Many studies show that incidence and prevalence rates of schizophrenia are related to the social characteristics of the patient's environment; hypotheses—such as that of social isolation—have been invoked to account for the association, but for the most part remain unconfirmed. That the symptoms of schizophrenia or that the clinical form of the illness may also be affected by environmental factors is less clearly established. Nevertheless, some interesting observations have been made, by Benedict and Jacks (1954) and by Yap (1951) for example. Sherman and Sherman's (1934) study of delusions in a mixed American population is probably the most detailed investigation of this kind. They found that American men formulated their grandiose delusions in terms of wealth; foreign-born males did so more often in terms of literary or artistic abilities; and in negroes a religious component tended to predominate. White women were less grandiose and more paranoid than men; but in negro women the reverse was found. Hallucinations were more common in women than in men, and far more common among negroes than whites. Somatic delusions were found more frequently in white than in negro families.

The trainee psychiatrist usually looks upon patients' relatives as a nuisance. Later, he realizes that an essential part of psychiatric treatment is to mitigate the effects of the patient's illness on his family, and to protect him from injudicious interventions on the part of his friends. Finally, it may occur to him that the patient's illness might be causally linked with recent or past psychological disturbances of close associates. A review of recent researches into the relationship between illnesses of individual patients and psychological disturbances in the people around them (Post and Wardle, 7) revealed that much of the work was inconclusive, largely because the investigators had been prematurely preoccupied with some theoretical issues of interpersonal psychiatry. It was, therefore, decided to approach the subject from a practical, clinical angle.

Many investigators have pointed out the social and psychological meanings of broken homes and their effects on individuals' behaviour. Goldfarb (3) stressed the importance of normal parental relationships both in ego formation and in the transfer of ego functions from parent to child. Thompson (16) maintains that the loss of a familiar perceptual framework may be as equally important as the loss of a love-object. Bowlby (2) points out that love deprivation and superficial relationships frequently lead to maladjustment and delinquency. Kardiner (4) emphasizes the importance of the social and cultural values of tender emotion as the basis of social cohesion and culture. Several research workers have found high incidences of broken homes among schizophrenics (Pollack et al., 10; Lidz, 5; Oltman et al., 8) and among neurotics (Madow and Hardy, 6; McGregor, 7). Other research workers have been concerned with the incidence of broken homes among individuals who attempt suicide (Palmer, 9; Reitman, 11; Sainsbury, 12; Batchelor and Napier, 1; Stengel and Cook, 14; Walton, 18; Teichner, 15; Toolan, 17; Simon, 13). However, the majority of the latter group of studies have lacked comparative control groups. The present study investigates several factors of social disorganization which distinguish a group of attempted suicides with a history of broken homes from a group of psychiatric out-patients who have not attempted suicide but have a history of broken homes. All comparisons will be between attempted suicides and psychiatric out-patients from broken homes.

Towards the end of 1961, the authors undertook a survey of the state of development of Industrial Therapy in mental hospitals of England and Wales (1). The results showed that already, of the 181 hospitals taking part in the survey 47·5% currently have Industrial Units and a further 15% are proposing to open them in the near future. This paper is a statement of some of the advantages and difficulties in opening an Industrial Therapy Unit. In discussing these problems we have drawn upon the experience we have gained over the past 6 years, the first 2 years of which we carried out sub-contract work and the last 4 years in running a commercially self-contained manufacturing business. The type of workshop that we have in mind is one dealing with a wide range of mental disability. The aims of the Unit will therefore be directed on many levels: the two principal levels being (1) preparing some patients for resettlement and (2) the occupational rehabilitation of patients with poor clinical prognosis within the walls of the hospital.

Not uncommonly, schizophrenia seems to arise in close connection with the puberal years. This is sometimes attributed to psychological or physiological stresses at puberty, but there is no really adequate understanding of the phenomenon. One cannot predict at all dependably which personality characteristics or which stresses will result in a schizophrenic breakdown near puberty.

