes are committed, when literary masterpieces are written, ages of admission to hospitals for the insane, and so on.

Pick's disease and Alzheimer's disease are well-defined, if rare, groups of cases which have been differentiated from the main bulk of the dementing psychoses occurring at and around the presenile period. Although these two sub-groups have much in common on the clinical side, their histopathological features are so strikingly different that many authorities consider them to be separate disease-entities.