The reprinting by the Institute of Psychiatry, on its fiftieth anniversary, of Dr. Peter Scott's paper (1) describing Maudsley's work as a pioneer in criminology reminds us of the prominent part Maudsley played in the debate between psychiatrists and lawyers which has been in progress for nearly a century and a half, with, for much of that time, little satisfaction for either side. It is a classic example of the difficulties of inter-disciplinary communication. My only qualification to be the Maudsley Lecturer is that I happen to be doubly qualified in law and medicine, and, as Chairman of the Institute, a good deal closer to psychiatry than most lawyers. My qualities as an interpreter must therefore make good the intellectual deficiencies of which a glance at the list of my forty-seven distinguished predecessors makes me acutely conscious.

In the preceding paper the effect of experimental distraction was examined and the findings discussed. The present report is concerned with a similar study of the effect of distraction on tests which involve another aspect of schizophrenic performance, that of psychomotor ability. Earlier studies (Chapman and McGhie, 1961, 1962) produced both clinical and experimental evidence that auditory distraction disrupted the motor responses of some schizophrenic patients. As the previous experimental findings were based on two tests involving only very limited areas of psychomotor performance, it was necessary to examine patients on a wide range of psychomotor tests. A second aim of the present investigation was to assess any differential effects due to variation in the sensory modality of the distracting stimuli.

One hundred and sixty Scottish psychiatrists complete a questionnaire eliciting the extent of their use of the term ‘borderline patient’ and the factors affecting this. The term was used by 27.5 per cent, the majority of whom felt that it ought to be included in current diagnostic classification systems. There was, however, general dissatisfaction with the vagueness of current definitions of the term and a confusing use of numerous diagnostic labels.

Use of the term was not related to status, geographical location, or familiarity with American psychiatric literature. The practice of psychodynamically-oriented psychotherapy and extended working contact with psychiatry in North America were found significantly to increase its use.

We have presented a case of folie à deux in which the wife was the primary (dominant) partner and the husband the secondary (submissive) partner. The husband's symptoms seemed to have resolved as his dependency shifted from his wife back to his mother. Treatment is recommended by deliberately shifting dependencies only when there is advantage in doing so. For most patients, the aim should be independence.

An emerging appreciation by practitioners and researchers, long held by patients and carers, is that neuropsychiatric features of dementia and the challenges they present are as important as those of cognitive losses.

Although it is widely believed that behaviour modification is successful in an institutional setting, the lasting efficacy of such programmes for adolescents with acting-out and conduct problems has long been questioned. A follow-up enquiry was carried out at one and two years on adolescent patients who had been through an institutional behaviour modification programme. The results were compared with those obtained for a similar group of patients who were accepted for the programme but not admitted; significantly more of the treatment group than the comparison group had improved in terms of behavioural outcome measures, and their level of independent living was greater.

This issue reports a community-based study quantifying the extent to whichsubthreshold hypomanic or depressive symptoms in childhood or adolescencepredicted subsequent formal bipolar disorder status and mental healthservice attendance. This editorial emphasises the low predictive power ofthe signal and considers early intervention implications.

Jaspers' textbook General Psychopathology has in the past been described as the ‘most important single book on the aims and logic of psychological medicine’ (Shepherd, 1990). In recent years it seems to have rather fallen off the psychiatric syllabus. Its diminished importance is exemplified by changing opinions about delusions. Nowadays, delusions are considered by many to lie on a continuum with normal beliefs, and this model underpins modern cognitive therapy for psychosis (Kingdon & Turkington, 1994). Jaspers, in contrast, considered that delusions were distinct from normal beliefs. This required him to formulate a distinct mechanism of delusions that resembles, to large extent, the concepts of ‘modularity’ proposed by Fodor (Fodor, 1983) (who has not yet entered the psychiatric syllabus!). The continuum model suggests that delusions ought to be treatable. However, trials of cognitive-behavioural therapy for psychosis suggest significant benefit in only about half of patients treated (see Turkington & McKenna, 2003). What prevents therapeutic change along the dimensions of belief in non-responsive patients? One possibility is that Jaspers was right after all. In this month's debate the modular view of delusions is taken by Dr Hugh Jones and the case for a continuum model is argued by Professors Philippe Delespaul and Jim van Os.

