In 1897 Ganser delivered a paper entitled “Concerning an Unusual Hysterical Confusional State” in which he described three prisoners who developed transitory symptoms of mental illness. The main features were disturbances of consciousness with subsequent amnesia for the episode, prominent hallucinations, sensory changes of an hysterical kind and, on questioning, peculiar verbal responses which have come to be regarded as the hallmark of the Ganser state. The illness terminated abruptly with full restoration of normal mental function. Despite Ganser's designation of the condition as hysterical, controversy over its precise nosological status has persisted over the past sixty-odd years. Is it in fact a form of hysteria, or is it a psychotic illness of brief duration? Is the hysterical pseudo-dementia described by Wernicke (1906) identical with or distinct from the Ganser syndrome? What is the relationship, if any, of the symptomatology of the Ganser state—the often-described “vorbeireden” and “approximate answers”—to the disordered thought of the schizophrenic and the dysphasia of the patient suffering from organic brain disease? Is it a fact that the Ganser syndrome occurs most frequently in patients in military or civil prisons and is rare in the non-delinquent population? To these and other problems the standard textbooks of psychiatry return conflicting answers.

This study, in two parts, compares the immediate and more long-term outcome of two groups of schizophrenic patients admitted to hospital before and after the introduction of pharmacotherapy in the form of reserpine and the phenothiazines. There have been differences of opinion as to whether the undoubted improvement which has occurred in the prognosis of schizophrenia, at least in the short term, since the introduction of chemotherapy has been due to the use of these drugs, to changes of administrative treatment, or to both. There has been evidence from mental hospital statistics (Shepherd et al., 1961) that changes in outcome began before the introduction of the drugs and were almost certainly related to the changes of administrative treatment or institutional management which have occurred in the mental hospitals over the same period. It may well be that the use of drugs has facilitated these changes as well as having a more direct effect oh prognosis, but the relative importance of these two factors is difficult to assess from mental hospital statistics. Comparison between results obtained in different hospitals is also of limited value because of the number of uncontrolled variables. There would seem, therefore, to be an advantage in the more detailed examination and comparison of a smaller number of patients admitted to the same hospital, and the present investigation is of this type. The material consists of two groups, of 50 patients each, admitted to the Professorial Unit at the Maudsley Hospital in the years 1952/53 and 1956/57 respectively. Since the policy throughout has been to admit only non-compulsory patients for relatively short-term treatment, administrative changes in this hospital between the two periods are likely to have been minimal. The aim was to compare both immediate and long-term outcome in the two groups and to examine the effect of a number of variables on this. The short-term outcome will be considered in the first and the long-term outcome in the second paper.

This paper describes an investigation into the reasons for change in diagnosis in a group of 200 mental hospital patients who were admitted to hospital four times in two years. The cohort consists of the 44,047 patients in England and Wales who had their first admission in 1954, and 46,238 similarly admitted in 1955. The first two years of their progress has already been described in detail (Brooke, E. M., 1963), and further reports are in progress.

This is a clearly recognizable complex of internal family relationships which lies behind, and is an integral part of, the illness presentation pattern of one or more of the individual family members. It may explain many of the emotional problems experienced by children which are noted by either the School Doctors or the Child Guidance Clinics. It is routine procedure in such cases to interview the mother of the affected child, but it is not the practice to see any older generation. Only the family doctor is in a position to see the three generation complex involved.

This study is an investigation of the social class background of a randomly selected sample of young people appearing in the London Juvenile Courts; and of the relationships between their social class and sex and the number and types of offences with which they were charged.

Anorexia nervosa is a disorder characterized by loss of weight occurring as a result of a reduced intake of food; it may be aggravated by vomiting, excessive exercise or purgation. Females are affected much more commonly than males; the illness often begins during adolescence and one of its early manifestations is the cessation of menstruation.

The two major follow-up studies of children suffering from infantile psychosis, that of Kanner's cases (Kanner, 1943 and 1949; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956; Eisenberg, 1956; Kanner and Lesser, 1958) and that of psychotic children seen by Creak (1962, 1963a and b) have shown the generally poor prognosis for these children. In both studies about half the children were in full-time residential care (usually mental sub-normality hospitals) at follow-up, and only 5 per cent. to 17 per cent. could be said to be well adjusted. Similar findings have been reported in the other published studies (reviewed in Rutter, 1966a). Kanner and Eisenberg have described the course of the characteristics of aloneness or autism shown by all or nearly all children with infantile psychosis (Kanner, 1943; Kanner and Eisenberg, 1955; Eisenberg and Kanner, 1956). Although some psychotic children emerge from their solitude to a greater or lesser extent, a lack of social perceptiveness usually remains even in adolescence or early adult life.

During the 1950s, epidemics of an illness which came to be known as Benign Myalgic Encephalomyelitis were reported from many different parts of the world. Fourteen such epidemics have been reviewed by Acheson (1959). As each fresh outbreak was reported several curious features began to emerge. No virus or other aetiological agent could ever be incriminated, in spite of strong evidence for an infective origin. The illness showed a strange predilection for young women, particularly nurses, and several epidemics occurred in association with poliomyelitis. And though muscular weakness and other neurological disabilities were often severe, objective evidence of damage to the central nervous system was usually conspicuously absent. Indeed, in comparison with other forms of encephalomyelitis the illness seemed mild, even trivial, yet those affected often suffered repeated relapses and exacerbations for many months or even years, and were always curiously slow to regain their former vigour.

