The monoamineoxidase inhibitor drugs are now widely used in the treatment of depression, and complications occurring in patients so treated have been reported with varying frequency. The drugs most frequently implicated have been tranylcypromine (Parnate), tranylcypromine plus trifluoperazine (Parstelin) and phenelzine (Nardil) in decreasing order of frequency. These complications may be divided into three symptom-complexes which may merge one into the other, as they have the common basis of rapid elevation of systemic blood pressure.

In most instances presenile dementia is based on well-defined organic diseases and it is not necessary to resort to cerebral biopsy to establish a diagnosis. These organic disorders cover a wide spectrum and include cerebro-vascular disease, tumours, trauma and well-defined degenerative states such as Huntington's chorea, vitamin deficiencies, endocrine disturbances, infections (bacterial and viral) and poisons such as alcohol, lead, barbiturates, bromides and carbon monoxide. The effects of liver and kidney failure as well as the hypercapnia of pulmonary insufficiency account for others.

This investigation is concerned with the histological changes found in cerebral biopsy specimens taken from 59 patients with presenile dementia. We have defined the presenile dementias as organic dementing diseases occurring before the age of 65; although 5 of the patients were a few years older than this at the time of biopsy, in all cases there was unequivocal evidence that the dementia was established before the 65th year. The clinical findings in 56 of these patients are described in the preceding paper (Sim, Turner and Smith, 1966).

The lumbar air encephalogram (L.A.E.G.) was introduced by Dandy in 1919, and in 1929 the first report of its use in schizophrenia was published by Jacobi and Winkler. Since then numerous papers have appeared, most of which have claimed to demonstrate cerebral atrophy in chronic schizophrenic patients. All these studies have suffered from the fact that no adequate series of normal controls has yet been collected. Most of the authors concerned made no attempt to use controls, nor did they consider the possibility of observer error or of the bias which may exist when the reporting radiologist knows the diagnosis and is looking for abnormalities.

Chromosomal abnormalities involving the autosomes are nearly always associated with serious defects in intelligence. This is true of the first disease recognized to result from a chromosomal aberration, Down's syndrome (Lejeune, Gautier and Turpin, 1959), and a series of other disorders, including the “cri du chat” syndrome, also first described by Lejeune and his co-workers (1963).

Since the initial observations of a relationship between depression and an increase in urinary adrenal glucocorticoids in psychiatric patients by Reiss (1953) and Rizzo et al. (1954), there have been a number of studies confirming this relationship using various chemical techniques (Board et al., 1957; Bunney et al., 1964 and 1965; Gibbons, Gibbons, Maxwell and Wilcox, 1960; Gibbons and McHugh, 1962; Gibbons, 1964; Kurland, 1964a and 1964b; Pryce 1964). One of the questions that immediately comes to mind in reviewing this work has to do with the specificity of this relationship. Perhaps the rise of urine corticoids in depression is a non-specific response to disturbance, as has been demonstrated in various forms of psychological stress (Hamburg, 1962) and in severe psychiatric disturbances such as acute schizophrenic episodes (Sachar et al., 1963). On the other hand it is tempting to hope that there may be a more specific relationship demonstrable between the complex psychobiological phenomenon of depression and some kind of neuroendocrine activation analagous to a syndrome like “periodic hypothalamic discharge” (Wolff et al., 1964). This syndrome is manifested by periodic episodes (lasting several days) of withdrawal and depression associated with marked elevations in 17-hydroxycorticoid excretion. Mandell et al. (1963) have recently demonstrated that subthreshold stimulation of limbic sites intimately related to hypothalamic modulation produces marked changes in plasma 17-hydroxycorticoids in man. Limbic areas have been related to affectual phenomena on a speculative basis since the classical papers of Papez (1937).

