Associations in 52 normal individuals were examined between plasma and cerebrospinal fluid (CSF) concentrations of tryptophan (Trp) and tyrosine, and concentrations of monoamine metabolites in the CSF, and scores on an aggression questionnaire, the Kinsey Institute Reaction List II, and the Eysenck Personality Questionnaire. There was a significantly positive correlation between CSF 5-hydroxyindoleacetic acid (5-HIAA) levels and extroverted aggression scores, and a significantly negative correlation between CSF 5-HIAA levels and introverted aggression scores. Males showed higher plasma Trp concentrations than females, and significantly positive correlations between plasma Trp concentrations and scores on extroverted aggression and the Eysenck E scale. Males, furthermore, showed a significantly negative correlation between CSF Trp levels and scores on the Eysenck P scale, and a significantly positive correlation between concentration of 3-methoxy-4-hydroxy-phenylglycol in CSF and scores on moral aggression. These results suggest that central serotonin influences aggression in normal individuals through effects on personality.

This study investigated psychosocial morbidity, coping styles and health locus of control in 64 cases with and without chronic fatigue identified from a cohort of primary care patients recruited 6 months previously with a presumed, clinically diagnosed viral illness. A significant association between chronic fatigue and psychosocial morbidity, somatic symptoms and escape-avoidance coping styles was shown. Chronic fatigue cases were significantly more likely to have a past psychiatric history and a current psychiatric diagnosis based on a standardized clinical interview. Twenty-three of the cases fulfilled criteria for chronic fatigue syndrome (CFS). Such cases were significantly more fatigued than those not fulfilling criteria, but had little excess psychiatric disorder. A principal components analysis provided some evidence for chronic fatigue being separable from general psychosocial morbidity but not from the tendency to have other somatic complaints. Past psychiatric history and psychological distress at the time of the viral illness were risk factors for psychiatric ‘caseness’ 6 months later, while presence of fatigue, psychologising attributional style and sick certification were significant risk factors for CFS. These findings extend a previous questionnaire study of predictors of chronic ‘post-viral’ fatigue.

We report on the first South African two-stage community prevalence study of psychiatric morbidity, conducted in Mamre, a rural ‘coloured’2 village, 50 km from Cape Town. Randomly selected adults (N = 481) were assessed using the Self-Reporting Questionnaire (SRQ) as a first-stage screen and the Present State Examination (PSE-9) was administered to a proportion of the sample (N = 121) as the second-stage criterion. Demographic, health care utilization, and substance abuse data were also collected. Using the PSE-9 CATEGO Index of Definition of 5, the weighted prevalence of psychiatric morbidity was 27·1 % (confidence interval of 19·5−34·7 %), the majority of cases being given a tentative diagnosis of depressive or anxiety disorder. The CATEGO algorithm may not be fully appropriate in this cultural context as there was an apparent overdiagnosis of paranoid states. The SRQ's weighted sensitivity and specificity were 0·49 and 0·82 respectively. Overall, the SRQ correctly identified 67% of cases and non-cases. No demographic variables predicted psychiatric morbidity, but there was an indirect link between morbidity and primary care utilization. Further South African studies of the validity of both the SRQ and of criterion instruments are needed. These may contribute to knowledge regarding cultural factors affecting psychiatric diagnosis.

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.

The effects of life events, social support and marital relationships on outcome were examined in a predominantly recurrent in-patient sample of depressives studied longitudinally every 3 months to remission and up to 15 months thereafter. Outcomes examined were length of time to remission, presence of residual symptoms at remission, and subsequent relapse. There were few associations between these outcomes and the social variables. These findings add to other recent evidence that psychosocial factors are relatively unimportant in the subsequent course of severe and recurrent depressions, in contrast to their contribution to onset of such depressions and subsequent outcome of milder depressions.

The term ‘pseudohallucination’ is currently used to name imaginal experiences whose relationship to one another and to hallucinations ‘proper’ remains obscure. Clinicians, including specialists in psychopathology, disagree on how pseudohallucination must be defined and on its diagnostic role. Empirical research is unlikely to help as the term does not have a stable referent. Historical and conceptual analyses, on the other hand, are of great use to show how this untidy state of affairs has obtained. This paper includes a full account of the history of pseudohallucination and concludes that: (a) the problem has resulted from the fact that the history of the word, concept (s) and putative behaviour (s) failed to ‘converge’ (i.e. there never has been a time when the three components have formed a stable complex); (b) failure to converge has been caused by the fact that the concept of pseudohallucination is parasitical upon that of hallucination, and that the latter has proved to be far more unstable than what is usually recognized; (c) hence, pseudohallucination is a vicarious construct (i.e. one created by a temporary conceptual need, and which is not associated with a biological invariant); (d) pseudohallucination is used as the ‘joker’ in a poker game (i.e. made to take diagnostic values according to clinical need) – this has led to diagnostic complacency and retarded important decisions as to the nature and definition of hallucinations; and (e) the language of current descriptive psychopathology is not fine-grained enough to generate a stable frame for pseudohallucination. This suggests that its boundaries and usage will remain fuzzy and unbridled.

