Background. Numerous studies have suggested, via the interpretation of negative priming effects, that subjects with schizophrenia are less able than controls to inhibit irrelevant distracting information. Further issues concerning impairment in inhibitory processes are investigated here. First, recent research has revealed that negative priming (NP) effects can be caused by different processes, distractor inhibition or perceptual review. Therefore, conclusions concerning reduced inhibition in patients with schizophrenia are not possible from previous NP research. Secondly, previous NP studies have required subjects to identify some feature of the target. This is the first study to examine NP that uses a spatial task in patients with schizophrenia.

Method. Twenty-eight subjects with schizophrenia and 28 age and sex matched non-psychiatric control subjects completed a computerized NP task that eliminated the possible contribution of perceptual review.

Results. Subjects with schizophrenia had reduced levels of NP compared to control subjects on this spatial NP task (t=2·46, P<0·02). Current age, positive, negative or total PANNS scores did not correlate with negative priming scores, but post hoc analyses revealed that clozapine-treated patients had significantly greater levels of negative priming than patients receiving typical antipsychotic medications.

Conclusions. The present experiment eliminated the contribution of perceptual review to negative priming and demonstrated that when a pure measure of inhibition is taken on a localization task, patients with schizophrenia were less able to inhibit irrelevant distracting stimuli. The fact that NP was reduced in a spatial task suggested a more diffuse reduction in inhibition than previous studies that examined only identification-based responses.

Background. We sought to develop a refined measure of eight personality traits or constructs observed in those who develop depression. We report the psychometric properties of the derived Temperament and Personality (T&P) questionnaire, as well as a pilot study examining its capacity to differentiate over-represented personality traits in those with depression.

Method. The factor structure of the T&P measure was examined in a general practice sample of 529 subjects. We imposed a range of factorial solutions to determine how higher-order molar constructs arborized to eight lower-order constructs. Scale scores generated at each derived tier were contrasted for 52 out-patients with major depression and control subjects from the general practice sample to pursue over-represented personality constructs, and to clarify if an optimal number of constructs could be identified.

Results. In the factor analysis, some 90% of the items loaded on their a priori construct. The questionnaire showed high internal consistency, test–retest reliability and minimal sensitivity to mood state effects. Analyses rejected the hypothesis that risk to depression might be generally affected by individuals merely scoring high on all ‘normal’ personality styles, whether higher-order or lower-order traits.

Conclusions. Findings suggest that, while identified constructs linked well with the widely accepted theoretical model of personality (the Five Factor Model) at one tier, such a fixed model may be too inflexible. We therefore detail potential advantages to using a multi-tiered model of personality traits in application studies.

Background. There has been growing interest in factors that might influence the prescription of psychotropic drugs in general practice.

Method. This was a multi-centre study using a two-phase stratified sampling strategy in primary care facilities from 14 different countries to determine factors associated with the prescription of psychotropic drugs.

Results. A total of 1763 consecutive GP attenders aged between 16 and 65 years of age were recruited. Although antidepressants were used more for depressive disorders and anxiolytics for patients with anxiety, the differential diagnosis was otherwise not an important factor in prescribing behaviour. Antidepressants and anxiolytics were prescribed twice as frequently in client centred clinics following a ‘personal physician model’ as opposed to non-client centred settings, where care was less personalized. The reverse was true of hypnotics (adjusted odds ratio of 0·5). General practitioners with a positive view of their undergraduate psychiatric training and who had had further postgraduate experience in the speciality were significantly less likely to prescribe medication, and if they did they were more likely to use antidepressants. Older patients were significantly more likely to be prescribed psychotropic medication. Several other patient factors emerged when individual classes of medication were considered; these included the loss of a spouse and the absence of physical ill health in the case of antidepressants, and female sex, fewer years of schooling and unemployment in the case of anxiolytics.

Conclusions. Social, health care and GP factors are at least as important as clinical features in the prescription and choice of psychotropic medication.

