Utilizing a wide range of eighteenth- and nineteenth-century biographical sources, the eating pathology of Dr Samuel Johnson is illustrated and examined. His presenting symptoms are considered in the light of modern criteria for eating disorders and current research on bulimia nervosa and rumination disorder.

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.

Seven (21%) of 34 patients with a severe DSM-III diagnosis of major depression had red-cell folate levels below 150 ng/ml. This subgroup with folate deficiency had significantly lower CSF 5-hydroxyindoleacetic acid (5HIAA) compared to neurological controls. For all depressed patients red-cell folate was significantly correlated with CSF 5HIAA and homovanillic acid (HVA). CSF tetrahydrobiopterin (BH4) was significantly correlated with CSF 5HIAA and HVA and red-cell folate. Our observations provide further evidence of the links between folate, biopterin and monoamine metabolism in depression.

Depressive symptoms have been reported in patients with mild to moderate Alzheimer's disease (AD). Recent evidence suggests that a noradrenergic deficit originating from neuronal degeneration in brainstem nuclei may represent an organic correlate of these disturbances. We examined the neuropathological changes in the locus coeruleus (LC), substantia nigra (SN), basal nucleus of Meynert and cortex of 52 patients (12 male, 40 female, mean age 83·2 ± 6·4 years) with pathologically verified AD. Fourteen patients (1 male, 13 female) showed signs of depression. The majority of these patients suffered from severe physical disability or sensory impairment and developed persistent delusions, but had less cognitive impairment. Neuronal counts in the LC were significantly lower than in the 38 patients without depression (36·9 ± 14 ·0; 51·4 ± 28·0 neuromelaninpigmented cells per section per nucleus; F = 3·4, df = 1, 50, P = 0·04). Neuron counts were higher in the basal nucleus of Meynert in depressed AD patients and there were no differences of the neuron numbers in the SN. Depression (main effect; F = 4·5, P = 0·04) contributed significantly to the variance of neuronal counts in the LC, even when covarying for gender, age of onset, cognitive impairment and cortical Alzheimer pathology. The observed disproportionate loss of noradrenergic and cholinergic neurons in the LC and basal nucleus of Meynert may represent an important organic substrate of depression in AD.

The aim of the study is to provide (i) a standardized procedure for a Cancellation Test of Digits, designed to assess in the visual modality selective attention deficits in patients with Alzheimer's disease, and (ii) a detailed analysis of how patients cope with it.

Age-, education-, and sex-adjusted normative scores earned by 352 healthy controls are set forth, as well as data yielded by the Digit Cancellation Test in 74 Alzheimer patients, in 26 patients with a CT-assessed frontal lobe lesion and in a group of 24 healthy subjects urged to perform the task with a shortened time-constraint. Findings include discriminant power of Alzheimer patients versus healthy controls, sensitivity to cognitive evolution of the dementing process and analysis of errors. Attention data failed to supply psychometric support for the posterior-to-anterior algorithm of progressive cortical encroachment of Alzheimer's disease suggested by PET-findings.

Emphasis is put on methodological aspects of neuropsychological research on Alzheimer patients and on the analysis of processing components of the tests employed. Results are discussed in the light of the relationships between psychometric assessments and related functions, and underlying neuronal degeneration.

The National Adult Reading Test (NART) is widely used in clinical and research settings to estimate pre-morbid intellectual levels. The validity of the NART in estimating pre-morbid ability in Alcoholic Korsakoff Syndrome (AKS) is examined in the present study. Twenty AKS subjects were compared with 40 healthy controls. The validity of the NART as a pre-morbid measure in AKS was examined using four methods. AKS subjects made more NART errors than controls, had lower NART predicted IQ than demographically predicted IQ, made more NART errors than predicted by demographic variables and demonstrated NART performance which correlated with degree of memory impairment. It is concluded that NART performance is detrimentally affected by the AKS and that estimating pre-morbid intellectual level in Korsakoff's psychosis using the NART may be invalid. Furthermore, it is postulated that the impaired ability to pronounce correctly irregular words in AKS may reflect a failure in cognitive ‘error checking’ which may represent a consequence of frontal lobe dysfunction.

Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD.

Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%.

Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.

Syndromes of dyskinetic movements in subjects (N = 70) with chronic schizophrenia were investigated, using principal components analysis of AIMS ratings. Consonant with previous research, three discrete groupings were found, namely dyskinetic movements of lips-jaw-tongue, limb-truncal and facial movements. These were then related to demographic, psychological and movement disorder variables. The limb-truncal, but neither the lips-jaw-tongue nor facial movements components, were associated with negative symptoms and cognitive impairment.

The goals of the present study were to explore: (1) whether schizophrenics, depressives, and normals differ in their likelihood of expressing different emotions; and (2) whether the types of expressions subjects exhibit are associated with their level of reported depressive symptomatology. Subjects were asked to imagine: seeing, smelling, or tasting something disgusting; and having something wonderful happen to them. Subjects were asked to show the experimenter what their face would look like if these things happened. The groups differed in how frequently they exhibited anger or contempt in the first condition and happiness in the second condition. The depressives were most likely to exhibit anger/contempt and least likely to exhibit happiness. Using Beck Depression Inventory scores as dependent variables, there were significant interactions between diagnostic group and the type of facial expressions exhibited. The associations between facial expressions and BDI scores were in the opposite directions for depressives and schizophrenics.

