Community surveys abroad have shown that there is a high prevalence of serious mental illness in old age, much of which is not treated in hospital (Gruenberg, 1961; Nielsen, 1963). Most community surveys of the aged in this country have, however, been concerned chiefly with general medical and social problems (Sheldon, 1948; Simonds and Stewart, 1954), or have formed part of whole-population studies and recorded only the most severe kinds of mental disturbance in old age (Mayer-Gross, 1948). An exception is the study of a Scottish rural practice by Primrose (1962).

Over the last few decades, social psychiatry has demonstrated correlations between mental illness and certain broad social categories. At the same time clinical, genetic and psychological studies have continued their traditional interest in the illness of the individual. The divergence of these two approaches has left relatively unmapped a large area which is of considerable psychiatric interest; despite much descriptive work, very little has been clearly established (outside genetics) concerning mental illness in the small, closely-integrated group, of which the prime example in our culture is the family. Out understanding of how personal and social factors jointly contribute to mental ill-health might well be furthered by studies in this field.

In Scotland the central collection of forms bearing details of admissions to all psychiatric hospitals was begun in January, 1962. These forms are intended to provide knowledge about the incidence of psychiatric disorders and the result of treatment. The details of this scheme and the nature of the information required were presented at a meeting of the Scottish Division of the Royal Medico-Psychological Association in 1961, and in the discussion which followed the reliability of data which depended on clinical diagnosis was questioned.

Case records of 42 consecutive cases of obsessional states (seen between January, 1958 and April, 1962) were taken for detailed socioclinical analysis at the Psychiatric Clinic, Irwin Hospital, New Delhi. The case-taking, diagnostic, prognostic and therapeutic evaluations were made by the same psychiatrist, i.e. the author. The sample constituted only about 2 per cent. of the total new attendance of the clinic during the period.

Two surveys of mental hospital in-patients, one by Gore and Jones (1961) the other by Cooper and Early (1961) resulted in different conclusions when the present and future need for psychiatric accommodation was considered.

There is a general impression amongst doctors that students and ex-students of Psychology suffer more from psychiatric disorders than do the rest of the population. This impression has not, however, been backed by any figures so far as I can discover. Davidson et al. (1955), for example, in their study of the detection of psychological vulnerability in students, make no special mention of Psychology students. Nor is there any special mention of Psychology students in the Proceedings of the First International Conference on Student Mental Health, edited by Funkenstein (1959). This present paper is an attempt to remedy the deficiency in part, and to encourage others to collect and publish further data.

This study was undertaken to learn more about a group of patients, married women, who had become housebound by their phobic anxiety symptoms. It was felt that it would be of some value to discover to what extent they formed a homogeneous group, what the outcome of their illness was in general terms, and specifically what proportion remained housebound and what data there had been available on admission to hospital that might in retrospect be seen to have had prognostic significance.

Two hundred years ago “griefe” was officially regarded as a cause of death. It is doubtful if the Registrar-General would accept such a diagnosis today but the loss of a loved person continues to be seen as a cause of a wide variety of physical and mental ailments.

The nervous origin of paroxysmal tachycardia was stressed by many German-speaking authors (Hering, 1911; Rothberger and Winterberg, 1911a; Rothberger and Winterberg, 1911b; Schlesinger, 1906) at the beginning of the century. Thus Schlesinger (1906) pointed out that many patients who suffered from this disorder had neurasthenic or hysterical personalities. He postulated that there was a mechanism responsible for the attacks of tachycardia which could be set in motion by a stimulus in the nervous system. Somewhat later a French cardiologist (Gallavardin, 1922) described a type of paroxysmal tachycardia which he believed was of nervous origin. In more recent times Stokvis (1947) has given an account of a Jewish patient who was taught to think himself into an attack in order to avoid deportation by the German occupation authorities in Holland. There is some pharmacological support for the central origin of paroxysmal tachycardia. Thus Klein (1940) described a schizophrenic patient who when treated with pentamethylene tetrazol developed supraventricular paroxysmal tachycardia four minutes after the injection of the drug. He suggested that the delay between the injection and the onset of the attack indicated that the attack was due to an effect of the drug on the central nervous system. Several different workers (Evans, 1940; Peters and Penner, 1946) have claimed that intravenous injection of ergotamine tartrate will relieve an attack of supraventricular paroxysmal tachycardia within a few minutes. Rothlin and Cerletti (1949) have shown that the effect of adrenaline on the heart is not altered by ergot alkaloids, so that the effect of ergotamine in paroxysmal tachycardia cannot be due to an unopposed vagal effect and must therefore be due to a direct action on the brain centres which regulate cardiac activity.

