The concept of mood stability is attractive to both patients and clinicians alike, and hence the term ‘mood stabilizer’ has widespread currency. However, its worldwide acceptance and use in clinical practice is at odds with the absence of official recognition by regulatory authorities. The ideal mood stabilizer is said to have efficacy in the treatment of acute manic and depressive episodes, and also be effective in the prevention of recurrences. However, in reality, few drugs with perhaps the exception of lithium, come close to this gold standard; yet many agents aspire to the title, and some have arguably achieved it prematurely. It is, therefore, important to reconsider the definition of a mood stabilizer and critically review which agents, if any, satisfy the necessary eligibility requirements by reference to reasonable criteria and comparator data. The term mood stabilizer is an important label. It needs to be applied judiciously because it confers clinical credibility and qualifies long-term use in maintenance and prophylaxis. It is also important with respect to developing guidelines for treatment and the further development of novel agents. Most importantly, however, it is a term that is innately appealing because of what it promises: for this reason alone it should encompass only those agents that can deliver.

Background. Bright light and high-density negative air ion exposure are efficacious for winter and non-seasonal depression compared with a low-density negative ion placebo. Similarly, auditory stimuli improve mood in clinical populations. This study compared the short-term effects of bright light, an auditory stimulus, and high- and low-density negative ions on mood and alertness in mildly depressed and non-depressed adults.

Method. One hundred and eighteen subjects, 69 women and 49 men (mean age±S.D., 19·4±1·7 years), participated once across the year. Subjects were randomly assigned to one of four conditions: bright light (10000 lux; n=29), auditory stimuli (60 dB; n=30), or high-density (4·5×1014 ions/s flow rate; n=29) or low-density (1·7×1011 ions/s; n=30; placebo control) negative ions. Exposure was for 30 min on three consecutive evenings between 1900 and 2100 hours. Mood and alertness assessments, using standardized scales, occurred before, and 15 and 30 min during exposure. The Beck Depression Inventory classified subjects as depressed ([ges ]10; n=35) or non-depressed (<10; n=83).

Results. The three active stimuli, but not the low-density placebo, reduced depression, total mood disturbance (a global affect measure) and/or anger within 15–30 min. Neither testing season nor degree of depressive symptoms affected response to stimuli.

Conclusions. The auditory stimulus, bright light and high-density ions all produced rapid mood changes – with small to medium effect sizes – in depressed and non-depressed subjects, compared with the low-density placebo, despite equivalent pre-study expectations. Thus, these stimuli improve mood acutely in a student sample, including a subset with depressive symptoms.

Twenty women with anorexia nervosa were investigated at varying stages during weight gain. Basal prolactin and TSH and prolactin responses to TRH were normal and unrelated to body weight. LH, FSH and 17β oestradiol were low in emaciated patients and rose with weight gain. There was no correlation between serum gonadotrophin and prolactin concentrations. T3 and T4 concentrations were low but T3 rose with weight gain during refeeding over 4–6 weeks, whereas T4 remained low. A positive correlation was found between the TSH response to TRH and body weight.

The abnormalities in the hypothalamic–pituitary–thyroid axis were similar to those seen in a variety of chronic illnesses and appear to be unrelated to the amenorrhoea. The failure of restoration of normal function at least after short-term refeeding requires further investigation.

It was concluded that the amenorrhoea in anorexia nervosa is not associated with changes in prolactin but is determined primarily by changes in the hypothalamic–pituitary–gonadal axis. These changes are induced largely by nutritional factors but psychological factors may also be involved.

Two hundred and thirty-five entrants into the MRC trial for mild to moderate hypertension were matched with control subjects in order to assess the psychological effects of a screening programme and recruitment into a clinical trial. The prevalence and incidence of psychiatric morbidity among the trial participants were compared with those of the controls by means of responses to a self-administered questionnaire and diagnostic psychiatric interviews. No differences among the groups were shown between screening and entry into the trial, but after entry the prevalence of psychiatric morbidity among the trial participants fell. This was due to a greater improvement of those with psychiatric symptoms at entry in this group, the incidence of new morbidity being similar among the groups.

In total, 103 cases were randomly selected from the Groningen, Nottingham and South Verona registers. Six raters (two in each of the register areas) were involved in coding these cases according to the ICD–9. In general, interrater agreement was satisfactory when codes were grouped into a limited number of categories. Nevertheless, considerable variation in agreement rates was found. We distinguished three steps in the diagnostic process. The selected logistic model showed that reliability is significantly affected in each step, but only substantial in the first where clinicians formulate a diagnosis.

