Since the introduction of penicillin into therapeutics the important question of the penetration of the blood-brain barrier by the antibiotic in infections of the nervous system has cropped up. In vital staining experiments Goldman (1913) observed that the acid semi-colloidal dye, trypan blue, which makes its way from the blood into the tissues, is unable to penetrate into the central nervous system. When the dye was injected into the cerebrospinal fluid it passed without difficulty into the brain substance. These observations were later verified by other investigators and have been verified for other substances (dyes, drugs, toxins, etc.).

The aim of the study was to explore the way psychiatric symptoms might influence independent psychiatric assessment of outcome one year after stereotactic subcaudate tractotomy. In a sample of 34 patients consecutively accepted for psychosurgery the results showed that both ‘good’ and ‘poor’ outcome groups improved overall. No patients were significantly worse and the symptoms which improved most were nervous tension, depressed mood and somatic anxiety. It was not possible to identify symptomatic predictors of outcome because the preoperative symptom profiles of both groups were so similar. The reason why symptomatic outcome is so variable despite a basically identical psychosurgical technique is discussed.

The studies to be discussed were carried out within the framework of the Personal Construct Theory, as proposed by G. A. Kelly (4) and summarized by Bannister (1), and follow the line that thought disorder in offspring may be related to some kind of thought disorder in parents (2,6).

We have recently demonstrated that some patients with atypical bipolar affective disorders, characterized by psychotic manias and depressions, have fluctuating and episodic high urinary phenylethlamine (PEA) excretion. We treated a 30 year old woman, who has this disorder, with 200 mg/24 hours of carbidopa. Her psychosis was ameliorated and the urinary PEA output stabilized to a low normal level. Upon withdrawal of carbidopa her psychosis worsened and improved again when carbidopa treatment was reinstated. Carbidopa did not affect the duration or severity of the patient's mood cycles.

To make a comparative study of the fatiguability of chronic schizophrenics and non-psychotic depressives and to test Kraepelin's hypothesis that schizophrenia is typified by rapid and acute fall-off in work performance (Kraepelin, 1910). Kraepelin's explanation of the cause of this fall-off was in terms of constriction of volition. However, on the basis of operational definitions, there appears to be little justification for regarding the phenomenon as other than a special case of fatiguability.

The effects of apomorphine, a stimulant of dopamine autoreceptors, were studied in 12 chronic schizophrenics on neuroleptic treatment; both subcutaneous and intravenous administration were used. Apomorphine has been reported to have therapeutic effects in previous studies but, we were not able to confirm any significant and specific differences in psychotic symptoms or tardive dyskinesia scores with apomorphine administration, compared with placebo. These results do not support the importance of dopamine autoreceptors in the regulation of schizophrenic and dyskinetic symptoms in chronic neuroleptic-treated patients.

The discovery that iproniazid benefits certain subjects with depression, linked with the demonstration that it inhibits the enzyme monoamine oxidase (MAO), led to the hypothesis that inhibition of MAO was the essential mechanism by which iproniazid caused relief of symptoms (Pletscher, 1959). Iproniazid, unfortunately, can produce serious toxic effects, particularly on the liver (Pare and Sandler, 1959), and this has limited its clinical application. For this reason a search has been made for MAO inhibitors with an effective anti-depressant action yet without the serious toxic effects of iproniazid. Among the newer compounds for which such claims have been made is N-isonicotinoyl (-N-N-benzylcarboxamidoethyl) hydrazine or Nialamide.

Economic evaluations of new and existing pharmaceutical products are an essential input into decision-making in health care. Health care systems around the world face steady increases in the total cost of pharmaceuticals. Increasingly, health care funders have to choose which drugs are subsidised and which are not reimbursed from public funds. In psychiatry, a number of new pharmaceutical products have recently been developed for the treatment of depression and schizophrenia which cost considerably more than traditional pharmacological products. Governments and purchasers, with limited budgets and expanded demands for funding, require pharmaceutical companies to demonstrate the cost-effectiveness of their new therapies. It is no longer sufficient to consider the clinical or therapeutic effects of new drugs: purchasing choices are predicted on studies which identify, measure and value what is given up when a product is used (the cost) and what is gained (improved health outcome).

A marked elevation in human growth hormone (GH) following intravenous infusion of thyrotropin releasing hormone (TRH) was seen in three of seven adolescent male schizophrenic patients receiving neuroleptic drugs, and in one of five controls matched for age, sex, and developmental stage, receiving the same drugs. A positive family history for schizophrenia was noted in all three schizophrenic ‘responders' but in only one of the remaining patients. The response patterns of thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4 following TRH infusion were not significantly different in the two groups. No significant correlations were found between T3, T4, TSH, or GH response patterns and age of patient, duration of illness, medication dose or duration, weight change, or hours of sleep preceding testing.

I propose in this lecture to pass in review the various forms of insanity which you find in the Table, and by a brief reference to their history and symptoms to show you how they really are distinct forms of disease, and that in each or nearly so there will be found some peculiarities in the symptoms or progress of the case which render it somewhat different from other forms of insanity; such in fact as in many instances would lead you to detect the cause, and such certainly as to justify us in classifying it as a distinct form of insanity.

Gilles de la Tourette's syndrome (GTS) is a relatively rare neuropsychiatric disorder characterised by multiple motor tics accompanied by vocalisations. It usually starts in early childhood and is more common in males than females. Obsessional compulsive disorder (OCD) is an integral part of GTS (Robertson, 1989). GTS is also associated with coprolalia, copropraxia, and other echophenomena, as well as attention-deficit disorder, self-injury, and other behaviour problems (Robertson et al, 1988; Robertson, 1989). Family pedigree studies have demonstrated that most GTS cases in the community are mild and do not receive medical attention (Kurlan et al, 1987; Robertson & Gourdie, 1990).

This paper describes a comparison of two therapeutic regimes for depressive illness: (a) imipramine, and (b) a preparation containing amitriptyline hydrochloride and perphenazine in the ratio 25:2 (Triptafen-DA).

A sample of chronic schizophrenic patients from an urban community, living outside hospital, were reassessed on the Present State Examination one year after a first examination. During this time their use of psychiatric hospital services was recorded. One hundred and two patients had satisfactory interviews on both occasions. These could be divided into Heavy, Medium and Light users of services, the numbers being 8, 14 and 63 respectively, while 17 only saw their general practitioners or had no treatment. A ranking of the sample in terms of severity showed no correlation with use of these services; second PSE scores were not significantly different from the first. Heavy and Medium users of hospital services were in contact with Social Services to a significantly greater extent than other patients.

Despite available therapies, mental disorders are the predominant chronic diseases of young people. Increasing the validity of descriptive psychiatry is now essential. Mathematical approaches can help characterise clinical phenotypes and aid both causal research and therapeutics in the community and the clinic.