In the last decade, much physiological and biochemical information has been collected about the organic role played by the enzyme “true” cholinesterase in the transmission of nervous impulses (Crossland, 1957; Feldberg, 1957; Nachmansohn, 1959); but attempts to explain the function of pseudocholinesterase have been less consistent, and confined mainly to the effects of physical disease (Berry et al., 1954; Koster et al., 1943; Kunkel et al., 1947; McArdle, 1940) with one exception: Richter, (1942) discovered a significant relationship between raised pseudocholinesterase activity and neurotic anxiety or depression. Eysenck commented on this behavioural link (1947), but no further investigations appear to have been carried out in spite of the provocative theme. The possibility of other behavioural abnormalities being associated with an elevated pseudocholinesterase level therefore seemed to merit some attention.

Severe agoraphobia is difficult to treat. Encouraging immediate results have been reported with diverse treatments, including intensive psychotherapy (Friedman, 1959), acetyl choline injections (Sim, 1964), antidepressant drugs (King, 1962) and more recently with behaviour therapy (Wolpe, 1958). It is this latter claim which this paper examines. Early reports (e.g. Meyer, 1957; Wolpe, 1958) suggested that behaviour therapy might prove to be a rapid and effective treatment, but a small series studied by Meyer and Gelder (1963) demonstrated that results were not always as effective as single case reports suggested, and showed clearly that the treatment was often lengthy, taking 80 hours on the average. A retrospective investigation of a larger series (Marks and Gelder, 1965; Cooper, Gelder and Marks, 1965) again failed to support the early claims, although it was shown that behaviour therapy is an effective treatment for circumscribed phobias such as fears of animals and insects.

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.

In this paper “response inhibition” refers to the individual's capacity to refrain from responding in ways that are inappropriate. Inappropriate responding, usually in the form of over-responding, is more natural when we are young; but as we grow older our capacity to inhibit response, and hence our effectiveness, is normally expected to improve.

Light may be thrown on the aetiology of human abnormalities by studying the position in birth order occupied by affected individuals and the age of the mother at the time of their birth. There should be no shift from average population values in either of these respects in the case of conditions directly and solely due to an abnormal gene, though there may be such a shift in conditions due to chromosomal abnormalities, such as mongolism (Down's syndrome). If, however, the question of a chromosomal anomaly does not arise, then departure from normality in birth order and maternal age suggest that environmental factors are involved in the causation of the condition.

The relationship between child and adult psychiatric illness, though of fundamental importance, has received scant attention, perhaps because of the split which exists between the study and treatment of children and of adults.

The lithium ion has been found increasingly valuable in the treatment of manic illness (1, 2). In the therapeutic use of lithium there are two phases, stabilization and maintenance. These data have been reviewed by Gershon and Yuwiler (1), but a clear explanation of the pharmacodynamics involved is not evident. Animal experimentation has been used to study the behaviour of the lithium ion as compared with other cations. The lithium ion's behaviour resembles sodium in some tissues and enzyme systems but is more like potassium in others. These authors have reported a three- to fourfold increase in the tolerance for toxic symptoms due to lithium ion in manic patients as compared to normals. They found that this increased tolerance decreased to normal as the patient's manic state subsided.

This report is based on a study of 21 cases of anorexia nervosa treated and followed-up for a mean period of 1½ years.

Introductory View

Bereavement is only the most measurable of many possible traumata in childhood; it is fortunately not the commonest and its frequency is still diminishing.

Conventional Child Guidance treatment includes a diagnostic “work-up” of five to ten hours and then weekly psychotherapeutic and casework interviews for the child and mother which last for months or years and are very expensive of professional time. There have been few reports of evaluation of such treatment, though Levitt (1963) combined the results of a number of studies to include nearly 10,000 child patients. Of those who received treatment, between two-thirds and three-quarters were improved, but a similar improvement rate occurred in those who were not treated. Eisenberg and Gruenberg (1961) found short-term treatment as effective as intensive psychotherapy, and Phillips and Johnston (1954) and Phillips (1960) claimed better results with short than with conventional treatment. Among the few reports from Britain is that of Barbour and Beedell (1955). They found no difference in outcome between treated and untreated cases or between short and long methods of treatment.

Huntington's chorea is transmitted by a rare autosomal Mendelian dominant gene. Its hereditary transmission is facilitated by a late onset of the condition in many cases. Often the first signs are not seen until late in the reproductive period, so that it is not uncommon for a patient already to have produced a number of children before the diagnosis is made. On a theoretical basis, 50 per cent. of these offspring are at risk for carrying the gene and consequently for developing the condition themselves.

