It has been shown by Parkes (1) and other workers that about 45 per cent. of out-patient schizophrenics are unreliable at taking their phenothiazine medication. It is in this group that many relapse and require readmission to hospital. Kline (2) quotes that 20 per cent. of in-patients are also unreliable in this regard. With the advent of a long-action phenothiazine injection fluphenazine enanthate, control of these difficult patients may well prove more effective.

Ireland has the highest rate of hospitalized mental illness on record. This is borne out both by the World Health Organization figures for treated mental illness (W.H.O., 1961), by international comparisons of point prevalence rates (Arentsen and Strdmgren, 1959) and by consideration of first admission rates (Hammer and Lcacock, 1961). The Irish national figures for each of these measures were respectively 7·12, 10·81 and 1·45 per 1,000 population in 1959. The rates exhibit a distinct geographical pattern within Ireland: they are highest on the coastal areas furthest from Dublin, while in the Dublin area they are as low as those of most western European countries. All three measures have risen over time, and the intercounty variation has also increased since 1900. In 1959 the coefficients of variation for both first admission and hospitalization rates were equal to 25·1 per cent.

The search for objective indices in diagnosis and prognosis of patients suffering from mental illness remains a matter of great clinical interest. While advances in this field have been reported from time to time, no method has become unequivocally established, and in affective disorders much interest has focused on the possible link between mood and physiological change. Cannon's work on the “Bodily Changes in Pain, Hunger, Fear and Rage” (1920) indicated the breadth of this relationship and gave impetus to attempts at rating emotional responses by the severity of their accompanying autonomic changes. Papez (1937) also emphasized that “emotion is such an important function that its mechanism, whatever it be, should be placed on a structural basis”. While this is being sought currently in the limbic system, reticular formation and hypothalamus, the importance of the autonomic system as effector pathway of physiological responses accompanying emotional states has in no way diminished.

Biochemical studies on the urine of schizophrenic in-patients and out-patients have shown the drug rejection rate to vary from 5 per cent. to 32 per cent. in the U.K., U.S.A., and U.S.S.R. (3, 4, 8, 9, 11, 12). Even higher rejection rates (70 per cent.) were found with depressed out-patients (12), and high rejection rates have been found in antenatal patients prescribed ferrous sulphate, out-patients supposedly taking P.A.S. for their tuberculosis, and patients on drugs for rheumatoid arthritis (1, 2, 5, 6, 7).

The view that depersonalization experiences can “be regarded as occupying a position somewhere between the delusional and the non-delusional” was first suggested by Ackner (1954) who gave as an example the depressive's experience of malaise. If this is accepted into the normal framework of experience it will be attributed to illness or fatigue. If it is accepted and organized into a delusional framework, the depressive delusion that the body is rotting away (for example) may be exhibited. If, however, the experience cannot be accepted into either a normal or a delusional framework it will remain peculiar, foreign, strange, and unreal and will appear as depersonalization. Ackner commented that if delusions should develop, experiences of change “will tend to be included” within them, and thus not appear as depersonalization. Discussing depressive depersonalization in particular, he considered that “with delusional development, the unreality feeling tends to recede”.

This paper reports primarily the use of the MWLT (Walton and Black, 1957) on aged subjects with a variety of clinical conditions. Earlier studies by Walton (1958), Walton, White, Black and Young (1959) and Walton and Mather (1961) demonstrated that the MWLT identified over 80 per cent. of organics without any misclassification of non-organics. More recently, Orme, Lee and Smith (1964) found that 81 per cent. of organics were correctly classified, but only 69 per cent. of non-organics. Misclassification was particularly serious with schizophrenics (70 per cent.). Other reports, including Newcombe and Steinberg (1964), White and Knox (1965), have found as few as 47 per cent. of the organic group correctly classified. These recent studies cast some doubt upon the original claims of the MWLT as a diagnostic test of generalized brain damage. We hope to present further evidence on the efficiency of the MWLT; particularly on its use with elderly subjects.

Benzhexol hydrochloride (Artane, Pipanol, Trihexyphenidyl) was the first of a range of synthetic antispasmodic drugs to be made available for the symptomatic treatment of Parkinsonism. Selected as the most potent of a series of substituted piperidyl propanols examined pharmacologically by Cunningham et al. (1949), it was shown to have half the activity of atropine sulphate in inhibiting neurogenic spasm in isolated rabbit intestine. This activity was associated with advantageously reduced mydriatic, anti-sialogogic and vagal inhibitory properties in laboratory animals.

There is evidence that the susceptibility to certain diseases varies in people of different blood groups. Associations have been claimed to exist between the ABO blood groups and diseases such as duodenal ulcer, carcinoma of the stomach, pernicious anaemia, diabetes mellitus, and rheumatic fever. The most convincing evidence for an association between a blood group and a disease is that of the increased frequency of group O in patients with duodenal ulcer (Aird et al., 1954), and also an increased frequency of non-secretion in the same disorder (Clarke et al., 1956).

The essential function of the clinical psychologist, from the point of view of society as a whole, must be to make available to the Health Service the contribution of the science of psychology. This means much more than the kind of sophistication which stems from an experience of psychiatric disorder and from a study of the psychiatric literature. We will now consider the implications of such an approach for the three main aspects of clinical work: assessment, modification, and research.

Previous assessments of nortriptyline (Bennett, 1962; Rose and Leahy, 1964) have suggested that it has useful anti-depressant properties, and a preliminary trial in which the present authors were involved (Rose et al., 1965) found that it compared sufficiently favourably with amitriptyline to merit further controlled study.

Twenty chronic patients, group 1, entered a hospital factory unit for one month and received varying increases of pay. They were compared with three control groups, each of ten patients. Thus group 2 received increases of pay similar to those of the group entering the factory, but remained outside the factory unit. Another, group 3, had already been in the unit for several months, and were discharged from the unit into other hospital employment for one month without change of pay. Another, group 4, remained in the factory throughout with no change of pay. Forty per cent. of each group was female. The control groups were matched with group 1 for age, duration of stay and group test results. Ranges and averages were: age, gp. 1, 36–66, 52·1, gp. 2, 34–65, 50·1, gp. 3, 38–68, 50·5, gp. 4, 21–63, 46·1; duration of stay, gp. 1, 1–35, 17·6, gp. 2, 3–27, 14·0, gp. 3, 2–32, 12·6, gp. 4, 2–27, 13·9 years. The distribution of patients between hospital wards was the same in each group. Eighty per cent. of each group had a diagnosis of chronic schizophrenia. Eight patients from group 1 and four from each of the control groups took part in an additional group discussion with one of the experimenters during the month trial period. A list of different topics were worked through, e.g. driving, smoking, taking risks, etc., and photographs from the 1963 Year Book and coloured advertisements were used, preferences and associations being asked for with each topic.