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.

To Shakespeare's famous question: “Can'st thou not minister to a mind diseased?”, Eysenck (10) gave a decided negative answer. Hebb (11) has also asserted that “There is no body of fact to show that psychotherapy is valuable”. From 1954 onwards, Rogers (12) has taken up the challenge and shown that changes occur in psychotherapy which do not occur without it, and has suggested that these changes are valuable.

The Psychological Impairments Rating Schedule (PIRS) was originally designed by the WHO (Jablensky, 1978; see also Biehl et al this volume) and was used as a supplement to the Present State Examination (PSE) (Wing et al, 1974) in a number of collaborative WHO studies. It was mainly designed for assessing selected areas of psychological and behavioural impairments (or deficits) in patients who have suffered, or are suffering, from functional psychotic disorders. It comprised items and scales for rating observed behaviour and was filled in immediately or soon after a psychiatric or PSE interview. Raters were encouraged to take note of a subject's current behaviour and function both before and after the interview proper. The first two sections of PIRS included all behavioural items of PSE (ninth edition). Sections 18–20 as well as a number of items taken from other psychopathological rating scales and items formulated de novo.

The growth hormone and hypotensive responses to clonidine have been measured in six drug free severely depressed patients before, and at two weeks after, the surgical procedure of stereotactic sub-caudate tractotomy. The responses were unaltered two weeks after operation, by which time a small clinical improvement was evident. These findings are discussed in relation to central a adrenoceptor functions in depression, and the effect upon this of antidepressant treatment.

Forty-six mentally ill women with radiologically verified hyperostosis frontalis interna (HFI) were compared with 46 matched mentally ill women without HFI in respect of mental morbidity among the full siblings of the two groups. It was found that mental morbidity was lower among the siblings of mentally ill women with HFI than among those of similar mentally ill women without HFI. A reasonable interpretation of these findings is that the combination mental illness-HFI is more often exogenously determined than other forms of mental illness.

Case notes of all patients admitted from two adjacent catchment areas with a diagnosis of schizophrenia, schizoaffective disorder, or psychosis were examined for information concerning the patient's family. On average, case notes contained only 9–25% of the basic information looked for. Family trees were rarely drawn. A record was made of contact with families of only half the sample. It is suggested that information concerning families is not considered of major importance in the management of such cases.

25-year-old female patient with a psychotic illness lasting three months in which schizophrenia and depressive episodes occurred was studied by serial EEGs. These were coded, masked and rated in a set way without knowledge of the clinical state. It was found that the schizophrenic state was characterized by a decrease in the amount and poor organization of alpha activity, as well as the occurrence of paroxysmal phenomena in particular atypical spike and wave. In the depressive episode, alpha activity was prominent and only scanty paroxysmal features were seen. Using these criteria a series of EEGs from psychiatric patients were assessed ‘blind’ with a view to separating them into either a schizophrenic or a depressive category. This proved possible in 17 cases (9 depressive and 8 schizophrenic). In only two was the categorization completely misjudged. These results suggest that further detailed study of the EEG, possibly with computer analysis, combined with assessment of the behavioural state might not only yield useful diagnostic information but also lead to a better understanding of the underlying neurophysiological basis of certain mental disorders.

This report describes 17 cases of chlormethiazole abuse or dependence. These include one case with symptoms and signs of withdrawal and two other similar cases where undoubted dependence was combined with excessive alcohol intake. Seven other patients with alcoholism who indulged in drug-seeking behaviour involving chlormethiazole are also reported, together with a further seven abusers of various other drugs who were also discovered to be taking chlormethiazole.

In a day hospital all staff members must be able to make rapid decisions, even when they cannot refer to their seniors. It is difficult to develop this capability in a teaching day hospital where the staff and student groups are constantly changing. It has, however, been facilitated by regular staff discussions with a visiting psychotherapist. In these staff groups, the study of role attributions and dynamics characteristic of families has diminished the interference caused by ‘family’ type dynamics in daily professional interaction. The paper describes the effect of such discussion in stimulating the adoption of a treatment approach which takes the family situation into account. This family approach is distinguished from family therapy, and its advantages are discussed.

Evidence was found against the hypothesis that heterozygous carriers of a schizophrenic gene have a reproductive advantage through enhanced fertility. In consequence an investigation was made of the possibility that an advantage is gained through diminished early mortality among the offspring of carriers. The results were equivocal. While an observed deficit of infant deaths was attributable to under-reporting, the possibility of a true advantage could not be ruled out, because of the statistical unreliability of the findings in a sample of the size available. A plea is made for a collaborative effort to settle the issue.

Progress in science depends upon the fertility of inspiration, the acuteness of observation, and the accuracy of instruments to measure those observations. It is with respect to the last of these that progress in psychiatry has lagged. Instruments in plenty have been devised, many have been acclaimed and some accepted as a standard against which the other measures are judged; some have even come to be used as a definition of the disorder to be measured, the achievement of a certain score indicating that the disorder is present.

The recent development of new neuroleptics that differ from the conventional neuroleptics in both mechanism of action and side-effects profile has introduced problems in their clinical assessment, and highlighted ongoing issues in the design and methodology of clinical trials. These issues are broadly grouped and discussed as follows: sampling problems and selection of patients; design issues; problems in measurement; ensuring compliance; recognition of extrapharmacological issues; and statistical models. For patients to benefit from the development of new neuroleptics, clinical settings have to be prepared for testing their efficacy and safety without too much delay in well designed clinical trials.