The adult adjustment of children who were partially reared in foundling homes or other child care institutions is largely unknown. There is ample proof that major personality and character disturbances attributed to lack of maternal or emotional nurture appear in many children during or soon after periods of institutional care. Several authoritative reviews of the subject have appeared (Bowlby, 1952; Yarrow, 1961; Ainsworth et al., 1962). The later history of such children is much less clear. Retrospective studies of persons located through psychiatric clinics or delinquent groups suggest that considerable psycho-social disability persists well into adolescence. In particular, shallow feelings and loyalties, inability to form or tolerate emotional relationships, and asocial behaviour are frequently described (Bowlby, 1946; Goldfarb, 1947). However, other evidence supports at least partial spontaneous recovery (Beres and Obers, 1950; Clarke and Clarke, 1959; Stott, 1956). The adult fate of children who receive institutional care, though of compelling theoretical and practical interest, remains speculative.

Many authors, examining personality changes after brain injury, have observed that lesions of the orbital surface of the frontal lobes are more frequently accompanied by emotional changes than lesions in any other part of the cortex. Amongst others, Schuster (1902), Berger (1923), Kleist (1931) and Rylander (1939), have called attention to this fact, and experimental work by Fulton and Ingraham (1929) on cats has established confirmatory evidence. Freeman and Watts (1942), in their study of leucotomized patients observed that, if only the lower quadrants of the white matter in the prefrontal area were cut, the results of leucotomy were better than when the cut was placed in the upper quadrants only. Groups of cases, in whom only the lower quadrants were sectioned, have also been reported on by Dax and Radley Smith (1943 and 1946), Reitman (1946) and Hofstatter et al (1945).

Disorders of the skin, either congenital or acquired, associated with nervous disorders and disturbance of normal mental functioning arc numerous. The classification is very wide-ranging and includes: phakomatoses, hamartoses, adenomatoses and neurocutaneous syndromes. In 1972, Liebaldt and Leiber collected 40 titles of the syndromes, and since then many more reports of the new syndromes and their variants have appeared in the world literature.

This paper reports part of a research into the relationship of certain aspects of mental functioning and the psychiatric illnesses of old age. One of the apparent deficits of function to which much importance has been attached is “memory impairment”. This is commonly considered part of various clinical syndromes, especially of the “organic” mental disorder of the senium. The measurement or estimation of memory function is, therefore, thought to be of considerable importance and most clinicians working with elderly patients use some kinds of tests which purport to measure it. There are, however, some points of conflict between clinical usage and the evidence of objective investigations in this area. It has never, for example, been demonstrated in relation to memory assessment that “memory” as such, can usefully be considered as even relatively independent of intelligence in young normal adult subjects (Eysenck and Halstead (1)).

In 1965 the Education Committee drew up a questionnaire on postgraduate training which was circulated to recognized psychiatric hospitals and psychiatric units in general hospitab. The results have been published in this Journal (November 1968, 114, 1441). The Committee recognized that this method of inquiry was by no means ideal, and in order to provide confirmatory information another questionnaire on postgraduate experience and training was circulated to a group of consultant psychiatrists in the United Kingdom. This group comprised all those who were appointed as consultants in adult psychiatry (including psychotherapy) by public appointment (i.e. not personally upgraded) for the first time between 1 October 1963 and 30 September 1966, and who had six or more N.H.S. sessions. A list of all those consultants who were thought to fall into this group was compiled with the help of Regional Hospital Boards and the Ministry of Health, and 191 questionnaires were sent out, with a request that the form be returned uncompleted if the individual had been wrongly assigned.

“A neuroendocrine hypothesis to explain the clinical activity of convulsive therapy is described. The hypothesis is based on the diabetes/insulin model and suggests that hypothalamic dysfunction with an insuffiency of a mood-maintaining peptide is the basis for affective disorders. Repeated seizures enhance the production and release of the hypothalamic peptide antidepressin – the active principle that relieves both neuroendocrine and behavioral abnormalities.”

The aim of the present study is to compare the mental health of children of schizophrenic mothers born before, during and after the onset of the mother's illness.

During the period 1979–1982 the incidence of suicide and parasuicide for students aged 15–24 years was found to be lower than that of others of the same age in Edinburgh. A comparison of student parasuicides with matched non-student parasuicides shows similar parasuicide repetition rates, but some differences in respect of precipitants (twice as many students reporting no major event prior to the episode), agent of poisoning (analgesics more commonly used by students; hypnotics, tranquillisers and barbiturates, by controls), and social and clinical characteristics (a greater proportion of controls reporting parasuicide in the family, a criminal record and being the victim of violence).

The treatment of mental disorders by drastic methods coming as a “shock” to the patient was applied early in history all over the world (1). The severity of the procedure usually varies with the degree of civilization achieved. The earliest method was occipital branding. Water cures followed later: “The frantic person was placed with his back to the water without being permitted to know what was going to be done. He was knocked backwards into the water by a violent blow on the chest, when he was tumbled about in a most unmerciful manner until fatigue had subdued the rage.” Anglo-Saxon priests used a form of treatment described in Bald's Leechbook: “In case a man be a lunatic take the skin of a mereswine (porpoise), work it into a whip, swing the man herewith, soon he will be well. Amen.” (1).

