Background. Abnormalities of brain serotonin (5-HT) transmission have been implicated in the pathophysiology of bulimia nervosa (BN), but no conclusive data have yet been provided. The purpose of this study was to assess 5-HT transmission via the measurement of the prolactin (PRL) response to the specific 5-HT releasing agent d-fenfluramine (d-FEN) in both patients with BN and comparison subjects.

Methods. According to a double-blind placebo-controlled design, plasma PRL response to d-FEN was measured in 14 drug-free bulimics and 14 matched healthy controls. In both patients and controls, eating-related psychopathology, depressive and obsessive–compulsive symptoms, and aggressiveness were measured by rating scales.

Results. Baseline plasma levels of PRL and 17β-oestradiol were significantly reduced in bulimic patients, whereas basal plasma levels of cortisol did not significantly differ from healthy controls. PRL response to d-FEN was not different between patients and controls as groups, but it was significantly blunted in bulimics with high frequency bingeing ([ges ]2 binge episodes per day; N=7) as compared to both those with low frequency bingeing ([les ]1 binge episode per day; N=7) and matched controls. A significant negative correlation emerged between the frequency of binge episodes and the hormone response to d-FEN. Moreover, although patients scored higher than healthy subjects on rating scales assessing depressive and obsessive–compulsive symptoms and aggressiveness, no significant correlation was found between these measures and the PRL response to d-FEN.

Conclusions. These results support the idea that serotonin transmission is impaired in bulimic patients with frequent binge episodes.

Antipsychotic treatment resistance affects up to a third of individuals with schizophrenia. Of those affected, 70–84% are reported to be treatment resistant from the outset. This raises the possibility that the neurobiological mechanisms of treatment resistance emerge before the onset of psychosis and have a neurodevelopmental origin. Neuropsychological investigations can offer important insights into the nature, origin and pathophysiology of treatment-resistant schizophrenia (TRS), but methodological limitations in a still emergent field of research have obscured the neuropsychological discriminability of TRS. We report on the first systematic review and meta-analysis to investigate neuropsychological differences between TRS patients and treatment-responsive controls across 17 published studies (1864 participants). Five meta-analyses were performed in relation to (1) executive function, (2) general cognitive function, (3) attention, working memory and processing speed, (4) verbal memory and learning, and (5) visual−spatial memory and learning. Small-to-moderate effect sizes emerged for all domains. Similarly to previous comparisons between unselected, drug-naïve and first-episode schizophrenia samples v. healthy controls in the literature, the largest effect size was observed in verbal memory and learning [dl = −0.53; 95% confidence interval (CI) −0.29 to −0.76; z = 4.42; p < 0.001]. A sub-analysis of language-related functions, extracted from across the primary domains, yielded a comparable effect size (dl = −0.53, 95% CI −0.82 to −0.23; z = 3.45; p < 0.001). Manipulating our sampling strategy to include or exclude samples selected for clozapine response did not affect the pattern of findings. Our findings are discussed in relation to possible aetiological contributions to TRS.

Background. An international, multi-site study funded by the Price Foundation has collected 237 affected relative pairs to identify potential genetic factors that may contribute to the pathogenesis of anorexia nervosa (AN). The current report utilized this sample to derive phenotypes from the personality and behavioural traits assessed in a large number of individuals with eating disorders.

Methods. Multivariate analytical techniques were used to characterize the relationships among personality (e.g. trait anxiety, perfectionism, harm avoidance, novelty seeking) and behavioural traits (obsessions and compulsions) in individuals with eating disorders (primarily AN; N = 348) and assess the effectiveness of these traits in classifying subjects into diagnostic subtypes.

Results. Factor analysis revealed that the most influential factor was one of trait anxiety, harm avoidance, perfectionism, obsessive–compulsive behaviours, and diminished self-directedness, although the precise nature of this factor differed slightly across sites. Discriminant analysis was used to evaluate the utility of these personality/behavioural factors in predicting subdiagnosis. Overall, the misclassification rate was 34 %; however, there was an 80 % rate of accurate classification of those individuals with a diagnosis of restricting-type AN.

Conclusions. Trait anxiety, harm avoidance, perfectionism, obsessive–compulsive behaviours and diminished self-directedness may best be conceptualized as parts of the same underlying construct among individuals with eating disorders, particularly AN. These personality and behavioural traits were also found to be of some utility in classifying eating disordered individuals into diagnostic subgroups, particularly those with restricting-type AN. We expect these phenotypic findings to benefit our ongoing search for genetic loci underlying the liability to eating disorders.

Three hundred and six male subjects in a community survey reported on their ‘motivation for drinking’. Factor analysis revealed three major factors. Factor 1 relates to N (neuroticism) score, more extreme drinking, and likelihood of drink-related trouble. Factor 2 is associated with more privileged and factor 3 with less privileged class status.

