Background. Most studies of social support appear to assume that it is something that the external environment provides to an individual. However, longitudinal and genetic studies are beginning to question this assumption. The purpose of the present study is to differentiate quantitatively the intra-individual determinants of social support from its extra-individual components.

Methods. The subjects were 103 high school exchange students who were enrolled in a 1-year placement with a host family in various countries of the world. The People In Your Life scale, a reliable and validated self-report measure of perceived social support, was administered before their departure from home, after 6 months of stay in a completely unfamiliar foreign community and 6 months after their return home. Structural equation models were examined that partitioned the intra-individual and extra-individual components of social support, and the best fitting models were selected.

Results. Between 24% and 69%, or up to 86% depending on the situation, of the variances of social support measures were stable across situations and considered intra-individual; 31% to 76% of what is measured as social support was of extra-individual origin. Moderately strong correlations were noted between the intra-individual components and the trait extraversion.

Conclusions. Measures of social support, which is usually tacitly understood as something extrinsic to an individual, in fact may not be measures of the external environment only.

Background. ‘Forward psychiatry’ was introduced by the French Army in 1915 to stem the loss of troops to base hospitals. Also known by the acronym PIE (proximity to the battle, immediacy of treatment and expectancy of recovery, including return to duty), it was subsequently used by the British and Americans in both World Wars. The US Army used PIE techniques in Korea and Vietnam. Although widely accepted as an effective intervention, forward psychiatry is not amenable to random-controlled trials and only one controlled outcome study has been conducted.

Method. All 3580 soldiers with shell shock admitted to 4 Stationary Hospital between January and November 1917 were recorded. Unit details, military experience, length of stay and outcomes were analysed. Soldiers were categorized into combat, combat-support and non-combatant groups. Admissions were correlated with military operations to compare the impact of defensive and offensive phases of warfare.

Results. Rates of admission for shell shock rose significantly during offensives when physical casualties escalated. Combat troops were disproportionately represented. Over 50% of admissions had less than 9 months service in France and 21% broke down within 3 months of going overseas. Less than 20% returned directly to combat units, most going to other hospitals, convalescent depots or base duties.

Conclusions. Forward psychiatry was not effective in returning combat troops to fighting units but, by allocating soldiers to support roles, it prevented discharge from the armed forces. Uncertainties remain about relapses, including other routes that servicemen used to escape from a combat zone.

Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35–0.42, p < 0.001, I2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13–0.29, p < 0.001, I2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36–0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02–0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.

The effects of non-invasive, non-convulsive electrical neuromodulation (NINCEN) on depression, anxiety and sleep disturbance are inconsistent in different studies. Previous meta-analyses on transcranial direct current stimulation (tDCS) and cerebral electrotherapy stimulation (CES) suggested that these methods are effective on depression. However, not all types of NINECN were included; results on anxiety and sleep disturbance were lacking and the influence of different populations and treatment parameters was not completely analyzed. We searched PubMed, Embase, PsycInfo, PsycArticles and CINAHL before March 2021 and included published randomized clinical trials of all types of NINCEN for symptoms of depression, anxiety and sleep in clinical and non-clinical populations. Data were pooled using a random-effects model. The main outcome was change in the severity of depressive symptoms after NINCEN treatment. A total of 58 studies on NINCEN were included in the meta-analysis. Active tDCS showed a significant effect on depressive symptoms (Hedges' g = 0.544), anxiety (Hedges' g = 0.667) and response rate (odds ratio = 1.9594) compared to sham control. CES also had a significant effect on depression (Hedges' g = 0.654) and anxiety (Hedges' g = 0.711). For all types of NINCEN, active stimulation was significantly effective on depression, anxiety, sleep efficiency, sleep latency, total sleep time, etc. Our results showed that tDCS has significant effects on both depression and anxiety and that these effects are robust for different populations and treatment parameters. The rational expectation of the tDCS effect is ‘response’ rather than ‘remission’. CES also is effective for depression and anxiety, especially in patients with disorders of low severity.

Background. Current cognitive models of positive symptoms of psychosis suggest a mechanism of defective self-monitoring that may be relevant for (i) expression of psychosis at the clinical and subclinical level and (ii) transmission of risk for psychosis.

Method. The study included 41 patients with psychosis, 39 non-psychotic first-degree relatives, 39 subjects from the general population with a high level of positive psychotic experiences, and 52 healthy controls with an average level of positive psychotic experiences. All subjects performed a speech attribution task in which single adjectives with a complimentary or derogatory meaning were presented to them on a computer screen; subjects had to read aloud and determine the source (self/other/uncertain) of the words they heard. In some of the trials, participants’ speech was distorted, in others they heard someone else's voice (alien feedback condition) that could also be distorted.

Results. No large or significant differences in errors in the speech attribution task were found between the four groups in any of the conditions.

Conclusions. Contrary to previous work using this paradigm, this study found no evidence that either expression of psychosis or risk for psychosis was associated with impairment in self-monitoring.

The blood counts of 80 patients with depression were examined (50 unipolar, 30 bipolar). Many had reduced numbers of circulating lymphocytes. This abnormality was more common in the unipolar group (52%) than in the bipolar group (27%). When those patients with an abnormal dexamethasone suppression test response in both groups were compared, the relative and absolute lymphocyte counts were significantly lower in unipolars. Although cortisol hypersecretion may reduce lymphocyte numbers it is not yet clear whether the findings can be satisfactorily explained in this way.

