Potential mediators of the modest association between retrospectively rated parental behaviour and adult affective symptoms in offspring were investigated in a national longitudinal study of a cohort followed to the age of 43. Personality measures from adolescence could account for a small part of this association. Personal relationships in adulthood were more strongly associated with both parental behaviour and symptoms: marital history, emotional support, social network and availability of help in a crisis. Poor parenting did not lead to a general vulnerability to later life events, and socio-economic status and financial hardship were not implicated in the link between parental behaviour and adult symptoms. However, parental affectionless control was associated with certain types of life stressors in adulthood, i.e. interpersonal as opposed to non-interpersonal life events. Collectively, aspects of personal relationships accounted for much of the elevated symptom levels in those rating parents as low on care or high on control. Findings were consistent with the notion that interpersonal competence is important in the continuity between childhood experience and adult mental health, but other possible interpretations are discussed.

The diagnostic specificity and predictive utility of the classical prognostic indicators in schizophrenia were examined in psychotic patients enrolled in the Suffolk County Mental Health Project. First-admission psychotic patients with schizophrenia (N = 96), major depression (N = 42), and bipolar disorder (N = 64) drawn from 10 facilities in Suffolk County, New York, were assessed during their initial hospitalization and at 6–month follow-up. Longitudinal consensus diagnoses were determined after the 6-month interview. The diagnostic groups shared similar background characteristics, but schizophrenics had poorer pre-morbid adjustment, longer periods of psychosis before hospitalization and more negative symptoms initially. Except for rehospitalization, schizophrenics had the worst and bipolars the best functioning at follow-up. Among the classical prognostic indicators, the best predictor of 6-month outcome for each diagnostic group was premorbid functioning.

Immediate memory for visuospatial information was assessed in patients affected by Alzheimer-type dementia but with unimpaired visuo-perceptual functions. Patients were given two tasks: one was a traditional visuospatial memory task (Corsi's block tapping test), the second explored specifically immediate memory for visuospatial patterns. The experiment was conducted in two parallel groups of patients in Italy and the United States, each with its own appropriate sample of normal control subjects. Results showed a specific deficit of visual working memory in demented patients, even in a task in which control subjects achieved error-free performance. These data are interpreted in the light of the Working Memory Model, and suggest that in dementia the functions of the Visuospatial Scratchpad, unlike the functions of the verbal subsystems, may be impaired.

A rating scale for depression, intended for international studies of drug treatment, is presented. The reliability between raters differing in training and language was 0·86 (Swedish and English raters) and 0·92 (Swedish and Danish raters); the reliability between two Swedish raters was 0·97. There was a strong correlation between severity of depression as measured on this scale and on a nurses' rating scale (0·87). The correlation with patients' self-ratings of depression was weaker (0·63) but still significant.

Background. We assessed lateral preference in 80 male patients with combat-related post-traumatic stress disorder (PTSD) and in 100 healthy age-matched male controls.

Methods. Hand, foot, eye and ear preferences were examined, using the Edinburgh Handedness Inventory-Modified and the Coren Inventory of Lateral Preference.

Results. Mixed lateral preference was noted in significantly more PTSD patients than controls (65 v. 43%, P<0·005).

Conclusions. These results indicate a possible hemispheric imbalance (less lateralization) in PTSD patients, with the right hemisphere playing a more active role in perceptual and cognitive processing and in the regulation of biological responses in these patients. This imbalance may be relevant to the pathophysiology of PTSD.

Objective. To determine how often requests are made for euthanasia and physician-assisted suicide (EAS) in the absence of severe disease and how such requests are dealt with in medical practice in The Netherlands.

Method. Retrospective interview study. Participants: 125 general practitioners (GPs), 77 nursing home physicians (NHPs), and 208 clinical specialists.

Results. In The Netherlands, each year approximately 400 people request EAS, because they are ‘weary of life’. Thirty per cent of all physicians have at some time received an explicit request for EAS in the absence of severe disease; 3% of all physicians had granted a request for EAS in such a case. Most requests for EAS to GPs in the absence of severe disease (n=29) were made by single people aged 80 years and over. While their problems were most frequently of a social nature, 79% had one or more non-severe illnesses. Most GPs refused the request; half of them proposed an alternative treatment, which the patient often refused. Nineteen people who did not receive any treatment persisted in their wish to die; the request for EAS from 5 out of 10 patients who received one or more types of treatment was withdrawn or became less explicit.

