Of recent years a considerable amount of study has been devoted to the nerve changes which are to be found in sane patients dying during the senile epoch, but comparatively little has been written concerning the alterations which occur in the nervous system of aged insane individuals. The object of this communication is to attempt from the pathologist's standpoint to elucidate some of these characteristic senile phenomena. I propose to briefly describe the morbid changes, both macroscopical and microscopical, which in my experience occur in aged insane persons, and to conclude by offering some remarks on the pathology of certain of these phenomena which I have particularly investigated. Before proceeding further, I would mention that the entire material for my observations has been afforded by the Lancashire County Asylum, Rainhill, and to Dr. Wiglesworth, the Medical Superintendent of that institution, I am indebted for permission to make use of that material and the asylum records in the compilation of this paper. My investigations have extended over a period of 18 months, and comprise the partial examination of the nervous system of all patients over 60 years of age who have died since my appointment as pathologist to the asylum. Of such cases θere have been 22 males and females their average age bone a matter of difficulty. In cases where no adhesion exists and the calvarium is readily removed, a slackness and dimpling of the dura mater—particularly of the frontal area—is generally seen, and proclaims an atrophy of the enclosed parts. The subdural hæmatoma or so-called pachymeningitis interna hæmorrhagica, so frequently met with in general paralysis of the insane, is not uncommon in senile insanity. Of 54 cases of that affection observed by Dr. Wiglesworth1 in this asylum, 12 occurred in patients over 60 years of age, while in a series of subdural hæmatomata collected by Sir J. Crichton-Browne and Dr. Bevan Lewis2 at the Wakefield Asylum, nine per cent, occurred in cases of “pure senile atrophy” of the brain, and 26·5 per cent. in cases of “chronic disorganization of the brain” (which, I take it, includes many senile cases); and, lastly, of the 50 cases of senility which I have examined, four presented this condition. The subdural fluid is invariably increased in quantity. The arachnoid membrane, particularly that covering the sulci and meningeal veins, is generally opaque, and the pacchionian bodies hypertrophied. A subarachnoid hæmorrhage I have only seen in one case, viz., in a demented female, æt. 78, who a few days before death suddenly became partially paralyzed in the extremities of the right side. At the autopsy an extremely wasted brain with a great excess of cerebro-spinal fluid was found, and lying in a hugely dilated subarachnoid space, situated at the point of junction of the horizontal limb of the intra-parietal sulcus with the post-central sulcus on the surface of the left hemisphere, was about 1½ ounces of dark, clotted blood and sanious serum. This was obviously pressing upon subjacent parts of the ascending parietal, superior parietal, and supramarginal convolutions—hence the paresis. The source of the hæmorrhage was not discovered, but that it issued from a ruptured, small pial vessel was doubtless. Further, that the hæmorrhage had actually occurred into the subarachnoid space was undeniable, as the stretched arachnoid membrane was clearly distinguishable confining it, and on the surface of the underlying cortex, which, by the way, was not lacerated, the delicate pia mater could be plainly traced. in fact, can often be detached in one sheet, but it does happen in some cases, especially if the brain be somewhat decomposed, that its removal is accompanied by a decortication exactly similar to that which is described as characteristic of general paralysis. In all the senile brains which I have examined there has been more or less atrophy and decrease in weight, and in some cases it has reached an extreme degree, leaving thin convolutions, and wide, shallow, gaping sulci. The frontal segment invariably suffers most, and the cerebellum and the mesencephalon participate in the wasting. The following table shows the average weight of the various parts of the brain in the cases I have examined:—

The widespread use of group treatment as one of the modern methods of psychotherapy has provided us with an opportunity to study psycho-social phenomena in a fairly uniform social setting.

A unique case of a homicide committed by a young male psychotic inpatient on a fellow-patient is reported and discussed with regard to the special victim-offender relationship, the relationship between suicide and homicide, the phenomenon of aggression and the question of the management of a highly suicidal psychotic patient, including the issue of continuous observation.

Extrapyramidal symptoms, including oculogyric crisis, are well recognised side-effects of clopenthixol medication, but precipitation of prolonged oculogyric crisis on addition of nifedipine to an ongoing clopenthixol regime has not so far been reported.

An 18-year-old male, originally diagnosed as suffering from infantile autism but with a developmental history and clinical picture in keeping with Asperger's syndrome, and showing current signs of impairment of higher cerebral functioning, is presented. The subject and several males of his family present behavioural disturbances of an enduring type. An aminoaciduria was discovered in the subject and his father. A possible relationship between the metabolic disturbance and the neurological and behavioural disturbance is raised. Mechanisms for this relationship are discussed, including sporadic hyperlysinaemia.

