To demonstrate how 'senile dementia emerged as an important psychiatric concept is not an easy task. Although the history of general psychiatry can be satisfactorily traced to the spirited endeavours of Hippocrates (460–375 B.C.), Celsus (circa 30 a.d.), Soranus the elder (circa 100 a.d.), and Aretaeus (circa 150 a.d.), the psychiatry of old age unfortunately lacks such a clear and well-defined genealogy. The term 'senile dementia’ itself seems to have been first used by Aretaeus, the physician of Cappadocia, but exactly how it had evolved and how it was differentiated, if at all, from normal senescence is not at all clear. Certainly modern psychiatry has inherited a wealth of graphic description of old age in general, and for a detailed account of the relevant ethnographic literature the reader is referred to the excellent article by Rosen (1961). From a scientific point of view, however, it is unfortunate that the spirit of enquiry and the descriptive contributions of the early writers seem to have been tempered more by the degree of optimism or pessimism with which they anticipated the intellectual and behavioural foibles of old age, than by a desire to explore and evaluate systematically its possible deviations.

A thorough and systematic assessment of a patient should lead to a comprehensive diagnostic statement. The first component of this is the multi-axial diagnostic formulation.

Positive change in prescribing practice in psychiatric services can be achieved with participation in the UK Prescribing Observatory for Mental Health (POMH-UK) quality improvement programmes. Key elements are feedback of benchmarked performance for local clinical reflection and customised change interventions informed by the national audit findings and parallel qualitative work. However, progress is gradual and gains generally modest.

The condition of physiological homeostasis results from the maintenance of a steady state for the functions of organs and the levels of different blood constituents, despite the constant variability of other factors from without and within tending to upset that steady state. Most organs of the body show variability and adjustment of their functions in the presence of stresses, but the brain cannot itself make such adjustments. Yet any change in the external or internal environment of the body affects the brain, and particularly the cortex, most severely. Homeostatic mechanisms function as defensive mechanisms, protecting the cortex of the brain from harmful alterations in the internal environment.

Clinicians often assume, in a somewhat casual manner, that injury to the brain at birth has been the cause of this or that case of defect. Cerebral diplegia, hemiplegia, hydrocephaly and numerous types of cerebral maldevelopment have been attributed to this cause. Some American psychologists have tended to ascribe to birth injury every case of defect with plegia (Doll, Phelps and Melcher, 1932). Equally categorical denials of the influence of birth trauma in the aetiology of mental defects have been expressed (Berry, 1933). The decision between these opposing points of view involves the examination of some difficult questions. There are two rather obvious principles to be applied. First, any case in which birth injury is diagnosed must present symptoms or signs, which could reasonably be attributed to this cause. Secondly, a history of events at the time of birth must be ascertained and the evidence carefully weighed with a view to finding out whether conditions likely to produce injury were present. A third point to be kept in mind is that, even when proof of cerebral injury at birth is reasonably complete, the effect of such injury on the intelligence level has still to be assessed. In any given case of defect with a possibility of birth injury, we must ask ourselves what the intellectual level would have been in the absence of such injury.

It has generally been considered by obstetricians and psychiatrists that the insanity of pregnancy, in common with other forms of insanity associated with the reproductive function, offers a favourable prognosis from the point of view of complete mental recovery of the mother. This standard view is to be found in most text-books on midwifery and mental diseases.

Pseudocyesis is an uncommon condition in which the psychological and somatic phenomena are usually thought to arise with neurotic rather than psychotic illness. We report a patient whose pseudocyesis took a course not previously described, culminating in an acute schizophrenic episode. Despite this she demonstrated many similarities with neurotic patients previously described in the literature. A phenomenological explanation, the belief of pregnancy as an overvalued idea, is discussed.

It has been suggested that cerebral noradrenaline turnover in patients can be assessed from the excretion in urine of 3-methoxy-4-hydroxyphenylethylene glycol (MOPEG). Studies were therefore made on the effects of mild exercise on the excretion of the conjugates of MOPEG as this might complicate interpretation. Changes are produced, but there are individual differences between subjects.

Physical fitness was also studied and, although it could not be shown to be the factor explaining differences between different patients, nevertheless it is probably a factor influencing the levels of MOPEG excreted.

The study of the distribution of free MOPEG and its sulphate conjugate in a human brain also raised doubts about the proportions which could have a cerebral origin.

The observations suggest the need for caution in using MOPEG excretion to detect abnormal amine changes in brain. They do not, however, conclusively refute the hypothesis that MOPEG sulphate in urine significantly reflects cerebral noradrenaline activity.

Five cases of Gilles de la Tourette's syndrome occurring in the Chinese are described. The onset, course, symptomatology and family psychopathology are similar to those reported in Caucasians. On the parameters of APGAR score, psychological testing, EEG and psychiatric examination all had at least one abnormality. The response to haloperidol was uniformly good. Follow-up results showed that all were able to lead a fairly normal life after treatment. Though the cases are few in number, the findings seem to support the hypothesis that the syndrome has an organic substratum subject to psychological influences.

Family studies of schizophrenia have indicated familial differences between paranoid schizophrenia and other Kraepelinian subtypes of schizophrenia. Kallmann (1938) noted the lower morbid risk for schizophrenia in the families of paranoid probands as compared to the families of hebephrenic and catatonic probands. This finding was confirmed for siblings by Hallgren and Sjögren (1959).

The immense literature on schizophrenia abounds in discoveries of single associations between the symptoms of the disease and certain other factors. Braithwaite (1960) says in speaking about “science like psychology and the social sciences which make great use of tendency statements… that to assert an isolated tendency statement is to say very little”. Such isolated statements in themselves are not explanations. A theory, on the other hand, interprets information; it explains.

In attempting to resolve the issue of the relative importance of environmental and genetic factors in mental illness migration studies have been inconclusive (Dohrenwend and Dohrenwend, 1969). Among West Indian immigrants an increased incidence of mental disorder as compared to the native population and the population at home has been suggested (Hemsi, 1967). Other workers have attached great importance to environmental factors in explaining the atypical picture of West Indian mental illness (Gordon, 1965; Tewfik and Okasha, 1965).

During the course of a morbidity study in two communities in the town of Croydon, carried out between 1960 and 1962, it proved possible to incorporate an investigation of the shortened version of the Maudsley Personality Inventory (M.P.I.). This twelve-item questionnaire, constructed by Eysenck (1958) for studies of this type, gives measures of neuroticism and extraversion as defined within his personality theory (Eysenck, 1959). Initially the inventory used was identical with that described by Eysenck. After a time (during which test-retest was carried out on 130 adults), however, it was felt that three of the questions relating to extraversion were rather cumbersome, and the following changes were made. Question D, “Are you happiest when you get involved in some project that calls for rapid action?”, was amended to “Are you happiest when you get involved in something that calls for rapid action?”. Question G, “Do you usually take the initiative in making new friends?”, was amended to “Do you usually take the first step in making new friends?”. Question L, “Would you be very unhappy if you were prevented from making numerous social contacts?”, was amended to “Would you be very unhappy if you were prevented from meeting lots of people ?”. It was assumed that these minor alterations would not significantly affect the extraversion scores, and this assumption is borne out by the fact that neither the means of scores nor the test-retest correlations were significantly different on comparison of the two versions. This present study reports the frequency distribution of M.P.I. scores in the population studied and the test-retest reliability of the inventory.