This is a report of a phenomenological and descriptive study of forty-four patients seen early in their first hospitalization for schizophrenia. Most patients had a prodromal phase (median duration 30 months) during which the commonest symptoms were decreased drive and dysphoria. Symptomatology was often similar to that of a reactive depression; there was no instance resembling endogenous depression. A prodromal triad of deterioration in school or work performance, schizoid withdrawal and anergia was identified and this may have some diagnostic use. Twelve of the fifteen patients who exhibited this triad had also experienced disturbed flow of thought. Some patients experienced increased sexual drive, usually towards the end of the prodromal phase or in early overt psychosis. Some also reported regular fluctuations in symptomatology; these cycles, usually of a few good days and a few bad days, occurred in the prodromal phase and/or early overt psychosis. The transition to manifest psychosis was usually quite abrupt. An oneirophrenic experience, termed a ‘complex state”, was common either at the beginning of psychosis or soon thereafter. In the ‘complex state” a number of symptoms are experienced together or in such rapid succession that separating them is artificial. Perplexity and emotional arousal, usually dysphoric, are always present, and there is invariably at least one symptom of disturbed perception or delusion. Perceptual disturbances may affect any modality and often more than one; the perceptual alterations may be simple or complex. Disturbances of visual perception were reported more frequently than might have been expected, tending to be associated with good prognosis. Motor blocking, slowing or inco-ordination may occur, and although clouding of consciousness was experienced as part of the complex state, it was not possible to document this satisfactorily. Delusions usually developed within complex states or more commonly as explanations of them, so that the concept of primary delusion may be invalid. These findings were further discussed with particular reference to the work of Conrad and Chapman.

This is a six-year follow-up study of one hundred and thirty geriatric psychiatric patients admitted to the Winnipeg Psychiatric Institute in 1964. The main findings were: 1) Survival rates were lowest in senile patients with arteriosclerotic dementias. Those with other dementias and confusional states and male paranoid patients did somewhat better. Female paranoid patients and those with affective disorders did not differ significantly from the general population. 2) The survival rate of patients with senile dementia supports the view that the short-term prognosis has improved in recent years. 3) No significant difference was found between the survival rate of those with senile and arteriosclerotic dementia. 4) The high mortality rate of male paranoid patients was probably due to the high incidence of serious physical illness and alcoholism. It is suggested that a sizeable proportion of these cases were secondary to extracerebral somatic disease. 5) The commonest primary causes of death were: a) Bronchopneumonia in the group with dementias. b) Myocardial infarction in those with confusional states. c) Heart disease and other causes in those in the paranoid group. d) Malignant disease and suicide in those with affective disorders. 6) The frequent occurrence of malignant disease in affective disorders is noted.

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There are complex relationships between cancer and mental state, of which the most readily understandable are the psychological reactions of patients with established malignant disease. More speculative, and difficult to study, is the possibility that psychological states may predispose to the development of cancer. Currently, theoretical and research interest centres on a third topic — the high frequency of cases in which an underlying malignant disease presents as a ‘functional’ psychiatric illness, usually a depression. The suggestion is made that this may eventually be explained by an immunological mechanism.

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