In Part I of this communication the theoretical basis for the investigation was outlined. Details of a statistical study were given and it was suggested that these confirmed a greater incidence amongst schizophrenics than normals of subjects excreting an excess of indole substances. In addition the question of hepatic dysfunction was investigated in 48 schizophrenic patients using the Cephalin-Cholesterol Flocculation Test. The results of this investigation were essentially negative.

Psychiatry is handicapped in the task of evaluating new methods of treatment because it has had to tackle the problems presented by early and mild cases without modern psychometric methods. There is clearly something wrong when the spontaneous remission rate in schizophrenia can be reported by the New York State Hospitals as 59 per cent. (1944) at a time when the equivalent figure in Kent (Monro, 1950) was 24 per cent. The practical impact of this failure to define terms is that the majority of articles describing the results of new treatments lose most of their force. This happens most obviously when the cases considered are presented simply in diagnostic categories, for example, as x schizophrenics or y hysterics. The trouble can be lessened by giving more clinical detail, but seldom can enough diagnostic and prognostic information be given to enable the reader to arrive at a proper evaluation of the issues presented. New descriptive techniques are therefore an urgent practical necessity, as well as being theoretically desirable.

The “mnestic syndromes” proper belong to the class of “organic syndromes” of which they are a more or less ill defined sub-group. Though memory disturbances do occur in psychogenic disorders, the mnestic syndrome has in relation to these only a differential diagnostic significance. Disturbances of memory may, of course, appear in other organic syndromes, but only when memory defects are the dominant clinical feature or the sole defect (probably quite rare) should one speak of the “mnestic syndrome”. A number of sub-types or syndromes, e.g. the so-called Korsakov syndrome, are contained in the mnestic syndrome. As the syndrome may show various types of amnesia, dysmnesia or hypermnesia, the term “mnestic syndrome” was suggested rather than “amnestic syndrome” (Conrad, 1953).

In recent years an ever-increasing interest has been taken in the possible use of serum enzyme investigations in clinical diagnosis, prognosis and therapy control. That clinical abnormalities are accompanied or even induced by biochemical aberrations is accepted. That the serum enzyme pattern may show consequent abnormality before the signs and symptoms familiar to the physician appear, has been also demonstrated in several disease states, such as caeruloplasmin in Wilson's disease (Scheinberg and Gitlin, 1952) and the transaminases in infective hepatitis (Wroblewski, 1957).

Tranquillizing drugs have become widely accepted as a major form of treatment in psychiatry. However, reports in the literature on these drugs have frequently been conflicting, with a marked tendency for the results of uncontrolled studies to be much more favourable than those obtained in studies where some method of control has been adopted. Sargant (1956) has emphasized many of the social, economic, and moral implications inherent in the extravagant and indiscriminate use of tranquillizers in general and has stressed the need for the proper evaluation of their therapeutic effects. In view of this need, we undertook a controlled comparative study of the effects of two of the phenothiazine compounds, promazine (“Sparine”) and chlorpromazine (“Largactil”), in the treatment of chronic psychosis.

In the six years since Delay and his associates first used chlorpromazine in psychiatry, at least forty-eight separate side-effects have been attributed to the drug. While many of these are minor, and indeed the majority are readily controlled in in-patients, the search for a phenothiazine of therapeutic value equal to or better than chlorpromazine, but with less or no side-effects, is well worth while. In out-patients there are two reasons for taking side-effects seriously. Firstly, they frequently lead to the patient ceasing to take the drug and thus relapse may occur. Secondly, they may be dangerous or even fatal if unreported—for example the signs of agranulocytosis.

While anomalies of sensory and perceptual responses characterize many mental disorders it is only recently that any serious attempt has been made to investigate them experimentally.

The following case of Folie à Trois, in which a married couple and the husband's brother shared a system of paranoid delusions, is being reported firstly because of the rarity of the condition, and secondly because it presents several unique features which it is hoped will shed further light on the nature of induced psychosis.

Controversy has raged for over half a century as to whether schizophrenia, the most severe of all mental illnesses, could have an organic basis or whether its origin lay strictly in the psyche. Over the years, physiologists have probed into almost every aspect of the soma in the quest for some abnormality which would account for the schizophrenic syndrome. Many possibilities have been considered, investigated to a degree and then abandoned when definitive answers were not forthcoming. A dominant approach throughout has been the search for some psychotoxic material circulating in schizophrenic body fluids. Activity has been spurred by the recurrent recognition that chemical agents such as the ergot alkaloids, mescaline, bulbocapnine and lysergic acid diethylamide (LSD-25), could induce in normal persons transient mental disturbances similar to those seen in schizophrenia.

This paper describes the development of three self-monitoring forms to enable students to make constructive use of audiotapes of their interviews with patients. Each interactogram is described in detail, with examples where necessary.

In 1957 Krantz, Truitt, Ling and Speers found that the inhalation of small amounts of hexafluorodiethyl ether (Indoklon) produced convulsions in animals, and it was later used as a therapeutic convulsant for the treatment of psychiatric patients (Krantz, Truitt, Speers and Ling, 1957).

The biochemical aspects of manic-depressive psychosis have been adequately, reviewed by McFarland and Goldstein (1939). From previous investigations, it is apparent that there is a marked alteration in carbohydrate metabolism mainly associated with a change in glucose tolerance. This phenomenon is related to alterations in emotional state and there is no suggestion that it is the cause of the mood swings which occur periodically in this type of psychosis. Apart from these variations in the control of carbohydrate metabolism, it has so far not been possible to demonstrate any changes in the blood levels of any products derived from carbohydrate metabolism.

Need-adapted treatment of schizophrenia is an integrative treatment model developed in the Turku Schizophrenia Project. It is based on the interactional viewpoint and understanding on the interactional level. Experience of family and network therapy has shown that immediate interactions-oriented intervention is an essential starting-point for the treatment. It creates the possibility for the treatment as a whole to become a therapeutic process. For clinical purposes, it has seemed logical to divide the patients into three groups; the methods and focus of the family-oriented work differ somewhat between the groups. The main separator between these is the level of social functioning before the psychosis.

Electroencephalographic (EEG) monitoring was carried out in 169 bilateral and 114 unilateral applications of electroconvulsive therapy (ECT), given to 51 patients in an everyday setting within the National Health Service by junior medical staff. In 2.5% of bilateral and 8% of unilateral applications there was disagreement between clinical and EEG assessment as to whether a fit had occurred. When an EEG fit was said to have occurred only if it lasted longer than 25 seconds, then disagreement rose to 7% in bilateral and 28% in unilateral applications; disagreement was higher with unilateral applications, as they produced more short fits than bilateral applications. If future work shows duration of seizure is clearly associated with clinical efficacy, it is suggested the case for routine EEG monitoring is greatly strengthened.

Epilepsy can occur in patients without any changes apparent in the electroencephalogram. Thus the diagnosis of epilepsy is essentially made on clinical grounds. The clinical features of epilepsy are rela tively easy to learn to mimic. Feigned epilepsy can occur in adulthood or it may occur in childhood, as part of a Munchausen syndrome by proxy as described by Meadows (1984). We would like to describe a case of feigned epilepsy with global amnesia, and several other symptoms of aberrant illness behaviour.

A weekly clinic was held for one year in a London probation office with 41 probation officers. Only 23 cases were referred but the clinic was found to be a valuable forum for discussion of problems with the officers, 10 per cent of whose clients were estimated to be receiving psychiatric treatment elsewhere. Suggestions are made to improve collaboration between psychiatrists and probation officers.