The treponemal serological status of 800 patients above the age of 65 was reviewed. Twenty-one were found to be positive and the venereologists advised against treatment in all referred cases. The question is posed whether syphilis serology screening in the elderly mentally ill should be confined to those patients with obvious clinical manifestation of syphilis or with obscure psychiatric presentations.

The following assessments represent two reviewers' comments on both the original and revised versions of the paper by J. Peuskens on behalf of the Risperidone Study Group. The reviewers were originally anonymous.

The present investigation belongs to a series of studies (1) in which an attempt has been made to contribute to an understanding of the mechanisms underlying those forms of therapy of mental diseases which directly involve physiological mechanisms.† In the previous work an experimental analysis was performed in order to determine the common factor involved in the various forms of so-called shock therapy. It was found that all forms of this therapy produced in the experimental animal an increased reactivity of the centres of the sympathetic system to direct (2) and reflex stimulation (3). Chronic experiments (4) also showed that these alterations in autonomic reactivity persisted for a long period of time if the “therapy” (e.g., electroshock) was applied repeatedly as it is commonly done in the human patient. Special experiments revealed that increased sympathetic reactivity can be demonstrated in the hypothalamus (5).

During the past three years some clinical applications of corticotrophic hormone have been studied, and in this paper is described a form of involutional melancholia in which hypopituitarism and secondary hypoadrenalism are factors. Nine such cases were treated with corticotrophic hormone; in addition two cases of pituitary cachexia in young women were similarly treated.

This paper reports the work of a clinical team on 100 consecutive first admissions to a unit constructed for the treatment of psychopaths at Balderton Hospital, Newark, Notts, and opened 1958–61. To prevent bias all male admission with behaviour disorder admitted between 1958–60 are here reported except: five admitted for observation of less than a week, twenty-two admitted only for remand, and those with a Wechsler or Stanford Binet I.Q. less than 56. The unit specialized in delinquents with mental disorder, and received admissions from all over Britain.

Imipramine hydrochloride (N-(γ-dimethylaminopropyl)-iminodibenzyl hydrochloride, “Tofranil”) has been shown by many investigators to be of value in the treatment of depressive states. The reports of Kuhn (1957, 1958) and of Kielholz and Battegay (1958) have been followed by confirmatory papers from other authors. A number of contributors to the McGill University Symposium on Depression and Allied States (1959) commented favourably on the value of imipramine in depression; Hoff, however, while agreeing that the drug is useful in acute depressions stated that he found it ineffective in chronic depression.

The Children's In-patient Department of the Maudsley Hospital has now been running for two years, and currently accommodates twenty to twenty-five in-patients of both sexes. These range through severe organic disabilities, early cases of delinquency or behaviour disturbances and emotional or psychoneurotic problems. In the under fives there are a high proportion of acute disturbances of behaviour and habits. It is believed that our experience in developing this unit and discussion of our problems solved and still to be met will prove of value to other hospitals planning similar accommodation.

Alcohol-related dementia represents an underrecognised mental disorder with both clinical and public mental health aspects. There is considerable scope for improving its assessment within both mainstream and specialist mental health services, but ongoing challenges remain in ensuring its timely detection so that appropriate preventative and rehabilitative interventions can be applied.

The social behaviour which is the material of psychological observation at any given time is the product of a certain genetic constitution on the one hand, and of a complex process of social, educational, familial and, to some extent, uterine environment on the other. The social behaviour of human beings cannot be subjected to direct methods of genetic analysis. The genetic psychologist may be compared to the astronomer, in so far as he has to rely on Nature to perform the experiments which he himself is unable to undertake. To the category of such experiments belongs the phenomenon of twin production. In the production of monozygotic twins Nature provides us with individuals of the same genetic constitution. Such differences as they exhibit arise uniquely from the operation of differences in the environment in which they are placed. In ordinary circumstances they share many more features of environment than any other two individuals selected at random from the population. When reared together, the extent of their dissimilarity can only throw light on such differences of nurture as may operate on members of the same family unit and of the same age. If they are reared apart, the measure of resemblance exhibited by monozygotic twins may throw light on the influence of social environment in a less restricted sense. With a sufficiently large sample of twins reared apart, a satisfactory standard of comparison for assessing the extent of resemblance due to genetic constitution, plus the effects of a common uterine environment, would be provided by the degree of resemblance existing between their foster sibs in families into which they have been adopted. Such data cannot be collected easily. As yet they do not exist in sufficient quantity to yield satisfactory conclusions.

