The term “agoraphobia” was coined by Westphal, who in 1872 published a monograph Die Agoraphobie (12) in which three male patients were described with the following symptoms:

… impossibility of walking through certain streets or squares, or possibility of doing so only with resultant dread of anxiety … no loss of consciousness … vertigo was excluded by all patients … no hallucinations or delusions to cause this strange fear … agony was much increased at those hours when the particular streets dreaded were deserted and the shops closed. The patients experienced great comfort from the companionship of men or even an inanimate object, such as a vehicle or a cane. The use of beer or wine also allowed the patient to pass through the feared locality with comparative comfort. One man even sought, without immoral motives, the companionship of a prostitute as far as his own door … Some localities are more difficult of access than others; the patient walking far in order not to traverse them … Strange to say, in one instance, the open country was less feared than sparsely housed streets in town. Case 3 also had a dislike for crossing a certain bridge. He feared he would fall in the water. In this case there was also apprehension of impending insanity.

A number of studies have demonstrated that married pairs in which both partners have, or have had, a psychological illness are substantially commoner than would be expected by chance. These have been reviewed elsewhere (Kreitman, 1964; Nielsen, 1964). In most of these investigations the findings have been analysed in terms of “neuroticism” or of nonspecific “mental illness” without reference to diagnosis, and detailed attention has rarely been given to any other clinical features.

The literature on “psychogenic” potency disorders in the male is vast, and opinions abound on every aspect of these disorders. However, despite this abundance there is a dearth of factual data. The present author has been able to find only two major studies which have set out to study systematically and objectively facets of these conditions. El-Senoussi et al. (1959) undertook a statistical study to delineate psychological factors related causally to impotence; whilst Johnson (1965b) retrospectively studied male potency disorders to define their natural history.

The relationship between mental disorder and social background has for many years attracted the interest of epidemiologically oriented psychiatrists. Investigations in several countries have demonstrated that patients admitted to mental hospitals are recruited to a large degree from the lower social strata of society, but there is still a vast difference of opinion in so far as interpretations of these findings are concerned.

The County Borough of Southend-on-Sea is a seaside town with an estimated population of 166,390 in 1965, approximately 24 per cent. of whom were over the age of 60, as compared with 17.8 per cent. of the total population of England and Wales, and 17.7 per cent. of the population of urban areas, outside the conurbations, with populations of 100,000 and over. As in other seaside towns of a similar character, the suicide rate is high: 181 per million population in 1965, as compared with 108 per million in England and Wales, and 120 per million in urban areas outside the conurbations with populations of 100,000 and over (Registrar-General, 1967). Of 237 (46.4 per cent.) consecutive suicides in Southend 111 were over the age of 60 at the time of death.

The assessment of suicidal intent is one of the most important problems of clinical psychiatry. An earlier study (Robin, Brooke and Freeman-Browne, 1968) has confirmed the high incidence of suicide in admissions diagnosed at first contact as suffering from affective disorders, and found that 8 per cent. male in-patients and 5 per cent. female in-patients so diagnosed committed suicide during a follow-up of 6–11 years. It was also shown that in male patient suicides unemployment at the time of first admission and a previous history of self-poisoning or self-inflicted injury occurred more often than in matched controls, while a history of more than one suicidal attempt was found more often in female suicides than in matched controls. Female suicides were treated less often with E.C.T. than their controls, and more often with tranquillizers.

