The epidemiology of mental problems in the Gomel region in the republic of Belarus was studied in a two-stage survey of a broad based population sample (N = 1617), using the General Health Questionnaire (12-item version) and the Munich Diagnostic Checklist for DSM-III-R. The Gomel region is one of the areas that was most severely affected by the Chernobyl nuclear diaster in 1986. In the studied population sample 64·8% had a GHQ-score above the threshold of 2. A DSM-III-R psychiatric disorder was present in 35·8%, with especially high rates for affective (16·5%) and anxiety disorders (12·6%). Dysthymia, general anxiety disorder, adjustment disorders and ‘not otherwise specified syndromes’ made up almost two-thirds of the observed morbidity (22·9%). A higher prevalence of mental health problems, both in terms of the GHQ and the DSM-III-R was observed among people who have been evacuated and in mothers with children under 18 years of age. These data indicate that the Chernobyl nuclear disaster may be partly responsible for the high prevalence of (milder) psychiatric disorders and psychological distress in the Gomel region, even 6 years after the event. Future studies comparing the data from Gomel region with an unexposed area will have to provide a more definite answer concerning the impact of this nuclear disaster on mental health.

The scope for the early detection of dementing disorders in the elderly by means of screening techniques is reviewed in the light of the basic principles of early disease detection. It is concluded that, while there is an increasingly urgent need for the development and application of psychogeriatric screening methods as a step towards preventive action, such methods are still at an early experimental stage. Prescriptive screening programmes are contra-indicated at present. The most immediate requirement is for evaluative research, which should be planned to take account both of the properties of the screening instruments and of the health-care and social settings in which these are to be applied. No major progress in this field can be expected unless it proves possible to integrate methods of early case-detection, and of systematic surveillance of the at-risk elderly, into the work of primary medical and social services.

Background. Behavioural syndromes (thought disturbance, social withdrawal, depressed behaviour and antisocial behaviour) offer a different perspective from that of symptomatic syndromes on the disability that may be associated with schizophrenia. Few studies have assessed their relationship with neuropsychological deficits. We hypothesized that these syndromes may represent behavioural manifestations of frontal-subcortical impairments, previously described in schizophrenia.

Method. Long-stay inpatients (n=54) and community patients (n=43) with enduring schizophrenia were assessed, using measures of symptoms and behaviour and tests of executive functioning. The relationship between syndromes and neuropsychological function was assessed using multiple regression and logistic regression analyses.

Results. Significant associations were found between performance on the spatial working memory task and the psychomotor poverty symptomatic syndrome, and between attentional set-shifting ability and both disorganization symptoms and the thought disturbance behavioural syndrome. These results were not explained by the effect of premorbid IQ, geographical location, length of illness or antipsychotic medication. Length of illness was an independent predictor of attentional set-shifting ability but not of working memory performance.

Conclusion. The specific relationship between negative symptoms and spatial working memory is consistent with involvement of the dorsolateral prefrontal cortex. The associations between difficulty with set-shifting ability and both disorganization symptoms and behaviours may reflect inability to generalize a rule that had been learned and impaired ability to respond flexibly. The specific relationship of illness duration to set-shifting ability may suggest progressive impairment on some executive tasks. The nature of these relationships and their neurobiological and rehabilitation implications are considered.

Background. Dementia screening instruments, such as the Cambridge Cognitive Examination (CAMCOG), measure a variety of cognitive functions. However, memory impairment generally is the first sign of Alzheimer's disease (AD). It seems logical, therefore, to use only memory-related items for the early detection of AD. We divided the CAMCOG into a memory section and a non-memory section, and tested the hypothesis that the memory section predicts AD better than the non-memory section. We also provide normative data for both sections.