We investigated serum creatine phosphokinase (CPK) and associated parkinsonic (SEPS) and dyskinetic (AIMS) movements in 32 hospital admitted acute catatonic patients. Thirty-two (N = 24 without neuroleptics on admission) catatonic patients were compared with 32 non-catatonic dyskinetic psychiatric patients, 32 non-catatonic non-dyskinetic psychiatric patients and 32 healthy controls. CPK was significantly higher (p = 0·015) in catatonics (mean 255·75, s.d. ± 226·54) than in healthy controls (38·6, ± 27·4) and non-catatonic non-dyskinetic psychiatric patients (57·1, ± 120·8) whereas there was no significant difference between catatonics and non-catatonic dyskinetic psychiatric patients (453·4, ± 128·5). There were significantly positive correlations between CPK and AIMS, as well as significantly negative correlations between CPK and SEPS, in all three groups. Our results suggest that increased serum CPK in catatonia may be related to occurrence of dyskinetic movements. Furthermore, we were able to distinguish a parkinsonic (low CPK, low AIMS, high SEPS) and a dyskinetic (high CPK, high AIMS, low SEPS) subtype in catatonia.

Electro-convulsive treatment (ECT) was therapeutically ineffective in 27 (20 %) of 136 depressed patients. Failure to respond occurred in long-lasting depressions and in patients with a history of long-lasting depressions. In these cases the depression lasted at least 6 months. The hypothesis is proposed that ECT is effective only when given within 6 months of the spontaneous end of the depression. Clinical and nosological implications are discussed.

Using data collected by the Salford Psychiatric Case Register from 1 January 1968 to 1 January 1972, the current use of psychiatric inpatient beds is presented and trends discussed. Estimates are given for the likely occupancy at 1 January 1982, for short and medium stay (under one year), and long-stay (one year or more) beds. Three methods of projecting the accumulation of new long-stay patients are described and discussed. The total occupancy by 1982 is likely to be about 2·3 beds/1,000 total population, about 1·7/1,000 for long-stay patients.

Seven volunteers received diazepam for a 3-week period, maximum dose rate 25 mg per day, and were tested on a variety of functions before, at two points during, and at two points after the period. Their performance was compared with that of 8 controls and was inferior on a number of measures. There was no indication either of habituation or of potentiation of the effects as the period continued. Equally, the low performance persisted for some time after administration ceased, although performance was on the whole better than during the experimental period. The particular measures showing deterioration suggested that the effects are similar to those of barbiturates as opposed to those of, for example, chlorpromazine.

Background. Depressive syndromes not fulfilling the criteria for specified disorders (subthreshold depression, SD) may be clinically important. We aimed to study SD in old and very old age, in comparison with subjects with no depressive symptoms (NDS) and subjects with major depression (MD).

Methods. A community-based random sample of 516 subjects, age 70 to 100 years and over, stratified by age and sex, was examined. All participants were investigated by psychiatrists and by geriatricians independently.

Results. In 16·5% (N = 85) of the study subjects SD was identified. Study subjects with SD had, similarly to the subjects with MD, significantly more somatic diagnoses and used more somatic as well as psychotropic medications than the subjects with NDS. Self-ratings and observer ratings of depression indicated that SD was a milder depressive state than MD.

Conclusions. Compared with MD, SD is probably a milder form of depression. The increased use of psychotropic medications indicates that at least a portion of these individuals have a disorder requiring treatment. One of the characteristics of SD is co-morbidity with somatic illnesses and physical disability.

The age-specific lifetime prevalence rate of a disease is the proportion of persons surviving to a given age who have experienced the disease at any time during their lives. This measure of morbidity has been used to report findings in many of the epidemiological surveys of mental disorders of the last 30 years. This paper presents a life-table method for estimating age-specific lifetime prevalence rates from incidence and mortality data. The method is applied to Monroe County, New York, case register data on the incidence of schizophrenia. Using this method, we estimate that at least 3% of the White population surviving to age 55 have experienced an episode of schizophrenia at some time during their lives. The difficulties of producing valid estimates of lifetime prevalence and the difficulties in interpreting differences reported in such rates make this morbidity measure of secondary importance to incidence and point-prevalence data.

This study reports the psychiatric morbidity in 76 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brain stem and cord lesions). The presence or absence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 33 patients suffering from rheumatic and neurological conditions not known to involve the brain was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers.

Over half of the patients with the clinical presentation of single lesions had MRI abnormalities in the brain, but past and present psychiatric morbidity were similar in patients and controls and no significant associations were found between the presence of MRI abnormalities and psychiatric morbidity. The degree of social stress experienced by the patients with clinically isolated lesions appeared to be highly relevant in the causation of psychiatric symptoms.