Background. Patients with schizophrenia have a winter–spring excess of births compared with the general population, the cause of which is unresolved. Fluctuations in the magnitude of the seasonal variation may provide clues to its aetiology.

Methods. All Finnish patients with schizophrenia born between 1950 and 1969 (N = 15892) were identified from two nationwide health-care registers. Their background demographic information was obtained from the Population Register Centre, which also provided monthly numbers of births in each municipality of Finland as multidimensional tables, with sex and year, month and place of birth as marginals. The incidence of schizophrenia was modelled using Poisson regression analysis, with sex, onset age, birth cohort, place of birth (urban/rural), trend and seasonal variation as explanatory variables. We also constructed a monthly time series and decomposed it into three components – seasonal, trend and remainder.

Results. Seasonal variation of births among patients born in the 1950s, especially between 1955 and 1959, was marked, but decreased among patients born in the 1960s. No interaction between place of birth or sex and seasonal variation was observed. The incidence was higher among the rural-born than the urban-born, but declined more slowly among the urban-born than the rural-born.

Conclusions. The intensity of the factor causing the seasonal variation of births in schizophrenia may be decreasing. Urban birth may be emerging as a risk factor for schizophrenia in Finland, as elsewhere.

This paper focuses on the morphology of affective disorder. We set out to confirm on the island of Lewis a cross-over result originally found on the island of North Uist, whereby in those sections of the population where the rates of depression were lowest the rates of anxiety were highest. These sections of the population varied in the degree to which their members were integrated into the traditional way of life. ‘Integration’ was characterized in terms of churchgoing and crofting (the word for farming in the Hebrides). It is predicted here that the churchgoing rather than the crofting component of the integration measure would account for any cross-over result found concerning the morphology of symptoms. This hypothesis, derived from a theoretical concern with links between repression and anxiety, is not confirmed. Instead, crofting is found to be the component of the integration index which predicts anxiety/phobia without depression. In seeking to explain this unexpected finding further significant associations between crofting, pure anxiety/phobia and the style of personal relationships are revealed. It is also confirmed that types of severe events among women are also found to vary with the degree of integration into traditional society. A perspective is then developed which might explain how the interaction between style of personal attachments and types of provoking event could produce variations in the morphology of affective disorder.

Serum concentrations of anti-hippocampal antibodies and in vitro production of the lymphokine interleukin-2 (IL-2) in response to phytohaemagglutinin (PHA) stimulation were determined using an enzyme immunoassay in 49 schizophrenic patients and 41 healthy controls. Decrease in IL-2 production, a finding frequently associated with many autoimmune diseases, was associated with an elevation in anti-hippocampal antibody optical density (AHA-OD) in schizophrenic patients. Although some control subjects had elevated antibody levels, this elevation was not associated with decreased IL-2 production. Low IL-2 production is well known to be a state marker associated with active autoimmune disease. We suggest that production of hippocampal antibody is a trait marker of vulnerability to autoimmune diseases. Thus, our finding of low IL-2 production in patients with high concentrations of hippocampal antibody is compatible with the possibility that such patients have an ongoing autoimmune process.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membershp analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three of more somatic symptoms from the somatization disorder section of the Dagnostic Interview Schedule. The analysis indicates that seven ‘pure’ types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One ‘pure’ type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Background. Individual genome-wide linkage scans and meta-analyses support that one or more susceptibility genes for schizophrenia are located in chromosome 8p. A gene from this region, neuregulin 1 (NRG1), known to be involved with glutamatergic function, has been found to be associated in some studied samples.

Method. We have examined a new combined schizophrenia sample with 136 schizophrenia families largely of European ancestry (EA) and 646 subjects with DNA. We genotyped 14 single nucleotide polymorphisms (SNPs) in NRG1 including those reported to comprise schizophrenia-associated haplotypes in Icelandic, Scottish, Irish, and Chinese Han populations.

Results. We found no evidence of association at a single-marker or a haplotypic level. We review methodological aspects of previous studies to enable us to put our findings into context.

Conclusions. Our failure to find an association between NRG1 and schizophrenia might reflect different linkage disequilibrium (LD) patterns found in different populations, disease allelic heterogeneity, clinical heterogeneity of schizophrenia, or inadequate statistical power deriving from moderate sample size. NRG1, if a true gene for schizophrenia, accounts for a small fraction of the disease in most populations. The confirmation of NRG1 as a schizophrenia susceptibility gene will require studies with a comprehensive set of markers and in larger samples. The possibility remains that reports of NRG1 association might reflect false positives.

Inj. (Des-Tyr1)-γ-endorphin was used in a pilot study over a period of 12 days for the treatment of 11 schizophrenics and the assessments were carried out using standardized rating scales. Only 2 patients showed an improvement. Euphoria and excitement were observed in 3 patients. The findings are discussed in contrast to the earlier reports of a dramatic improvement with the compound.

Nine male patients with bulimia nervosa, accounting for one in 24 bulimic patients attending a clinic for eating disorders, are described. Symptomatology and demographic characteristics were similar in males and females. A history of either anorexia nervosa or obesity was always present, and a chronic course was seen in 6 patients. Five of the men showed atypical sexuality.