The blood pressure response to the injection of the parasympathomimetic drug methacholine (Mecholyl) has been used extensively in psychiatry to delineate various aspects of mental disease. Although originally used in diagnostic classification (Altman et al., 1943), its use, following the investigations of Funkenstein and his co-workers (1948, 1952), has more often been as an aid in prognosis or as a guide to the most useful type of somatic therapy. Investigations into this aspect of the test have resulted in many contradictory reports, and even after so many years there is still no agreement on the test's validity or usefulness.

The aim of this study is to describe by means of certain psychological tests various personality characteristics of those who have made suicidal attempts and to see how they differ from other psychiatric patients and from normals who have not made such attempts at suicide.

In recent years there has been a wide interest in the cross-cultural aspects of mental illness. Information concerning incidence, symptomatology and attitudes towards mental illness in the developing countries may contribute to the understanding of psychological processes and psychiatric problems. Kline (1963) reported a number of surveys of psychiatry in non-Western countries. One of these surveys was conducted in Kuwait, which is culturally and geographically intimately related to Iraq. This study aims at adding to Kline's data by providing information about various facets of psychiatry in Iraq. The present data were collected through interviews with a number of practising psychiatrists and through reference to hospital statistics and other relevant literature, in addition to the authors' clinical experience.

In 1963 the Child Psychiatry Section of the R.M.P.A. set up a small committee to study problems concerned with the schools for maladjusted children. The role of the psychiatrist in the ascertainment and subsequent placement of such children varies between one part of the country and another so that there was general uncertainty about the respective roles of the educational and psychiatric services in dealing with maladjusted children.

Do the relatively high N-scores observed in neurotic patients reflect a stable characteristic of the neurotic's personality, or are they temporary manifestations occurring only in the acute phase of the illness? Similarly, do the relatively low E-scores of dysthymic patients remain low through variations of clinical state or are they also temporary? The temporal stability of M.P.I. scores is of some practical importance. Criteria for psychiatric diagnosis often include assessments of personality before the illness. Fairly reliable information about this can often be obtained from relatives, but in other cases the clinician is faced with a problem that might appear insoluble. How is he to assess previous personality during an acute illness which may influence the behaviour on which personality is judged?

Sleep disturbance is commonly found in depression. Plasma cortisol levels in non-hospitalized normal subjects show a rise prior to waking, with peak values at between 5 and 8 a.m. (9, 10). In a group of eight normal subjects, Perkoff (10) changed the sleep rhythm to sleeping during the day, using darkened rooms, and found that the plasma cortisol level followed suit, rising sharply in the two-hour period before waking. He stated: “A fundamental characteristic of the diurnal variation of plasma 17 OHCS concentration is the abrupt rise which occurs during the sleep period.”

Obesity, one of the major threats to health and longevity in Western society, is usually treated with some form of weight-reducing regime. However, in recent years several authors have cautioned against the widespread prescription of reducing diets for obese patients because of the danger of inducing severe depression. The present investigation was undertaken to determine the actual risk of such severe depressive illness occurring among a group of obese dieters attempting weight reduction under the supervision of their general practitioner.

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.

Foulds (1961) has drawn what appears to be a useful distinction between personality traits and neurotic and psychotic symptoms and signs. This distinction is helpful both in diagnosis and in the assessment of treatment. Within the framework of this personality-trait and symptom-sign differentiation, Caine and Hawkins (1963) introduced a measure of what they describe as the hysteroid-obsessoid dimension of personality; and reasons in defence of this admittedly rather ugly terminology have been stated recently by Caine and Hope (1964). The self assessment hysteroid-obsessoid questionnaire (HOQ) was developed as a refinement of the hysteroid-obsessoid rating scale previously devised by Foulds and Caine (1958), which they had not found to be adequate in differentiating between groups of obsessoid and groups of hysteroid persons. The questions in the HOQ are framed in simple language and require only a true-false response. Caine and Hawkins have reported the results they obtained from administering this questionnaire to neurotic in-patients, some of whom also completed the Maudsley Personality Inventory (MPI), albeit at different stages of treatment. Although the MPI has been used extensively with samples drawn from non-psychiatric populations, both in the United States and the United Kingdom, Caine's questionnaire, a relatively new instrument, has not been as widely tested.