Plasma growth hormone (GH) release after TRH injection was investigated in 27 unipolar and 23 bipolar depressive women, and in 39 normal female controls matched for age, sex and menopausal status. Peaks of GH secretion after TRH were observed in some depressive patients as well as in some normal controls, but there were no significant differences in GH response after TRH administration between patients and controls. The implications of these findings are discussed in reference to such factors as non-specific stress responses and abnormal neuroendocrine circadian rhythms in affectively ill patients.

Before undergoing interview, parents reported that a computer-assisted interview would lack the friendly and personal approach of one conducted by a clinician but, after completing the interview, parents showed more acceptance of the procedure. Computer-assisted interviewing has the potential to play an important role in the collection of clinically relevant information from both parents and children referred to child psychiatry services.

In two cases of folie à trois, affecting two Soviet-Jewish families who emigrated to Israel, both elderly parents in both cases shared the paranoid delusional beliefs of an only child. Severe trauma in the past and social maladjustment in the present may be among the precipitating factors for the development of the shared paranoid disorder.

A case of childhood affective disorder with episodes of depressive stupor in a 13-year-old pre-pubertal boy is described. Changes in the patient's clinical state were accompanied by changes in the dexamethasone suppression test. A family history of affective illness on the maternal side, with phenomenological similarities, is noted.

When mongolism was first described, it was considered by some authors to be a form of cretinism (Seguin, 1866), and with the discovery of the effect of thyroid treatment in cretinism, this was tried in mongolism also. The disappointing results diverted attention to other endocrines. Tredgold, in 1929, was recommending a mixture of thyroid, pituitary, thymus, suprarenal and pineal glands, though he did not believe that such treatment was curative.

In a pair of male monozygotic twins discordant for schizophrenia, MRI revealed no abnormality in the ill proband, but extensive white-matter damage of likely congenital origin in the psychiatrically normal twin. These findings are difficult to reconcile with multifactorial models of schizophrenia, and raise the possibility that some forms of brain damage may preclude expression of the schizophrenia genotype.

I greatly appreciate the honour which the Society has done me in asking me to read a paper by way of introducing a general discussion on the treatment of mental disorders. My remarks will deal with the relationship of physical disorder to mental symptoms. The main point to which I will more particularly draw your attention is to the need for a closer study of the extent to which mental symptoms are the result of some auto-intoxication or infection from one or other of the free mucous surfaces of the body, the gastro-intestinal tract being, in virtue of its size and function, the most important channel. If the relationship is a close one our outlook on mental disorders necessitates greater attention being directed to the investigation and treatment of our patients with the aid of modern methods, than has hitherto been done. The literature of the subject contains many references of a general kind to what is called the toxic factor in the ætiology of insanity, but the systematic investigation of mental disorders from this point of view has not yet been carried out with the reasonable degree of completeness which modern medicine demands. In this connection it is right to refer to the valuable and suggestive work carried out by Lewis Bruce many years ago, the probable significance and value of which has, I think, been largely lost sight of. There is little new in the conception of the aetiology and treatment of mental disorders, which I am going to present for your consideration. It is, however, largely new in the sense that it has not yet been adequately tested. Prof. Robertson has lately drawn my attention to the interesting fact that the leading alienists in France more than 100 years ago entertained the view that the primary cause of mental disorders was to be found in visceral changes. Pinal in his classical text-book on mental disorders in 1809 wrote as follows:

The introduction of neuroimaging techniques for the study of brain structure and function has revolutionised the endeavour to elucidate the pathology of psychiatric disorder, the Holy Grail in psychiatry (Krishnan, 1990). Emil Kraepelin discovered the two major mental disorders, dementia praecox and manic-depression, and conceived their aetiology in brain pathology. It was Alois Alzheimer, however, his most successful student, who discovered the neuropathology of Alzheimer's disease. Sigmund Freud, who started his inquiries in brain science, lost faith and shifted to the study of the mind. Brain science and mind ‘science’ rapidly became odd bed fellows and parted company. The breakdown in communication fostered a mistrust in both parties, aborting endeavours of reconciliation. The evidence for the neuropathology of the ‘functional’ psychoses has, however, been inconclusive. It was the advent of brain-imaging techniques that rejuvenated brain sciences and modern neurosciences. The introduction of neuroimaging techniques, such as the electroencephalogram (EEG) in the 1920s and the whole-brain blood-flow techniques (Berger, 1929; Kety & Schmidt, 1948), antedated the discovery of psychotropic drugs. Pneumoencephalography was also applied to study brain structure in schizophrenia (Storey, 1966). The true methodological leap, however, was the introduction of computerised methods to construct three-dimensional images from two-dimensional data, enabling the development of computerised tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET) and single-photon emission computerised tomography (SPECT).