Background. Prior evidence on the relationship between hostility and minor health problems is limited to cross-sectional self-report studies. In the present study, this relationship was examined prospectively.

Methods. Hostility of 1077 municipal employees was measured by a questionnaire survey and minor health problems by using 4-year register-based absence data including medically certificated diagnoses.

Results. High hostility predicted a high total number of long-term sickness absence spells among men, but not among women. In separate diagnostic categories (musculo-skeletal, traumas and injuries, respiratory), hostility related positively and linearly to absences due to traumatic causes and curvilinearly (U-shape) to absences due to musculo-skeletal causes. Controlling the effects of health risk behaviour and demographic background did not significantly change these figures. However, health risk behaviour moderated the relations of hostility to overall long-term sickness absences, and to traumatic and musculo-skeletal absences, being significantly stronger in high-risk groups. No association was found between hostility and non-certificated short-term absence spells.

Conclusions. The results suggest that hostility plays a role in the aetiology of minor health problems.

Background. Most national suicide prevention strategies set improved detection and management of depression in primary health care into a central position. However, suicidal behaviour among primary-care patients with depressive disorders has been seldom investigated.

Method. In the Vantaa Primary Care Depression Study, a total of 1119 primary-care patients in the City of Vantaa, Finland, aged 20 to 69 years, were screened for depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. Depressive disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the 137 patients with depressive disorder were included in the study. Suicidal behaviour was investigated cross-sectionally and retrospectively in three time-frames: current, current depressive episode, and lifetime. Current suicidal ideation was measured with the Scale for Suicidal Ideation (SSI), and previous ideation and suicide attempts were evaluated based on interviews plus medical and psychiatric records.

Results. Within their lifetimes, 37% (51/137) of the patients had seriously considered suicide and 17% (23/137) attempted it. Lifetime suicidal behaviour was independently and strongly predicted by psychiatric treatment history and co-morbid personality disorder, and suicidal behaviour within the current episode was predicted most effectively by severity of depression.

Conclusions. Based on these findings and their convergence with studies of completed suicides, prevention of suicidal behaviour in primary care should probably focus more on high-risk subgroups of depressed patients, including those with moderate to severe major depressive disorder, personality disorder or a history of psychiatric care. Recognition of suicidal behaviour should be improved. The complex psychopathology of these patients in primary care needs to be considered in targeting preventive efforts.

The vanadium content of hair, whole blood, serum and urine was estimated by neutron activation analysis in samples from manic patients, depressed patients, recovered manic patients, recovered depressed patients and normal controls. The results suggest that manic patients have significantly raised vanadium levels in hair which fall towards control levels with recovery, but there are no significant differences in the mean vanadium content of whole blood or serum. In contrast, depressed patients have raised levels of vanadium in whole blood and serum which appear to fall with recovery. Levels of vanadium in serum correlate strongly with those in whole blood, but neither shows significant correlation with vanadium in hair for either patients or controls. Hair and blood probably serve as indicator tissues for differing aspects of vanadium metabolism.

A whole population cohort of 157 patients with idiopathic Parkinsonism, most of whom had previously been clinically examined by Mutch (1986 a), were assessed to determine prevalence figures for dementia and examine the relationship between dementia, cognitive impairment and Parkinsonian signs. Dementia according to DSM-III-R criteria was diagnosed in 23·3% of all patients (95% confidence interval: 17·1 to 32·4%). Dementia and cognitive impairment were associated with overall measures of Parkinsonian impairment and rigidity, but not tremor, even after controlling for age, sex and education.

Fifty hospitalized patients with bipolar affective disorder were interviewed on discharge from hospital. Over the subsequent 12 months, 36 of these patients were readmitted to hospital. Compared with the remainder, those readmitted had had more past hospital admissions and on interview were rated as being less able to recognize and respond to early symptoms of relapse and were less accepting of medication.

Serum concentrations of the third and fourth components of the complement system and total complement haemolytic activity were measured in 167 psychiatric patients. Total complement haemolytic activity was decreased in chronic schizophrenic patients as compared to healthy controls and bipolar patients. The relatively diminished total haemolytic activity was not attributable to drug treatment. It is not clear if the reduced total haemolytic activity is an epiphenomenon or related to the involvement of an autoimmune process in the pathophysiology of schizophrenia.

Thyrotropin response to thyrotropin-releasing hormone is impaired during endogenous depression and normalized between the depressive periods. Changes in the thyrotropin response to thyrotropin-releasing hormone were shown to be of predictive value and might be useful in the control of continuation therapy with antidepressants in patients with endogenous depression.

Factor analysis was performed on objectively measured and subjectively reported characteristics of 46 nights' sleep in four healthy male subjects. The fragmentation of sleep by awakenings during the night, the delay before falling asleep, the total duration of sleep, and the amount of delta-wave sleep formed the bases of four separate factors.

