An investigation into the extent and nature of social inadequacy among outpatients diagnosed as neuroses and personality disorders was undertaken on patients aged 18–49 attending one clinic over a six-month period. A feature of this survey was that each patient took part in a standard social interaction test, and their performance was assessed by two psychologists. A relatively high proportion of patients, one in six on the most conservative estimate, and probably over one in four, were judged by psychologists and psychiatrists to be socially inadequate, and the results showed a clear pattern of behavioural, social and personality factors associated with these judgements. Implications for assessment and treatment are discussed.

A post mortem enquiry has been made into the social family and clinical circumstances of 50 individuals who, according to a coroner's verdict, killed themselves in Brighton. A dimensional analysis of the 123 variables thus collected suggested the possibility of three distinct types of suicide: ‘depressive suicide’, ‘sociopathic suicide’ and ‘physical illness suicide’. The reliability of this typology has been checked by the analysis of 55 selected variables for a total of 193 cases considered by the same coroner. A cluster analysis has confirmed that the data contain at least three independent types of suicide. Some implications for the prevention of suicide are discussed.

Twenty-nine published ward rating scales for long-stay psychiatric patients are reviewed according to a standard set of criteria. Attention is paid to details of the rating setting, the rating procedure, and scale construction and evaluation, and some detailed recommendations are made. Only 4 scales meet a subset of 5 minimal criteria.

Background. Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication.

Method. A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n=62) and medicated ADHD-CT (n=58) compared to an age- and gender-matched healthy control group (n=39) was completed.

Results. Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory.

Conclusions. Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.

Over the past few decades, theory and research on depression have increasingly focused on the recurrent and chronic nature of the disorder. These recurrent and chronic forms of depression are extremely important to study, as they may account for the bulk of the burden associated with the disorder. Paradoxically, however, research focusing on depression as a recurrent condition has generally failed to reveal any useful early indicators of risk for recurrence. We suggest that this present impasse is due to the lack of recognition that depression can also be an acute, time-limited condition. We argue that individuals with acute, single lifetime episodes of depression have been systematically eclipsed from the research agenda, thereby effectively preventing the discovery of factors that may predict who, after experiencing a first lifetime episode of depression, goes on to have a recurrent or chronic clinical course. Greater awareness of the high prevalence of people with a single lifetime episode of depression, and the development of research designs that identify these individuals and allow comparisons with those who have recurrent forms of the disorder, could yield substantial gains in understanding the lifetime pathology of this devastating mental illness.

In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.

The plasma beta-endorphin response to glucose ingestion was compared in 8 bulimics and 8 controls. The bulimics demonstrated a sustained elevation of plasma beta-endorphin unrelated to glucose ingestion throughout the 5-hour study period. It is hypothesized that such an elevation of beta-endorphin is the result of stress and that it may play an important role in the perpetuation of the binge-vomiting cycle.

Previous studies have suggested that, because of the chronic and disabling nature of mental illness, psychiatric patients do not fare as well in their careers as they should do. In the present study the parental social class, the current social class and the social mobility has been compared in 2,861 male referrals to the psychiatric services in North-Eastern Scotland and 1,487 men randomly selected from the local population. Within the psychiatric sample similar comparisons have been made between diagnostic groups. In all three aspects of social class considered decade of birth was shown to be an important variable.

Background. Although lifetime major depression (LTMD) is assessed with only moderate reliability in community samples, some predictors have emerged for ‘reliable’ LTMD. Given the large impact of sex on risk for LTMD, it is of interest to know if there are sex differences in the reliability of LTMD and its predictors.

Methods. A total of 5603 members of male–male and male–female twin pairs from a population-based registry were interviewed twice with a mean inter-interview interval of 19 months. LTMD was assessed on each occasion using DSM-III-R criteria. Univariate and multivariate logistic regression analyses were used, combining forward and back-prediction.

Results. The long-term test–retest reliability of LTMD was moderate (κ = +0·48) and did not differ significantly between males and females. In a multivariate model, the significant predictors of a stable diagnosis of LTMD, none of which differed across sex, were younger age at onset, older current age, history of treatment, increasing number of symptoms, level of impairment or level of distress, longer duration of episodes, higher current level of depression and the presence during the depressive episode of sad mood, weight loss, hypersomnia or fatigue. Using these variables, it was not possible to predict ‘stably diagnosed’ LTMD with both high sensitivity and high specificity.

Conclusion. In community samples, LTMD is diagnosed with moderate reliability. Although diagnostic stability can be predicted by variables related to severity, distress and treatment-seeking (probably acting to make depressive episodes more ‘memorable’), highly accurate prediction of stably diagnosed cases is not possible. Long-term recall is also significantly influenced by current symptoms. Neither the stability of LTMD nor its predictors differ in men and women.

Diatheses confer vulnerability to disorder but are not necessarily manifest overtly or consistently. It is suggested that the main empirical findings of studies with abnormal personality support the notion that they are diatheses rather than disorders. This includes their onset early in life, their variability of expression dependent on setting, their greater association with more severe disorders and their acceptance as intrinsic components of functioning by most suffering from these conditions. It is argued that a separate axis of classification for personality diatheses rather than disorders is justified.

Objective. To determine the relationship between self-perceived health and suicidal ideation among patients in general internal medicine practice settings.

Method. A representative sample of 4007 patients was assessed for current suicidal ideation, self-perception of health, current medical disorders and current mental disorders (major depression, generalized anxiety disorder, panic attacks and alcohol use disorder) with the PRIME-MD Patient Health Questionnaire.

Results. Patients with self-perception of poor health, compared with those who reported more favourable health perception, were significantly more likely to report current suicidal ideation (35.2% v. 8.3%; χ2 = 97.4, df = 1, P<0.0001). Multivariate logistic regression analyses revealed that the perception of poor health was associated with a significantly increased risk of suicidal ideation (OR = 3.1, CI 1.9, 5.0), even after adjusting for sociodemographic characteristics, mental disorders and common physical illnesses.

Conclusion. Self-perception of poor health is associated with a significantly increased risk of suicidal ideation among general medical patients, even in the absence of common mental and physical disorders. These findings add to a growing literature on the importance of self-perceived health in the treatment and outcomes of mental and physical well-being by documenting self-perceived poor health as a risk factor for suicidal ideation in medical patients.

Background. This paper examines the associations between puberty and three important health behaviours (smoking, food intake and exercise) and explores whether these associations are mediated by puberty's relationship to stress and psychological difficulties.

Method. Data were taken from the first year of the ongoing, 5-year, Health and Behaviours in Teenagers Study (HABITS). This is a school-based study set in 36 schools in London. In the first year of the study, 4320 students (2578 boys, 1742 girls) in their first year of secondary education took part.

Results. Among girls, being more pubertally advanced was associated with a greater likelihood of having tried smoking. Among boys, being more pubertally advanced was associated with a greater likelihood of having tried smoking, a higher intake of high-fat food and higher levels of exercise. More pubertally advanced girls experienced more stress but not more psychological difficulties. There were no associations between puberty and either stress or psychological difficulties in boys. Stress and psychological difficulties were associated with health behaviours in girls and boys, but neither of these factors mediated the relationship between pubertal stage and health behaviours found in girls.

Conclusions. These results suggest that the onset of puberty has a marked effect on the development of health behaviours. Puberty was related to an acceleration of the development of unhealthy behaviours, except for exercise behaviour in boys, where advanced puberty was associated with more exercise. These changes were unrelated to adolescent issues of stress and a causal explanation for these associations must be sought elsewhere.