Three hundred and twenty-six consecutively admitted patients with functional psychotic illnesses to which no diagnostic classification had been applied were followed up after 2·5 years. They were examined in social, clinical and psychological terms and the CATEGO programme and DSM-III criteria were applied to data concerning the index episode to derive diagnostic classifications. The deterioration in occupational functioning and the hospital careers of patients with diagnostic classifications of schizophrenia were worse than those in the other groups and positive and negative features were also more severe in patients with a classification of schizophrenia. By contrast, no differences in psychological test performance were found between the groups based upon diagnostic classification. Impaired psychological test performance was found and it was strongly related to concurrent mental state abnormalities, particularly negative symptoms. It is concluded that the diagnostic classifications used were of limited value in predicting outcome in functional psychosis.

Plasma free tryptophan is significantly decreased in monopolar, depressed patients. No evidence was found to suggest that poor nutritional history prior to hospital admission was responsible for these low levels. Factors known to influence tryptophan—albumin binding in plasma, e.g. concentration of plasma proteins, albumin and non-esterified fatty acids, did not account for the low levels of free tryptophan in depressed patients. A significant decrease in plasma free tryptophan levels was found in perimenopausal but not in pre- or post-menopausal female controls. This mirrors the decrease in circulating oestrogens. Although exogenously administered oestrogens do not have any therapeutic efficacy in relieving mild residual depressive symptoms of lithium treated patients, they increased the levels of plasma free tryptophan. Clofibrate also displaces tryptophan from plasma protein binding sites in both depressed patients and controls. Utilization of the increased levels of plasma free tryptophan is reduced in depressed patients. A situation therefore exists in depressed patients where the plasma free tryptophan is not only reduced but also leaves the plasma less readily than in control subjects.

There has been concern about whether standardized psychiatric interviews make valid diagnoses. Agreements between the Diagnostic Interview Schedule (DIS), as an example of a standardized interview, with independent assessments by a clinician are reasonably high in most studies, but the clinical assessment is itself of uncertain validity. Using predictive ability is an alternative way of judging validity. Data are presented to show that the DIS is almost as good at prediction as a clinician's assessment, but here too there are problems. Because prediction is probabilistic (i.e. the same disorder can have multiple outcomes, and different disorders can share outcomes), it is not possible to say how good prediction has to be to demonstrate perfect validity.

Across varied methods of validity assessment, some disorders are regularly found more validly diagnosed than others, suggesting that part of the source of invalidity lies in the diagnostic grammar of the systems whose criteria standardized interviews evaluate. Sources of invalidity inherent in the content and structure of a variety of diagnoses in DSM-III and its heir, DSM-III-R, are reviewed and illustrated, in part with results from the Epidemiological Catchment Area study.

The relationship between diagnostic criteria and standardized interviews is symbiotic. While attempts to adhere closely to existing diagnostic criteria contribute to the diagnostic accuracy of standardized interviews, the exercise of translating official diagnostic criteria into standardized questions highlights problems in the system's diagnostic grammar, enabling standardized interviews to contribute to improvements in diagnostic nosology.

The clinician has no objective criteria of good health; he is likely to identify its presence only in the absence of disease and dysfunction. Yet the layman is able to give a global assessment of his own health as good, average or poor. The present paper explores the correlates of self-assessment of health in a large community sample and, by the use of two linear models, describes the effects of age, sex, reported symptoms, and long-standing illness on self-rated health status. It is suggested that global ratings are influenced by age and sex and by the experience of both physical and psychological symptoms, and that there are no interactive effects between symptoms and the demographic variables.

Background. Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole. The relationship between these factors and cerebral anatomy has been investigated in schizophrenia only. This study aimed to address the relationship of symptom factors to clinically important variables and cerebral anatomy in a sample of psychotic patients with a spread of diagnoses.