133 samples of plasma taken from 9 normal control and 8 manic-depressive subjects were analysed for vanadium by atomic absorption spectrometry. Mean plasma vanadium concentrations were 0·15 μM in normal control, 0·34 μM in manic and 0·28 μM in depressed subjects, and 0·23 μM in manic-depressive subjects after recovery. The differences between normal subjects and manic and recovered subjects were statistically significant. Significant negative correlations were found between plasma vanadium concentration and the ratio of Na–K–Mg ATPase to Mg–ATPase in 2 manic-depressive subjects, but not in normal subjects. The results suggest that vanadium may be a cause of the variations in Na–K–Mg ATPase and sodium pump activity which are associated with manic-depressive illness.

This study investigated the stability and change in teacher-reported problem behaviours across a four-year period. An epidemiological sample of 811 children aged 4–12 at the initial assessment was assessed twice with the Achenbach Teacher Report Form (TRF). We found medium stability in the level of TRF total problem scores. Highest stability was found for aggressive and other externalizing behaviours. Stability was higher for girls than for boys. Of the girls who could be regarded as disturbed at base line, 50% could still be so regarded four years later, whereas only 23% of the boys could be considered persistently disturbed across the study interval. Girls' scores on the Externalizing syndrome were especially stable.

Background. It has been well established in the literature that a strong genetic component exists for schizophrenia. Available data are compatible with the hypothesis that for most cases of schizophrenia, the genetic component consists of multiple genes acting in an additive manner with the genotype for schizophrenia being present when the number of genes is greater than a threshold number. Twin studies suggest that the genotype for schizophrenia is unexpressed in some individuals who carry it. This phenomenon of reduced penetrance has led to a diversity of hypotheses concerning the aetiology of schizophrenia. Based on a review of the literature a neuro-developmental model is proposed for schizophrenia that involves the actions of the schizophrenia genotype, canalization and stochastic events.

Conclusions. The schizophrenia genotype is programmed to disrupt the migration of neuronal cells in the developing cortex during the second trimester, resulting in impaired embryogenesis. The presence of a specific lesion is the reason for the onset of schizophrenia later in life. The genotype for schizophrenia often remains unexpressed, or demonstrates variable expressivity, because of the actions of canalization and stochastic events that may allow migrating neuronal cells to reach or approach the target data. Stochastic events also influence whether canalization will be successful, therefore, chance plays a major role under normal conditions in determining whether the schizophrenia genotype will be expressed. Certain environmental factors acting during early development, such as high temperatures resulting from maternal illness, may increase the penetrance of the schizophrenia genotype.

Background. Neuroticism is widely used as an explanatory concept in etiological research of psychopathology. In order to clarify what neuroticism actually represents, we investigated the genetic association between neuroticism and cardiovascular measures.

Method. In 125 female twin pairs (18–30 years), electrocardiogram and continuous finger blood pressure were assessed during two rest and two mental stress conditions. Mean values for baroreflex sensitivity (BRS), heart rate variability (HRV) and inter-beat interval (IBI) were calculated for each condition. Neuroticism was assessed by multiple questionnaires. Multivariate genetic model-fitting analyses were used to investigate the genetic correlation between latent neuroticism and the cardiovascular autonomic nervous system (ANS) measures.

Results. Neuroticism was negatively correlated to BRS and HRV. Neuroticism was not correlated to IBI. For BRS, this phenotypical relation was entirely determined by shared genetic influences. For HRV, the genetic contribution to the phenotypical correlation was not significant, but the proportions of explained covariance showed a trend of more genetic than environmental influences on the phenotypical relationship.

Conclusions. High neuroticism is associated with a deregulated ANS. Pleiotropic genetic effects may be partly responsible for this effect.

Background. There are no published criteria for improving the quality of effectiveness of randomized controlled trials (RCTs) in psychiatry.

Method. The authors review and systematize the relevant literature on effectiveness trials, with particular reference to psychiatry.

Results. In planning effectiveness RCTs in psychiatry, seven sets of issues need to be carefully considered: (i) study question (i.e. is the study question expressed in an answerable way?); (ii) reference population (i.e. what is the reference group or subgroup to which the trial results should be generalized?); (iii) patient sample (i.e. how far does the sample reflect the target population?); (iv) study settings (i.e. how representative are the study settings of routine clinical sites?); (v) study interventions (i.e. is the study intervention manualized, acceptable to patients and suitable for widespread use?); (vi) control condition (i.e. are the key characteristics of the control condition well described, and do they vary within and between sites?); and (vii) bias (e.g. attrition, blinding, concealment, consent and contamination).

Conclusions. More effectiveness trials are needed which have sufficient statistical power to provide precise answers to assist clinicians in making treatment decisions. The development of effectiveness trials in psychiatry, both for studies of individual treatments and for service evaluations, may be enhanced by carefully considering and justifying decisions in relation to each of the seven key headings proposed here.