This study aims to describe factors associated with cognitive decline among 2584 subjects, aged 65–74, who were followed up for 54 months in the Medical Research Council Elderly Hypertension Trial (1982–1989). The subjects completed a cognitive test, the Paired Associate Learning Test (PALT), five times over this period. Decline on the PALT was associated with advanced age, male sex, rural residence, depression and low intelligence. These effects were modified by gender and level of pre-morbid intelligence. Advanced age, rural residence and number of cigarettes smoked daily were only associated with PALT decline among women of below median intelligence. The association between depression and PALT decline was only apparent in women of below median intelligence and men of above median intelligence. While these findings are consistent with other research into cognitive decline, they differ in some ways from reported risk factors for dementia, suggesting aetiological separateness. That women were more vulnerable than men to the effects of age and smoking raises the question of the impact on cognition of accelerated atherosclerosis after the menopause.

A group of 72 long-term patients, who were retained in Friern Hospital until the final stage of its closure programme, underwent a comprehensive psychiatric and social assessment shortly before moving to other hospitals. These patients were then compared with the rest of the long-stay patients who were considered suitable for community placement.

The residual group consisted of younger patients with shorter duration of stay, compared with the rest of the hospital population. Although not excessively disabled functionally or physically, the residual patients were slightly more disturbed in mental state in comparison with the rest, with notably higher levels of subjective anxiety.

A range of 13 problem behaviours were designated by staff as a direct impediment to placing a patient in a community setting. Most common problem areas were aggressiveness, non-compliance with medication and inappropriate sexual behaviour. Fourteen per cent of the residual group had none of these special problems. Some other patients have remained in hospital solely because they refused to leave.

It is argued that a distinction should be made between the residual patients who were actually transferred to other hospitals, and a core group of extremely disturbed patients for whom further hospitalization is likely to be the only alternative.

Although cognitive research on attention has advanced significantly in recent years, these advances have produced few specific hypotheses regarding the attentional impairment seen in depression, and few experiments designed to test them. We review the limited neuropsychological literature on impaired attention in depressive states, with emphasis on areas where the findings of modern cognitive research might be applied in the future to design more sophisticated tests of attentional impairment. At present, it is not possible to determine whether the attentional deficits seen in depression are specific to this disorder, or whether they represent a final common pathway of impaired cognition seen in many different mental and organic deficit states, such as schizophrenia and dementias.

The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.

This paper reports the results of a study designed to explore the validity of a shiftwork model of affective disorders. Fifty-five student nurses doing nightwork for the first time were recruited to a study designed both to replicate an earlier study of the effects of nightwork on cognitive, emotional and neurovegetative measures and to assess the effects of nightwork on personality measures and the role of personality factors and nightwork induced disturbances in predicting accommodation to nightwork. As in the earlier study, concentration, interest, energy, sleep and appetite were significantly disturbed by nightwork and there was an increased perception of recent criticism from others. The findings from both studies were, therefore, aggregated to explore further possible relations between outcomes and the pre-nightwork level of affective symptoms and sensitivity to interpersonal criticism. These predicted poor response. In contrast, measures of cognitive style and symptom interpretation did not predict outcome. The findings are not inconsistent with proposals that disturbance of circadian rhythms consequent on psychosocial disruptions may play a part in the genesis of or maintenance of depression. They also support a proposal that nightwork induced changes may be a suitable human model for investigation of aspects of the affective disorders.