Frontal leucotomy has been used in the treatment of psychiatric illness for over twenty years. Its popularity has undergone the usual fluctuations of a newly-introduced form of empirical therapy, and at present there are many different opinions about its value (Lancet, 1962; Pippard, 1962). For a critical review of the clinical and psychological literature, see Willett (1960). The standard operation has fallen out of favour, not because it was thought to be ineffective, but because it had undesirable side-effects on the personality. Various “modified” operations have, therefore, been introduced. Using one of these—the “orbital undercutting” technique—Knight (1960) has reported excellent results in 129 cases of long-standing depression. Robin (1958, 1959), however, has reported no difference between the outcome for 198 patients who had a standard leucotomy for functional psychoses, fifty-two of them affective, and an equal number of carefully but retrospectively matched controls.

E.C.T. is rightly regarded as a highly safe procedure and, although several thousands of treatments are given annually at this hospital, the occurrence of any serious complication is extremely rare.

Extra-pyramidal reactions following on the administration of the major tranquillizers have been frequently reported on (May and Voegele, 1956; Druckman, Seelinger and Thulin, 1962; Freyhan, 1957).

The clinical manifestations that may result from abuse of alcohol are numerous. Profound, sometimes fatal, hypoglycaemia, first described a little over 20 years ago (Brown and Harvey, 1941), is among them although as far as we are aware, not previously described in this country. This may be due partly to differences in drinking habits here and abroad where “bootleg” liquor is more readily available, and partly to failure to recognize this complication of alcohol. Many cases of alcohol induced hypoglycaemia may well go undiagnosed, alcoholaemia alone being held responsible for bizarre behaviour or alteration in consciousness following the drinking of alcohol-containing beverages. In some cases, a patient brought into the casualty department with a provisional diagnosis of “drunkenness” is found to have a low blood sugar and the diagnosis hastily altered to the more socially acceptable one of “hypoglycaemia”, but without the cause of the hypoglycaemia ever being determined.

The most pressing problem in general practice today is the provision of adequate psychotherapy for psychogenic illness, which is responsible for 30 per cent. of all consultations (College of General Practitioners, 1958) and only a small proportion of which can be treated by trained psychiatrists. This paper describes a form of brief psychotherapy directed towards modifying neurotic character traits and securing freer expression of personality assets in the passive compliant type of personality which was found in 71 per cent. of all patients specially interviewed in late 1959 and 1960 in a working-class Belfast practice.

The present study on the acquisition of Staphylococcus aureus by patients during their stay in a mental hospital, and the nasal carrier rate in the institutionalized patients, was prompted by the fact that in 1959 and 1960 193 out of a total of 407 deaths in Napsbury Hospital were due to lung infection, and that a bacteriological study of 45 unselected cases at necropsy in 1960 had suggested that the fatal lung infections were predominantly staphylococcal (Table I). The incidence of staphylococcal skin lesions, however, remained low, and only 147 cases of this kind were reported during 1959 and 1960 (4 per cent. per annum of the population) (Table II).

The genetic evidence concerning affective illness of later life is still conflicting and the relationship of such conditions to the manic-depressive psychosis unclear. Kallman (1955) believed that, genetically, involutional melancholia bore a closer relationship to schizophrenia than to the manic-depressive psychosis. An increased risk for schizophrenia amongst the relatives of such patients was not observed by Kay (1959) and Stenstedt (1952). Both these writers do however describe a lower loading for manic-depressive psychosis than would be found amongst the relations of manic-depressive patients, though a much higher incidence than in the general population. Both Stenstedt and Kay assumed that they were dealing with a heterogeneous group of patients containing both psychotic and neurotic depressions.

Fetishism is relatively rare as a primary medical problem. Curran (1) describes only five cases in his series of 4,000 patients seen in private practice.

It is defined by Freud (2) as a condition “in which the normal sexual object is replaced by another which, though related to it, is totally unfit for the normal sexual aim”.

The principal clinical features of this rare, familial disease are the triad of skeletal deformities, structural anomalies of the cardiovascular system, and mental subnormality.

The syndrome is attributed to a recessive gene, and Morquio (1929) held the view that the underlying pathology consisted of mucoid changes occurring in the cartilages in place of their normal calcification.

Ospolot is tetrahydro-2-p-sulphamoylphenyl-1, 2 thiazine 1, 1-dioxide, with a structural formula: