Addictions are highly prevalent in bipolar disorder and greatly affect clinical outcomes. In this editorial, we review the evidence that addictions are a key challenge in bipolar disorder, examine putative neurobiological mechanisms, and reflect on the limited clinical trial evidence base with suggestions for treatment strategies and further developments.

Psychodynamic psychiatry makes a significant educational, scientific and therapeutic contribution to contemporary psychiatry. Recent developments in gene–environment interaction, neuropsychoanalysis and the accumulating evidence base for psychoanalytic therapies and their implications for practice are reviewed.

Lesbian, gay, and bisexual (LGB) young people have been found to be at greater risk of suicidal behaviour. National prevention strategies have identified the need to reduce suicide risk in this population. However, research on specific risk factors for LGB young people that might inform suicide prevention programmes are at an early stage of development.

Cortisone therapy has been claimed to produce favourable results in clinical schizophrenics (Cohn and Karnosh, 1951; Cohn et al., 1953). Rees and King (1952) carried out a controlled investigation on the effects of Cortisone given in moderate doses over a four-day period to a group of schizophrenic patients and found no significant changes in symptomatology, behaviour or in a series of psychological and physiological tests.

In a personal communication Dr. Cohn suggested that Cortisone given in higher doses over a longer period would probably be therapeutically more effective in chronic schizophrenia.

The present paper describes a controlled investigation into the therapeutic effects of Cortisone given in high dosage over a relatively prolonged period.

7044 is a new phenothiazine derivative which can be regarded, pharmacologically, as resembling chlorpromazine much more closely than it does promethazine. It is said to have the characteristic central properties of chlorptomazine more highly developed, and in addition anti-adrenaline properties with anti-histamine properties comparable to those of promethazine. On a theoretical basis it might have the clinical indications of chlorpromazine.

The problem of estimating objectively the value of any new form of treatment is constantly presenting itself in all branches of medical work. In the case of shock therapy applied in the treatment of mental disease, the task is especially difficult. Standards of initial severity and degrees of improvement in mental diseases are subject to very wide interpretations. Disagreement on questions of diagnosis is common even among psychiatrists who employ the same terminologies. Thus, it is not surprising to find that widely divergent claims have been made about the value of shock treatment in mental diseases. In most of the large surveys, patients have been classified as (i) Recovered, (ii) Much improved, (iii) Improved, or (iv) Unimproved after shock treatment, but little unanimity about the results has emerged. In Table I, the figures given by Malzberg (1938) and Pollock (1939) for New York State and those for Ohio, given by Bateman and Michael (1940), are compared with figures obtained in a survey of the Ontario Mental Hospitals in 1941.

While the best accounts of anxiety appear in the French literature, which contains a number of monographs on anxiety (19, 23, 32, 34, 40), psychoanalysis regards anxiety as the primitive reaction of the pain principle, and deals with it in a fair proportion of its investigations.

It is interesting to recall that fifty-five years ago Maudsley wrote as follows:

Therapeutic convulsions were introduced by Meduna in 1934, but it was not until the latter part of 1938, after many thousands of fits had been induced all over the world, that spinal injuries were first recorded (Wespi, 1938; Stalker, 1938). The reason for this is not far to seek; it lies in the fact that these injuries are for the most part symptomless, and consequently to be found only by means of routine radiographic examinations. In 1939 alarming reports of the high incidence of compression fractures following induced convulsions were published, and the possibility of subsequent permanent disability led in many hospitals to the abolition of a very useful form of treatment.

Though twelve years have now passed since the first prefrontal leucotomy was performed, the status of this form of therapy is still far from settled. There are some who would never perform the operation at all; and some who would reserve it for the chronic sick; while others (Fleming, 1944) would advise its use at an early stage in the illness in cases where there were reasonable grounds for believing that recovery would not otherwise occur. With opposition of a purely emotional kind, the profession as a whole need hardly concern itself; for appeals that the integrity of the nervous system be maintained at all costs are unlikely to impress those whose daily work brings them into contact with the personality degradation of chronic mental illness. It is difficult to see why interference with the brain in order to save sight or to save life in the case of tumour should be regarded as either more or less wicked than interference designed to save human reason.

This report concerns 100 patients treated by prefrontal leucotomy. The technique employed has followed that of Freeman and Watts.

In the case of the 47 manic-depressive patients treated the prognosis without operation was considered very poor. The majority (34/44) had failed to respond to electric convulsive therapy, which was contra-indicated in the remainder by reason of physical health. Seven out of these 47 cases had been in hospital under two years, but there was a history of many years' poor social adaptation or recurrent mental illness. The average duration of illness in the recovered cases of this manic-depressive group was 31 months. That of the failures 45 months.

In this short paper I have no idea of adding one to the already too numerous class-names of insanity, but I am anxious that asylum physicians should have their attention called to a clinical type of disease which may exhibit mental symptoms, and may thus add to the small store of useful knowledge of the subject.

Before proceeding with the subject of this paper, it is my very great privilege to extend to the distinguished members of the Royal Medico-Psychological Association the cordial greetings of my own Chief of Service, Dr. W. Parsons, the Commissioner of the New York State Department of Mental Hygiene, who has long held in high respect his European acquaintances in the field of psychiatry; in particular, those residing in the British Isles. For purpose of clarity it should be explained that the Department of Mental Hygiene is a branch of the State Government, and the Commissioner is charged with the execution of the laws relating to the custody, care and treatment of the insane, mental defectives and epileptics in all public and private licensed institutions.

Atkinson (1971), in his chapter studying the role which coroners and research workers play in defining suicide, noted that by 1927 Hans Rost's bibliography of suicide cited nearly 4,000 works on the subject, while 2,000 further publications were listed by Schneidmann and Farberow between 1927 and 1961. He had personally traced another 300 studies subsequently. In the face of this vast output one hesitates to add yet another paper. However, historical surveys of popular views on suicide have received relatively scant attention, much of the most valuable work being carried out by historians.