Background. We wished to assess the effect of three types of medication on verbal memory impairments in schizophrenia.

Method. Forty-eight patients with schizophrenia and 40 healthy control subjects underwent a battery of verbal memory tasks, including free recall, recognition and short-term memory span. All the patients were on antipsychotic medication. In addition, 24 were taking anticholinergic drugs (benztropine) and 30 were taking benzodiazepines. A subsample of 39 had clinical ratings for depressive symptoms. Regression analyses were conducted on the memory measures in this subsample, with negative symptoms, depression, type of antipsychotic medication (conventional v. atypical), benzodiazepines and anticholinergic drugs as predictors.

Results. Type of antipsychotic medication made no significant contribution to memory deficits and benzodiazepine use made very little contribution. However, anticholinergic medication was a predictor of memory impairment, especially with regard to semantic organization. Complementary analyses revealed that patients taking any type of drug with anticholinergic activity (benztropine and/or antipsychotic agents) were significantly impaired relative to the other patients on measures reflecting free recall efficiency and semantic organization.

Conclusions. Drugs with anticholinergic activity are the major pharmacological agents that contribute to the verbal memory deficit observed in patients with schizophrenia. These drugs appear to act by impeding semantic organization at encoding.

Background. The importance of genetic factors in the aetiology of manic-depressive illness (MDI) has been repeatedly confirmed and indicators of vulnerability to the illness in families with affective disorders are needed. Abnormal event-related potentials (ERP) may be markers of genetic vulnerability to mental illness. Long latency and low amplitude of P300 have consistently been reported in schizophrenic patients and their relatives. A few studies have also shown P300 deficits in MDI patients, but no ERP study has been performed on their relatives.

Methods. ERPs were recorded during an auditory oddball task in 19 relatives belonging to families with two or more bipolar patients and in controls with no familial or personal history of affective disorders. The relatives were selected as having no affective disorders on a lifetime basis, but eight had an anxiety disorder.

Results. In all relatives, a lower P300 amplitude and a longer P300 latency was found, with much longer reaction time and post-N200 duration till button-press than controls. A lack of P300 amplitude dominance in the right hemisphere was also found in relatives in comparison with controls. There also appeared to be a frontal predominance of ERP abnormalities in relatives.

Conclusion. We report the first evidence of deficits in reaction time and in P300 amplitude and latency, and a lack of P300 right-sided dominance, in relatives of manic-depressive patients. This pattern may constitute an endophenotypic marker of manic-depressive disorder.

Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.

Data on self-reported symptoms collected in the East Baltimore site of the Epidemiologic Catchment Area Program are analysed in parallel fashion for the two syndromes of anxiety and depression. Patterns of relationships of anxiety and depression to sociodemographic factors, prior psychopathology, and life events fail markedly to distinguish the two syndromes.

This paper describes a comparison of the cerebral cortical appearance of 101 patients with a history of clinical depression and 52 control subjects. An age-related increase in sulcal widening was evident in both groups. However, after controlling for age, the patients were found to differ from control subjects in two respects: they had a greater amount of sulcal widening, most noticeably in the frontal and temporal areas; and there was a positive correlation between increasing sulcal widening and increasing lateral ventricular size not found in the control subjects. Patients with a past history of treatment by electroconvulsive therapy showed more sulcal widening in the parietal and occipital areas than those not so treated.

Using a double-blind placebo-controlled cross-over design, the effect of equine conjugated oestrogens tablets (Premarin®) was studied in 20 women with the climacteric syndrome followed during 15 months. Sixteen women were equally improved on placebo and oestrogen. Only 2 patients had an improved sense of well-being on oestrogen and not on placebo. The psychological diagnosis was unrelated to the subjective response to oestrogen or placebo. Performance in psychological tests administered before and during treatment periods was not changed by oestrogen or placebo.

Background. Somatoform disorders such as neurasthenia and chronic fatigue syndrome are characterized by a combination of prolonged mental and physical fatigue. This study aimed to investigate the heritability of somatic distress and determine whether this dimension is aetiologically distinct from measures of depression and anxiety.

Method. Measures of anxiety, depression, phobic anxiety, somatic distress and sleep difficulty were administered in a self-report questionnaire to a community-based sample of 3469 Australian twin individuals aged 18 to 28 years. Factor analysis using a Promax rotation, produced four factors: depression, phobic anxiety, somatic distress and sleep disturbance. Multivariate and univariate genetic analyses of the raw categorical data scores for depression, phobic anxiety and depression were then analysed in Mx1.47.

Results. Univariate genetic analysis revealed that an additive genetic and non-shared environmental (AE) model best explained individual differences in depression and phobic anxiety scores, for male and female twins alike, but could not resolve whether additive genes or shared environment were responsible for significant familial aggregation in somatic distress. However, multivariate genetic analysis showed that an additive genetic and non-shared environment (AE) model best explained the covariation between the three factors. Furthermore, 33% of the genetic variance in somatic distress was due to specific gene action unrelated to depression or phobic anxiety. In addition, 74% of the individual environmental influence on somatic distress was also unrelated to depression or phobic anxiety.

Conclusion. These results support previous findings that somatic symptoms are relatively aetiologically distinct both genetically and environmentally from symptoms of anxiety and depression.

This paper investigates the memory disorder of Alzheimer-type dementia by comparing the performance of Alzheimer patients on selected memory tests with that of Korsakoff patients and healthy controls. Alzheimer patients have deficits in both primary and secondary memory, and this finding is compared with that which pharmacological studies predict would occur on the basis of cholinergic depletion. The deficits in primary memory are unlikely to be accounted for in terms of cholinergic depletion, and provide a possible explanation for the disappointing results of trials of cholinergic replacement therapy in this disorder. On the other hand, the pattern of deficit in secondary memory is entirely consistent with that expected from cholinergic depletion.

