Mesmerism was for a period very popular in Victorian Britain. The special clinical approach developed by Dr J. Esdaile while on duty in British India is elaborated in detail. The controversy surrounding Esdaile's treatment of surgical, medical and psychiatric cases at the ‘mesmeric hospital’ at Calcutta is discussed, and the main arguments are set within their contemporary socio-cultural context. Some of the arguments advanced for and against mesmerism contain concerns similar to those that have been raised during later decades in regard to hypnotism and hypnotherapy.

We present the development and standardization of a measure of spiritual, religious and philosophical beliefs. An interview was constructed based on on-going studies by the authors of the nature and strength of belief held by people hospitalized with an acute illness. The interview was tested with three standard populations–staff of a teaching hospital; attenders to an inner city general practice; and people with clearly defined, devout religious beliefs–in order to establish population norms, validity and reliability for each question. The interview performed well with satisfactory validity and high internal and test–retest reliability. It is not presented, however, as a final product which will meet all needs in this complicated area of study. Rather, we have attempted to refine a measure of spiritual and religious belief that might apply to people with a range of personal and public faiths. It is clear that people are able to express these aspects of their lives in a way that can be measured with acceptable reliability and validity. We believe that this interview could, therefore, be applied in any medical, psychological or social setting in which a measure of belief is sought.

This study investigates health and mental health services use by adults with and without newly incident mental disorders and uses prospectively gathered data from the Epidemiologic Catchment Area Program, a multi-site interview survey of adult household residents in the United States. Study subjects were 13400 participants who completed interviews in the initial survey and also in a follow-up 1 year later, and who reported no contact with mental health services in either the specialized mental health sector or in the general medical sector in the 6 months prior to the initial survey. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. ‘Hierarchical’ and ‘filter’ models of mental health services provide frameworks useful in understanding the possible effects of specific categories of psychiatric disturbances on use of health services. Only a minority of individuals with newly incident psychiatric disorder report discussion of mental health issues in a health care setting. Persons who developed a mental disorder during the follow-up interval were just as likely to consult a non-psychiatrist physician for their mental health problems as to consult a specialist in mental health, even accounting for other factors known to be associated with differential use of health care services. This large community study of incident psychiatric disorders strengthens prior evidence on the importance of the general medical sector in the care of individuals with psychiatric disturbances.

This study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0·22, 95% confidence interval 0·10 to 0·52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0·37 and 0·26, respectively). This large community study extends previous work on mental health services and ethnicity.

This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.

This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

To investigate the effects of demographic variables on changes in rates of depressive symptoms in a non-clinical population, a 4-year follow-up study was conducted on a total of 6378 employees of a Japanese electrical company. Data were collected five times at 1-year intervals (T0—T4) using a questionnaire that included the Zung Self-rating Depression Scale (SDS). Of the non-depressed (i.e. having a SDS score of 47 or less) at baseline (N = 4857), 14% were found depressed at least once during T1—T4. Younger, never married, female and blue-collar workers were significantly at greater risk for becoming depressed during the follow-up period (P < 0·05). Of the depressed at baseline (N = 505), 20% were depressed every time during T1—T4. Younger workers were significantly at greater risk for persistence of depressive symptoms during the follow-up period (P < 0·05). The results suggested that age is associated with both occurrence and persistence of depressive symptoms, while gender, marital status and occupation are associated only with the occurrence.

In order to describe the explanatory models and the etic and emic phenomena of common mental disorder in Harare, Zimbabwe, 110 subjects were selected by general nurses in three clinics and by four traditional healers from their current clients. The subjects were interviewed using the Explanatory Model Interview and the Revised Clinical Interview Schedule.

Mental disorder most commonly presented with somatic symptoms, but few patients denied that their mind or soul was the source of illness. Spiritual factors were frequently cited as causes of mental illness. Subjects who were selected by traditional healer, reported a greater duration of illness and were more likely to provide a spiritual explanation for their illness.

The majority of subjects were classified as ‘cases’ by the etic criteria of the CISR. Most patients, however, showed a mixture of psychiatric symptoms that did not fall clearly into a single diagnostic group. Patients from a subgroup with a spiritual model of illness were less likely to conform to etic criteria of ‘caseness’ and they may represent a unique category of psychological distress in Zimbabwe. A wide variety of emic phenomena were elicited that have been incorporated in an indigenous measure of non-psychotic mental disorder. Kufungisisa, or thinking too much, seemed to be the Shona term closest to the Euro-American concept of neurotic illness.

