This paper examines the assumption that dementia in old age is a universal phenomenon that will vary in its prevalence and manifestation because of social and cultural factors. It finds that while researchers have been successful in demonstrating the commonality of dementia, they have been less successful in showing whether or not it varies across cultures and between social and ethnic groupings. The inconclusiveness of findings may, in part, be a function of diagnostic differences and the research methodologies employed.

New instruments and measures are being devised to overcome these problems. However, the sociocultural context in which dementia occurs and the meaning of the disorder to those involved (as sufferers and caregivers) are often missing dimensions. In particular, there is little knowledge about how the disorders of old age in non-Western settings are experienced and understood. In this respect anthropology has a special contribution to make to research on dementia.

Case studies of patients with familial schizophrenia may help to define the pathophysiology of this illness and indicate potential candidate genes for genetic linkage studies. In this regard, the clinical, radiological and pathological assessments of a 39-year-old affected man from a pedigree with familial schizophrenia are presented. Brain imaging with CT indicated moderate cortical atrophy, particularly of the temporal lobes. Neuropathological examination revealed granular ependymitis, indicating possible past ventricular pathology. Granular ependymitis was reported to occur in genetic developmental disorders with neuronal migration abnormalities. In the present case, heterotopic clusters of neurons were visualized in the entorhinal cortex, suggesting that temporal lobe development was not entirely normal. This case study suggests that genetic factors could be investigated further as one possible aetiology of certain neurodevelopmental abnormalities observed in schizophrenia.

In patients with winter seasonal affective disorder (SAD) the onset of a depressive episode is probably associated with the decreasing amount of light during the autumn. A highly predictable onset of a recurrent depressive episode with seasonal pattern provides a rationale for testing the efficacy of bright-light treatment as a preventive measure. Twelve out-patients with winter SAD were assigned to start bright light treatment either when they were well, or not to start it until the first symptoms of depression had already emerged. The severity of depressive symptoms was prospectively rated for a parallel randomized comparison. Bright light given well in advance of the emerging symptoms prevented a depressive episode. Clinical remission was significantly more frequent in the former subgroup of the patients in January and in March. To sum up, bright light can be successfully administered as prophylactic treatment for the prevention of winter SAD.

A sample of over 6000 women was recruited in the last trimester of pregnancy and administered a 40-item self-report questionnaire designed to detect the presence of factors that were likely to increase the risk of postpartum depression. The mental state of almost 5000 of these women was determined at around 6 to 8 weeks postpartum. By conducting a series of logistic regressions on two-thirds of this sample the original set of variables was reduced to a predictive index of 17 items with weighted scores calculated for each. This index was then applied to the remaining one-third of the sample as a validating procedure and specificity and sensitivity calculated. The index offers a system for the prediction of postpartum depression that could be of use in both research and clinical practice.

This study is an attempt to demonstrate confabulation in schizophrenia. Twelve patients who met DSM-III-R criteria for schizophrenia were matched for age, sex and pre-morbid IQ with 12 volunteers, 9 of whom were normal healthy subjects, with the remainder being depressed patients. To elicit confabulation, subjects were asked to recall narratives. In addition, subjects were examined on a number of neuropsychological tests. Confabulation was denned as recall of information not present in the narrative. Variable amounts of confabulation were observed in all schizophrenics, while only one control subject confabulated. The content and structure of their productions differed from previously reported forms of confabulation in that schizophrenic patients spontaneously rearranged the original narratives to produce new ideas. The amount of confabulation was found to be related to difficulties in suppressing inappropriate responses (Hayling test) and formal thought disorder, but unrelated to understanding of the gist or moral of the narratives. Tentative mechanisms for the process of confabulation are proposed, based on specific difficulties with comprehension, response monitoring and response suppression.

In 15 women with Late Luteal Phase Dysphoric Disorder (LLPDD) and in 15 normal control subjects, personality traits were assessed using the Millon Clinical Multiaxial Inventory (MCMI) during follicular and luteal menstrual-cycle phases. Compared with controls, LLPDD subjects had less compulsive but more passive/aggressive and borderline/cycloid traits, and more depression and hypomania. Menstrual-cycle phase did not significantly affect personality variables in either group. In particular, depression and hypomania in LLPDD subjects suggests a relationship with affective disorders.