In the last few years many studies have appeared relating directly or indirectly to the role of adjustment in the ageing process. What factors influence the adaptability of the elderly person to his or her own disability, isolation or approaching death? In general the studies done by sociologists stress the importance of the social situation in which these persons find themselves. P. Townsend's book “The Family Life of Old People” (1957), the articles of Havighurst (1958) and his group in Chicago, and of Post (1958) are examples of this view. In what may be regarded in some way as a reaction to this tendency, we have the theory of disengagement of Cumming et al. (1960), in which “ageing is seen as an inevitable mental withdrawal or disengagement resulting in decreased interaction between the ageing person and others in the social system to which they belong”. But it is Irving Rosow (1960) who emphasizes this point more clearly. After critically reviewing diverse approaches, he states (and I quote from different paragraphs throughout his paper), “The root of the problem lies in regarding adjustment as a state or a condition at a point in time”. “What gerontologists have called adjustment is actually the result of the product of the ageing process”. “Thus it follows that the only way to evaluate conditions in later life is to compare them with some earlier patterns”. From there on he presents his own sociological theory of adjustment. Strengthening this view still further, a psychologist, Robert Peck (1960), reporting on one phase of the “Kansas Study of Adult Life” by the University of Chicago Committee on Human Development writes, “Adjustment to middle age and old age, in so far as it has been measured in this research, seems largely determined by personality characteristics which have been laid down earlier in life”. It is psychiatrists, however, who have insisted on the importance of the previous personality in the problems related to ageing, as may be noted in the publications of Cameron (1956) and Roth (1959).

An investigation was undertaken to determine the fate of 100 consecutive female admissions over 65 to a mental hospital. The patients were admitted to Kingsway Hospital, Derby, between October 1958 and December 1959 and were each followed up for a year or until death. These 100 patients formed 24% of the total female admissions for the period. The catchment area from which they came includes the County Borough of Derby (a heavy-industrial town) with a total of over-65 female population of 8,724; Shardlow Urban District (a rather rambling and mainly country area) with 5,633; and Long Eaton Urban District (a light-engineering town) with 1,934. Thus the total over-65 female population was 16,311. Working from these figures the expected admissions from these areas would be (in %): 53: 35: 12, whereas the actual figures were (in %): 62: 30: 8. This shows, as one would expect, a proportionately higher admission rate from the industrial areas.

Pick's disease most commonly begins in the midlife period. Sjogren, Sjogren and Lindgren (1952) in their series of 18 anatomically verified cases of Pick's disease found that the average age of onset was 54·5±2·7 years. Escourolle (1956) segregated from the literature 184 cases in which he considered the diagnosis of Pick's disease to be “indisputable” and demonstrated therefrom that the sixth decade is the period of highest incidence. Pick's disease, however, has frequently been reported to erupt in the seventh decade and occasionally in the eighth, ninth and tenth decades. (Bonfiglio, 1926; von Braunmühl, 1928; Moyano, 1932; Sjogren, Sjogren and Lindgren, 1952.)

Recently there has been a resurgence of interest in the subject of hypoparathyroidism and it has become increasingly clear that psychiatric symptoms may frequently be found in patients with hypoparathyroidism, even where no evidence of tetany is present. It is significant that in a survey, in the Cardiff area, of 82 patients who had had a thyroidectomy, Davis et al. (1961) found that mental symptoms (defined as a feeling of uneasiness, tension and anxiety, sometimes with attacks of panic, often with depression) occurred in 66 per cent. of 26 patients whose plasma calcium was below 9·3 mgms/cent, in 51 per cent. of 31 patients whose plasma calcium lay between 9·3 and 9·8 mgms./cent. and in 35 per cent. of 23 patients whose plasma calcium was above 9 · 8 mgms./cent. They estimated that at least 24 per cent. of the patients showed partial parathyroid insufficiency, and that this apparently accounted for many minor but disabling symptoms, particularly depression and lassitude. They found that often these symptoms could be cured by the administration of calcium.

The role of phenothiazine derivatives in controlling the symptoms of mental diseases has been investigated by many workers by determining its site of action in the central nervous system.