Methods. Normal subjects (N = 169) and patients with incident AD (i.e. satisfying AD criteria between 1 and 3 years from baseline; N = 25) were participants in the Amsterdam Study of the Elderly (AMSTEL), a population-based longitudinal study on cognitive decline and dementia. Patients with prevalent AD (i.e. satisfying AD criteria at baseline; N = 155) were either recruited in a memory clinic or came from AMSTEL. Normal subjects were cognitively intact at baseline and remained so for at least 3 years. The CAMCOG was administered to all subjects. AD was diagnosed by DSM-III-R criteria.

Results. Logistic regression analysis showed that the memory section was related to prevalent AD, whereas in multivariate analysis the non-memory section was not (after correction for the memory score and demographic characteristics). A similar analysis showed that the memory section predicted incident AD, as did a higher score on the non-memory section. The MMSE did not predict incident AD better than age alone.

Conclusion. For the early detection of AD it is best to use the memory and non-memory sections separately instead of the total CAMCOG score.

Two groups of medical students answered a modified version of the Leyton Obsessional Inventory twice, with 8 weeks between tests. On one occasion it was administered in its original card-sorting (postbox) form; on the other, it was given as a written questionnaire. Fifty students answered the postbox form first, 50 the questionnaire first. Correlation between the 2 tests was reasonably good (r = 0·73–0·77). Scores on the first occasion of testing were significantly higher than on the second, but differences between scores on the 2 forms were not significant. Mean scores of male and female students were similar.

Three hundred and forty-three eating disorder patients (50% anorexia nervosa, 37% bulimia and 13 % atypical eating disorder) were seen by the eating disorder service in the Wellington (New Zealand) region between 1977 and 1986. Ninety-six per cent were female. Annual rate of referral for anorexia nervosa remained stable at 5 per 100000 population (34 per 100000 females aged 15–29 years). Annual referral rate for bulimia increased from 6 to 44 per 100000 females aged 15–29 years.

A double-blind comparison was made of the effects of amantadine hydrochloride, orphenadrine hydrochloride, and placebo in the control of the effects on the extrapyramidal nervous system of fluphenazine decanoate. Patients were assessed with regard to the main symptoms of Parkinsonism, the leading clinical signs, performance in walking, writing and squeezing, changes in mood, and unwanted effects of medication. Neither of the pharmacologically active substances was superior to placebo. Attention is drawn to the paucity of evidence for the effectiveness of anti-cholinergic drugs in both Parkinson's disease and in drug-induced Parkinsonism. The special difficulties in performing trials of substances used in relieving the unwanted effects of other drugs are discussed in relationship to defects in methodology in both this and earlier trials. The findings of the present study are not conclusive but show a clear need for further research in this field. The possible theoretical and practical importance of such research is discussed.

Background. There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis.

Method. Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress.

Results. Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients.

Conclusions. Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.

Background. Chronic fatigue syndrome (CFS) remains an idiopathic and controversial entity.

Method. We screened 31405 individual members of the Swedish Twin Registry (aged 42–64 years) for the symptoms of fatiguing illness via a telephone questionnaire. We refined self-reported symptoms via data from several national registries and from physician review of all available medical records in order to approximate closely the dominant case definition of CFS.

Findings. The 6-month prevalence of CFS-like illness was 2·36% (95% CI 2·19–2·53) and was markedly higher in women than men, odds ratio 3.92 (95% CI 3·24–4·72) with no significant association with age or years of education. There was a highly significant association with occupation that disappeared after accounting for gender.

Interpretation. CFS-like illness may be more common that previously acknowledged. There is a marked increase in risk by gender. Previous reports that CFS is more prevalent in individuals in certain occupational categories were not confirmed and may have been due to confounding by gender.

Cognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.

Background. The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions.

Method. A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up.

Results. Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9·6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2·07 (95% confidence interval (CI) 1·13–3·00) and 1·62 (95% CI 0·70–2·55) respectively] and PEP patients [2·37 (95% CI 1·35–3·39) and 1·93 (95% CI 0·92–2·94) respectively].

Conclusions. The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.