“The great majority of physicians, including our own specialty, have written off frontal lobe surgery as a therapeutic weapon for any illness short of chronic major psychosis.”

The proven effectiveness of electroconvulsive therapy (E.C.T.) and antidepressant drugs has lately led to a resurgence of interest in the treatment of depressive states. Amongst the principal problems currently confronting the clinician, the following would seem to be particularly pertinent: should E.C.T. be used in preference to drugs or vice versa? Which drug is to be preferred? Can drug response be predicted? How long should drugs be given? When are drugs contra-indicated? Given in maintenance dosage after a depressive episode, do antidepressants lower the rate of relapse? This paper, the third report on an investigation of the effectiveness of amitriptyline (‘Tryptizol’, ‘Elavil’, ‘Tryptanol’) and imipramine (‘Tofranil’) in depressive states, sets out to answer the above questions in the light of the results that were obtained.

Roth and Rosie (1953) discussed the beneficial effect of E.C.T. in a wide range of psychoses complicated by clouding of consciousness, including syndromes of frankly organic origin. The treatment has been used effectively for psychotic symptoms in G.P.I. (Ewald and Haddenbrock, 1942; Bini, 1947; Solomon et al., 1948; Yaskin, 1948; Kalinowsky, 1949; Lopez Ibor, 1950), pellagra and pernicious anaemia (Fernandes and Polonio, 1946). It is perhaps not surprising that a search through the literature has failed to bring to light a case of stupor subsequent to a head injury being treated with E.C.T.

Retrospective and prospective studies of personality development each have their own strength and weaknesses (1, 3). However, as parental recall of the characteristics of their children when younger is so inaccurate (10), certain developmental questions require longitudinal study in order to avoid the biases inherent in the retrospective method (6).

Current planning in the field of the community mental health services places considerable emphasis on the after-care of patients discharged from hospital. This is partly in response to the high re-admission rates experienced as a result of the “revolving door” policy, partly to a scepticism about the present state of knowledge regarding factors amenable to primary prevention techniques, and partly to a belief that keeping the patient in the community is in itself beneficial both to the patient and to the community. The benefits of such a policy are felt to lie in avoidance of institutionalization and furthering of rehabilitation, and in preventing a re-distribution of roles within the family to exclude the patient. The primary purpose of the policy is not necessarily to cut short the illness of the patient, at least as measured by time under treatment, and evidence will be given below to suggest that in fact time in treatment is prolonged. This study focusses on one issue. Can aftercare in fact prevent re-admission to hospital to any significant extent? In view of the complex nature of the decision to select which patients are to receive after-care and which not, a factor in itself likely to prejudice any results, successive discharges from a psychiatric hospital falling within selected categories were randomly allocated to psychiatric after-care and to their general practitioner, and followed for a six-month period. A null hypothesis was set up that the re-admission rate during the follow-up period would not significantly differ in the two groups.

In a previous paper (Kay, Beamish and Roth, 1963) we studied the prevalence of various kinds of psychiatric disorder in a random sample of old people living at home in Newcastle upon Tyne. During the interviews, special attention was paid to the collection of social data. For, as Townsend (1957a) pointed out, old age is an epoch of diminishing social contacts and domestic support, and isolated old people make disproportionately heavy demands on the institutions of the Health and Welfare Services. By comparing the medical status and social circumstances of subjects with organic brain syndromes, those with functional disorders, and those without psychiatric abnormality, we have attempted to explore further the relative importance of these factors in the two main groups of mental disorders in old age.

Family psychiatry has the primary aim of studying the inter-relationship of mental health and disorder within families and using this knowledge in the treatment and prophylaxis of mental illness in the different family members.

Attempted suicide has been described as “one of the most disturbing and costly abnormal behaviour patterns in our society” (29). Various suspected predisposing factors have been extensively studied, including physical and mental illness (e.g. 24, 17, 11, 25, 6), alcoholism (e.g. 19, 8, 3, 12), interpersonal conflicts (e.g. 10, 30, 14), old age (e.g. 15, 34, 23), and social isolation and degeneration (e.g. 7, 28, 33).

The conjunction of hypothyroidism and mental illness has been of great interest to psychiatrists for almost a century. Sir William Gull (1873) noted mental changes in his original description of hypothyroidism, as did Ord (1878) when he coined the term myxoedema. Savage (1880) reported the first patient with myxoedema to be found in a mental hospital population.

Complaints about lack of sleep are frequently made by patients diagnosed as depressed, and various recent studies have examined this symptom by attempting to measure sleep either objectively or subjectively. In the former approach bed movements have been recorded by Cox and Marley (1959), Hinton and Marley (1959), and Hinton (1961, 1962), while Oswald et al. (1963) have based their work on EEG changes during sleep. Since lack of sleep is essentially a personal experience, most of the objective data have been combined with subjective records, such as patients' descriptions of sleep, patients' and nurses' ratings of sleep, patients' estimates of length of sleep and nurses' observations of length of sleep. Isaacs (1957) comments that no one method used alone provides a satisfactory estimate of the hypnotic properties of drugs.

It is widely recognized that somatic complaints are frequently encountered in depressive illness and in some instances these may predominate in the clinical presentation. Studies relating to the occurrence of such symptoms in depression have been reviewed by Cleghorn and Curtis (1959), who point out that in a number of patients mood disturbance may not be readily apparent. It is not unusual for these patients to be referred initially to a general medical or surgical clinic, where after investigation it is concluded that their complaints cannot be understood in terms of physical disease (Stoeckle and Davidson, 1962).

Whilst it is well known that drugs can cause behavioural changes (Trouton and Eysenck, 1960) relatively little attention has been given to the effects of drugs on complex cognitive functions. The purpose of this study was to determine the effects of two drugs frequently used in psychiatric treatment (chlorpromazine and chlordiazepoxide) on performance in problem solving situations as well as in tests involving speed and accuracy.

The diagnostic classificatory system in use in modern psychiatry appears to be the product of countless acts of “subjective factor analysis”. Psychiatrists have observed that particular symptoms tend to occur in clusters, and these clusters have been labelled and given a status akin to that of disease entities in general medicine. It is a continually developing empirical system, and it is customary to reexamine such systems periodically to assess the state of current practice and its validity.