A sample of 31 male and female depressed patients was interviewed to investigate spontaneous, intrusive memories of immediate and past life events. Previous findings that depressed patients experience high frequency intrusive memories were confirmed, as was an association between intrusive memories of childhood abuse and severity of depression. Patients reported intrusive memories for a variety of other events, particularly involving illness and death. Limited support was obtained for the hypotheses that the course of depression would be related to the activation of negative memories, and that immediate life events would trigger the activation of memories of similar events from the past.

High expressed emotion in relatives has been shown to predict a poorer outcome in a range of disorders and cultures. However, variation in predictive power is considerable, and this could partly be due to low inter-rater reliability. Sixty-nine relatives of 47 acutely admitted schizophrenic patients were interviewed using the Camberwell Family Interview. Audiotapes were assessed by pairs of raters drawn from a group of seven approved raters. Inter-rater reliability was good for criticism, hostility, emotional over-involvement (as a six level scale) and expressed emotion index (EOI cut-off score 2–3); and it was fair, but unsatisfactory, for emotional over-involvement (binary scales), warmth, positive remarks and expressed emotion (EOI cut-off score 3–4). These findings suggest that the warmth scale and the dichotomized versions of the EOI scale should be used with caution. The influence of warmth on the outcome in schizophrenia may have been underestimated because of low reliability.

Recent literature on insight has paid little attention to patients' social backgrounds and cultures. Discharge summaries from 357 patients with a psychotic illness were examined to investigate factors associated with insight. A highly significant association was found between British white ethnic origin and being thought by the admitting psychiatrist to have some insight. Possible explanations include: different ways of understanding mental illness in different cultures, greater stigma leading to greater denial of illness in some cultures, greater illness severity at admission in some ethnic groups and racial bias in psychiatrists' ratings.

The Defense Style Questionnaire (DSQ) was administered to patients with a specific phobia (animal type; N = 54) and to control subjects (N = 29). Results indicated that specific phobia patients and non-phobic control subjects exhibit a similar pattern of defences. Also, the study investigated whether specific DSQ defence styles affect behaviour therapy outcome. It was found that an immature defence style, and especially the defence mechanism projection, was related to less favourable treatment results.

Survivors from a nationally representative sample of elderly people originally screened in 1985 were reassessed in 1989 and again in 1993. On each occasion respondents were rated as cognitively impaired, borderline impaired or unimpaired (using a brief information/orientation scale), with the validity of these ratings assessed in subsequent clinical interviews. Where follow-up screening was not possible, information was derived from death certificates and hospital case-notes. Over 8 years (1985–93) the overall incidence rate per person–year at risk was 1·58%, giving age-specific rates of 0·72, 1·32, 1·63, 3·46, 2·55 and 1·41% for the age groups 65–69, 70–74, 75–79, 80–84, 85–89 and ≥ 90 respectively. Of 43 individuals classified at screening as borderline impaired in 1985 and 1989, 19 were diagnosed as demented at clinical interviews conducted within 16 weeks of screening. Four-year follow-ups among the remaining 24 showed that 15 had died, while 6 showed a worsened cognitive status. Controlling for both age and sex, aggregated 4-year mortality was significantly higher among those defined at screening in 1985 and 1989 as either impaired or borderline, when compared with the unimpaired.

The dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder – especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

Both motivational and defect theories have been offered to explain variations in insight among schizophrenic individuals but the results of tests of these theories have been inconclusive and inconsistent. The present study was designed to test the hypothesis that both motivation and cognitive deficits affect insight, with a trade-off between the two processes, giving rise to quadratic relationships between insight and cognitive deficits. Twenty-six schizophrenic patients completed battery of neuropsychological tests and participated in an interview designed to assess insight. In a multiple regression analysis predicting test results from insight scores, the linear component was non-significant while the quadratic component accounted for a highly significant 56% of the variance. Theoretical and clinical implications of this result are discussed briefly.

