This paper describes the social and clinical progress of a group of male schizophrenic patients who left London mental hospitals during 1959 and were followed up for one year. The study was designed to test specific hypotheses concerning the association between family relationships and the course of the patient's illness (Brown et al., 1962).

From a review of the literature Carstairs (1959) demonstrated that the sharp rise in admissions to mental hospitals since the Second World War has been due to the changing pattern of use of these hospitals, and not to any significant change in the prevalence of major mental disorder. The present paper examines statistics relating to admissions to Scottish mental hospitals in general, and to Dingleton Hospital in particular, in the 15 post-war years 1945–1959, with the object of showing some of the ways in which the character of admissions to mental hospitals has changed over that period.

In recent years it has become widely known that behaviour therapy (conditioning therapy) is effective in the treatment of neuroses. However, in many minds, this knowledge has come to be hedged by some erroneous qualifications, of which the commonest are: (a) that behaviour therapy leaves the “deep” cause of neurosis untouched, and (b) that it is successful with “monosymptomatic” and allegedly simple cases like phobias, but not with more complex neuroses, such as obsessions and “character neuroses”.

To Shakespeare's famous question: “Can'st thou not minister to a mind diseased?”, Eysenck (10) gave a decided negative answer. Hebb (11) has also asserted that “There is no body of fact to show that psychotherapy is valuable”. From 1954 onwards, Rogers (12) has taken up the challenge and shown that changes occur in psychotherapy which do not occur without it, and has suggested that these changes are valuable.

Many of the changes which make up the revolution in the treatment of the mentally ill in large hospitals in recent years have been facilitated by the use of new drugs, the tranquillizers. A patient who takes his tranquillizer responds better to other treatment, the staff becomes more friendly and helpful: such an anti-vicious cycle hastens recovery. A patient who refuses to take his medication in tablets or capsules is given it in liquid form, the ingestion of which can be more easily checked.

Although the number of anti-depressant drugs available has grown rapidly in recent years, they are still broadly classified into three main groups. First are the general nervous system stimulants, exemplified by amphetamine, second the group derived from the phenothiazines exemplified by imipramine and third, the monoamineoxidase inhibitors—the first example of which was iproniazid. The general stimulants have many disadvantages, their place in treatment is limited, but fairly well defined. Many monoamineoxidase inhibitors have been found to have serious toxic effects, but some, including tranylcypromine appear to be reasonably safe and effective (Agin, 1960).

Haloperidol is a drug that fulfils Delay's criteria of a neuroleptic in that:

1. 1. It inhibits psychomotor agitation without producing sleep.

2. 2. Alleviates psychomotor manifestations.

3. 3. Produces with increasing dosage characteristic extrapyramidal signs.

Ataractic drugs have been the mainstay of treatment in schizophrenia for the last eight years. Since their introduction, mental hospitals, in various areas of the United States and in every country, have been able to discharge more patients than they admit. Despite this fact there remains much divergent opinion about the value of these drugs, doubt arising from inconsistent therapeutic results and the relapse rate. Also, some double-blind studies have cast some doubt upon the efficiency of these drugs. We are reporting this relatively small study because we feel that it opens an insight and possibly suggests a method of standardizing treatment in the near future.

This study is concerned with the relationships between TAT measures of Organization and Hostility and scores on Progressive Matrices (PM), Age and Stay (time in hospital) in a schizophrenic sample.

A fundamental area, if not the fundamental area, of psychological disturbance, according to classical Freudian psychoanalysis, as is well known, is the fear of being castrated. According to Freud (10; 11, p. 267) this is a fear of being castrated by the father as a reprisal for incestuous desires toward the mother. So closely is the fear of castration related to the father that Braatøy (4) has suggested that it be renamed “father anxiety”. None the less, the concept of the castrating mother also plays a prominent role in psychoanalytic literature. De Monchy (7) Blos (2), Fairbairn (8), Klein (18), and Bergler (1) are among those who have most emphasized the fear of the mother.