The point prevalence of depression measured on one occasion between 2 and 5 months after childbirth was estimated to be 13·1% in 352 mothers living in urban Portugal; the criterion was a score of 13 or more on a translated version of the Edinburgh Post-natal Depression Scale (EPDS). More detailed comparisons were made between a subgroup of 118 mothers and 118 matched controls who had not borne a child in the previous 2 years. Post-natal women were twice as likely as non-childbearing controls to meet the EPDS criterion for depression. In comparison with controls, they were also more severely depressed as judged by their total scores on another questionnaire, the Zung Scale. Comparisons of individual symptom scores (Zung Scale) showed that childbearing women, as a whole, reported more somatic symptoms than controls, but when only those women judged to be depressed or dysphoric by the EPDS were compared, this difference disappeared. Stepwise logistic analyses of symptoms contributing to the categorization of a ‘case’ of post-natal versus non-post-natal depression did not reveal any very clear divergences in selfreported psychopathology. In childbearing women, two factors were found significantly to contribute to higher depression scores; women with more children and those from lower socioeconomic groups were most at risk.

Previous studies have reported an increase in depression among recent birth cohorts. Concurrent with the increase in rates of depression, there have been increases in rates of drug and alcohol abuse and dependence. This study sought to determine if the recent increase in rates of depression could be attributed to co-morbid alcohol and drug abuse. The data derived from two studies: (1) a sample of relatives of probands with affective disorder; and (2) a community survey of the US population. The piecewise exponential statistical model was applied to evaluate the association of gender, age, period and birth cohort with rates of major depressive disorder (MDD) separately for those with, and without, diagnoses of alcohol or drug abuse.

Elevated rates of MDD occurred among those with co-morbid drug and alcohol abuse in both the family and community samples. However, there were also temporal increases in rates of MDD in those with no such co-morbidity. Specifically there were effects of age and gender for both studies; in addition, there was a period effect in the family study and a birth cohort effect in the community sample. The recent increases in depression in the US cannot be accounted for solely by concurrent increases in co-morbid drug and alcohol abuse. Temporal (period and cohort) effects on rates of depression occur in addition to the contribution of co-morbid drug and alcohol abuse or dependence.

A study was conducted, which simultaneously used GPs and epidemiological assessment procedures (MMSE, CAMDEX), to identify individuals with DSM-III-R dementia in the same population. In addition, a 1-year follow-up assessment was conducted in patients with a CAMDEX-diagnosis of dementia. In the non-institutionalized group, which was assessed both by the GP and with the epidemiological test battery, the prevalence of dementia according to the GP was 2·2%, whereas the prevalence based on the epidemiological approach amounted to 5·2%. In general CAMDEX-diagnoses of dementia were confirmed at 1-year follow-up, and thus the discrepancy between the two prevalence estimates must be attributed to the low sensitivity of the GPs. Sensitivity of the GP was related to help-seeking behaviour, with low sensitivity in patients with a low contact rate. It was also related to the use of less specific diagnostic labels by the GP (cognitive impairment), and to poor recognition of cognitive impairment in patients who visited their GP.

We examined the reliability of the OPCRIT system from ratings produced by 30 USA and European clinicians involved in molecular genetic research. The OPCRIT system facilitates a polydiagnostic approach to research on severe psychiatric disorders. OPCRIT comprises a 90-item checklist of signs and symptoms and a suite of computer programs, which together generate diagnoses according to the operational criteria of 12 major classificatory systems (e.g. DSM-III, DSM-III-R, RDC, ICD-10). Thirty summaries of actual cases ranging in signs and symptoms, taken from independent sources, were rated by participants from research centres across Europe and the USA using the OPCRIT system. Each rating was then compared to a standard rating using a kappa statistic. Good levels of reliability were observed within all classifications (e.g. DSM-III-R, kappa = 0·73, RDC, kappa = 0·71; ICD-10, kappa = 0·70) and a similar pattern of ratings was found in both the European and USA samples. We conclude that the OPCRIT system, is both flexible and practicable retaining the ‘top-down’ advantage of operational definitions as well as the ‘bottom-up’ potential offered by well defined signs, symptoms and other component items. Within the limitations of an international, multicentre design this study shows that the OPCRIT system affords good reliability with raters from a variety of geographical and theoretical backgrounds.

There is evidence of growth faltering in infants of mothers with eating disorders. The aim of the current study was to examine whether this is a specific relationship. Thus, the infants of mothers with eating disorders were compared with infants of mothers with post-natal depression and a large comparison group. This study also aimed to explore possible mechanisms whereby growth disturbance comes about.

It was found that the infants of mothers with eating disorders were smaller, both in terms of weight for length and weight for age, than either comparison group infants or infants of mothers with post-natal depression. There was little evidence, however, that mothers with eating disorders preferred smaller children or were dissatisfied with their children's shape or that they misperceived their children's size. On the contrary these mothers seemed highly sensitive to their children's shape and, compared with the other two groups, were more likely to judge their children's size accurately. None of these maternal measures significantly predicted the child's growth.

