The recent and pending introduction of new antipsychotic medications carries the hope of a significant advance in the treatment of schizophrenia. Although the propensity of these agents to cause fewer motor side-effects than conventional neuroleptics may lead to improved compliance and clinical effectiveness, the promise of a significant impact upon the lives of patients may primarily reside in the evidence that the atypicals alleviate negative features such as emotional flattening, social withdrawal and impoverished speech. Auditory hallucinations and delusional thinking are the more dramatic expressions of illness, but these negative symptoms, along with neuropsychological deficits, are arguably more responsible for the persisting debilitation exhibited by schizophrenics (McKay, 1980; Pogue-Geile & Harrow, 1985; Breier et al. 1991; Crow, 1991; Mukherjee et al. 1991; Kane & Freeman, 1994; Perlick et al. 1992; Green, 1996; Green et al. 1997). Negative symptoms and neuropsychological deficits are minimally responsive to conventional neuroleptics (Goldberg et al. 1991; Meltzer, 1992; Lee et al. 1994; Meltzer et al. 1994), leaving schizophrenics ill-equipped to deal with the demands of normal living.

The claim is often made that clozapine alleviates both negative symptoms and neurocognitive deficits (e.g. Meltzer, 1995a). Although there is hope that the newer antipsychotics will do likewise, the evidence for neurocognitive gains in particular is, so far, limited. Only a few studies of the effects of novel antipsychotics (such as risperidone, olanzapine, sertindole and related in-trial agents) on neuropsychological functioning have been undertaken. When effects have been demonstrated, their significance has remained unclear.

This state of affairs is unsatisfactory, as a positive impact upon neuropsychological functioning would be of interest for more than just clinical reasons. An amelioration of cognitive deficiencies would suggest that these features are not inexorably tied to an irreversible pathology, such as gross neurodevelopmental aberrations or loss of neural tissue. Rather, such gains would suggest a treatable underlying pathophysiology, lending hope to other treatments, including cognitive rehabilitation. Since these deficits are increasingly viewed as fundamental to our conceptions of severe psychiatric illness (Goldberg et al. 1991; Green, 1996; Nuechterlein & Subotnik, 1996), neurocognitive changes might reciprocally shed light on these medications and schizophrenia. Finally, differential effects on cognition across medications should be factored into cost–benefit analyses, particularly when these effects are accompanied by broader adaptive functioning gains.

Is there any reason to believe that the novel antipsychotics will significantly improve the functional capacities of schizophrenics? Several considerations are relevant, including purported action mechanisms, animal behaviour findings, neurological effects, negative symptoms effects and existing cognitive outcome data.

Background. There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data.

Methods. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand.

Results. The lifetime prevalence rates/100 for suicide ideation ranged from 2·09 (Beirut) to 18·51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0·72 (Beirut) to 5·93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married.

Conclusions. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Background. The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy (six self-help booklets) alone to six sessions of cognitive therapy linked to the booklets, which contained elements of dialectical behaviour therapy.

Methods. Thirty-four patients, aged between 16 and 50, seen after an episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N=18) or treatment as usual (TAU N=16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined.

Results. Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT (median 0·17/month MACT; 0·37/month TAU; P=0·11) and self-rated depressive symptoms also improved (P=0·03). The treatment involved a mean of 2·7 sessions and the observed average cost of care was 46% less with MACT (P=0·22).

Conclusions. Although limited by the small sample, the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.

Background. The aim of the study was to identify sociodemographic and clinical risk factors for death from suicide and undetermined injury in residents of one health district.

Method. Data were collected on all cases of suicide (ICD-9 E950–959) and undetermined injury (ICD-9 E980–989) for residents in North Staffordshire Health District between 1991 and 1995. Controls, identified from the Coroner's inquest register, who died from other causes, were matched for age and sex.

Results. Two hundred and twelve pairs of cases and matched controls were identified. Multivariate analysis (conditional logistic regression) showed that the risk of death due to suicide and undetermined death was associated with: recent separation, relationship difficulties, experience of financial difficulties, history of past criminal charges or contact with the police, a past history of deliberate self-harm, being on psychotropic medication at the time of death and a diagnosis of bipolar affective disorder. For sociodemographic variables, a univariate analysis found associations between the cases and being separated, living alone, having a past history of criminal charges and unemployment. Cases were more likely to have a psychiatric disorder, past history of deliberate self-harm and a past history of psychiatric contact for themselves or a family member. Controls were more likely to have a current medical disorder. Cases were more likely than controls to be on any form of medication at the time of death and to have received a prescription for psychotropic or non-psychotropic medication in the week and month before death. Cases were more likely than controls to have had contact with medical services in the week and month before death, with the general practitioner in the week before death and with psychiatric services at any time in the year before death. Strong associations were found between suicide and undetermined injury and life events such as recent separation and bereavement, and financial and relationship difficulties.