Age and sex-adjusted first admission rates for operationally-defined schizophrenia and other non-affective psychosis in different ethnic groups were calculated over the period 1988–1992 in a defined catchment area in South London. Standardized rates for schizophrenia, corrected for age- and gender-related under-reporting in the 1991 census and a 20% underestimate of the size of the ethnic minority populations in the area, were not only higher in the Afro-Caribbean group (SMR: 3·1; 95% Cl: 2·0–4·7), but also in the African group (SMR: 4·2; 95% Cl: 2·8–6·2). It was further found that higher rates were not specific to schizophrenia. These findings suggest that some common factor associated with ethnic minority membership is important in producing an excess of psychotic illness.

The causal attributions that people make about bodily symptoms or sensations are likely to influence their decisions whether or not to consult a doctor. Previous research has supported the model that people tend initially to look for external or environmental explanations for bodily sensations (normalizing attributions) and only if this process fails do they search for attributions internal to themselves (somatic or psychological attributions). This study tested two hypotheses about frequent general practice attenders: (1) compared with others, they are more likely to make somatic attributions and less likely to make normalizing ones; and (2) given a bodily symptom together with a somatic explanation, frequent attenders will have greater difficulty than others in finding reasons why the given (pathological) explanation is untrue. The frequent attenders' group had themselves initiated an average of 12 general practice visits in the 12 months before assessment, while a control group of infrequent attenders had not made appointments to see their general practitioner for an average of 24 months. The results provide partial support for the hypotheses. Frequent attenders generated significantly fewer normalizing explanations for a series of common bodily sensations than the comparison group, although the two groups did not differ in their somatic attributions. Given a common bodily sensation and an accompanying pathological explanation, the frequent attenders were less able than the control group to generate reasons why the given explanation might be untrue. Some associations were found between these measures and anxiety.

The aim of this study was to assess the ability of the Whitely Index, Illness Attitude Scales and Somatosensory Amplification Scale to differentiate in patients with medically unexplained physical symptoms between hypochondriacal and non-hypochondriacal patients and to examine whether the scores on these questionnaires are predictive of long-term outcome in terms of recovery of presenting symptoms and number of visits to the general practitioner. The study population consisted of 183 consecutive patients, who presented with medically unexplained physical symptoms to a general medical out-patient clinic. The Health Anxiety subscale of the Illness Attitude Scales and the Whitely Index were best in discriminating between hypochondriacal and non-hypochondriacal patients. The sensitivity and specificity of the Health Anxiety subscale of the Illness Attitude Scales were 79% and 84%, and of the Whitely Index 87% and 72%. The Whitely Index was negatively associated with recovery rate at 1 year follow-up. The Illness Behaviour subscale of the Illness Attitude Scales appeared to be predictive of the number of visits to the general practitioner. These findings might have clinical implications in helping to distinguish in patients with medically unexplained symptoms those for whom there is a high chance of persistence of the symptoms and/or of high medical care utilization.

In a study carried out in 21 general practices in Mannheim, Germany, a stratified random sample (N = 507) of patients over the age of 65 years was drawn from the total of nearly 4000 who were medically documented. Eighty per cent of the sample were examined, using the Hierarchic Dementia Scale to test cognitive functioning and the CAMDEX criteria to assess global clinical severity. Repeat assessment after a mean interval of 27 months showed that all new cases of clinical dementia had arisen in persons with mild deficits initially and represented one-fifth of this group. The first-assessment ratings of cognitive function proved to be strongly predictive of risks for age-corrected mortality, admission to long-term care and dependency at follow-up, as well as of further progressive cognitive decline.

The reliability and criterion validity of Russian versions of three psychiatric screening questionnaires (the General Health Questionnaire, 12-item version; the Goldberg scales for anxiety and depression; and, the Bradford Somatic Inventory) were assessed in the Gomel region (Belarus), one of the most severely contaminated areas that resulted from the nuclear power plant explosion at Chernobyl in 1986. All instruments were found to have good internal reliability indices. Retest reliability of the GHQ, not tested for in the other instruments, was modest. Criterion validity, using a semi-structured interview on the basis of the Munich Diagnostic Checklist for DSM-III-R as external criterion, was good for the Goldberg scales, but modest for the two other instruments.