The possibility that schizophrenia is associated with a relative deficiency of neuraminic acid in the cerebrospinal fluid has been suggested by Bogoch (1) and confirmed by Chistoni and Zappoli (5).

The work to be reported is a replication and refinement of a previous study (Bannister, 1960). As preface to the previous study, four traditional approaches to the problem of schizophrenic thought disorder were briefly reviewed, namely “dissociation” (Kretschmer 1936), “deterioration in mental efficiency” (Babcock, 1933), “concretism” (Kasanin 1946) and “overinclusion” (Payne, Matussek and George, 1959). These explanations and the experimental work arising from them were not utilized in the current research since it is argued that they suffer from three major defects.

Taking the needle and being needled are contemporary colloquialisms which have some significance to those who administer injections for psychological purposes. They suggest that the experience of receiving hypodermic injections must be a relatively common one in our society, and also that such an experience is generally considered to be unpleasant. The corollary of these conclusions is that such a public attitude of mind is likely to foster preconceptions in relations to injections so that, whether or not the pain threshold itself is actually exceeded, the individual receiving an injection will be predisposed to regard the experience as a stressful one.

In reviewing controlled trials using mono-amine oxidase inhibitors in the treatment of depression it is soon obvious that workers vary as to whether they consider “depression” as a symptomatic mood change in diverse conditions or as a disease entity. Where the latter occurs, a variety of classifications of depressive illnesses appear, and that most widely used is the broad separation between endogenous and reactive depressions. Other points to note are the authors' definition of improvement, and particularly whether this refers to one aspect of the mental state only and whether the patient left hospital before receiving any treatment other than the drug.

Amitriptyline hydrochloride is 5–(3 dimethylaminopropylidine)–dibenzo (a,d) (1,4) cycloheptadiene hydrochloride. Structurally it is not related to the hydrazines and is not a monoamine oxidase inhibitor. It bears some resemblance to the phenothiazines and its chemical structure is related to imipramine, in which the central seven numbered ring is azepine, nitrogen replacing the partially unsaturated carbon of the amitriptyline cycloheptadiene ring (Dorfman, 1960; Vernier, 1961).

Thioproperazine is a phenothiazine compound with a piperazine nucleus in the side chain. The pharmacological investigations of Courvoisier et al. (1958) indicate that it is much less sedative than other phenothiazines and that it has weak anti-adrenaline, anti-histamine and anti-serotonin activity. Clinical reports by Delay et al. (1958), Perrin et al. (1958), Denber et al. (1959), Levy and Maarek (1960) and Perret et al. (1961) indicate improvement in schizophrenic patients, but their papers described trials of this drug in which both recent and long-term cases or other diagnostic groups were included. Denham and Carrick (1961) reported the total remission of symptoms in 32 of 58 chronic schizophrenics treated by the discontinuous method with significant improvement in a further 25. Their acceptance of the view that improvement was correlated with the occurrence of hypertonic syndromes and that failure of treatment was likely if anti-parkinsonism drugs were used to suppress the hypertonicity, excludes the possibility of the type of continuous treatment employed with other phenothiazines. Denber et al., however, advocated the suppression of these drug effects and Perret et al. reported 47% improvement using the continuous method in another mixed group of chronic patients.

At the International Symposium on Niamid (nialamide)—1-/21—(benzylcarbamyl) ethyl/2-iso-nicotinoyl hydrazine—a mono-amine oxidase inhibitor, held in Lisbon in November, 1959, T. S. Davies reported that a 35-year-old mongol of imbecile grade, who had previously been inert and who had never spoken, gradually began to speak in monosyllables and, after two months on the drug, was able to converse in short sentences, showed increased physical activity and was able to undertake simple domestic tasks. It is not clear exactly what dosage of Niamid this patient received, but it was within the range of 30 mgm to 75 mgm daily. This report received wide publicity, out of its context, in the lay press, with its inevitable tendency to give the impression that a treatment of mongolism had been discovered, an impression which it is perhaps unnecessary to say Davies had certainly not intended to give.