Conclusions. The study provides an analytical investigation utilizing a dead control group, data gathered from several sources and adequate numbers of cases. It confirms many of the risk factors identified in other studies and highlights the high proportion of suicides who have been in recent contact with the criminal justice system or have been prescribed medication shortly before death.

Background. Acute tryptophan depletion (ATD), a means of reducing brain serotonin synthesis, lowers mood in normal males with a multi-generational family history of major affective disorder (MAD) and in normal women devoid of any family history of psychiatric illness. As both a family history of MAD and female sex are factors predisposing to depression, the hypothesis that a mood lowering response to ATD may reflect a susceptibility to depression was further investigated in young women with an extensive, multi-generational family history of MAD. In addition, the temporal stability of mood change following repeated trials of ATD was also assessed in this study.

Methods. To deplete tryptophan, a tryptophan deficient amino acid mixture was ingested on two separate occasions. The control treatment, administered on a third occasion, was a nutritionally balanced amino acid mixture containing tryptophan.

Results. A marked lowering of plasma tryptophan (85–90%) was achieved by both depletions. In comparison to the balanced condition, family history positive (FH+) women showed no lowering of mood to either the first or second ATD (N=13) and N=12, respectively). Mood change between the two ATD trials (N=13) exhibited poor temporal stability.

Conclusions. These results may indicate that serotonin responsiveness is not an important characteristic of vulnerability to depression in these women. Alternately, these negative results may be due to the exclusion of a large number of FH+ women who had already experienced an episode of depression, resulting in the selection of a biased FH+ sample who are resistant to the mood lowering effects of ATD.

Background. The aim of this review was to survey the available literature on prodromal and residual symptoms of unipolar major depression and bipolar disorder.

Methods. Both a computerized (Medline) and a manual search of the literature were performed.

Results. In a substantial proportion of patients with affective disorders a prodromal phase can be identified. Most patients report residual symptoms despite successful treatment. Residual symptoms upon remission have a strong prognostic value. There appears to be a relationship between residual and prodromal symptomatology (the rollback phenomenon).

Conclusions. Appraisal of subclinical symptomatology in mood disorders has important implications for pathophysiological models of disease and relapse prevention. In depression, specific treatment of residual symptoms may improve long-term outcome, by acting on those residual symptoms that progress to become prodromes of relapse. In bipolar disorder, decrease of subclinical fluctuations and improvement of level of functioning by specific therapeutic strategies may add to the benefits provided by lithium prophylaxis.

Background. Recent studies have suggested that subjects with depression suffer a diagnosis-specific motivational deficit, characterized by an abnormal response to negative feedback that endures beyond clinical recovery. Furthermore, it has been suggested that negative feedback may motivate non-depressed controls, but not depressed patients, to improve their performance in neuropsychological tests.

Methods. We describe two studies. The first compared performance on the simultaneous and delayed match to sample (SDMS) task from the CANTAB neuropsychological test battery, in 20 patients with severe depression with 20 with acute schizophrenia, 40 with chronic schizophrenia and 40 healthy controls. The second examined the performance of depressed patients with diurnal variation in symptoms and cognitive function.

Results. All patients groups showed impairments on the simultaneous and delayed match to sample task compared to controls. Depressed patients did not show an abnormal response to negative feedback. Controls did not show a motivational effect of negative feedback. Depressed patients with diurnal variation showed no variation in their response to perceived failure. There was no evidence of abnormal response to negative feedback in any patient group using the ‘runs test’ or of a motivational effect in controls. Conditional probability analysis was not independent of the total number of errors made in the SDMS task.

Conclusions. Further studies are suggested to examine whether an abnormal response to negative feedback characterizes particular subgroups of patients suffering from depression.

Background. Although depressed patients demonstrate impaired performance on a range of neuropsychological tests, there is little research that examines either frontal cognitive deficits or possible differences in test performance between melancholic and non-melancholic subtypes.

Methods. Depressed subjects were administered a broad neuropsychological battery. In an overall analysis, 77 depressed subjects were compared with 28 controls. In a second set of analyses, the depressed sample was divided into melancholic and non-melancholic subsets according to DSM-III-R, the CORE system and the Newcastle scale. These depressed subsets were contrasted to controls and with each other using ANCOVA controlling for age, IQ, simple reaction time and Hamilton Depression scores where appropriate.

