Since the time of Esquirol (1838) a discrimination has been made between illusions and hallucinations. The latter are generally taken to be perceptions that spring into being in a primary way and not transpositions or distortions of any genuine perception (Jaspers, 1962). There are, however, various phenomena comparable to hallucinations proper (as defined above), such as various forms of imagery and pseudohallucinations, which may be part of normal experience. This paper is concerned with a comparison of various types of hallucinatory phenomena differentiated on phenomenological grounds.

The following case study offers an exceptional opportunity to illustrate the wish-fulfilling nature of auditory hallucinations in a hysteric (Breuer and Freud, 2; Freud, 11), the conditions under which these hallucinations are experienced, and their response to treatment.

In the controversy over the nature of schizophrenic “dementia” the weight of opinion has fallen on the side that emphasizes the differences which exist between this state and organic cerebral degenerations. While acknowledging these differences, it is important also to draw attention to the similarities between the impairment of chronic schizophrenia and the defect of organic dementia as it occurs in the elderly. We have chosen to compare the extent of perseveration in the two groups because this is a neglected field and because objective tests of such behaviour are readily devised.

Merskey, Gillis, and Marszalek (1962) reported that in chronic schizophrenic patients reaction to pain was greatest in those patients showing either over-activity or under-activity as measured by a ward activity rating scale. They also reported a significant difference between certain age groups, the oldest and youngest age groups showing the greatest reaction to pain. The authors attributed the difference between age groups to the effects of tranquillizing drugs, since there existed a high correlation between age groups and their dosage of such drugs. It was concluded that ward behaviour in schizophrenics is a poor indicator of their sensitivity to stimulation.

Time judgments of various kinds are often disturbed in schizophrenia, but a review of the literature (Orme, 1962) suggests the disturbance is not characteristic in type. The present writer has studied (Orme, 1964) the verbal estimation of an elapsed “filled” interval with various clinical groups. Subjects were asked, after 30 minutes of interviewing, “How long have we been together, how long does it seem to you?” A summary of the distribution of time estimates is given in Table I. The most statistically significant feature (see Orme, 1964 for details) is the contrast between the hysteric, psychopathic and manic groups on the one hand, and the melancholic, anxious and depressed neurotic on the other. Individual variations in estimates appear unrelated to age, sex and intelligence.

It has been suggested (Mednick, 1958) that high drive acting “upon remote response tendencies is a major root of the disordered thinking of schizophrenics”. Thought disorder would be a product of a high level of drive, increasing generalization and reducing discrimination. The relevant drive in this context is anxiety.

In 1963 Ödegård published a catamnestic study of the 5,010 boys and girls who graduated (i.e. left after obtaining the “graduation certificate” by examination) from the high-schools (Gymnasiums) of Norway 1916–20. When this population group was followed until 1950, 117 were found to have been admitted to psychiatric hospitals for a psychosis. This material proved too small for a detailed statistical analysis, and the conclusions, although interesting and suggestive, remained inconclusive.

Psychiatric disorders occur among all groups of the general population, but it would be difficult to suggest a group of young people in whom the consequences are more serious than that of university students. So much is at stake during the short time spent at university that students cannot afford to be ill for any reason, least of all from psychiatric disorders where the ability to study, the first requirement of all students, is especially impaired. Much of the concern with which university authorities view the mental health of their students is due not only to the widely-assumed relationship between psychological illness and poor academic performance, but also to an increasing awareness of the central role played by emotional factors in the adjustment of the young adult to the new, competitive and often demanding world of higher education. Certainly the suicide rate is one criterion of mental illness which suggests that students are exposed to special risk: it is many times greater for undergraduates than for the equivalent age groups of the general population (Carpenter, 1959; Parnell, 1951; Parnell and Skottowe, 1957). While the suicide rates are high, particularly among students at the older English universities, the actual numbers are very small, and suicide is fortunately only a rare expression of psychological illness among students. Carpenter's (1959) analysis, showing that suicide rates differ in different universities (annual rates of 0.2 per 1,000 living students at Oxford and Cambridge, 0.06 per 1,000 at other British universities), has prompted speculation by university physicians as to whether the case load of psychiatric morbidity among students varies from university to university, and whether this is influenced, adversely or beneficially, by differing cultural and environmental factors in the universities and differing social and demographic characteristics of the student populations.