Diffuse loss of cortical volume and ventricular enlargement have been demonstrated in schizophrenia using imaging. In addition, histological studies have provided evidence that the number of neurons in the medial temporal lobe structures is reduced and that the cytoarchitecture is abnormal. In an attempt to correlate these histological findings with in vivo estimates of neuronal integrity we have studied the concentration of the neuronal marker N-acetyl aspartate (NAA) in the hippocampi of schizophrenics using in vivo Magnetic Resonance Spectroscopy (MRS). Compared with a group of healthy volunteers schizophrenics showed a 22% loss of NAA in the left hippocampus. Two other metabolites, choline and creatine showed bilateral reduction in schizophrenics and these achieved significance in the left hippocampus. These results indicate a significant depletion of NAA in schizophrenia and are in close agreement with the reported neuronal loss in the hippocampus detected histologically. We propose that in vivo MRS is a valid measure of integrity of neuronal populations in schizophrenia.

In the course of a large twin study of Alzheimer's disease we used a two-stage telephone screening procedure. The modified Telephone Interview for Cognitive Status (TICS-m) served as an initial screen for dementia in 12709 individuals. The telephone Dementia Questionnaire (DQ) was then asked of collateral informants for subjects with TICS-m scores below 28, as well as for samples of persons with higher TICS-m scores. Based upon DQ responses, individuals with cognitive impairment not attributable to focal causes underwent assessment for the clinical diagnosis of Alzheimer's disease (‘Alzheimer's dementia’), as did their twins. Well-defined Alzheimer's dementia was apparent in 39 subjects. Employing a cut-off of 27 or lower as indicative of cognitive impairment, the sensitivity of the TICS-m in the detection of Alzheimer's dementia was estimated at >99% and specificity at 86%. Inclusion of the DQ increased the specificity at the 27/28 cut-point to 99%. The TICS-m score was associated with an area under the receiver operating characteristic (ROC) curve of 0·88 (95% confidence interval 0·81 to 0·94). The maximum number of cases of Alzheimer's dementia remaining undetected in the sample was estimated to be 34.

HIV infection has been associated with decline in a number of cognitive functions that are components of ‘working memory’. Thus, tests of working memory that require the interaction of these components may be particularly sensitive to cognitive dysfunction that arises from HIV infection. To assess this possibility, working memory was examined in 147 HIV-seropositive (HIV+) and 38 HIV-seronegative (HIV−) males using the Reading Span Test and the Digit Span subtest from the Wechsler Memory Scale-Revised (WMS-R). Speed of information processing, a component of some working memory tasks, was assessed with a version of the Sternberg Memory Scanning task. Results indicated that symptomatic HIV+ subjects were impaired relative to HIV− control subjects on the Reading Span and Digit Span tests. Asymptomatic and mildly symptomatic HIV+ groups exhibited a trend toward impairment on these tests, and on the whole, a greater proportion of HIV+ subjects than HIV− subjects were impaired. The groups did not differ significantly in information processing speed. These results indicate that deficits in working memory are apparent in at least a subset of HIV-infected individuals. These deficits are most apparent in symptomatic HIV+ individuals, but the decline may begin during the asymptomatic phase of infection.

There has been much debate about the exact nature and time of onset of the cognitive impairments associated with infection by the human immunodeficiency virus type 1 (HIV-1). Studies to date have not reached consistent conclusions. The present study comprised 22 asymptomatic and 18 symptomatic HIV-1 seropositive men, whose only risk factor for contraction of the virus was sexual intercourse, and 18 seronegative controls matched for age and IQ. Subjects were given computerized neuropsychological tests from the CANTAB battery, which assessed visuospatial memory, attention and executive function. Both the asymptomatic and the symptomatic HIV-1 seropositive subjects showed a selective pattern of deficits relative to the controls. In addition, the seropositive subjects were subtly but significantly impaired on tests of executive function but unimpaired on certain tests of visual memory. This finding supports an hypothesis that frontostriatal dysfunction occurs in HIV-1 infected individuals prior even to the expression of clinical symptoms.

