If a person is faced with some potentially frightening task such as making a speech, then the company of a friend, who contributes nothing directly, may improve the delivery of the speech by his emotional support, more traditionally called moral support. It seems the same article as that which ought to be supplied to a child by its parents, to a patient by his therapist, or to a worker by his supervisor so that efficiency can develop and be maintained. However, a therapist or a supervisor may not know when emotional support is being given; sometimes the presence of another person can be embarrassing, and so a normally efficient pattern of behaviour may be disturbed. For this reason an examination of the nature of support seems warranted.

This paper reports a case which is noteworthy for two unrelated reasons, one genetic and the other therapeutic. The genetic interest lies in the rare instance of an identical twin with obsessive compulsive neurosis whose twin brother had a similar illness. The therapeutic interest focuses on clinical changes which occurred during unsuccessful treatment by desensitization and by aversion relief. These changes aid our understanding of compulsive behaviour and the difficulties in its treatment. At one stage in treatment independence was noted between anxiety and compulsions which suggested that compulsive behaviour need not always be maintained by its anxiety-reducing properties. The case history will first be described and discussed from the genetic point of view. The second part of this paper will focus on the unrelated aspect of treatment.

In 1962, Perley and Guze introduced specific criteria for the diagnosis of hysteria based on clinical observations made in 1951 by Purtell, Robins and Cohen. A number of reports have been published since 1962 evaluating the limits and usefulness of these criteria. A recent paper by Guze (1967) summarizes a large part of this work and explores various problems of definition and methodology. In 1968, two papers appeared in this journal evaluating the criteria for hysteria by applying them to women with chronic medical illnesses (Woodruff) and to normal women (Farley, Woodruff and Guze). The present study is an extension of the method used in those reports.

There exists a vast literature on the puerperal psychoses. Most of it is incomplete in that rarely is any definition of the “puerperal period” made; frequently there is no attempt to differentiate between the various clinical syndromes seen when aetiology is considered, and little consideration is given to the extent of constitutional predisposition to psychiatric illness in the probands.

Thought disorder has always been regarded as an important symptom of schizophrenia. Attempts have been made to measure it by means of psychological tests: patients who manifest thought disorder clinically have been found to perform idiosyncratically on tests of concept-formation (1). The purpose of the first part of this investigation was to confirm the already established finding that schizophrenics, as a whole, are more thought disordered than controls. Not only were patients tested, but also their first-degree relatives; this aspect of the investigation, however, will be dealt with in the second part of the paper.

There has been a great deal of argument during the past 30 years about the symptomatic differences between anxiety and depressive states. Mapother (1926) thought that anxiety states should be regarded merely as one of the numerous sub-divisions of the manic-depressive illnesses, since they merged through a series of patients into agitated depression. Lewis (1966) too saw no sharp division between anxiety states and depression and classified agitated depression and anxiety states together as one sub-division of the affective disorders. Garmany (1956, 1958) and Mayer-Gross, Slater and Roth (1960), however, felt that anxiety states and depression were basically different forms of illness.

Barry and Barry (1961, 1964) have reviewed the evidence for an association between season of birth and the major psychoses. Their figures show that, with a single exception, every study has found an excess (though not always a significant excess) of schizophrenic and manic-depressive patients born between January and April, and a deficit born between May and August, compared with the control populations. The single exception was their own study (1964) on schizophrenic patients in private mental hospitals, a finding which led them to conclude either that the private class of patient is protected from some adverse seasonal influence or that schizophrenic patients come chiefly from a subgroup of the population which has a comparatively high birth rate during the first four months of the year. Norris and Chowning (1962) drew attention to the fact that the seasonal distribution of births in a general population may vary appreciably from year to year in a particular country and from place to place within that country in any one year, and suggested that such variations make difficult any comparison between births of patients and of a large general population taken over a number of years, the procedure which had hitherto been adopted.

There has been a tendency to dispose of all the problems peculiar to children under ‘Primary childhood behaviour disorders'. This term would, as pointed out by Cameron (1955), have as broad a meaning as the legal term ‘insane’ or the social term ‘delinquent’. Unless there is delimitation of the terminology used, any aetiological investigation is bound to produce confused results. Furthermore, most aetiological studies suffer from lack of a normal control group and many published works apparently dealing with childhood conditions include adolescents in their case material.

Recent investigations suggest that there may be an abnormality of calcium and magnesium in depressive illness. Flach (1964) followed the urinary excretion of calcium in depressed patients maintained on a constant intake of calcium before and during recovery. Those patients that recovered showed a significant decrease in the excretion of calcium. Coirault et al. (1959) reported an increase in ionized calcium and a decrease in total plasma calcium on recovery from depression. Cade (1964) reported considerably raised total plasma magnesium levels in depressed patients both before and after recovery. A connection between affective disorders and calcium metabolism is suggested by the common occurrence of such states in both hypo- and hypercalcaemia (Denco and Kaelbling, 1962; Rookus and Speelman, 1961). The present paper reports an investigation into total and ionized plasma calcium and magnesium in a group of depressed patients both before and after recovery. The effects of lithium carbonate, a compound used in the treatment and prophylaxis of affective disorders (Baastrup and Schou, 1967; Schou, 1963) on plasma concentrations of magnesium and calcium was also investigated.