Weckowicz (1960), using pictures of common objects with superimposed lines, found that schizophrenics were less able to see the hidden figures than normal subjects and other patients. Unfortimately the task turned out to be too easy; most of the normal subjects and more than a third of the acute schizophrenics obtained the maximum possible score. Such a distribution of scores makes it difficult to carry out further analysis of the results. The aim of the present study was, using a more difficult task to obtain a better distribution, to confirm the lowered capacity of schizophrenics and to relate it to other variables. The task used was the ‘Gottschaldt Figures Test’, published by the University of California Institute of Personality Assessment and Research. This consists of the identification of two simple geometrical figures embedded in complex designs. The score (maximum = 20) is the number of figures correctly identified on two sheets, 2 minutes being allowed for each sheet. To ascertain how this task is ‘normally’ related to certain major personality variables, a group of neurotic patients was used, since they would not be expected to have any special disability on a task of this type.

When a frequency distribution of motor vehicle accidents in any particular group is analysed, there is found to be a number of individuals who have a greater proportion of accidents than can be explained by chance alone. Research on the psychology of accident causation has been aimed largely at isolating particular personality characteristics which seem to be associated with high accident liability. However, the results from past research have been far from encouraging. Very little has been conclusively proved regarding the bearing of any one attribute on the accident rate, and there is still no single specific factor that is psychometrically capable of being identified as a predictor of accident liability.

The relationship between ordinal position of birth and mental illness, and particularly schizophrenia, is a familiar issue to regular readers of this journal. Its significance rests mainly in the fact that on genetic grounds each ordinal position of birth in a sibship is equally vulnerable. Therefore conclusive evidence of a positive relationship between birth order and mental illness, while not excluding the importance of hereditary factors, offers a good indication of the operation of some, possibly early, familial environmental influences.

There have been numerous psychotherapeutic approaches (e.g., total push, community therapy, token economy, buddy system, etc.) advocated for hospitalized chronic schizophrenics. Although these programs have had relative success in producing improvement in at least some of these patients, it remains to be demonstrated whether this improvement is due to the specific nature of these programs or to certain non-specific factors, such as attention and/or structure, common to all psychotherapeutic interactions.

Questionnaire replies from 43 experienced psychiatrists showed wide variation in the ways they would manage a common type of neurotic problem. There were considerable differences in the nature and duration of treatment and in the use of other members of the psychiatric team. The conclusions have implications for training and for the use of health care resources.

Over the past three years, progress in the molecular genetics of familial Alzheimer's disease has been fast and fundamental. The seminal finding that some cases are due to a mutation in the β-amyloid precursor protein (APP) gene has been followed by the discovery of a major additional locus for the disease on chromosome 14. The combined data suggest that the genetic sites accounting for most early-onset familial Alzheimer's disease cases have now been located. In addition, research is revealing the mechanisms by which the genes exert their pathogenicity. This promises to provide the explanatory link between the genes and the clinicopathological syndrome. The ultimate goal, an understanding in similar terms of the much commoner senile, sporadic form of Alzheimer's disease, is now a realistic target.

Platelet monoamine oxidase (MAO) activity was studied in 33 in-patients with bipolar and schizoaffective disorder who were treated with lithium. Platelet MAO activity was found to increase following 10–41 days of lithium treatment compared to a prior drug free period, and the increase was positively correlated with the duration of lithium treatment. The increase in platelet MAO activity was not correlated with clinical improvement as measured by the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment Scale (GAS). The number of platelets per unit of blood was also significantly correlated with the number of days of lithium treatment. However, the increase in the number of platelets in lithium-treated patients was not correlated with the increase in MAO activity and thus appears not to account for it. These results indicate that studies relating platelet MAO activity to psychiatric diagnosis should be interpreted cautiously if patients are receiving lithium carbonate.

Greiner and Nicolson (1965) put forward the hypothesis that schizophrenia was associated with a state of increased melanogenesis which they attributed to a biochemical defect in the pineal gland. Isolated literature reports had documented the occurrence of hyperpigmentation in schizophrenia. These observations might be relevant, as the neurone and melanocyte have common features: both are ultimately derived from the neural plate; both require tyrosine as precursor in the biosynthesis of their specific products (catecholamines and melanin respectively); and many neurocutaneous diseases show coexistent neuropsychiatric and pigmentary disorder.

The first part of this study of female monozygous twins discordant for childbirth covered intrapair differences before pregnancy (Kaij and Malmquist, 1970). This part is focused on the influence of motherhood on health, presented as intrapair differences in gynaecological, other somatic, and psychiatric morbidity after pregnancy.