The standard technical vocabulary used to define placebo therapies and experimental placebo controls in medicine and psychiatry is both confusing and obscure. To achieve conceptual clarity in the theory of placebogenic phenomena, this paper offers (1) a rigorous articulation of the placebo notion, (2) a lucid new terminology that obviates the defects intrinsic to the traditional locutions employed in the placebo literature, and (3) a substantial revamping of A. K. Shapiro's influential prior definition of‘placebo’. This paper supersedes an earlier version (Grünbaum, 1981).

By means of a National Case Register of patients admitted to psychiatric hospitals in Norway it was possible to study the case-histories of the 199 patients admitted from 1916 to 1975 with a diagnosis of Huntington's chorea. Ascertainment is likely to have been most complete for the years 1930–50, when the prevalence rates ranged between 6 and 7 per 100000 population. The social adjustment of the patients was found to be more favourable than expected up to the onset of serious psychiatric and neurological symptoms. The marriage rate and the rate of reproduction were not lowered. Occupational distribution and the pattern of migration were normal. Depression and suicide were remarkably rare. The age of onset among single patients was nearly 10 years lower than among the married, and more than 13 years lower on admission to hospital, indicating selection for marriage. With a marriage rate of about 70% and the late manifestation of the disease, predictive tests without prospects of treatment are apt to increase significantly the burden on the carriers.

The results of an examination of the 238 cases of anorexia nervosa on the Aberdeen Psychiatric Case Register for the period 1965–82 are reported. A highly significant increase in the number of cases over time was found. The average annual incidence rate for the period 1978–82 was 4·06 per 100000 population. The case notes of every second patient on the register were inspected to assess diagnostic reliability, to define patient characteristics further and to look for changes in these over time. The diagnosis was highly suspect in 5% of cases. A social class bias was found, with an over-representation of classes I and II but an under-representation of social class III. Few significant changes were noted in the patients over time. The utilization of services was also examined, and it was found that 24% of the patients remained in contact for 4 years or more.

The plasma beta-endorphin response to glucose ingestion was compared in 8 bulimics and 8 controls. The bulimics demonstrated a sustained elevation of plasma beta-endorphin unrelated to glucose ingestion throughout the 5-hour study period. It is hypothesized that such an elevation of beta-endorphin is the result of stress and that it may play an important role in the perpetuation of the binge-vomiting cycle.

Fifty-six bulimia nervosa patients were treated by means of a behavioural approach and followed for at least one year after completion or dropping out of treatment. Outcome was encouraging in about half of the patients and several psychiatric indicators, such as duration of illness and response to treatment, were identified. The significance of the findings and unresolved methodological issues are discussed.

‘Weight pathology’ – defined by Kalucy et al. (1977) as ‘deviations in weight, shape, eating behaviour and activity’ – has been hypothesized to be unduly common in families with anorexia nervosa. It was investigated in this study by means of questionnaires evaluating both weight history and attitudes towards weight-related matters in 58 mothers of anorexia nervosa patients and 204 mothers of schoolgirls of similar age and socioeconomic status (SES). No support was found for the hypothesis. A family history of aberrant weight and mother's current weight and past weight histories showed no significant differences between the groups. 142 other mothers of schoolchildren and 446 attenders at Weight Watchers also completed the questionnaire on attitudes towards weight-related matters. Mothers of patients showed a lower concern on all scales than did all other groups. The findings are discussed in relation to earlier controlled studies of family factors in anorexia nervosa.

The evidence on cognitive decline in senile dementia is reviewed with respect to the distinction between controlled and automatic processing. It is argued that controlled processing, which requires the attentional resources of the individual, declines in early senile dementia. However, automatic processing, which does not require attentional resources, is well maintained until late in the disorder. Implications of this view are drawn for the development of effective screening instruments which can be used for the early detection of dementia in the general population.

The Geriatric Mental State and a new computerized diagnostic system, AGECAT, are briefly described. A nomenclature for designating cases for epidemiological work is introduced. Concordance between AGECAT and psychiatrists' diagnoses for these studies, hospital and community based (total of 541 subjects), achieved overall kappa values of 0·84 for a psychiatric hospital sample and 0·74 for a community sample. The values for depression and organic illness specifically in these settings were psychiatric hospital 0·80/0·86, and community 0·80/0·88, respectively.

The inter-rater reliability of Brown's measure of ongoing difficulties (‘severity’) is shown to be comparable with that of the measure of life events (‘long-term threat’) when using data from an elderly subject pool. Test–retest reliabilities for both the life event and difficulty measures are shown to be adequate if based on ‘consensus’ ratings. The question is raised of generalizability of the concepts of ‘threat’ and ‘severity’ across the lifespan.