Results. The total depressed sample was impaired on most mnemonic tasks, simple reaction time and Trails B. Similar findings applied to DSM-III-R melancholic and non-melancholic subjects. When defined by the CORE and Newcastle (narrower definitions of melancholia), melancholic patients were additionally impaired on WCST (perseverative response) and (for Newcastle) digit symbol substitution. In contrast, the cognitive performance of the CORE and Newcastle-defined non-melancholic patients was largely unimpaired.

Conclusions. Using narrower definitions of melancholia, i.e. CORE and (in particular) Newcastle, melancholic patients were impaired on mnemonic tasks and tasks of selective attention, and set-shifting while non-melancholic subjects were largely unimpaired in their cognitive performance. These differences may be due to impairment of specific neuroanatomical regions in narrowly defined melancholic patients, in particular the anterior cingulate.

Background. The study aimed to assess the current and lifetime rates of post-traumatic stress disorder (PTSD) and major depression (MDD) among Nazi concentration camps survivors.

Methods. We investigated 51 Italian political deportees and 47 Resistance Movement veterans who reported traumatic experiences during active service. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale and the shorter version of the Hopkins Symptoms Checklist were also administered.

Results. The lifetime rates of PTSD and MDD were 35·3% and 45·1% respectively among deportees and 4·3% and 6·4% among former partisans. The current rates for PTSD and MDD were 25·5% and 33·3% among deportees and 4·3% and 4·3% among former partisans. Dissociative symptoms were more severe among deportees than among Resistance movement veterans.

Conclusions. Concentration camp internment, even for political reasons, appears to have severe long-term psychiatric consequences.

Background. This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe.

Method. Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N=197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up.

Results. Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points.

Conclusions. Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.

Background. In recent years, evidence has accumulated that a significant proportion of schizophrenic patients have severe memory impairment, which cannot be attributed to the effects of medication, chronicity or institutionalization. Our group has demonstrated that memory impairment is associated with poor psychosocial outcome and treatment resistance. Work on the classical amnesic syndrome has suggested that memory training is facilitated by adopting an ‘errorless learning’ approach, where subjects do not experience failure during learning. This is based on the theory that the preserved implicit memory of amnesic patients results in implicitly remembered incorrect responses interfering with target items, in the absence of a functioning explicit memory system to allow differentiation.

Method. We compared three groups of subjects, memory-impaired schizophrenic patients, memory unimpaired schizophrenic patients and healthy controls.

Results. An errorless learning approach conferred a significant advantage on the memory-impaired schizophrenic group, bringing their performance up to the level of both control groups. In contrast, adopting a traditional trial and error, or errorful approach resulted in markedly impaired performance in the memory-impaired schizophrenic group only.

Conclusions. We conclude that errorless learning approaches may be worthy of further evaluation in the cognitive rehabilitation of memory-impaired schizophrenic patients.

Background. The performance of the CES-D in a sample of elderly community residents was assessed. The influence of dementia on test performance and the necessity for the use of four factor scores instead of a single summary score of the CES-D were studied.

Method. Two hundred and eighty-seven subjects out of the general population aged 60–99 years were personally interviewed with standardized diagnostic tools and completed the CES-D. Best-estimate diagnoses served as ‘gold standards’ for receiver operating characteristics (ROC) analysis.

Results. The CES-D discriminated well between depressive and non-depressive subjects. Exclusion of demented subjects from the sample did not markedly increase test performance. Current depressive illness and dementia led to high scores on the CES-D. Unlike the factors ‘depressive affect’, ‘somatic/vegetative complaints’, and ‘interpersonal relations’, the factor ‘positive affect’ of the CES-D discriminated well between demented and non-demented participants.

Conclusions. The CES-D is a valid instrument for screening for depression in a community sample of elderly subjects. Its use can be recommended even if the presence of dementia is likely. The use of factor scores of the CES-D does not substantially contribute to an improvement of overall test performance, but, nevertheless, allows a more detailed insight and better interpretation of test results.

Background. Breathlessness in asthma often cannot be explained with objective variables indicating airways obstruction. The hypothesis that unrealistic breathlessness results from false interpretation of sensations was tested.

Methods. Sixty-four children and adolescents with asthma, aged 9–18 years, were randomly assigned to: (1) standardized physical exercise for induction of general symptoms; (2) equipment causing itching through skin irritation; or (3) physical exercise combined with equipment causing itching through skin irritation. Pre-test and post-test measures were: lung function; breathlessness; general symptoms; itching; state anxiety; and worry.