Conclusions. Most physicians in The Netherlands refuse requests for EAS in the absence of severe disease. Most patients persist in their request. In an ageing population more research is needed to provide physicians with practical interventions to prevent suicide and to make life bearable and satisfactory for elderly people who wish to die.

Forty-two patients with functional visual loss were followed for more than 4 years after presentation. Only 22 patients had a diagnosable psychiatric syndrome or personality disorder at follow-up. Twenty-three patients continued to have findings of functional visual loss at follow-up. Despite continued signs of functional visual loss, few were socially or economically impaired, and 8 of these 23 patients had no evidence of any psychiatric disorder. The implications of these findings are discussed.

Background. The opportunity to study district-wide educational interventions on suicide rates is rarely available. In 1997, the authors carried out a district-wide training programme for primary care, accident and emergency, and mental health workers (47% of eligible staff trained), and demonstrated improvements in skills, attitude and confidence among the recipients of the training.

Method. Suicide rates (including definite suicides and undetermined deaths) and population statistics were collected for a district and region of England from official sources from 1993–2001. A before-and-after (1994–1996 and 1998–2000) training intervention analysis was conducted on suicide rates.

Results. The suicide rate in 1994–1996 was 8·8 per 100000 before our educational intervention and unchanged at 8·6 per 100000 in 1998–2000 after it (p=0·783).

Conclusion. Brief educational interventions to improve the assessment and management of suicide for front-line health professionals in contact with suicidal patients may not be sufficient to reduce the population suicide rate.

Background. Patients who present with chest pain but have normal coronary angiography and who are told by their cardiologist that they do not have heart disease, have a poor symptomatic, psychological and quality of life outcome and remain concerned about a serious cause of their symptoms. They frequently complain they have not had enough information. The study aimed to test the effectiveness and acceptability of a brief psychological intervention based on cognitive behavioural principles.

Methods. Consecutive patients with chest pain and normal angiograms were assessed and invited to take part in a randomized controlled evaluation. The intervention consisted of an individualized information and discussion session by a specially trained cardiac nurse, together with a handout and cassette providing information and advice and telephone follow-up to discuss progress, answer questions and reiterate advice.

Results. The treatment proved to be unacceptable to some patients and there was no evidence of efficacy.

Conclusions. Implications for the preparation of patients undergoing angiography and for the timing and delivery of information and advice following a negative result are discussed.

Background. In primary care consultations patients with emotional distress tend to give verbal cues or symptom reports with psychological or psychiatric contents. This study examined the cue behaviour defined not only by psychological, but also by medical, social and life episodes related contents in patients with and without emotional distress, recognized and not by their GP. The GP's verbal behaviour in relation to patients' cue emission was also investigated.

Method. For the six participating GPs two groups of matched pairs of patients (N = 238) were created. The two groups comprised either patients considered by GPs as being without emotional distress or patients considered as emotionally distressed. Within each pair, one patient was a case (GHQ-12 score > 2) and the other was the matched control (GHQ-12 score < 3). The medical interviews with these patients were transcribed and classified according to the Verona Medical Interview Classification System (VR-MICS).

Results. GHQ positive patients of both groups gave more cues in terms of total proportion than their matched controls (GHQ negative patients). The proportion of cues given by patients was related also to GP's verbal behaviour, increasing with closed psychosocial questions and decreasing with the use of active interview techniques. Attribution of emotional distress was more frequent when patients were high attenders and had a past psychiatric history. The content of cues changed in relation to GP's attribution: recognized patients gave more cues and more often with psychological content, patients not recognized as distressed gave mainly cues related to their lifestyle and life episodes.

Conclusions. To improve the recognition of those emotionally distressed patients most likely to be missed GPs should increase their attention to cues related to life style and life episodes.

The significantly favourable changes in medical students' general attitudes to psychiatry which we found after their 8-week clerkship in psychiatry and at the end of their clinical curriculum were not maintained at the end of their first post-graduate year. Three of their specific attitudes to psychiatry changed significantly in an unfavourable direction over this 2-year period. Our findings suggest that, while favourable changes in students' specific attitudes to psychiatry can be found following a clerkship, these attitudes do not seem to endure and, in some cases, they later become less favourable. The results are discussed with reference to the relationships between undergraduate medical training in psychiatry, attitudes to psychiatry, and subsequent career choice, particularly general practice.