Von Winiwarter, in 1879, published his pathological findings in a case in which there was obliteration of the vessels of the leg due, as he considered, to a proliferative process in the intima, that is to say, an “endarteritis obliterans.” Other views on the pathology came to be propounded, notably that of van Manteuffel, who considered that consequent upon arteriosclerosis of the popliteal artery a white thrombus formed, which, spreading peripherally and becoming organized, produced the picture of an obliterative endarteritis. Twenty-five years after Winiwarter's paper Buerger published his observations based on 30 cases, with pathological studies on the vessels obtained from eleven amputated limbs. He disagreed with the views of both von Winiwarter and von Manteuffel. He found that besides an extensive obliteration of the larger arteries and veins there was a varying degree of peri-arteritis and arteriosclerotic thickening of the vessel wall, and concluded that the condition was a thrombotic process occurring in the arteries and veins, followed by organization and canalization, and not an obliterating endarteritis. He absolved the intima from any “considerable role in the genesis of the thrombotic process,” and attributed the thickening of the intima and the cellular infiltration and vascularization of the media and adventitia to the agency producing the coagulation of the blood and to the changes in the thrombus itself. He saw the final lesion as a vessel obliterated by dense connective tissue, canalized, together with some residual cellular infiltration and capillarization of the media and greater or less thickening of the adventitia and periarterial tissues, the thrombus having disappeared in the course of the development of this final result. He proposed the term “thrombo-angeitis obliterans” for the condition, and with the general adoption of the term Buerger's name came to be linked with it.

Since Delay, Deniker and Harl (1952) first reported favourably on the use of chlorpromazine in disturbed psychotic patients the extended use of pheno thiazines has contributed to the transformed atmosphere in mental hospital wards. There is still some doubt as to the precise mechanism of action of the phenothiazines. The blocking of arousal responses to afferent stimulation in animals following chlorpromazine has been fully demonstrated (Bradley and Hance, 1955, 1957). The production in man of a “parkinsoniansyndrome” by chlorpromazine and later phenothiazines has been taken as evidence of drug activity as a basal ganglion level (Kruse, 1957). More recent work suggests that chlorpromazine may act by depressing the collateral inflow into the reticular formation from the afferent pathways rather than the brain stem activating system itself (Key and Bradley, 1958).

This paper reports an attempt to determine the nature of dementia by analysing the results of mental tests applied to groups of patients clinically estimated to be demented in varying degree.

Previous investigations.—The relevant literature concerns the results of mental tests in psychosis and in normal senility. These topics having been recently fully surveyed elsewhere (Brody, 1942a), they need occupy no space here.

The case about to be described showed during the 18 months when she was under close observation certain remarkable pathological endocrine features. These, viewed together and in retrospect, throw considerable light on the relationship between pituitary function and so-called anorexia nervosa, and introduce a broader conception of the latter somewhat misleading designation.

In an earlier study (Stengel et al., 1955), reactions of various types of mental patients to eleven different painful and noxious stimuli were described. Two groups of 54 females and 43 male low-grade defectives were included in the original investigation, but it was felt at that time that the results needed further amplification before they could be usefully commented upon. In this earlier investigation only one of us actually carried out the tests, the reliability of which, therefore, was not clearly established. Furthermore, in the original testing of low-grade defectives no assessment of “Overt Reactivity” was made. As the relationship between this factor and pain reactivity in the other patient groups constituted an important finding of the study, we came to the conclusion that it would be necessary to retest some of the low-grade defective patients with these points in mind. This seemed all the more desirable as it is widely assumed that mental defectives in general, and especially low-grade mental defectives, are grossly deficient in sensitivity to pain.

It is not only the directly observable therapeutic effects of treatment which will determine the value of that treatment—in many cases the accompanying side effects are equally, if not more important, depending upon their nature and severity.