The year 1957 heralded a significant advance in the treatment of depressive states. It was then that Loomer et al. (1957), and Crane (1957), published their findings on the use of iproniazid, and Kuhn (1957), published his findings on the use of imipramine. Iproniazid was the first of a series of monoamine oxidase inhibitors which were rapidly developed and used in the treatment of depressive states. In the last few years, their use, especially in “endogenous” depression, has been eclipsed by the iminodibenzyl derivatives; first imipramine, then amitriptyline and later the demethylated derivatives, desipramine and nortriptyline. However, the later monoamine oxidase inhibitors are still widely used, especially in “reactive” depression and some neurotic states.

Three cases of a misidentification syndrome are presented. In this syndrome, which may be Capgras' or a new syndrome that we refer to as delusional gross replacement of inanimate objects, patients believe that their new possessions are replaced by inferior copies of the original objects by identified individuals. The patients believe that these individuals want to enhance themselves at the patients' expense, and feel persecuted by them.

Schizophrenia still offers the psychiatrist one of his greatest challenges, in spite of the volume of research that has been lavished on it, and the many important therapeutic improvements that have been achieved.

During the course of the psychoanalytical treatment of patients whose morbid jealousy is of the non-psychotic type it is possible to identify the unconscious causes of the pathological mental state. This material can provide an insight into the unconscious determinants of the contents of delusions of jealousy.

The diagnoses given to samples of 1,000 first admissions to English mental hospitals in 1977 and 1980 were compared in order to find out how much influence the 9th revision of the International Classification and its glossary had had on the diagnostic habits of English psychiatrists since its introduction in January 1979. Although the differences between 1977 and 1980 diagnoses were modest they were greater than those found in an earlier comparison of 1968 and 1971 diagnoses, before and after the introduction of the 8th revision. Comparison of all four sets of diagnoses, from 1968 to 1980, revealed some serial changes in the categorization of depressive illnesses and a slowly increasing familiarity with the ICD. Although a higher proportion of diagnoses used the nomenclature of the ICD in 1980 than in previous years, this was mainly because the ICD had adapted itself to the habits of English psychiatrists rather than the other way about.

In recent years workers in the area have reached and secured several points of critical importance in the aetiology of schizophrenia. Studies carried out on children bora to schizophrenic mothers but separated from them at birth or in early infancy have established that genetic factors play a major role in the disease (Heston, 1966; Karlsson, 1966; Rosenthal et al., 1968). The index children in these studies become schizophrenic at roughly the same rates (10–15 per cent) as children reared by their schizophrenic mothers and much more commonly than control children separated from non-schizophrenic mothers early in life and placed through the same agencies to comparable foster or adoptive homes.

Testing the null hypothesis has been the cornerstone of much statistical theory and practice over the last few decades. During this time it has encroached on most disciplines and become widespread in use within them. There are now few research papers in the scientific literature where the outcome of one or more hypothesis tests is not reported. With this ‘progress' there has undoubtedly been an improvement in the way in which data have been collected, analysed, and interpreted, and a move towards more objective evaluation of study results.

Ninety-two children who had been examined in a psychiatric study of five to twelve year-olds in long-term residential care were followed up four years later. Three-quarters were still in children's homes, but over half had been moved to different establishments. At both the original study and follow-up, the majority showed evidence of psychiatric disorder. Considerable continuity of behavioural pattern was found, particularly amongst those who originally had antisocial disorders, who were also most likely to have had changes of care-taker during the four years. It is suggested that the persistence of their disorder may be due to a vicious circle of unacceptable behaviour and adult rejection.

Psychiatrists have been interested in the terminal stages of schizophrenia for many years. The attempt to distinguish different lines of evolution for this mysterious illness has unfortunately not been very successful. One can only agree with Henri Ey, who said, ‘… the final stages (of schizophrenia) are not the clinical expression of well-defined types, of real entities. They are organized forms in the schizophrenic catastrophe, forms of liquidation of the bankrupt psyche, which depend less on a specific process than on its psychodynamic vicissitudes.’