Erythrocyte sodium and potassium concentrations, erythrocyte membrane ATPase (Na–K specific and non-specific) and the rate of potassium influx into erythrocytes (ouabainsensitive and insensitive) were estimated in a group of female patients suffering from mania and repeated on about two thirds of them when they had recovered. With recovery there was a statistically significant increase in the erythrocyte ouabain-sensitive potassium influx. The other parameters showed no significant overall change with recovery but the initial severity correlated significantly and negatively with the change in erythrocyte Na–K ATPase with recovery. The changes that occurred in the erythrocyte sodium concentration and Na–K ATPase activity were not random since they correlated significantly with changes in the active potassium influx.

Follow-up by examination of medical and psychiatric records was carried out on 357 patients with conspicuous psychiatric morbidity in two general practices three years after clinical and personality assessment using structured interview schedules. One practice was an inner-city urban one and the other was rural. Full follow-up data over the 3-year period was available for 301 patients (84 3%). After three years patients with personality disorder and those in the urban practice had greater morbidity, more contacts with all levels of the psychiatric service and more psychotropic drugs, particularly benzodiazepines. Despite this increased morbidity, the number of consultations with the general practitioner for psychiatric illness was no higher in the urban group and those for medical illness were significantly higher in the rural one. The implications of the findings are discussed with particular reference to developments in community psychiatric care.

Background. Visual masking tasks assess the earliest stages of visual processing. This study was conducted to address: (1) whether schizophrenia patients show masking deficits after controlling for sensory input factors; (2) whether patients have relatively intact forward masking (when the mask precedes the target) compared with backward masking (when the mask follows the target); and (3) whether the masking deficits in schizophrenia reflect an accelerated age-related decline in performance.

Method. A staircase method was used to ensure that the unmasked target identification was equivalent across subjects to eliminate any confounding due to differences in discrimination of simple perceptual inputs. Three computerized visual masking tasks were administered to 120 schizophrenia patients (ages 18–56) and 55 normal comparison subjects (ages 19–54) under both forward and backward masking conditions. The tasks included: (1) locating a target; (2) identifying a target with a high-energy mask; and (3) identifying a target with a low-energy mask.

Results. Patients showed deficits across all three masking tasks. Interactions of group by forward versus backward masking were not significant, suggesting that deficits in forward and backward masking were comparable. All three conditions showed an age-related decline in performance and rates of decline were comparable between patients and controls. Two of the masking conditions showed increased rates of decline in backward, compared to forward, masking.

Conclusions. We found age-related decline in performance that was comparable for the two groups. In addition, we failed to find evidence of a relative sparing of forward masking in schizophrenia. These results suggest that: (1) early visual processing deficits in schizophrenia are not due to a simple perceptual input problem; (2) sustained channels are involved in the masking deficit (in addition to transient channels); and (3) for the age range in this study, these deficits in schizophrenia are not age-related.

Background. Recent brain imaging studies suggest that proneness to violence and antisocial behaviour may be associated with dysfunction of the prefrontal cortex. The present study, therefore, examined aspects of prefrontally guided executive functions in a group of criminal violent men.

Methods. Violent offenders undergoing forensic psychiatric examination by court order undertook computerized tasks for planning, visual working memory and attentional set-shifting from the Cambridge Neuropsychological Test Automated Battery. Their performance was compared to that of subjects with marginal mental retardation and normal controls.

Results. Violent offenders performed well on tasks for spatial and figurative working memory, as well as on a test for planning. A marked impairment was observed in the attentional set-shifting task: offenders made significantly more errors than the other groups when required to shift attention from one perceptual dimension to another. Reversal learning was also deficient. Correlational analyses within the offender group revealed that poor performance on the perceptual shift problem was associated with fewer errors in tasks for working memory and planning.

Conclusions. The present results suggest that violent offenders show dual impairments in inhibitory cognitive control. First, they are deficient in shifting attention from one category to another. Secondly, the ability to alter behaviour in response to fluctuations in the emotional significance of stimuli is compromised. These deficits might constitute cognitive reflections of the biological prefrontal alterations observed in this group of people.

Background. Somatoform disorders may have their roots in childhood through processes that involve an enhanced parental focus on health. The aim of this study was to test the hypothesis that somatizing mothers will show less joint involvement than other mothers during play but greater responsiveness when this play involves a ‘medical’ theme.

Method. Cross-sectional observational study of 42 chronic somatizers, 44 organically ill and 50 healthy mothers and their 4–8 year-old children during structured play and a meal. Tasks comprised boxes containing tea-set items, ‘medical’ items and a light snack.

Results. Somatizing mothers were emotionally flatter and showed lower rates of joint attention than other mothers during both play tasks. While the three groups had similar rate of bids for attention, somatizing mothers were more responsive to their child's bids during play with the medical box than at other times. In contrast, the children of somatizing mothers ignored a greater proportion of their mother's bids during play with the medical box than did children of other mothers or during play with a non-medical theme.

Conclusion. The study has demonstrated tentative evidence in support of the hypothesis.