Associations between ischaemic heart disease and psychiatric morbidity in hospital recruited samples may be confounded by differential referral of patients with co-morbidity. Associations of angina, past history of myocardial infarction, blood pressure, and electrocardiographic evidence of ischaemia with psychiatric disorder can best be examined in community samples as reported here in 2204 middle-aged men from the Caerphilly Collaborative Study. There was a strong association between past history of myocardial infarction, non-specific chest pain, Angina Grade II and psychiatric disorder measured by the 30-item General Health Questionnaire. Electrocardiographic evidence of ischaemia alone was not significantly associated with psychiatric disorder. It is suggested that non-specific chest pain is a symptom of psychiatric disorder; conversely in severe angina psychiatric disorder is secondary to the pain, restricted activity and threat to life which angina implies.

Fifty patients with bulimia nervosa were followed up for a minimum length of 5 years. Standardized interviews, observer-rated instruments and self-rated questionnaires were employed both at entry and at completion of the follow-up period. After tracing, the positive response rate was 72%; one patient had died. At the time of follow-up 31% of those traced had made a complete recovery and 25% still fulfilled diagnostic criteria for bulimia nervosa. Judged on behavioural symptoms 47·2% of responders had a ‘good’ outcome. Good outcome was associated with fewer social problems, higher social class, and a significant improvement in eating attitudes at follow-up. All outcome groups reported a reduction of interference by symptoms in other areas of life, and an improvement in mood state. No factors, including those described in previous studies, were identified which predicted outcome.

The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a psychometrically sound self-report instrument for assessing women's attitudes towards their own bodies. The BAQ responses of a large sample of patients with eating disorders (ED) diagnosed in accordance with DSM-III-R criteria were compared with those from a normative population and from diverse groups of psychiatrically and physically ill patients. The ED group was distinct, and showed extreme responses in the area of weight and shape concerns. But a better discrimination between the ED and other populations was achieved using subscales that related to ‘body disparagement’ (an intense loathing of the body) and ‘attractiveness’, rather than to weight and shape concerns. ED patients may have a more pervasive disturbance in body-related attitudes than is currently widely accepted. Patients with anorexia and bulimia nervosa showed very similar attitudes despite the symptomatic differences between the groups.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.

Burnout signifies the chronic depletion of coping resources following prolonged exposure to emotionally charged demands. It is manifested by symptoms of emotional, physical and cognitive exhaustion, and is usually studied in relation to occupational stressors. We hypothesized that the major life crisis engendered by missile attacks would give rise to burnout or exacerbate preexisting burnout symptoms. We also hypothesized that individuals suffering from prewar burnout would appraise the war as being more threatening and would be more vulnerable to upper respiratory infections (URI). Wartime and pre-war (baseline) levels of burnout and related symptomatology (cognitive weariness, listlessness, tension and somatic complaints) were compared among 162 Israeli civilians who carried on with their employment duties throughout the Gulf War. We found that the war impacted primarily on younger individuals (age < 45). All the pre-war levels of the above measures increased significantly (except for a marginal increase in tension). The impact of the war was mediated by threat appraisal, as indicated by worry and apprehension. Worry was positively associated with pre-war burnout, and negatively with age and education. Pre-war burnout was associated positively with wartime URIs. It was concluded that the war accelerated the depletion of coping resources and that burnout may be affected by factors other than occupational stress.

Few empirical studies have examined the mental health of workers on North Sea oil and gas installations, and it is unclear from the available literature whether offshore employees show impaired mental health relative to their onshore counterparts. The present study was intended to clarify this issue by direct comparison of the General Health Questionnaire (GHQ) scores of onshore and offshore personnel engaged in similar work. As compared with published data, only the onshore group showed low GHQ-12 scores, although both groups were low in neuroticism. Analysis of GHQ subscale scores demonstrated that anxiety was significantly higher among offshore workers than among those working onshore, but there were no significant differences in somatic symptoms or social dysfunction. Regression analyses showed that this result was not affected by control for age, job level, and neuroticism, although there was a significant interaction between job level and neuroticism in predicting anxiety. The nature of the offshore environment, and the factors which may play a causal role in elevated anxiety among offshore workers, are discussed.

Factor analyses of the General Health Questionnaire have attempted to interpret the factors as measuring anxiety, depression and social functioning. Data from two large community surveys were used to conduct an unrotated principal components analysis of the 30-item General Health Questionnaire. A general factor, indicating overall severity of psychiatric disorder, accounted for around 30% of the variance. The next most important factor, accounting for about 8% of the variance, was bipolar with the positive (‘less than usual’) items of the General Health Questionnaire having positive coefficients and the negative (‘more than usual’) items having negative coefficients. It is suggested that the concepts of positive and negative mental health derive empirical support from the results and may prove to be a useful classification of dimensions of mental health in the community.

This paper describes quantitative and qualitative aspects of social support in a sample of 40 long-term schizophrenic day patients attending a rehabilitation unit. The influence of symptomatology and experience of life stressors on network and support characteristics was also investigated. The primary networks of these patients were found to be small, comprising on average 7 members, of whom only 3 were seen regularly. Despite this, subjects rated their perceived support as adequate. The secondary networks were of the order of 32. It emerged that greater prevalence of negative symptoms was significantly associated with lower ideal levels of support and this group of patients was significantly less likely to seek support in the event of a life stressor. This may be a protective mechanism to insulate the person from the effects of stressful relationships but at the same time means that they are isolated from potential supports. The clinical implications are discussed in terms of offering optimum support for this marginalized group.