Methods. In a sample of patients with functional psychoses, symptom data was obtained on four consecutive admissions using the OPCRIT symptom checklist. OPCRIT data was used to generate operational diagnoses in accordance with pre-set criteria and a principle components analysis was performed on symptom data. Factor loadings were compared between each admission to examine factor stability over time. Factor scores at first admission were also correlated with clinical variables obtained from patients' case notes. From the sample of 204 patients, 64 subjects were recruited and underwent an MRI scan of the brain. Regional anatomical volumes were compared with diagnosis and factor loadings at first admission.

Results. A principal components analysis gave a four-factor solution of ‘manic’, ‘depressive’, ‘disorganization’ and ‘reality distortion’ factors at each admission. Factors showed a high degree of stability over the four admissions studied. The factors were significantly associated with several clinical variables. Three of the four factors were associated with a specific pattern of cerebral anatomy.

Conclusions. This study suggests that factors may correspond to relatively specific disease processes underlying functional psychotic illness. We propose that the use of symptom factors may facilitate the investigation of the underlying mechanisms of psychotic illness.

Background. Since depressive disorders are now eminently treatable and early detection and treatment could bring substantial benefits, it is critical to address alternative presentations of depression in the general medical setting. Concern regarding under-diagnosis of depression in general medical settings has given rise to the question of whether the clinical disorder of depression differs qualitatively or only quantitatively across care settings.

Methods. Symptom profiles of depression were compared across care sectors to investigate how the presentation of depression among general medical service users might differ qualitatively from speciality mental health service users. Data on depression symptoms within 6 months of interview gathered in three community surveys that were part of the NIMH Epidemiologic Catchment Area Program were analysed using methods developed to assess item bias. The subjects were 4931 and 363 persons who reported a visit to the general medical sector or to speciality mental health respectively, within 6 months of interview.

Results. Compared with speciality mental health service users, general medical service users were less likely to present dysphoria (adjusted Odds Ratio, aOR=0·57; 95% Confidence Interval, CI=0·38–0·84) and feeling worthless, sinful, or guilty (aOR=0·63; 95% CI=0·40–0·98), but were more likely to present fatigue (aOR=1·71; 95% CI=1·09–2·69), even after holding constant other characteristics that might influence reporting of symptoms as well as level of depression.

Conclusions. These results suggest that there are qualitative differences in depression presenting in general medical care compared with speciality mental health care and call for a reconceptualization of depression in the general medical setting.

Three hundred and eighty former concentration camp inmates were identified and interviewed in the course of a community health survey in Jerusalem. A set of 8 questions derived from the Cornell Medical Index was used as an index of emotional distress. The concentration camp survivors had a higher prevalence of emotional distress and more symptoms of this type than other European-born members of the community, controlling for age and education. The findings suggested that 16·0% of the emotional distress observed in male camp survivors and 22·9% of that among female camp survivors could be attributed to the camp experience almost three decades after the Holocaust. In this survey, data were elicited in a context unrelated to benefit-seeking such as clinic or compensation claims.

Background. Previous research suggests that the inadequate primary health care received by people with learning disabilities may be the result of general practitioners' (GPs) negative attitudes. Few studies have investigated the evidence for this assumption. This study uses psychological theory to inform an investigation of the attitudes and emotions experienced by GPs when working with learning disabled patients, as assessed by reliable and valid measures.

Method. A questionnaire comprising an attitude measure and emotion measure was developed and tested for reliability and validity. This was mailed out to a total of 613 GPs registered with three Health Authorities, 310 questionnaires (51%) were returned.

Results. GP respondents held positive attitudes to working with patients who have learning disabilities. However, they were less positive about adapting their behaviour. Attitudes varied according to respondents' age and frequency of professional contact with this patient group. There was a strong association between attitudes and emotional experience. Attitudes were unaffected by learning disability training and non-professional contact.

Conclusions. Negative perceptions about working with patients with learning disabilities do not fully explain the inadequate healthcare provided to this group. Other factors may include insufficient awareness of the benefits of adapting the format of a consultation, and the quality of the interface between the GP and the carer accompanying the patient.