A psychiatric service was provided to the remote areas of Botswana by means of regular visits from psychiatrists and psychiatric nurses to the primary care facilities in those areas. The service was well used by the local health workers and general populations and encountered a substantial psychiatric morbidity. Studies in one region indicated that by using the primary care staff as case finders a substantial proportion of a total likely population of schizophrenic and epileptic patients could be bought into treatment. The specific conditions that enabled this service to become established are discussed.

In this investigation, the subjects were 180 female patients with pure endogenous depressions. These were divided into six different groups of 30 each. Of these groups, four were treated with nortriptyline, amitriptyline, imipramine and MAO-inhibitors respectively, and the results were compared with those obtained in the fifth group of patients who had been given electroplexy only, and finally with those obtained in the sixth group of patients who had received treatment before 1937.

The clinical manifestations that may result from abuse of alcohol are numerous. Profound, sometimes fatal, hypoglycaemia, first described a little over 20 years ago (Brown and Harvey, 1941), is among them although as far as we are aware, not previously described in this country. This may be due partly to differences in drinking habits here and abroad where “bootleg” liquor is more readily available, and partly to failure to recognize this complication of alcohol. Many cases of alcohol induced hypoglycaemia may well go undiagnosed, alcoholaemia alone being held responsible for bizarre behaviour or alteration in consciousness following the drinking of alcohol-containing beverages. In some cases, a patient brought into the casualty department with a provisional diagnosis of “drunkenness” is found to have a low blood sugar and the diagnosis hastily altered to the more socially acceptable one of “hypoglycaemia”, but without the cause of the hypoglycaemia ever being determined.

Variation in the CACNA1C gene has been associated with bipolar disorder in several genome-wide association studies. This gene encodes the alpha 1C subunit of L-type voltage-gated calcium channels, which play an essential role in neurons. We analysed 39 biomarkers in either cerebrospinal fluid or serum in relation to six different CACNA1C variants in 282 patients with bipolar disorder and 90 controls. We report associations of CACNA1C risk alleles with serum levels of BDNF as well as tissue plasminogen activator, which converts pro-BDNF to mature BDNF. This sheds light on links between CACNA1C genetic variants and pathophysiological mechanisms in bipolar disorder.

Mental illness recovery has been described as an outcome (symptom free) or process (symptom management) where peer supporters are essential. Whereas, substance use disorder recovery endorses outcome alone: achieving recovery once abstinent. Peer supporters with an abstinence agenda use confrontation for those in denial. Herein, we unpack this distinction.

Improving access to psychological treatments for common mental disorders is a priority in a number of countries worldwide. We consider the evidence presented by Harris et al on the Australian Better Access initiative, and discuss the challenges of delivering such intitiatives and evaluating their impact.

Cognitive–behavioural therapy self-help offers an accessible and efficient way to treat common mental disorders. The evidence-based self-help movement has an important foothold in the healthcare arena. This article surveys the emergence of self-help at a particular social and historical junction, and summarises key lessons from experimental and practice-based studies.

Ritalin (methylphenidate) is a drug which was developed by the firm of Ciba Limited. It resembles amphetamine in its central stimulant and sympathomimetic action but has quite a different chemical structure. Its general properties have been described by Meier et al. (1954) and by Drassdo and Schmidt (1954 a, b). Geller (1955) and Stier (1955) used Ritalin in the treatment of depressive states associated with apathy, while Ferguson (1955) found it of value in countering the depressive effects of reserpine therapy. Ferguson also notes that Ritalin seemed to have a beneficial action in cases of chronic schizophrenia and considered that his findings warranted a clinical trial.

Research was carried out by a small unit in the York Clinic at Guy's Hospital into the possible connection between migraine attacks and the patient's emotional life. The hypothesis was that migraine was a product of stress and should, therefore, respond to psychotherapy directed towards helping the patient to deal with his emotional problems in a more adequate way. The clinical aspects of the investigation and therapy are described in full elsewhere (2, 3). Evidence was produced to support the view that migraine is a stress disorder. Contact was kept with all the patients for a period ranging from 2 months to 2 ½ years. In a series of 20 patients eight patients were much improved by therapy, ten improved and two remained unchanged. This paper presents the results of some of the psychological tests which were applied to those 20 patients.

Since the introduction of prefrontal leucotomy by Moniz in 1936, an ever-increasing number of psychotics have been subjected to this operation. Results have been very satisfactory in certain types of psychosis and psychoneurosis, especially in obsessional tension states, in agitated depression, and in patients with considerable apprehension and anxiety, while less favourable results have been reported in many cases of schizophrenia, hebephrenia, and others. Naturally, with the number of cases operated on, experience has grown, and psychiatrists, neurologists as well as psychologists are nowadays, to some extent, in a position to determine which case is likely to benefit from the operation, and where leucotomy should rather not be resorted to.

This is an investigation to ascertain the ultimate fate of certified patients who have been discharged from a mental hospital as “recovered” or “relieved”.

Results of a previous investigation of manic-depressive psychosis with a continuity of cycles of short duration (Klein and Nunn, 1945) seemed to justify further study of this group. As such cases suitable for investigation are rare, we are again reporting observations on a single case, although the cycles were not as short and regular as in the earlier case. The patient at the time of his last admission to this hospital (in 1944) was aged 40, married, had a healthy child of 16, and was an employee of a tobacco factory. He was said to have been always very quiet and reserved, and had no history of mental illness before joining the Army in 1941. He went to the Middle East in July, 1942, and began to feel listless, tired and sleepless for the first time at the beginning of 1943. After spending four weeks in a military hospital he still felt low on returning to his unit, but soon afterwards was full of life; in his own words, “I could tear anything down.” A fresh period of depression set in later, and he was sent to a military mental hospital for six months, during which time he apparently changed several times from a depressive state into a manic one in which he felt “overstowed with vitality,” “with the energy of ten men.” From this hospital he was returned to England and invalided from the army in October, 1943, at which date he first became a patient in this hospital. An initial depression of about three weeks was followed by a manic condition, and on becoming more settled he took his discharge (at the beginning of December, 1943). In February, 1944, he was readmitted in depression, but went out again whilst in moderate mania in April. Whilst at home he continued his work in the factory, but in September, 1944, was once more admitted to hospital and has since remained. From the latter date till October, 1948, depressive periods have alternated with manic conditions. Wide variations have been noted in the duration of the two phases; at the beginning of the observation period of 21 cycles the manic state lasted longer than the depression, whilst in the last year the reverse was usually true. Manic periods varied between one week and 35 days, with an average of 18 days, while the variation shown by depressive phases was between 6 and 24 days, with an average of 13 days.

The object of this contribution is to draw attention to a hitherto imperfectly recognized type of septic infection, which has provided new fields of research, and has shown the way to a fuller appreciation of the ütiological relationship of sepsis and mental disorder.