Treatment by convulsion therapy implies the administration of analeptic drugs in massive doses to induce major epileptiform convulsions. Usually a single convulsion is induced on each occasion and this is done two or three times weekly. The number of convulsions varies greatly in different cases, but is commonly from five to twenty.

In a paper published in the Journal of Mental Science for July, 1950, I suggested that head-banging originated in the infant's desire to reproduce the thrust of the mother's apex-beat against his head while he was being nursed on her left arm, either as a means of self-comfort or in retaliation for what he had felt to be an attack or as both combined. In the present paper I propose to analyse this infantile experience further, and to trace to some of its component elements certain other peculiarities of childish behaviour.

I shall begin by considering the case of a bottle-fed baby, that is to say, one who at every feed is held in his mother's left arm with his right temple against her left breast (and I shall suppose that the mother is not herself a case of dextrocardia.) In addition to the teat in his mouth and the milk being swallowed, such an infant feels the thrust of the mother's apex as a series of taps against his head which tend to impart to the latter a rolling side-to-side movement, he hears her heart-beat as a rhythmic lub-dup, he feels the rise and fall of her chest in respiration as a slower to and fro rocking of his whole body, and he hears the sighing rustle of her breathing beneath his ear. The sound and thrust of the heart-beat are of course louder and stronger at the limit of the mother's expirations, and indeed the tap of the apex may be felt only then. In other words, the suckling hears two separate series of interwoven unsynchronized rhythmic sounds continuing throughout the whole of his feeding times. In addition to all this, he feels the warmth of the maternal body, the steady clasp of the mother's arm, he smells the milk and the woman's body odour (sweaty, or scented by her soap and talcum powder), and lastly, he feels (and may smell) her breath as an intermittent warm breeze on his face and in his hair. The mother seldom speaks while she is feeding her baby, and the room is often quiet, mother and child being alone together. A breast-fed baby also feels smooth warm skin under his fingers, but he has the mother's heart against his head, during only half his feeding times.

The other occasions on which a woman commonly holds a child firmly against her breast are, of course, when she is trying to comfort a crying baby, or to restrain a struggling toddler from escaping to some forbidden activity. Here the child is angry and the mother herself often either anxious or angry or both, so that her heartbeat is greatly increased in force, and the furious infant feels it as a series of aggressive blows on his head, each of which is accompanied by a bumping noise.

Clouding of consciousness is a common feature of organic psychoses. It may be of any degree of severity from acute delirium to some diminished capacity for clear thinking and impairment of retention for recent experiences. However, such a diminution in the level of awareness also occurs occasionally in “functional” mental disorders; severe and rapidly evolving attacks of mania or depression may be associated with some degree of clouding of consciousness, and Meduna in some recent papers (Meduna and McCulloch, 1945; Meduna, 1950) has redirected attention to “oneirophrenia,” an acute psychotic disorder originally described by Mayer-Gross (1924) in which clouding of consciousness is the general rule.

In the following paper a case of état dysmyélinisé of the globus pallidus, or as it is often synonymously called, “Hallervorden-Spatz disease”, will be presented. Records of thoroughly studied cases of this condition are still rather scanty and there is much need for a systematic extension of experience, the more so since, as Helfand (16, 17) has recently pointed out, progress in the elucidation of the condition has not always been enhanced by generalizations from findings based on too small a case-material. We are happy in having at our disposal the vast resources of the London County Mental Hospitals. It is hoped to follow up this paper by publishing further cases of a rather different nature, though with some characteristics in common with the case described here.

The present paper is a forerunner of what is hoped may be many devoted to psychiatrical material by experimental psychologists of the Spearman School of Factors.

Many phenothiazine derivatives are no. in use in the treatment of schizophrenia. We, in this hospital have used Largactil extensively and more recently Stemetil in the management of chronic schizophrenia.

Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.