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Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Most of the doctors are very poor in eliciting the history of mental illness. A number of patients complain of severe restlessness, chest apprehension (ghabrahat), anxiety, irritability, palpitations, sweating severe insomnia and fear of death. Such type of mental illnesses are increasing in the population day by day. These patients should be given more time and attention while listening to their complaints. They should be examined in detail from top to bottom not to find any organic illness but to give them satisfaction that you are looking out and excluding all the organic diseases which can cause such symptoms. Thus

a. if you are examining the neck by stretching the jaw upwards, and if the patient questions what are you suspecting, the answer should be "I am excluding a rare thyroid disorder which can cause sweating and palpitation".

b.quite often it happens that these patients are obese or have mild hypertension or palpable fatty liver or palpable spleen or a murmur of mitral valve prolapse or blood report shows slight glucose intolerance or raised blood cholesterol or triglycerides or the blood count shows mild anaemia. At this sitting the patient should not be told regarding any of the organic diseases. These can be tackled later on, after the mental health becomes normal and "panic attack" passes off, because there is absolutely no hurry to treat such illnesses.

The patient should not go back with the feeling that an organic disease was the cause of the complaints. Instead he/she should be explained that they have a disease but it is a disease of the mind and since it is very difficult to control this disease by talking, he or she will have to take proper doses of proper drugs for a particular period of time. Unless this is explained in detail, such patients are told by the relations that the doctor has said that there is no disease and she is only imagining the symptoms which will disappear with passage of time. Thus, the patient continues to suffer though a natural remission can take place after a few weeks or few months.

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