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.

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.

A diagnosis of personality disorder is commonly used in psychiatry. It is generally agreed to refer to a disorder manifested by limited adaptive flexibility and certain relatively fixed ineffectual modes of behaviour (Ausubel, 1961; Brody and Lindbergh, 1967; DSM II, 1968; Noyes and Kolb, 1958; Schneider, 1950; Small, Small, Alig and Moore, 1970; Walton, Foulds, Littman and Presly, 1970). However, of twenty or more different types of personality disorders only antisocial personality has been differentiated by rigorous criteria as a distinct diagnostic entity (Robins, 1967; Feighner, Robins, Guze, Woodruff, Winokur and Munoz, 1972; Robins, 1966).

In this study an attempt was made to relate personality as measured by the Middlesex Hospital Questionnaire (Crown and Crisp, 1966, 1970) to selected psychosocial characteristics of undergraduates in residence, the majority of whom were between 18 and 22 years of age. Individual questionnaires were sent out. Just under 50 per cent of the questionnaires were returned, and the present analysis is based on this sample.

Historical Background

Asthma is an illness which has puzzled our profession since earliest times. Each generation has based its concept of aetiology on current concepts of disease, so that delving into its history shows a colourful pattern of widely conflicting views.

Early in this century Osler (1910) is in favour of a nervous cause, though he pays little attention to treatment on psychological lines. After that date there is a procession of changing viewpoints.

In the second decade, anaphylactics, according to Conner (1917), have cracked the hard core of the aetiological riddle, but Eppinger and Hess (1917), writing of vagotonia, correlate this with the asthmatic attack.

Freeman (1921) writes of precipitating nervous reflexes. Bray (1934) is convinced that the allergist holds the key to solution. There is emphasis on allergic diathesis and an hereditary asthmatic constitution.

Wittkower (1935) showed that asthma might have a purely psychological conditioning. Since that time, belief in the importance of the psychological factor is still gaining ground.

The theme of the present communication arose from research of Bostock and Shackleton (1951, 1952) on the aetiology of enuresis. There emerged the concept of premature toilet training interfering with later development of urinary control. It suggested that a study of asthma in its early stages might show an interference in the normal process of respiratory and speech maturation.

As will be shown, there is a similarity, although the mechanism is more complicated.

Failure of treatment does not necessarily mean inappropriate treatment; it must first be ascertained that the treatment has been carried out. Increasing attention is being paid to this question in regard to drug therapy with estimations of blood and urine levels. Patients who fail to get better after leucotomy may have been unsuitably chosen; they may also fail to get better because the aim of the operation, namely to sever the thalamo-frontal radiations, has not been achieved. Neuro-anatomical studies have long suggested that not only do many patients remain with these tracts intact following a blind operative approach but that there is also great variability in the size and position of the lesions produced, a consequence of unreliable surface markings, brain fibre elasticity, complicating haemorrhages and progressive gliosis. The blind approach is no ideal surgical method, since it results in a largely fortuitous lesion (Meyer and McLardy, 1948, 1949; Beck, McLardy, and Meyer, 1950; Eie, 1954; Meyer and Beck, 1954). There is even a gross discrepancy between the actual and desired point of insertion of the leucotome (Dax, 1943). Whilst the effects of misplaced cuts have been studied by these workers, one can only guess what proportion of clinical failures can be attributed to misplaced cuts and what proportion of successes follow misplaced cuts (Meyer and Beck, 1954). Appeals for further studies with post-mortem correlates have been made by these authors.

In peripheral hospitals and their crowded outpatient clinics many neurotics are treated, sometimes for a number of years, with sedatives or tranquillizers, a few words of sympathy and encouragement and, often electroplexy. The reasons often given for failure to offer psychotherapy are that it is of doubtful benefit or that it is too time-consuming.

So many new compounds are now being introduced for the treatment of psychiatric disorders that it is difficult for the clinician to assess the accuracy of the claims made for them. If a form of therapy is one hundred per cent. effective in a disease which was previously one hundred per cent. fatal, for example vitamin B12 in pernicious anaemia, the question of a controlled trial does not arise. But even the manufacturers do not claim such a degree of effectiveness for drugs advocated for the treatment of mental illnesses, and in addition the natural course of such illnesses is very variable, so that it is essential that clinical trials of these drugs should be controlled. Foulds (1958) has reviewed British and American clinical trials of drugs in psychiatry during the years 1951 to 1956, and has shown that the less controlled a trial, the more likely it is to result in a favourable report on the drug being tested, presumably because of bias on the part of the clinician. Forrester (1958), however, on the basis of a completely uncontrolled trial of Stelazine on only twenty-five patients, concluded that “the amount of improvement in a few cases was not sufficient to encourage the further use of the drug”.

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.

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).

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).

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.

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).

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.

Psychiatric research has elucidated many unrecognized facts, and added much to our knowledge of the causes of criminal behaviour in mentally abnormal persons. At the same time the fluidity of modern psychiatry, itself evidence of progress, makes it difficult always to present simply and clearly modern views in a court of law. “”

Multiple deficiencies of vitamins and trace metals have been demonstrated in Down's syndrome. The picture is complex, especially since not all individuals are affected equally. Deficiencies are not age-related, but appear to be lifelong. The brain in Downs's syndrome does not develop adequately; one area, the hippocampus, which is concerned with memory, is poorly developed and is also involved in the pathological changes of Alzheimer's disease. The role of nutrients is discussed in relation to damage to the mature brain, and to the ageing process.

The reports on the good effect of L-DOPA on Parkinson's syndrome and on some forms of depression have prompted us to investigate if it might alleviate mental disorders not responding to conventional methods. Pare et al. (1962) suggested distinguishing between types of depression according to how they respond to antidepressant drugs. If L-DOPA were shown to be effective, it would provide another means of differentiating between obscurely defined mental states. We present five cases of psychic disorders in which depression was a prominent symptom. All were treated with L-DOPA after a wide range of conventional treatments over many years had proved of little use.