The relationship between psychiatric disorder and academic difficulty is clearly a complex one, for some severely disturbed students perform adequately, while clinically mildly disturbed individuals may fail completely. Emotional and psychiatric factors which could be associated with academic difficulty might include both the general factor of severity of disorder, and more specific factors related to the individual's personality motivation and attitude towards achievement and to his tutors. The nature of the demands, pressures and supports presented by the institution or by individual tutors is also likely to be of importance. In a previous psychometric study of all cases of academic and psychiatric difficulty from one year's intake at Sussex University (Ryle and Lunghi, 1968) it was shown that psychiatrically disturbed students in academic difficulty differed significantly from controls on the Nufferno Stress gain measure (Furneaux, 1965) whereas psychiatric patients who were coping academically scored in the same range as the controls. This difference was maintained when psychotic patients were removed from the academic difficulty group. No other psychometric scores distinguished between these two groups. The aim of the present paper is to make a preliminary attempt at defining what clinical features are associated with academic difficulty in a population of psychiatrically disturbed students. The sample studied consists of 38 male and 52 female psychiatric patients personally cared for by the author in a University Health Service encouraging direct consultation and tutor referral of students with personality or academic difficulties. Of these, 28 men and 37 women were the subjects of the previous study referred to above, the additional cases consisting of undergraduates of earlier intakes, and of 8 postgraduate students who had been personally assessed by the author over a two-year period.

Two common forms of alcoholism are described (World Health Organization, 1952; Kessel and Walton, 1965). The first is well recognized clinically, and has often been portrayed accurately by novelists and dramatists. So successfully has this more conspicuous form of alcohol addiction been publicized by Alcoholics Anonymous that Jellinek (1960) cautioned medical readers against overemphasis on it to the exclusion of the other clinical variety of the illness.

The Maudsley Personality Inventory (MPI) and its successor the Eysenck Personality Inventory (EPI) are frequently used to assess the personalities of psychiatric patients, and Eysenck advocates their routine administration as an aid to both diagnosis and treatment. However, a fundamental requirement of any personality test given to patients is that it should be relatively independent of the patient's mental state and reflect his personality rather than his illness. In depressive illnesses at least, it is doubtful whether this requirement is met. Coppen and Metcalfe (1965) administered the MPI to 39 patients with severe depression while they were depressed and again after recovery. Their mean N (neuroticism) score fell from 30.5 to 18.7 on recovery, and their mean E (extraversion) score rose from 17.3 to 20.6. Both changes were statistically significant. Assuming that the true scores were those obtained after recovery, it follows that the mean N score increased 63 per cent. and the E score decreased 19 per cent. during the episode of depression. The customary definition of personality as the relatively stable and enduring aspects of an individual's behaviour precludes such gross changes from being interpreted as changes in personality. One can only conclude, therefore, either that N and E scores obtained in the presence of severe depression are meaningless, or that they are a reflection of something other than the individual's personality. In the case of Coppen and Metcalfe's findings the most obvious explanation is that although patients are enjoined in the test instructions to rate their “usual way of acting or feeling” they do not in practice do so, but remain preoccupied with their current state of mind. Several MPI questions like “Does your mind often wander while you are trying to concentrate?” and “Have you often lost sleep over your worries?” are clearly relevant to the mental state of depression and probably attract positive replies from most patients regardless of their normal feelings.

In a random sample of 500 British women Coppen and Kessel (1963) found that certain menstrual symptoms—those of the premenstrual syndrome—i.e. depression, irritability, swelling, as well as menstrual irregularity, were positively correlated with Neuroticism on the Maudsley Personality Inventory. In a further study on the prevalence of menstrual symptoms in psychiatric patients (Coppen, 1965), a high incidence of menstrual symptoms was found in all groups, particularly neurotic women. Both these surveys were conducted by means of a menstrual questionnaire completed by each woman. This approach allows different groups to be investigated and compared, using a standardized measuring instrument. The purpose of this investigation was to see if cultural factors have any influence on the prevalence or severity of menstrual symptoms by administering a translation of the menstrual questionnaire to a sample of Spanish college students.

Although there have been various studies of the treatment of schizophrenia and articles on it are numerous, hardly any work has been done on the subject in Pakistan.

Longitudinal EEG studies in primary presenile dementia are conspicuously lacking (Kiloh and Osselton, 1966). Letemendia and Pampiglione (1958) found no changes, over a one year period, in the EEG patterns of several of their patients with Alzheimer's disease. Attention has recently been drawn to the relevance of duration of the particular illness when interpreting EEG data in primary presenile dementia (Gordon and Sim, 1967). The tendency to non-specificity of such data in this group of diseases underlines the importance of chronological variations in the EEGs, with regard to both differential diagnosis and prognosis.