Schizophrenia may be associated with increased prostaglandin synthesis in certain parts of the brain. This hypothesis is based on the following findings: (1) Catalepsy, which is the nearest equivalent in animals to human catatonia, develops in cats when prostaglandin E1 is injected into the cerebral ventricles and when during endotoxin or lipid A fever the prostaglandin E2 level in cisternal c.s.f. rises to high levels; however, when fever and prostaglandin level are brought down by non-steroid anti-pyretics which inhibit prostaglandin synthesis, catalepsy disappears as well. (2) Febrile episodes are a genuine syndrome of schizophrenia.

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 reports the social results of a double-blind placebo controlled trial of fluphenazine decanoate. Among patients on placebo there was a deterioration in family relationships, which was due to an increase in aggression, noisiness, talking about delusions, and socially embarrassing behaviour after withdrawal of active drug.

Background. Previous studies suggest that worry content and prevalence may vary as a function of age, but evidence is limited.

Method. Cross-sectional national survey of 8580 householders in Great Britain aged between 16 and 74 years. This analysis examined the relationship between age, worry content (relationships/family, financial/housing, work, health, miscellaneous), common mental disorders, and functional limitation, adjusting for other sociodemographic factors.

Results. Overall, the prevalence of worries declined with age. However, with the exception of worry about relationships, the strength of associations between worry types and mental disorder either remained constant or increased in the older age groups. Compared to the 16–24 years reference group, worries about relationships/family, finances/housing and work were lower in the 55–74 years age groups. Financial/housing worries were increased in the 25–44 years group, and health worries were increased in the 25–64 years groups. There were independent associations between all worry items and the categories of mental disorder. All worry types apart from miscellaneous worries were independently associated, positively or negatively, with functional limitation.

Conclusions. Worry content in the general population varies as a function of age, gender, marital status, and educational attainment. All categories of worry are more prevalent in individuals with common mental disorders. The lower prevalence of worries and their stronger association with mental disorder in old age emphasize the clinical significance of these symptoms in this age group.

Delay discounting paradigms have gained widespread popularity across clinical research. Given the prevalence in the field, researchers have set lofty expectations for the importance of delay discounting as a key transdiagnostic process and a ‘core’ process underlying specific domains of dysfunction (e.g. addiction). We believe delay discounting has been prematurely reified as, in and of itself, a core process underlying psychological dysfunction, despite significant concerns with the construct validity of discounting rates. Specifically, high delay discounting rates are only modestly related to measures of psychological dysfunction and therefore are not ‘core’ to these more complex behavioral problems. Furthermore, discounting rates do not appear to be specifically related to any disorder(s) or dimension(s) of psychopathology. This raises fundamental concerns about the utility of discounting, if the measure is only loosely associated with most forms of psychopathology. This stands in striking contrast to claims that discounting can serve as a ‘marker’ for specific disorders, despite never demonstrating adequate sensitivity or specificity for any disorder that we are aware of. Finally, empirical evidence does not support the generalizability of discounting rates to other decisions made either in the lab or in the real-world, and therefore discounting rates cannot and should not serve as a summary measure of an individual's decision-making patterns. We provide recommendations for improving future delay discounting research, but also strongly encourage researchers to consider whether the empirical evidence supports the field's hyper-focus on discounting.

Background. Prevalence rates of depression based on the GMS-AGECAT system are markedly higher than rates of major depression diagnosed using DSM-III and DSM-III-R criteria. Interpreting this finding is difficult since AGECAT diagnostic criteria have not been published.

Methods. We conducted a survey in Edmonton, Canada, in which 1119 community residents aged 65 years or older were administered the Geriatric Mental State (GMS) questionnaire. Depression was diagnosed using AGECAT and also according to criteria for DSM-IV major depression and minor depression. We identified 57 items in the GMS relating to major and minor depression which were then grouped into dysphoric, somatic and cognitive categories. The relationship of these symptoms to AGECAT depression was investigated by recoding symptoms to absent (nullifying) and recalculating the number of AGECAT cases. Data were weighted to reflect the underlying population.

Results. There were 143 cases of AGECAT depression (prevalence rate=11·4%), 14 cases of major depression (prevalence rate=0·86%) and 44 cases of minor depression (prevalence rate=3·6%). Of the 154 subjects with either AGECAT or DSM-IV depression, only 47 (31%) were depressed according to both diagnostic systems. Nullifying all dysphoric symptoms reduced the number of AGECAT cases to eight, whereas nullifying somatic and cognitive symptoms reduced the numbers of cases only to 138 and 142, respectively. By themselves, dysphoric symptoms accounted for 77 of the 143 cases of AGECAT depression, while somatic and cognitive symptoms alone accounted for no cases.

Conclusions. AGECAT depression is more inclusive than DSM-IV major or minor depression and AGECAT case status is determined mainly by the proportion of dysphoric symptoms.