In studies of the incidence and prognosis of disease in the elderly it is valuable to have an objective measure of the patient's mental state. In a previous paper (Isaacs, 1962) a paired-associate verbal learning test devised by Inglis (1959) was applied to a group of 50 normal and 100 hospitalized old people, and was found to give useful information on the relationship between test performance and such factors as incontinence of urine and prognosis for rehabilitation. In the present study a simplified version of this test was performed on a larger number of elderly hospital patients. The test proved valuable in determining the characteristics of patients with varying degrees of mental impairment.

Early in our clinical studies with the phrenotropic drugs, reserpine and chlorpromazine, we observed that psychotic patients receiving them were more resistant to treat for infectious processes that occurred during their hospitalization (Saunders, 1961). We also observed that in experimental animals, the LD50 of a standardized dose of bacteria was significantly increased if the rats had been previously treated with a phenothiazine. Preliminary observations led us to consider the role of these drugs in protein synthesis, with specific interest in the gamma globulin, since antibodies are associated almost exclusively with this fraction. Further interest in the problem of protein synthesis was stimulated by the reduced albumin and increased globulin levels found in most chronic psychoses, as the phrenotropic drugs are capable of significantly shifting this ratio toward normal. The question of phrenotropic drug action on antibody synthesis was asked at the Second International Congress of Psychiatry in September, 1957, and no specific information was known to the participants (Saunders, 1958). With this background, the question warranted further study in man. We designed our experiment to measure antibody response to oral poliovirus vaccine, Cox strains types 1 and 3, during phenothiazine therapy.

Many authors have observed a decrease in glucose-tolerance (G.T.) in melancholia (sec reviews by McFarland and Goldstein, 1939; Altschule, 1953). Using an intravenous test, the present author confirmed that G.T., and also body weight, were significantly lower in a group of depressions than in a matched control group (Pryce, 1958a), but that within the depressions G.T. was not related to body weight. In a subsequent study also (Pryce, 1958b) change in G.T. after treatment was not related to change in body weight nor to three measures of change in emotional state. These studies, therefore, failed to support the views that the decreased G.T. in depressions is related either to nutritional or to emotional factors.

Interest in the acid base metabolism in mental disease has existed almost as long as the relevant estimations have been available to clinicians. In the period from 1920 to 1938 many careful and accurate determinations of the factors involved were carried out, both in Europe and the United States of America. The results, while being sometimes equivocal, for the most part showed that there was no demonstrable change between those suffering from schizophrenia or depression and a normal hospital population. Since 1938 little interest appears to have been taken in the hydrogen ion concentration of the blood and the pCO2 in mental disease. During recent years great progress has been made in the apparatus for the determination of blood pH and pCO2 and fairly recently it became possible to estimate the first of these three places of decimals with a reproducibility of 0·005 of a pH unit and an equivalent accuracy for pCO2. In view of this great improvement in the apparatus available, it seemed worth while to estimate the blood pH and pCO2 in a large number of chronic mentally ill patients. The facilities and the patients were available in Hollymoor Hospital, so we decided to see whether with the much more delicate instruments now available it was possible to demonstrate any significant difference in the blood pH and pCO2 between schizophrenics and other mentally ill patients.

Several investigators have attempted to relate cerebral activity to extraversion and neuroticism. These include Berger (1933), Jasper (1937), Gottlober (1938), Henry and Knott (1941), Knott (1941), Darrow (1947), Lindsley (1950), McAdam and Orme (1954), Gastaut (1957) and Brazier (1960). The results, however, have been inconclusive.

Kallmann (1953) studied the differences between uniovular twins discordant for schizophrenia and found there to be a definite superiority in physical strength and body weight in the unaffected twin. This paper is concerned with some aspects of the growth of psychotic boys, to determine if the inferiority noted by Kallmann is generally detectable.

This report refers to investigations on a group of children in Smith Hospital, Henley-on-Thames (O'Gorman, 1958). Smith Hospital is a long-stay children's psychiatric unit, predominantly for children diagnosed as psychotic and requiring hospital care. In particular, children are admitted where it is thought that the home environment is a factor in the maintenance of the child's psychosis or where the child's disturbance is such that the parents are no longer able to cope with it.