This paper examines structural brain abnormalities, as evaluated by the CT scan, in first episodes of schizophrenia and their association with sociodemographic, diagnostic and clinical variables. The investigation included all patients with a first episode of schizophrenia who, over a 2-year period, made contact with any of the public mental health services of the Autonomous Region of Cantabria in Northern Spain. Diagnostic and clinical characteristics were evaluated through the use of the Spanish version of the Present State Examination (PSE-9) and the Scales for the Assessment of Positive and Negative Symptoms (SANS and SAPS respectively). The study demonstrated the presence of structural brain abnormalities in this sample of first episode schizophrenics. These abnormalities were mainly expressed in the presence of larger VBR for schizophrenic patients than in the controls, these findings being more marked in women than in men. We failed to reveal, however, any evidence of an association of these brain abnormalities with diagnostic or clinical characteristics.

We compared 71 patients with irritable bowel syndrome (IBS) and 40 patients with inflammatory bowel disease (IBD) using structured interviews for psychiatric, gastrointestinal and sexual/physical victimization histories, as well as self-reported measures of personality, functional disability and dissociation. IBS patients had significantly higher lifetime prevalence rates of major depression, current panic disorder, and childhood sexual abuse. Despite the absence of organic pathology, IBS patients had significantly higher numbers of medically unexplained physical symptoms and disability ratings equal to, or greater than, those of patients with severe organic gastrointestinal disease.

The procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) was examined against the consensus diagnoses of two clinicians for six anxiety disorders (agoraphobia, panic disorder (±agoraphobia), social phobia, simple phobia, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD) and major depressive episode (MDE)). Clinicians had available to them all data obtained over a 2- to 10-month period. Subjects were 98 patients accepted for treatment at an Anxiety Disorders Clinic, thus, all subjects had at least one of the diagnoses being examined. While the CIDI-Auto detected 88·2% of the clinician diagnoses, it identified twice as many diagnoses as did the clinicians. The sensitivity of the CIDI-Auto was above 0·85 except for GAD, which had a sensitivity of 0·29. The specificity of the CIDI-Auto was lower (range: 0·47–0·99). The agreement between the CIDI-Auto and the clinician diagnoses, as measured by intraclass kappas, ranged from poor (k = 0·02; GAD) to excellent (k = 0·81; OCD), with a fair level of agreement overall (k = 0·40). Canonical correlation analysis suggested that the discrepancies between the CIDI-Auto and clinicians were not due to different diagnostic distinctions being made. It is suggested that the CIDI-Auto may have a lower threshold for diagnosing anxiety disorders than do experienced clinicians. It is concluded that, in a sample where all subjects have at least one anxiety disorder diagnosis, the CIDI-Auto has acceptable validity.

As part of the Taiwan Aboriginal Study Project (TASP), a new acculturation scale (the Taiwan Aboriginal Acculturation Scale, or TAAS) has been developed among the aboriginal minorities of Austronesian origin in Taiwan. The design of the original 54 items was based on Milton Gordon's concept of assimilation in association with a careful consideration of cross-cultural validity. These items were administered to 144 subjects stratified by age and sex who were randomly sampled from four major Taiwanese aboriginal groups. Item analysis and factor analysis were applied to select an 18-item scale which has three subscales (factors): cultural assimilation, social assimilation, and social attitude. Results of validity and reliability studies of the TAAS were found to be acceptable. The development of TAAS demonstrates the applicability of the concept of acculturation as a process that involves changes both in attitude, and in behaviour, to non-western societies.

The study assessed the implications of childhood life events, Holocaust background, combat experiences, war captivity and negative post-captivity life events in the mental status of ex-POWs (164) and comparable controls (184), 18 years after the war. Findings confirm the association between stressful life events in the course of the life span and five outcomes: PTSD, intrusion and avoidance tendencies, psychiatric symptomatology, and impaired social functioning. Different life events have different effects. War captivity made the strongest contribution to all dependent variables.

Four WAIS (Wechsler Adult Intelligence Scale) subtests, and tasks of memory and cognitive control were administered to a population sample of 143 men and 179 women. Subjects with a minor advantage in years of education out-performed those with only primary schooling. Gender-related effects were also remarkable. Whereas the general abilities were equal in the genders, women out-performed men on recall of word pairs and objects, on verbal cognitive control and on Digit Symbol. In contrast, men excelled on Trail Making A, and on Block Design. The findings emphasize the need for age norms by gender and education for cognitive tests.