Results. Lung function decreased within normal parameters (3·8%, 1·1%, 2·6%, respectively) and did not differ significantly between conditions. Breathlessness increased significantly after exercise, particularly in condition 3. Breathlessness correlated with general symptoms and worrying, but not with changes in lung function, age, or asthma severity.

Conclusion. Biased symptom perception can explain unrealistic breathlessness. Prerequisites are situational cues triggering selective perception and ambiguous sensations associated with the anticipated (feared) physical state. Excessive breathlessness may often warrant objective confirmation by means of lung-function testing.

Background. There is controversy surrounding the factor structure of the Parental Bonding Instrument (PBI), a widely used instrument for assessing perceived parental rearing behaviours. Recent studies have proposed five different factor structures, including Parker et al.'s original two-factor model.

Methods. Four hundred and eighteen employed Japanese adults filled out the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model-fit.

Results. Parker's original two-factor structure fitted the data poorly. In general, three-factor structures showed better fit. Among the three-factor structures, Murphy's model and Kendler's model were superior (the adjusted goodness-of-fit index >0·8), with the latter providing the best fit to the data (the goodness-of-fit index >0·9). When considering invariance of factor structure across gender subgroups and across age subgroups, only Kendler's model was acceptable.

Conclusions. Parker's two-factor structure of the PBI may not be appropriate for assessing perceived parental rearing behaviours in a Japanese population. Three-factor structures, in particular Murphy's model and Kendler's model, are preferable. Kendler's model provided the best fit to the data and was relatively invariant across the subgroups in this study. Thus, Kendler's model might prove to be very important for obtaining a factor structure invariant across different cultures.

Background. The stress generation hypothesis proposed by Hammen (1991) holds that depressed individuals generate stressful conditions for themselves, which lead to recurrence. The original test of this hypothesis compared dependent life events in women with recurrent depression to medical and normal controls. Two further research questions emerged from this work: (a) do individuals with a history of many depressive episodes generate more dependent life events than depressives with fewer episodes?; and (b) what is the aetiological relevance of any stress that may be generated?

Methods. The present research tested differences in dependent and independent events between depressed individuals who had experienced: (a) no previous major depressive episodes; (b) one previous episode; and (c) two or more previous episodes. We predicted that, based on the stress generation hypothesis, recurrent depressives would show more dependent events than people without a depression history, and that these generated stressors would be of aetiological importance for precipitating recurrence (i.e. severe events in the 3 months preceding recurrence).

Results. Recurrent depressives experienced significantly more total dependent events than first-onset depressives in the 12 months, but not the 3 months, preceding their episode.

Conclusions. Although the findings supported the general premise of stress generation, the aetiological relevance of the generated stress for recurrence requires further study.

Background. Savant calendar calculators can supply with speed the day of the week of a given date. Although memory is suggested to be an important component of this unusual ability, memory function has never been systematically investigated in these skilled yet learning impaired individuals.

Methods. Eight savant calendrical calculators, most of whom had autism, were compared with eight verbal IQ, age and diagnosis matched controls on digit and word span tests and measures of long-term memory for words and calendrical information (individual years). In an analogue to the ‘generation effect’, the savants' memory for dates was also compared following calculation and study/read tasks.

Results. The savants did not differ from controls on measures of general short- and long-term memory. They did, however, show a clear recall superiority for the long-term retention of calendrical material. They also remembered calculated dates better than those that were only studied.

Conclusions. A general mnemonic advantage cannot explain savant date calculation skills. Rather, through exposure to date information, the savants are suggested to develop a structured calendar-related knowledge base with the process of calculation utilizing the interrelations within this knowledge store. The cognitive processing style characteristic of autism may also play a role in the acquisition of this savant ability.

Background. Previous studies on semantic priming have suggested that schizophrenic patients with language disturbances demonstrate enhanced semantic and indirect semantic priming effects relative to controls. However, the interpretation of semantic priming studies in schizophrenic patients is obscured by methological problems and several artefacts (such as length of illness). We, therefore, used a psychometric high-risk approach to test whether healthy subjects reporting language disturbances resembling those of schizophrenics (as measured by the Frankfurt Complaint Questionnaire subscale ‘language’) display increased priming effects. In addition, the Schizotypal Personality Questionnaire was used to cover symptoms of schizotypal personality. Enhanced priming was expected to occur under conditions favouring automatic processes.

Methods. One hundred and sixty healthy subjects performed a lexical decision semantic priming task containing two different stimulus onset asynchronicities (200 ms and 700 ms) with two experimental conditions (semantic priming and indirect semantic priming) each.