Termination of pregnancy for foetal abnormality has become frequent with the increasing sophistication of techniques of antenatal diagnosis. The aim of this study was to obtain quantitative and qualitative information about psychiatric morbidity in women after termination of pregnancy for foetal abnormality.

Two samples of women were compared. The first consisted of 71 women who had had a termination of pregnancy for foetal abnormality (FA group). The second consisted of 26 women who had experienced so-called missed abortion (MA group). Both groups had lost a pregnancy in the mid-trimester of pregnancy, but the MA group had no element of choice.

Standardized psychiatric and social measures were used to assess both groups on three occasions after the termination. In both groups, 4 weeks after the termination psychiatric morbidity was high (four to five times higher than in the general population of women), and social adjustement was impaired. Six months and 12 months after the abortion, levels of psychiatric morbidity were near normal.

Semi-structured interviewing was used to obtain information about the experience of grief after mid-trimester termination. For many women, symptoms of grief persisted throughout the year. These symptoms included typical features of grief as well as grief symptoms specific to pregnancy loss. The findings have implications for the counselling of women after termination for foetal abnormality or after missed abortion.

Background. A cohort study of a socially homogeneous group of teachers was commenced in 1978 to pursue possible risk factors contributing to the recognized female preponderance of depression.

Methods. Multiple measures of depressive experience included: (i) lifetime rates, duration and number of depressive episodes using two caseness definitions, DSM-III-R major depression and ‘all depression’ (which included a category of minor depression); (ii) self-report measures of state and trait depression, neuroticism, and self-esteem. DSM-III-R anxiety disorder rates are also reported and co-morbidity with major depression examined.

Results. At the 15-year review in 1993, the sample had a mean age of 39 years, there was a trend for a female preponderance in lifetime rates of major depression and ‘all depression’ (and which was more pronounced with the inclusion of data for anxiety disorders), with statistically significant differences in rates of social and simple phobias and combined anxiety disorders. Mean neuroticism scores were consistently higher for women.

Conclusions. The strong association between anxiety and depressive disorders suggests that greater reporting of anxiety and higher neuroticism scores in women may be a key determinant that contributes to any female preponderance in depression rates.

This study aims to describe factors associated with cognitive decline among 2584 subjects, aged 65–74, who were followed up for 54 months in the Medical Research Council Elderly Hypertension Trial (1982–1989). The subjects completed a cognitive test, the Paired Associate Learning Test (PALT), five times over this period. Decline on the PALT was associated with advanced age, male sex, rural residence, depression and low intelligence. These effects were modified by gender and level of pre-morbid intelligence. Advanced age, rural residence and number of cigarettes smoked daily were only associated with PALT decline among women of below median intelligence. The association between depression and PALT decline was only apparent in women of below median intelligence and men of above median intelligence. While these findings are consistent with other research into cognitive decline, they differ in some ways from reported risk factors for dementia, suggesting aetiological separateness. That women were more vulnerable than men to the effects of age and smoking raises the question of the impact on cognition of accelerated atherosclerosis after the menopause.

Nearly a century of observational studies and more recent longitudinal surveys reveal that, in infancy, girls and boys use force at similar rates. Over the next few years boys become significantly more aggressive. Alternative hypotheses accounting for the widening gender gap are evaluated. These include hypotheses about normative patterns of male escalation and female desistance; boys' preference for active play that promotes aggression; girls' tendency to hide aggression; girls' use of alternative forms of aggression; boys' increased risk for the cognitive and emotional problems that are linked to aggression; boys' sensitivity to situational triggers of aggression; and boys' vulnerability to adverse rearing environments. The evidence bearing on each hypothesis is mixed. In general, the overall difference between the sexes appears to be produced by a minority of boys who deploy aggression at high rates. Three general principles govern the emergence of sex differences in aggression: female precocity, male vulnerability, and the salience of sex as a social category that shapes children's lives.

Background. The pattern of all health care contacts among young people before and after attempted suicide is not well documented. Neither is it known if the health care contacts of young suicide attempters differ from those of older suicide attempters. This study investigated the age-related clinical characteristics of suicide attempters and the pattern of their contacts with health care before and after attempted suicide in different age groups, particularly adolescence and young adulthood.

Method. All consecutive 1198 suicide attempters treated in hospital emergency rooms in Helsinki between January 1997 and January 1998 were identified and divided into three age groups (15–24 years, 25–39 years, 40 years and over). Data were gathered on all health care contacts 1 year before and after the index attempt.

Results. Although adolescent and young adult suicide attempters suffered from severe mental disorders, a remarkable proportion of them were left without psychiatric consultation and aftercare recommendation following the attempt. Two-thirds of 15–19-year-old male suicide attempters had no treatment contact during the month before the attempt, while a quarter of them were referred to psychiatric consultation and a half had no healthcare contact in the month following the attempt.

Conclusions. These findings indicate considerable scope for improvement in the assessment of young suicide attempters and their referral to aftercare.

The General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS) were translated into Portuguese and were used in a pilot study of psychiatric morbidity in primary care at ‘The Health Centre Barra Funda/Bom Retiro’ of the Faculty of Medicine of Santa Casa Hospital at Sao Paulo, Brazil. The Portuguese translation of the CIS was found to be a feasible instrument for community studies in Brazil, but the Portuguese translation of the GHQ-30 was shown to be of limited use in this particular setting. The extent of minor psychiatric morbidity was very high (46%); 33% was regarded as conspicuous (CPM) and 13% as hidden (HPM).