Neurosyphilis, causing a psychotic illness of such severity as to necessitate admission to a mental hospital, though now rare, has not been completely eradicated. This study is based on 91 psychotic patients with neurosyphilis admitted to six mental hospitals between 1950 and 1965. Its main purpose is to ascertain the incidence, and to present the natural history of the neurosyphilitic psychoses during a period when antibiotics were available. It is likely that some patients in this series were given penicillin for an intercurrent infection in complete ignorance of the underlying syphilitic process. Indeed, Joffe, Black and Floyd (1968) and Heathfield (1968) have reported modifications in the clinical picture of neurosyphilis, tending to mask the diagnosis, caused by earlier administration of antibiotics for intercurrent infections. Thus the widespread use of antibiotics, though greatly reducing the incidence of neurosyphilitic psychosis, may well have increased the mutability of the disease as reflected in its changing prevalence, distribution and clinical characteristics.

At the close of the last century there began to spread in the field of psychiatry the idea that every specific pathological agent and every individual toxin produced a picture of psychological disorder that was uniquely characteristic of the causative agent. This idea was extensively developed in the work of Kraepelin (1892) and supplanted the view expressed earlier by Morel, who denied the existence of any specificity in psychological disorders related to their aetiology.

A possible association between birth order and schizophrenia has been sought by a number of investigators. The question considered as early as 1916 by Rüdin has not been resolved satisfactorily since; late birth order has been indicated in some samples of patients (e.g. Granville-Grossman, 1966; Schooler, 1964), early birth order in others (e.g. Solomon and Nuttall, 1966; Sundararaj and Rao, 1966) and an absence of any birth order effect has been reported for still other samples (e.g. Burton and Bird, 1963; Gregory, 1959; Smith and McIntyre, 1963).

Virtually nothing is known about the prevalence of mental illness in Ethiopia. The only two mental hospitals, one in Addis Ababa and one in Asmara, caring for about 800 in-patients from a population of 22 million perhaps reflect the type of severe psychotic illness occurring in this country (Pavicevic, 1966). A few authors (Leiris, 1958; Lord, Fuller Torrey, 1966; Messing, 1959; Giel, Gezahegn and van Luijk 1968a and b) mention the existence of psychoneurotic illness, indicating that local cults and native healers play a role in their management. However no epidemio logical survey has been conducted to provide more systematic information. Any attempt at such a survey is bound to meet with consider able difficulties. Hospital statistics regarding admission rates are influenced most of all by economic factors and by distance from hospital, especially during the rainy season when travelling is at times almost impossible.

Systematic psychiatric studies of tattooed men are rare. Lander and Kohn (1943) noted that they had a higher rate of rejection for military service on psychiatric grounds than non-tattooed men. Yamamoto et al. (1963) studied the male population of a Veterans Hospital. They compared the 65 (15 per cent) men who were tattooed with the 368 who were not. They found that the percentage of tattooed men on the psychiatric wards was not significantly higher than that on the general medical or surgical wards; the tattooed men, however, exhibited significantly more evidence of personality deviation than the non-tattooed men.

Section 54 of the Mental Health (Scotland) Act, 1960, enables a court to remand to hospital for psychiatric examination and report persons charged with an offence who also appear to be mentally disordered. This article reviews this section of the Act in its practical aspects as experienced by the consultant staff of one Scottish mental hospital during the two-year period 1965–6.

In recent years, studies on patients suffering from manic-depressive and depressive illness have shown that these patients have certain psychological and biochemical characteristics and also abnormalities in body-build and body-composition. Some of these characteristics are clearly concomitants of the illness itself, as they revert to normal after clinical recovery. However, some remain abnormal even after recovery, and the question arises: are these constitutional characteristics perhaps genetically determined, or are they the persisting result of the illness itself?

The following review deals with all persons remanded for trial or sentence in 1965 and 1966 on whom psychiatric reports were furnished by senior psychiatric staff of Leverndale Hospital, excluding those remanded directly to hospital under Section 54 of the Mental Health (Scotland) Act, 1960, this latter group having been the subject of a previous article by ourselves.

Physicians are often faced with the problem of determining whether long-stay schizophrenics require continuous treatment with tranquillizers. Prolonged ingestion of ataractics has both physical and economic disadvantages. Recent reports on oculo-cutaneous changes (3, 13, 20, 27, 28), persistent dyskinesia (6, 18) and sudden deaths (16, 25) have focused attention on the potential dangers of prolonged use of tranquillizing medication. On the other hand, discontinuation of medication may lead to recurrence of acute psychotic behaviour. The literature on drug withdrawal provides no solution to the dilemma. The results from drug discontinuation studies are complex and contradictory. Some investigators report extremely high relapse rates while others report little deterioration even when drugs are withdrawn for long periods of time. A brief review of the literature will give some indication of the contradictory nature of results.

The purpose of this paper is to report on therapeutic measures which have been used on my Unit at the Maudsley Hospital for several years and have been gradually elaborated with the help of registrars who have learned to apply them under my general supervision. The measures are derived from the therapeutic technique Freud recommended. In 1913, when he reviewed the development of his technique, he said: “In the earliest days of analytic technique we took an intellectualist view of the situation. We set a high value on the patient's knowledge of what he had forgotten, and in this we made hardly any distinction between our knowledge of it and his…. We hastened to convey [it] to the patient in the certain expectation of thus bringing the neurosis and the treatment to a rapid end.

Emotionalism, occurring as excessive or inappropriate weepiness or laughter, is a common and distressing symptom of the pseudobulbar state. It interferes with conversation, is socially embarrassing, and occurring during eating or drinking can be dangerous, particularly so in a patient already dysphagia Preliminary and uncontrolled use of imipramine in a few cases of this condition impressed us with its efficacy, and we therefore engaged in a “double-blind” form of therapeutic trial, comparing two dose strengths of imipramine with phenobarbitone and dummy tablets given in random sequence to each patient. Our favourable impression of imipramine being confirmed, we then attempted to assess the effect on this symptom of two other drugs of related pharmacology.