Background. There still is much debate with regard to the role of psychosocial factors in cancer. Evidence suggests that cancer and coronary heart disease (CHD) may have common causes. This study examined the role of pessimism, anxiety and personality in the development of cancer among men who had been diagnosed with CHD but were free of cancer at baseline.

Methods. Two hundred and forty-six men who were treated for CHD, but were free of cancer, filled out psychological scales at baseline. Patients and their families were contacted after 6–10 years to determine the incidence of cancer.

Results. At follow-up, 12 patients (5%) had been diagnosed with cancer (9 cancer deaths). Development of cancer was unrelated to cardiac pathology but was associated with age [ges ]56 years, poor exercise tolerance, pessimism and anxiety. The rate of cancer was 8/60=13% for men with a distressed personality (type-D) and 4/186=2% for non-type-D men (P=0·002); rate of cancer death was 10% and 2%, respectively (P=0·007). Type-D refers to the interaction between high negative affectivity and high social inhibition. Regression analysis yielded older age (odds ratio 4·6, 95% CI 1·5–14·3) and type-D (odds ratio 7·2, 95% CI 2·9–18·1) as independent prognostic factors for cancer.

Conclusions. Type-D personality was a prognostic factor for the development of cancer in men with established CHD. Psychosomatic research should take a broad enough view of the specific and the global psychosocial variables that may play a role in both cancer and CHD.

Background. Chronic fatigue has infrequently been studied in twins. Data from twin studies can inform clinical and research approaches to the management and etiology of human complex traits.

Method. The authors obtained telephone interview data on current chronic fatigue from 31406 individuals twins in the Swedish Twin Registry (aged 42–64 years, 75·68% response rate), from both members of 12407 pairs and from one member of 6592 pairs. Of the complete pairs, 3269 pairs were monozygotic, 9010 pairs dizygotic, and 128 pairs of unknown zygosity. Structural equation twin modeling was used to estimate the latent genetic architecture of varying definitions of fatiguing illness.

Results. Estimates of additive genetic effects, shared environmental effects, and individual-specific environmental effects were similar in males and females. No definition of current fatiguing illness (ranging from any fatigue to CFS-like illness) was strikingly distinctive. Individual-specific effects were the predominant source of variation, followed by modest genetic influences. We could not exclude a small but conceptually important contribution of shared environmental effects.

Conclusions. Current fatiguing illness appears to be a complex trait resulting from both environmental and genetic sources of variation without pronounced differences by gender.

A review of the literature describing patients with functional visual loss reveals that a significant proportion of them do not manifest psychiatric disease as defined by current nomenclature. Apparently, these individuals are highly suggestible and do not necessarily have psychological pathology. The ramifications of this finding are discussed.

Background. Catatonia, a symptom complex with motor, affective and cognitive symptoms seen in a variety of psychotic conditions and with organic disease, was examined using a motor task using functional magnetic resonance imaging (fMRI).

Methods. Two acute catatonic patients and two age- and sex-matched healthy controls performed sequential finger opposition (SFO) after being medicated with 2 mg of lorazepam (i.v.). Functional magnetic resonance images were collected using a gradient echo pulse sequence (EPI).

Results. Patients with catatonia showed reduced motor activation of the contralateral motor cortex during SFO of the right hand, ipsilateral activation was similar for patients and controls. There were no differences in the activation of the SMA. During left hand activation the right-handed catatonic patients showed more activation in the ipsilateral cortex, a reversal from the normal pattern of activation in which the contralateral side shows four to five times more activation than the ipsilateral side.

Conclusions. In catatonic patients there is a decreased activation in motor cortex during a motor task compared to matched medicated healthy controls. In addition activation of the non-dominant side, left-handed activity in right-handed patients, results in a total reversal of the normal pattern of lateral activation suggesting a disturbance in hemispheric localization of activity during a catatonic state.

A group of 72 long-term patients, who were retained in Friern Hospital until the final stage of its closure programme, underwent a comprehensive psychiatric and social assessment shortly before moving to other hospitals. These patients were then compared with the rest of the long-stay patients who were considered suitable for community placement.

The residual group consisted of younger patients with shorter duration of stay, compared with the rest of the hospital population. Although not excessively disabled functionally or physically, the residual patients were slightly more disturbed in mental state in comparison with the rest, with notably higher levels of subjective anxiety.

A range of 13 problem behaviours were designated by staff as a direct impediment to placing a patient in a community setting. Most common problem areas were aggressiveness, non-compliance with medication and inappropriate sexual behaviour. Fourteen per cent of the residual group had none of these special problems. Some other patients have remained in hospital solely because they refused to leave.