The factors leading to the fall in the mental hospital population which started in England in 1954 are not fully agreed. By some, the introduction of the phenothiazine drugs was held to be of first importance: other writers have stressed the role of social and administrative factors—of energetic rehabilitation and discharge policies together with measures to provide community services for discharged patients.

The Body Image is our concept of the shape, the size and the mass of our body and its parts. It allows us to evaluate the space which our body occupies, and thus enables us to move about freely in our environment.

Various forms of treatment have been recommended for multiple tics, including psychotherapy (Zausmer, 1954), behaviour therapy (Yates, 1958) and phenothiazines and other tranquillizers (Lucas, 1964; Kelman, 1965), but there have been no reports of an adequate controlled trial of any particular therapy.

This paper presents a replication of a study by Kiloh and Garside (1963). These workers carried out a factor analysis of 35 clinical features of 143 depressed patients. They demonstrated the presence of a factor which showed strong positive loadings with the clinical features classically accepted as characterizing neurotic depression and strong negative loadings with the clinical features characterizing endogenous depression. Of the 143 patients, 92 were diagnosed as more definitely suffering from endogenous or neurotic depression. Correlation coefficients were calculated between the diagnosis in these 92 cases and each clinical feature.

Many instances of regular cyclic or periodic psychiatric and clinical syndromes have been reported (Richter, 1957). The duration of each cycle varies from 2 days to 18 months but is usually constant in a given subject and bears no relationship to external factors. Presumably they have their origin within the body, and a disturbance of endocrine function has been suggested in many cases. Some women show cycles corresponding to the menstrual rhythm, the abnormal phase preceding or accompanying the menstrual flow.

Multitudinous factors play upon each patient; among them are the patient's relationship with the doctor, with other patients, with nurses, relatives, employers and a host of others. Many of these factors are unknown. This investigation is an attempt to put a numerical value on one facet of one factor and assess its relationship to a patient's recovery. The factor measured is the amount of attention given to each patient by the doctor.

In the previous paper a comparison was made between short-term outcome of two groups of 50 schizophrenic patients each, admitted to the Professorial Unit of the Maudsley Hospital before and after the introduction of reserpine and phenothiazines into treatment. It was shown that patients admitted in 1956/57 (Group B) had a better prognosis in terms of condition on discharge and length of stay in hospital than those admitted in 1952/53 (Group A).

On 30 March, 1966, at the Symposium “Enzymes in Mental Health” sponsored by the Carl Neuberg Society for International Scientific Relations, A. Hoffer (1) described the apparently successful treatment in 13 of 17 (acute and chronic) schizophrenic patients in 3 to 5 days by the daily oral use of 1 to 2 grams of nicotinamide adenine dinucleotide (NAD), better known as diphosphopyridinenucleotide (DPN). Widespread publicity given to this announcement attests to the need of more effective treatment for this illness. It also occasioned frequent and persistent inquiry from schizophrenic patients and their relatives as to the suitability of this treatment in their own instance. Rapid confirmation of the findings would justify widespread efforts to evaluate this preparation, whereas failure of confirmation would provide reasonable grounds for a more cautious approach to its use. The members of the Council of the American College of Neuropsycho-pharmacology decided that, as a group of impartial scientists, it would be appropriate for them to carry out such an investigation as rapidly as was compatible with adequate determination of the usefulness of the preparation.

This is the first of a series of papers reporting studies of various cognitive disorders in schizophrenia. The present paper deals with the validity of certain tests as measures of thought-process disorder: subsequent papers will relate type of disorder to various sub-categories of schizophrenia, as diagnosed clinically and by the Symptom-Sign Inventory (Foulds, 1965).

In previous communications (6, 9) we have presented data indicating that affective disorder (manic depressive disease, involutional depressive reaction, neurotic depressive reaction, psychotic depressive reaction) is more frequent in females than in males. More specifically, in a total sample of 366 affective disorder probands there was a ratio of 1·9 females to every male; and in the parents of the probands a statistically significant excess of mothers as compared to fathers was found to have suffered from the same illness. Calculations done on the same proband group revealed that alcoholism was significantly more prevalent in the fathers and siblings of the affective disorder group than in a matched control series. It appeared that if one added the alcoholic fathers to the affectively disordered fathers one found a prevalence of psychiatric illness in fathers which was similar to the prevalence of affective disorder itself in the mothers. Thus, it seemed that the deficiency in affective disorder diagnoses in fathers was made up by alcoholism.

A revival of interest in psychiatric classification has led to the use of statistical techniques such as factor analysis to help describe the depressive population. Several recent factor analytic studies rating symptoms in depressed patients have had results which portray a common clinical pattern (Hamilton and White, 1959; Kiloh and Garside, 1963; Rosenthal and Klerman, 1966b; Rosenthal and Gudeman, 1967). In each of these studies the first or primary factor has suggested the endogenous depressive pattern. In the most recent of these papers we presented the first factor in our study of 100 depressed women (Rosenthal and Gudeman, 1967). This factor was shown to be similar to the principal factors of the other studies, and to suggest the “endogenous” or “autonomous” pattern. This replication has been an encouraging indication that studies carried out in different patient populations may indeed give reproducible symptom patterns.

Therapeutic community principles have in recent years become increasingly and often enthusiastically applied. They have also attracted an extensive literature, including, among many, studies by Maxwell Jones (1952 and 1962), Cumming and Cumming (1962), and the contributions to two symposia: in Boston, edited by Greenblatt, Levinson, and Williams (1957) and in this country by Freeman (1965).