The mechanism whereby growth disturbance arises in the context of eating disorders does not appear to be by means of a direct extension of the maternal psychopathology to the infant.

In this longitudinal two-stage screening study of abnormal eating attitudes and behaviours in Polish schoolgirls self-report questionnaires (EAT-26) were completed by 747 schoolgirls aged between 14 and 16 years. On the basis of their EAT-26 scores 167 girls were selected for a clinical interview conducted blind to questionnaire scores. No clinical cases of DSM-III-R anorexia or bulimia nervosa were identified, however, there was a point prevalence of 2·34% for subclinical eating disorder and of 28·6% for dieting. Natural history was investigated, repeating the screening and interviews after 10 months. Both the group mean EAT-26 score and the proportion of subclinical cases remained the same at follow-up however, individual girls showed substantial fluctuations over time. On re-screening 11·5% of the sample had moved EAT category (based on scoring below or above the clinical cut-off point). Follow-up interviews showed that 58% (7) of the original subclinical cases were no longer cases while seven girls were ‘new’ subclinical cases. This second stage of the study also aimed to investigate the risk factors for the development of eating disorders. Several family factors distinguished the dieters from non-dieters at the initial stage. Subjects who began dieting between the initial and follow-up interviews had higher Body Mass Index, felt more overweight and had greater discrepancy between their current and ideal weights than the non-dieters. However, analysis of regression revealed no specific risk factors for development of a subclinical syndrome.

The birth distribution of 399 cases of Alzheimer's disease (AD) identified in the region of Saguenay-Lac-St-Jean (Québec) was compared with that of: (a) the population currently living in the area; and (b) the population born during the same period in the area. AD cases have been recruited since 1986 by the IMAGE Project. Cases and controls were grouped according to the month of birth and according to the day of birth using density estimation. Analyses showed a significant deficit of births in the month of May. We believe these preliminary results deserve further attention and we suggest two possible explanations that could lead to a deficit of AD births at specific periods during the year.

Abnormalities in central serotonin function have been implicated in the pathogenesis of anorexia nervosa. It is difficult, however, to separate neuroendocrine abnormalities induced by weight loss and malnutrition from those related primarily to the disorder itself. To minimize these influences, this study assessed long-term weight restored anorexics. A correlation between persistent eating-related psychopathology, co-morbid illness and serotonin dysfunction was sought. Nine female weight-restored out-patients who had previously fulfilled DSM-III-R criteria for anorexia nervosa and nine healthy controls participated. Following baseline estimation, prolactin and cortisol responses to 30 mg p.o. of D-fenfluramine were measured over a 5 h period. Eating related psychopathology was assessed using the Eating Disorders Inventory and Eating Attitudes Test. Depressive and obsessional symptoms were measured using the Beck Depressive and Maudsley Obsessive–Compulsive Inventories respectively. The Tridimensional Personality Questionnaire assessed impulsivity. The weight-restored anorexic group exhibited persistent eating-related psychopathology and significant co-morbid symptomatology. There was no difference between long-term weight restored anorexics and controls in their endocrine response to D-fenfluramine. Long-term weight-recovered anorexic subjects continued to exhibit behavioural and attitudinal disturbances characteristic of anorexia nervosa. The results suggest that abnormalities in 5HT activity do not contribute significantly to trait status in anorexia nervosa.

We present a 12-month prospective study of hypochondriacal worry in primary care. Data were obtained from 546 family medicine patients at the time of a physician visit for a new illness and again 1 year later. Patients were divided into four groups based on scores on the Illness Worry Scale: non-hypochondriacal (N = 460), transient hypochondriacal (N = 34); emerging hypochondriacal (N = 21); and persistent hypochondriacal (N = 31). Persistent patients had significantly more serious medical history but no more serious current illness than those low on illness worry. Patients with persistent illness worry were more likely than others to have a diagnosis of major depression or anxiety disorder, were more likely to believe that their most important significant other would pathologize new symptoms, yet were less likely to have been encouraged to see the doctor by them. Patients who became less worried over the year reported corresponding decreases in distress, attentiveness to bodily sensations, emotional vulnerability and pathological symptom attributions. We conclude that depressive or anxiety disorders, fears of emotional instability, pathological symptom attributional styles and interpersonal vulnerability provide the best prognostic evidence for enduring illness worry.