To our knowledge Pisa syndrome in childhood or adolescence has not previously been described. The syndrome developed in an adolescent girl following administration of neuroleptic medication for psychotic features, and was transiently thought to be abnormal illness behaviour. This case emphasises the need for early diagnosis and rapid effective treatment.

A review of some of the literature concerned with the aetiology of homosexuality shows that certain variables, in particular those involving the relationship between the homosexual and his parents, differ between studies involving populations of neurotic homosexuals and those concerned with non-psychiatric populations. Investigators concerned with the former group (Bieber et al., 1962; O'Connor, 1964; West, 1955), have placed emphasis on the importance of the mother-child relationship, having found this to be abnormally intense in the case of many homosexuals. On the other hand, a well controlled study by Bene (1965), involving a non-psychiatric population of homosexuals, revealed no difference between her homosexual and heterosexual groups as regards maternal overprotection. Her findings caused her to place more emphasis on the father-child relationship.

Despite the advent of the stimulant phenothiazines—effective, sometimes, when older dimethyl compounds fail—a proportion of chronic schizophrenics continue to resist treatment with both types of drug, and also fail to respond to intensive nursing regimes designed to combat the effects of institutionalization. These patients constitute a major therapeutic problem.

Both major classifications in psychiatry have now moved away from the multi-axial nosological model. This is clinically understandable as the specific categorical diagnoses, other than borderline personality disorder and personality disorder ‘NOS' (not otherwise specified) were so seldom used and empirical evidence would not support the polythetic categorical system. As a consequence, those with personality disorders, frequently referred to as Axis II disorders, now have to compete with all other mental disorders for clinical attention.

The assessment of the results of a treatment in any particular disorder is generally a very complicated one, by reason of the fact that the treatment does not usually improve all the manifestations of the disorder, and even when it does so, it does not affect them equally. The case of thyroid medication, which completely eliminates all the manifestations of thyroid deficiency, is an unusual one in medicine. Even where the pathological process may be completely stopped, as in general paresis and pulmonary tuberculosis, the patient may be left with residual loss of function due to irrevocable loss of normal tissue. In some cases the treatment itself may be of such a nature that the patient merely exchanges one disability for another. For example, the treatment of mild diabetes mellitus by a reducing diet may indeed eliminate the diabetes, but only at the cost of replacing it by chronic hunger and social restrictions, which many patients feel are worse than the original disease. In the end, they may give up their treatment. In some cases, the treatment has “complications”, which means to the patient that he merely exchanges one set of symptoms for another. For example, he may exchange the symptoms of duodenal ulcer for those of dumping syndrome.

It is good to be back in the serenity of this assembly after an interval of ten years, but I must ask your forbearance in view of the fact that the topic assigned me today is rather similar to the one I discussed here in 1947.

Figural after-effects are the observable results of a hypothetical process of satiation or inhibition which accompanies and follows the passage of neural currents consequent upon stimulation. Most of the work in this field has been on figural after-effects affecting contours. In this work an inspection figure is fixated for a fairly lengthy period of time; this is then withdrawn and two test figures are substituted. One of these test figures falls within the same area as the inspection figure while the other is well removed from this area. Differences in size between the two figures which are objectively equal are usually observed and are supposed to be a consequence of satiation set up by the inspection figure (McEwen, 1958).