Perhaps in no other applied discipline are there to be found so many differences of opinion as exist in clinical psychology today. Clinical psychologists in fact even disagree about the fundamental approach to their own subject. Let us examine briefly what appear to be the major approaches.

Nicotinic acid, well known physiologically and chemically as a vitamin if administered in small quantities, has many interesting additional properties when given in relatively large amounts. Altschul (2, 3) found that it markedly decreased the levels of cholesterol in rabbits made hypercholesterolemic by diet, and Altschul, Hoffer and Stephen (4) found that in divided dosages of three grams per day this vitamin produced appreciable decreases in the cholesterol levels of healthy young subjects and in patients from a general hospital. The decrease was related linearly to the initial cholesterol levels while the percentage decrease increased as the initial cholesterol levels were elevated. The incorporation of nicotinic acid into atherogenic diets inhibited the development of arteriosclerosis in rabbits (Altschul (2)). Of seventeen animals tested, two showed intense arteriosclerosis, six showed mild change, and nine showed no arteriosclerosis. Without nicotinic acid, at least thirteen of the rabbits would have had severe arteriosclerosis on the basis of many previous studies by Altschul (2) and by many other investigators.

During recent years various tranquillizing drugs have been used therapeutically, namely, chlorpromazine hydrochloride (Largactil), reserpine (Serpasil), benactyzine hydrochloride (Suavitil) and hydroxyzine (Atarax) in mental disorders. Chlorpromazine and reserpine, though effective to a certain extent in mental disorders of the disturbed type, have the disadvantage of certain side-effects which have necessitated reduction and even cessation of the drugs, even when proving clinically efficacious.

It is now generally conceded that slow wave activity tends to appear in the EEG as age advances. Attempts have been made with varying success to relate these slower rhythms to the presence of organic cerebral deterioration.

In a previous report (Cole and Glees, 1956) on methyl-phenidate (Ritalin) as an antagonist to reserpine (Serpasil) in monkeys we referred to a similar effect produced by amphetamine. Following up this work we have now studied and compared the effects of methyl-phenidate and amphetamine when given separately without reserpine to normal and leucotomized monkeys.

Bickford has underlined the need for devoting more attention to the chronic psychotic patient and stressed the possibility of accelerating what he believes to be the inevitable remission of the psychosis. There may be a current tendency to think in terms of the physical or pharmacological treatments in handling psychotic patients and to overlook the value of more conservative measures. Myerson attempted to revive interest in the latter by coining the term “total push” and providing a theoretical basis for the activities organized. Galioni et al. presented the results of a similar programme which showed 18 · 5 per cent. of the experimental group “separated” from the hospital as compared with 5 per cent. of the controls. Kamman et al. show that while the initial improvement certainly takes place, unless careful placement is achieved relapse occurs.

Experimental work on the performance of schizophrenic patients indicated that different patterns of response were to be found among patients who could be considered subjectively as withdrawn and inert on the one hand, and sociable and active on the other. This subjective classification appeared to cut across diagnosis within the schizophrenic group.

A Multi-Dimensional study of a consecutive series of female patients, aged 40–55,in whom psychiatric illness necessitated first admission to a mental hospital, has already been reported in its general and clinical aspects and in relation to the psychological test findings.

The frequency with which new drugs become available to the psychiatrist emphasizes the need for quantitative evaluation of their therapeutic effect. Comparable statements, scales of measurement and base-lines are required (Ref. 1–6).

It has now been established that megaloblastic anaemia may develop in patients receiving the anti-convulsant drugs phenytoin sodium (“Epanutin”) and primidone (“Mysoline”), given alone or in combination with phenobarbitone. Hobson et al. (1956) found 16 such cases described in the literature, and reported a case of their own in which megaloblastic anaemia developed in a patient addicted to a preparation (“Tuinal”) containing equal parts of amylobarbitone sodium (“Sodium amytal”) and quinalbarbitone sodium (“Seconal Sodium”), which are closely related chemically to primidone, sodium phenytoin and phenobarbitone. Characteristically the anaemia is not related to a deficiency of nor does it respond to treatment with vitamin B12, nor is there achlorhydria, thus distinguishing it from true Addisonian pernicious anaemia. The condition however responds promptly to the administration of folic acid by mouth.

Ritalin (methylphenidate) is a drug which was developed by the firm of Ciba Limited. It resembles amphetamine in its central stimulant and sympathomimetic action but has quite a different chemical structure. Its general properties have been described by Meier et al. (1954) and by Drassdo and Schmidt (1954 a, b). Geller (1955) and Stier (1955) used Ritalin in the treatment of depressive states associated with apathy, while Ferguson (1955) found it of value in countering the depressive effects of reserpine therapy. Ferguson also notes that Ritalin seemed to have a beneficial action in cases of chronic schizophrenia and considered that his findings warranted a clinical trial.

Anthropometry has benefited in the last 20 years from two distinct advances, the use of standardized photography by Sheldon (1940) and the application of factor analysis to physical measurements as initiated by Burt (1944). Tanner in a critical review (1947) compared these two main approaches to interpretation of body type. Later (1954) he defended photoscopic somatotyping against the charge of subjectivity in ratings by stating the degree of consistency obtained by experts, although such consistency is admittedly less common among less expert somatotypists. Factor analysis can claim some theoretical advantages, and certainly greater mathematical exactness than photoscopic typing: but here the question arises as to whether the measurements so far employed for factor analysis yield the best information; statistical treatment by itself, however sophisticated, is no substitute for the best or right choice of measurements.

Pacatal is one of the newer so-called tranquillizing drugs. It is a synthetic phenothiazine derivative—N-methyl-piperidyl-(3)-methylphenothiazine which was first investigated in Germany in 1954. It has the same basic structure as chlorpromazine but a different side chain.

Some years ago we began to evaluate steroidal compounds in the treatment of mental states and now report some results obtained with 6β-hydroxy-3:5-cyclopregnan-20-one (I), the most promising of the compounds studied.

We preface this short communication by emphasizing that it originates as a by-product from some work that is still in progress at the Burden Institute on the balance of electrolytes in various normal psychological and neurotic conditions. This research is chiefly being conducted by McLeod, Morrison and Fosbrooke, in the Biochemical Department, and Grey Walter in the electrophysiological laboratory.