Tryptophan has attracted attention during recent years for the possible role played by some of its metabolites in the aetiology and treatment of psychiatric disorders. Of these metabolites, serotonin has received special attention and considerable work has been carried out in order to elucidate its physiological and pharmacological actions. Studies from animal experiments are thus available on the function of serotonin in nervous activity (Marrazzi and Hart, 1955; Brodie et al., 1955; Pletscher et al., 1956; Welsh, 1957), but the results obtained thus far in psychiatric patients are uncertain. Recent researches in the affective psychoses (Burgermeister et al., 1963) did not reveal significant differences between patients and normal controls in the urinary output of 5-hydroxyindoleacetic acid (5-HIAA) before or after an oral 5-hydroxytryptophan load.

The lithium ion has been found increasingly valuable in the treatment of manic illness (1, 2). In the therapeutic use of lithium there are two phases, stabilization and maintenance. These data have been reviewed by Gershon and Yuwiler (1), but a clear explanation of the pharmacodynamics involved is not evident. Animal experimentation has been used to study the behaviour of the lithium ion as compared with other cations. The lithium ion's behaviour resembles sodium in some tissues and enzyme systems but is more like potassium in others. These authors have reported a three- to fourfold increase in the tolerance for toxic symptoms due to lithium ion in manic patients as compared to normals. They found that this increased tolerance decreased to normal as the patient's manic state subsided.

The blood pressure response to the injection of the parasympathomimetic drug methacholine (Mecholyl) has been used extensively in psychiatry to delineate various aspects of mental disease. Although originally used in diagnostic classification (Altman et al., 1943), its use, following the investigations of Funkenstein and his co-workers (1948, 1952), has more often been as an aid in prognosis or as a guide to the most useful type of somatic therapy. Investigations into this aspect of the test have resulted in many contradictory reports, and even after so many years there is still no agreement on the test's validity or usefulness.

During a study of schizophrenic patients under prolonged treatment with reserpine alternating with placebo, night and day portions of urine were sampled for the determination of 4.-hydroxy-3-methoxymandelic acid (VMA). We found that reserpine treatment caused a moderate decrease in the excretion of this metabolite of adrenaline and noradrenaline, as reported in detail elsewhere (Munkvad and Randrup). We also observed certain characteristic changes in urine volume and diurnal rhythm, and these changes will be reported on in the present paper.

While a study of schizophrenia and social class (Goldberg and Morrison, 1963) was in progress, it became obvious that some problems of hospital and community care among young male mental hospital patients should be pursued. Accordingly, it was decided to extend the project to a systematic follow up of the patients admitted to one of the two hospitals included in the study. This paper reports the findings in two parts; Part I relates length of stay in hospital to the severity of a patient's illness and to his circumstances before and after leaving hospital; Part II relates the patient's post-hospital work performance to certain other factors.

Observations on the wife of the alcoholic have been made from various standpoints. Bailey (1961), reviewing the literature, points out that interest has moved from the simple need to include her in her husband's treatment regime to seeing her as an individual who is herself handicapped, and emphasis has been placed on her dependency needs.

It has been shown (Wing and Giddens 1959, Wing 1960) that schizophrenics may benefit from a course at a Ministry of Labour Industrial Rehabilitation Unit. Psychiatric cases make “special demands on the staff time” (Ministry of Labour Gazette 1962) and if they comprise too high a proportion, may alter the atmosphere of the Unit from “industrial” to “hospital”. There follows a need for limitation by selection of such cases. Selection procedures however have not been fully worked out (Wing 1960).

It is generally believed that anorexia nervosa is due to an abnormal attitude of mind which results in an insufficient intake of food. As the term anorexia nervosa implies, many patients experience a loss of appetite, but sometimes this is not so, and vomiting is an alternative or additional device adopted by the patient to ensure a reduction in effective food intake. As a rule the patient induces vomiting by tickling her throat with her fingers, but sooner or later she becomes so proficient at vomiting that mechanical stimulation is no longer necessary. Nevertheless one should not assume that vomiting in anorexia nervosa is always under the control of the patient's will. In the patient described below vomiting became intractable and was found to be due to a physical disorder—acute dilatation of the stomach. Such a complication occurring in a severely undernourished patient is highly dangerous unless recognized early and treated effectively. The opportunity was taken to measure water absorption and gastric motility.