A survey was made of studies reporting population prevalence rates for the different types of neurotic disorders in order to determine the utility of these rates for familial and genetic research. Rates varied considerably among studies both for all neuroses and for particular types of neuroses, even among studies using similar methods examining similar populations. The method of case ascertainment (personal interview versus record searches) and the threshold for defining an individual as affected are important contributors to variation. The use of the published prevalence rates for quantifying familial and genetic effects on the neurotic disorders would be premature.

This paper compares the coverage of potential life events by the inventory developed by Tennant & Andrews (1976) and the post hoc designation originated by Brown (1974). It was found that the rubric of the inventory failed to describe 5% of ‘marked’ events and 21% of ‘moderate’ events. The relative risk of minor psychiatric disorder in response to events was 3·1 for those defined by the Brown technique and 1·4 for those using the inventory. The results suggests that the post hoc designation is superior. This superiority must be weighed against its undoubted costliness.

Animal models suggest a relationship between disturbed striatal dopaminergic function and stereotyped behaviour. Several studies show increased stereotypy in schizophrenic patients compared to normal controls. We investigated the performance of 12 antipsychotic-drug-free schizophrenic patients, and 15 healthy control subjects on a neuropsychological measure of stereotypy – the two-choice guessing task – and correlated this with in vivo striatal dopamine D2 receptor binding, as measured by 123I-iodobenzamide single photon emission tomography. Patients and controls did not differ with respect to the measures of stereotypy derived from the task. However, there was a significant correlation between one of these measures (RR Information) and the degree of striatal D2 receptor binding asymmetry in the patient group only. In view of research connecting striatal and frontal lesions with stereotypy in animals and cognitive inflexibility in humans, these data could suggest a similar disturbance underlying the phenomenon in schizophrenia.

Material with pleasurable affective connotations has been found to be better recalled to a significant extent than material with unpleasant connotations in healthy volunteer subjects. Age, neuroticism and extraversion, but not sex, have proved to be associated with the variability which different subjects show in this regard. The implications of these results are discussed in relation to various theoretical constructs which seek to explain the interaction between personality variables and cognitive performance.

A study has been made of cases coming before the Brighton coroner in the period 1970–2. Fifty cases in which a suicide verdict was recorded were specially studied, and relatives and acquaintances of the deceased were interviewed. The information thus obtained was compared with information available to the coroner in considering his verdict in 83 further cases in which he made a verdict of ‘suicide’. The reliability of thewhich the coroner's decision is based was largely validated. A study was made of variables which differentiated ‘suicide’ from 25 ‘open’ and 33 ‘accident’ cases considered by the same coroner. The prevalence of depression did not differentiate ‘suicide’ and ‘open’ cases, and this finding contradicts suggestions that the association of depression and suicide might be an artefact of the method of arriving at a suicide verdict. A number of other demographic and clinical factors did however significantly vary between ‘suicide’, ‘open’ and ‘accident’ cases.

A sample of 91 new referrals to a community based psychiatric outpatient service was compared with a cross-matched control sample of 107 patients attending the general practitioner's surgery. The subjects in both groups completed the General Health Questionnaire and there was a very marked difference between the scores of the two groups. Seventy-five of the psychiatric group had a high score on the questionnaire, and a large number of these were extremely high, while 74 of the general practice group had a low score. The ‘false’ positives and negatives are discussed. It is considered that the validity of this questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is further established in this study by showing that in matched samples the expected psychiatric morbidity in general practice can be compared with the much greater morbidity in psychiatric outpatient referrals. For the psychiatric sample more patients showed high scores and these tended to be much higher.

Background. Personality is an important determinant of suicidal behaviour. However, it has been studied little in relation to suicidal behaviour in depression.

Methods. Depressed patients who had attempted suicide (N=41) were compared with depressed patients who had never attempted suicide (N=56) and normal controls (N=56) for their scores on three personality questionnaires.

Results. Introversion was the only personality dimension where the post hoc test showed a different pattern between the two groups of depressed patients in their relation to controls. In particular, only depressed patients who had attempted suicide had significantly lower introversion scores than controls.

Conclusion. The personality dimension of introversion may be a risk factor for suicidal behaviour in depression.

Background. Autism is a neurodevelopmental disorder with an estimated genetic origin of 90%. Previous studies have reported an increase in brain volume of approximately 5% in autistic subjects, especially in children. If this increase in brain volume is genetically determined, biological parents of autistic probands might be expected to show brain enlargement, or at least intracranial enlargement, as well. Identifying structural brain abnormalities under genetic control is of particular importance as these could represent endophenotypes of autism.

Method. Using quantitative anatomic brain magnetic resonance imaging, volumes of intracranial, total brain, frontal, parietal, temporal and occipital lobe, cerebral and cortical gray and white matter, cerebellum, lateral ventricle, and third ventricle were measured in biological, non-affected parents of autistic probands (19 couples) and in healthy, closely matched control subjects (20 couples).

Results. No significant differences were found between the parents of the autistic probands and healthy control couples in any of the brain volumes. Adding gender as a factor in a second analysis did not reveal a significant interaction effect of gender by group.

Conclusions. The present sample of biological, non-affected parents of autistic probands did not show brain enlargements. As the intracranium is not enlarged, it is unlikely that the brain volumes of the parents of autistic probands have originally been enlarged and have been normalized. Thus, increased brain volume in autism might be caused by the interaction of paternal and maternal genes, possibly with an additional effect of environmental factors, or increased brain volumes might reflect phenotypes of autism.