Results. Analyses of variance revealed that the Frankfurt Complaint Questionnaire-‘language’ high scorers significantly differed from low scorers in three of the four priming conditions indicating increased automatic spreading activation. No significant results were obtained for the Schizotypal Personality Questionnaire total and subscales scores.

Conclusions. In line with Maher and Spitzer it is suggested that increased automatic spreading activation underlies schizophrenia-typical language disturbances which in our study cannot be attributed to confounding variables such as different reaction time baselines, medication or length of illness. Finally, results confirm that the psychometric high-risk approach is an important tool for investigating issues relevant to schizophrenia.

Background. Recent literature has demonstrated that psychiatric patients, particularly those with a diagnosis of schizophrenia, may be at high risk for HIV infection. In fact, HIV-risk behaviour, such as intravenous drug with sharing needles, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs has been reported by a substantial proportion of mentally ill patients.

Methods. In order to examine this problem in Italy, HIV-risk taking behaviour and knowledge about HIV/AIDS was investigated among 91 schizophrenic patients by using two self-report questionnaires (HIV-Risk Behaviour Questionnaire; AIDS-Risk Behaviour Knowledge Test).

Results. One-third of the patients reported having been tested for HIV infection and one tested seropositive (prevalence 3·4%). A high proportion of patients reported HIV-risk behaviour, such as injected drugs use (22·4%) and engaging in high risk sexual activity (e.g. multiple partners, 58%; prostitutes, 45%; occasional partners, 37%). Condoms were ‘never used’ by 41% of the patients and ‘almost never used’ by another 25%. In spite of these behaviours, 65% reported no concern of HIV infection. Knowledge about AIDS was lower among psychiatric patients than a healthy control group. Patients with long-lasting illness and numerous psychiatric admissions were less acknowledgeable about HIV infection. Certain misconceptions on HIV transmission were related to HIV risk behaviour.

Conclusions. These results indicate the urgent need for HIV educational programmes within mental health community-care settings.

Background. Temporal lobe atrophy on magnetic resonance imaging (MRI) has been suggested as a specific diagnostic marker for Alzheimer's disease (AD). No previous comparison with dementia with Lewy bodies (DLB) has been reported.

Method. T1-weighted MRI scans were performed on 11 subjects with AD (nine with NINCDS/ADRDA probable AD and two with neuropathologically proven AD) and nine subjects with DLB (four with probable DLB diagnosed by clinical criteria and five with neuropathologically proven DLB). Groups were matched for age, duration of illness and cognitive test score. Two raters, blind to diagnosis and neuropathological findings, measured the volumes of the frontal lobes, temporal lobes, hippocampi, parahippocampal gyri, amygdalae, and caudate nuclei using a computerized volumetric analysis system. Scans were also rated for medial temporal atrophy on a four-point scale by an experienced rater.

Results. AD subjects had significantly smaller left temporal lobes and parahippocampal gyri than those with DLB. Medial temporal atrophy was present in 9/11 AD cases (82%) and absent in 6/9 (67%) of DLB cases. Two neuropathologically confirmed cases of DLB had severe medial temporal atrophy; both had concurrent AD-type pathology in the temporal lobe (Braak stage 4).

Conclusions. This pilot study supports the hypothesis that a greater burden of pathology centres on the temporal lobes in AD compared with DLB, except in DLB cases with concurrent Alzheimer pathology. A larger study is needed to confirm these findings and to determine whether MRI has a role in assisting with the clinical differentiation between DLB and AD.

Background. Schizophrenia has been defined in part by disturbances of thought and language. The non-schizophrenic relatives of patients also have been found to show subtle disturbances of language that may be associated with vulnerability. Investigators have hypothesized that these phenomena in patients and their relatives are, at least in part, the result of weaknesses in facets of attention and memory.

Methods. The present study assessed some neuropsychological process correlates of three different measures of thought and language symptoms in 55 stable out-patients, using tests of immediate auditory memory impairment and auditory distractability, and carefully controlling for generalized deficit effects. A parallel assessment was made of referential communication disturbances in 59 non-schizophrenic relatives of patients and 24 control subjects matched to the relatives.

Results. In patients, formal thought disorder, disorganization, and referential communication disturbances were all associated with each other and with auditory distractability. In addition, as expected, referential communication disturbances were associated with immediate auditory memory impairment. Referential disturbance ratings for relatives were similar in magnitude to those for the stable out-patients, and much higher than for controls. However, the relatives' language ratings were not associated specifically with weaknesses in attention or memory as measured.

Conclusions. Impairments in immediate auditory memory and attention are associated differentially with different types of communication disturbances in schizophrenia patients. The cognitive substrate for referential communication disturbances in relatives appears to differ qualitatively from that for patients.