It is argued that a distinction should be made between the residual patients who were actually transferred to other hospitals, and a core group of extremely disturbed patients for whom further hospitalization is likely to be the only alternative.

Background. Several examinations have detected a relation between depressive symptoms and medical utilization. However, selection biases have been involved in most previous examinations. We sought to test the association between depressive symptoms and prospective, increased medical care utilization, in a population-based Canadian sample, while controlling for utilization due to medical illness and controlling for selection bias.

Methods. Data from the Nova Scotia Health Survey 1995, an age- and sex-stratified random sampling of 3227 Nova Scotian adults, included the Center for Epidemiological Studies-Depression scale and items assessing chronic medical conditions and current limitations in daily activities resulting from medical illness. We linked survey data with medical care utilization measures for the year following the survey, including out-patient visits, reimbursement for out-patient services, hospitalizations, and hospitalization days.

Results. After controlling for age, sex, count of medical diagnoses and current medical severity, those with a greater level of depressive symptoms were at greater risk of having increased medical care utilization in the following year. These results remained after removing mental health care utilization costs.

Conclusions. In a population-based sample, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures. Whether depressive symptoms are a risk marker or a causal risk factor for increased medical utilization remains to be explored.

In a case control study which formed one arm of a large, population-based investigation of colorectal cancer incidence, aetiology and survival, ‘The Melbourne Colorectal Cancer Study’, among others, 22 psychosocially orientated questions were asked by personal interview of 637 histologically confirmed new cases of colorectal cancer and 714 age/sex frequency matched community controls, from Melbourne (population 2·81 million). Self-reported childhood or adult life ‘unhappiness’ was statistically significantly more common among the cancer cases, while ‘unhappiness with retirement’ was similarly distributed among cases and controls. Questions which were formulated to test a particular personality profile as a cancer risk, and which included the elements of denial and repression of anger and of other negative emotions, a commitment to prevailing social norms resulting in the external appearance of a ‘nice’ or ‘good’ person, a suppression of reactions which may offend others and the avoidance of conflict, showed a statistically significant discrimination between cases and controls. The risk of colorectal cancer with respect to this model was independent of the previously found risk factors of diet, beer intake, and family history of colorectal cancer, and was also independent of other potential confounding factors of socioeconomic level, marital status, religion and country of birth. Although the results must be interpreted with caution, the data are consistent with the hypothesis that this personality type may play a role in the clinical expression of colorectal cancer and was also independent of other potential confounding factors of socioeconomic level, marital status, religion and country of birth. Although the results must be interpreted with caution, the data are consistent with the hypothesis that this personality type may play a role in the clinical expression of colorectal cancer and merits further study.

Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.

Data from a case-control study of Alzheimer's disease (AD) were analysed in relation to age of onset and familial/sporadic status. The analyses were restricted to environmental exposures which might injure the brain. Later-onset AD was found to be positively associated with starvation/malnutrition and with nose-picking and negatively with analgesics, while earlier-onset was associated with physical underactivity and nervous breakdown more than 10 years before. Sporadic AD was associated with starvation/malnutrition and with head injury. These analyses merit replication in other large case-control studies of AD.

Background. For irrational fears and their associated phobias, epidemiological studies suggest sex differences in prevalence and twin studies report significant genetic effects. How does sex impact on the familial transmission of liability to fears and phobias?

Methods. In personal interviews with over 3000 complete pairs (of whom 1058 were opposite-sex dizygotic pairs), ascertained from a population-based registry, we assessed the lifetime prevalence of five phobias and their associated irrational fears analysed using a multiple threshold model. Twin resemblance was assessed by polychoric correlations and biometrical model-fitting incorporating sex-specific effects.

Results. For agoraphobia, situational and blood/injury fear/phobia, the best fit model suggested equal heritability in males and females and genetic correlations between the sexes of less than +0·50. For animal fear/phobias by contrast, the best fit model suggested equal heritability in males and females and a genetic correlation of unity. No evidence was found for an impact of family environment on liability to these fears or phobias. For social phobias, twin resemblance in males was explained by genetic factors and in females by familial–environmental factors.

Conclusion. The impact of sex on genetic risk may differ meaningfully across phobia subtypes. Sex-specific genetic risk factors may exist for agoraphobia, social, situational and blood-injury phobias but not for animal fear/phobia. These results should be interpreted in the context of the limited power of twin studies, even with large sample sizes, to resolve sex-specific genetic effects.

Background. Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16.

Method. Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 in five primary care practices. Second-phase subjects for interview (n=197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.

Results. Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care.

Conclusions. The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.