The purpose of this paper is to give hospital statistics which, in the absence of previously published work or more detailed information, may give some indication of the types of illnesses most frequently found in the province of East Pakistan. Although selection of cases was unavoidable and more refined statistical testing would have been misleading, the figures show interesting comparisons with findings from other countries.

There have been only a few investigations into the seasonal prevalence of neurosis. Stocks (1949) found in a morbidity survey by interview the lowest prevalence of “nervous complaints” in July and August and the highest in October and November. Smiley, Buck, Anderson and Hobbs (1954) in Canada found that there was a higher number of insured claiming benefit for “mental illness” in January than in July. McCartney (1962) in private psychiatric practice in New York found that there was a seasonal variation in the number of referrals of various types of neurotic reactions. The purpose of this investigation was to examine the seasonal variation in attendances with symptoms of psychiatric ill health in a general practice and compare this with the seasonal variations of attendances due to physical illness.

The association of physical illness and psychiatric illness has been found by Doust (1952), Downes and Simon (1953), Hinkle and Woolf (1957) and others.

The present investigation was conducted in a general practice; the aim was to assess whether a physical illness could precipitate psychiatric ill health. The conditions in general practice appeared to be suitable for this investigation because patients can be observed before and after a physical illness.

In investigations in general practice it has been invariably found that the prevalence of neurosis in women is higher than in men. Logan (1960) found that housewives without family responsibilities had the lowest patient-consulting rate for psychoneurosis, and married part-time workers with family responsibilities had the highest rate. Tonge, Cammock, Winchester and Winchester (1961) found no significant difference in prevalence rates of neurosis between housewives and employed women.

Over the past twenty years there has been a rapid growth in the provision of special schools for educationally subnormal children. Between 1953 and 1962, for example, the number of pupils attending special schools for the E.S.N. rose from 19,000 to 36,000 but there were still 10,000 children awaiting admission on the latter date (Ministry of Education, 1963). The E.S.N. population is different both quantitatively and qualitatively from the mentally deficient group of children of pre-war days, yet we have surprisingly little knowledge of the general characteristics of this growing section of the child population.

A number of observations have been published with regard to elevated serum uric acid levels in patients with atherosclerotic (Eidlitz, 1961, 1962) and coronary disease (Gertler, Garn and Levine, 1951) and hyperuricaemia after myocardial infarction (Dreyfuss, 1959; Kohn and Prozan, 1959). Work has also been done on dominant traits for hyperuricaemia together with hypercholesterolaemia (Adlersberg, 1949; Harris-Jones, 1957; Salvini and Verdi, 1959; Schoenfeld and Goldberger, 1963). A greater incidence of cardiovascular diseases among gouty patients than among others has been noted (Gertler and Oppenheimer, 1953), as well as a tendency for spontaneous changes in the serum cholesterol level to be associated with changes of similar direction and magnitude in the serum uric acid level (Schoenfeld and Goldberger, 1963). In view of all these observations, an investigation was undertaken to ascertain whether the serum uric acid levels change with dietary fat composition as do the serum cholesterol levels.

The improvement shown by a group of severely subnormal patients after treatment with prothipendyl (Tolnate) was the reason for conducting a double-blind trial to assess the effects of the drug, while attempts were made to control the environment. The preliminary group studied consisted of 35 patients of both sexes, of all ages, who all exhibited pronounced behaviour disorders and presented acute problems in nursing and management. None had responded adequately to the more widely used tranquillizers and sedatives, but all except two patients with superadded depression, responded to prothipendyl in some measure without side effects.