A systematic survey of in-patient accidents and injuries in an inner London hospital over 9 years established that, after incisions and overdoses, self-incineration was one of the commoner methods of violent self-harm. A case-controlled study of in-patient suicide attempts compared a series of 12 self-incinerators with 12 patients using other methods. Irrespective of method, the suicide attempt was predominantly a psychotic act of young single people with chronic, severe disorders and considerable past parasuicide, in a setting of escalating self-harm. Younger age, greater psychiatric morbidity, absence of alcoholism, a history of childhood arson, past and current self-burning were the features specific to self-incineration, which had a 25% mortality rate.

An assessment of the long-term outcome for depression and anxiety disorders in a general population was made as part of the Stirling County Study. Measuring outcome as a dichotomy between experiencing recurrent episodes or not during a 17-year cohort interval, it was found that 56% of the ‘cases’ had a poor prognosis. While sex, age and level of severity were not significantly related to outcome, an initial diagnosis of depression was predictive of unfavourable prognosis. Only a few of these ‘cases’ received psychiatric specialty treatment. Some disorders in the community appear, however, to be as serious as those that come to the attention of psychiatrists.

All severely mentally handicapped children aged 5–19 years from the city of Manchester were identified in a cross-sectional study. A standardized Disability Assessment Schedule was used to assess the variety and degree of disabilities experienced by each child and by specific subgroups of the children. This paper focuses upon differences between groups of European and Non-European ethnic origin. Boys showed more disabilities than girls in both groups, but non-European children had more severe disabilities in virtually all categories.

This study confirms the validity of a Spanish version of the General Health Questionnaire in its scaled 28-item version. The screening instrument was tested on a sample of 100 patients attending an internal medicine out-patient clinic, who were examined independently by psychiatrists standardized in the use of the Clinical Interview Schedule (CIS). The questionnaire correctly identified 85% of “cases” with a cutting score of 6/7 (sensitivity 76·9%, specificity 90·2%), and 83% of cases with a cutting score of 5/6 (sensitivity 84·6%, specificity 82%), suggesting a discriminative power almost as good as the Spanish GHQ-60. It has the important advantage of being considerably shorter and, although the 4 subscales are by no means independent, its concurrent validity with CIS ratings suggests that they provide additional information concerning anxiety and depression.

Results are reported from a large population study (of working people) comparing Holocaust survivors and a control group in regard to emotional distress, satisfaction in life and psychosomatic symptoms. It was found that, even 40 years after the traumatic experience, this group of survivors exhibited a slightly higher degree of emotional disorders than controls who were not under Nazi occupation during WWII. These long-term effects were usually more prominent in women than in men, and the relationship to age was minimal.

Developmental psychopathology constitutes a research strategy that is concerned with questions about continuities and discontinuities over time (the developmental perspective) and over the span of behavioural variation (the psychopathological perspective). The utility of this approach is discussed in relation to childhood depression, autism and schizophrenia, and the effects of adverse life experiences.

Standard scores on tests of intelligence, memory and academic achievement were obtained from individuals with either schizophrenic spectrum disorders, mania, alcohol abuse, antisocial personality disorders or no mental disorder. The three cognitive measures were highly and positively correlated in three groups (normal controls, alcohol abusers and antisocial personality disorders), while in the schizophrenic spectrum and manic groups a pattern of average reading and spelling achievement was contrasted with lower intelligence and memory quotients. It was suggested that reading and spelling ability are more accurate predictors of premorbid ability in psychotic disorders than other psychometric scales. This parallels previous findings with organic dementias and raises questions about possible shared aetiological bases between dementias and psychoses.

Groups of highly anxious, moderately anxious and minimally anxious primiparous mothers (N= 147) were obtained on the basis of Spielberger trait anxiety scores in the postpartum period, and subjects were compared. Allocation to those groups appeared to be more likely to reflect constitutional levels of anxiety, rather than recent or current social stressors. Highly anxious mothers were distinguished on a number of presumed correlates of anxiety measured by clinical questions (e.g. terminating of anxious situations), hospital notes (e.g. mood problems noted by nursing staff) and blind rater assessments (e.g. unassertiveness). While highly anxious mothers were more likely to report more recent life events, less social support, and negative interpretations of the pregnancy, the hospital experience and the hospital staff, such variables were less discriminating when neuroticism levels were effectively controlled. This suggests an intrinsic perceptual bias, rather than that the factors were determinants. Highly anxious mothers had more delivery complications, while their babies were more likely to be dysmature and slow to suckle, features we interpret as consequences of the anxiety levels. In the postpartum period these mothers were more depressed, had more concerns about their baby, themselves and their marriage, and were less confident about coping and their parenting capacities. Such variables may be correlates or consequences of anxiety.