The procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) was examined against the consensus diagnoses of two clinicians for six anxiety disorders (agoraphobia, panic disorder (±agoraphobia), social phobia, simple phobia, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD) and major depressive episode (MDE)). Clinicians had available to them all data obtained over a 2- to 10-month period. Subjects were 98 patients accepted for treatment at an Anxiety Disorders Clinic, thus, all subjects had at least one of the diagnoses being examined. While the CIDI-Auto detected 88·2% of the clinician diagnoses, it identified twice as many diagnoses as did the clinicians. The sensitivity of the CIDI-Auto was above 0·85 except for GAD, which had a sensitivity of 0·29. The specificity of the CIDI-Auto was lower (range: 0·47–0·99). The agreement between the CIDI-Auto and the clinician diagnoses, as measured by intraclass kappas, ranged from poor (k = 0·02; GAD) to excellent (k = 0·81; OCD), with a fair level of agreement overall (k = 0·40). Canonical correlation analysis suggested that the discrepancies between the CIDI-Auto and clinicians were not due to different diagnostic distinctions being made. It is suggested that the CIDI-Auto may have a lower threshold for diagnosing anxiety disorders than do experienced clinicians. It is concluded that, in a sample where all subjects have at least one anxiety disorder diagnosis, the CIDI-Auto has acceptable validity.

Schizophrenics and controls were compared on a computerized test of attentional set-shifting which provides a componential analysis of the Wisconsin Card Sort Test and has previously been shown to be sensitive to frontal lobe dysfunction and Parkinson's disease. The main test was of extra-dimensional shifting where subjects are required to shift reponse to an alternative perceptual dimension. In one condition, termed ‘perseveration’, subjects are required to shift to a novel dimension and ignore the previously relevant one. In the other condition, termed ‘learned irrelevance’, subjects are required to shift to the previously irrelevant dimension and ignore a novel one. Chronic medicated schizophrenics (N = 32) show a highly significant impairment on the perseveration but not the learned irrelevance condition, as compared to normal age and IQ matched controls (N = 24). This was true even of a subgroup of patients with preserved IQ. The impairments in attentional set-shifting failed to correlate with patients' scores on the Mini-Mental State Examination (mean; S.D. 26·8; 1·8) or with scores on a test of recognition memory. These results provide evidence for a specific deficit in a set-shifting test of executive function and support a hypothesis of frontostriatal dysfunction in schizophrenia.

As part of the Taiwan Aboriginal Study Project (TASP), a new acculturation scale (the Taiwan Aboriginal Acculturation Scale, or TAAS) has been developed among the aboriginal minorities of Austronesian origin in Taiwan. The design of the original 54 items was based on Milton Gordon's concept of assimilation in association with a careful consideration of cross-cultural validity. These items were administered to 144 subjects stratified by age and sex who were randomly sampled from four major Taiwanese aboriginal groups. Item analysis and factor analysis were applied to select an 18-item scale which has three subscales (factors): cultural assimilation, social assimilation, and social attitude. Results of validity and reliability studies of the TAAS were found to be acceptable. The development of TAAS demonstrates the applicability of the concept of acculturation as a process that involves changes both in attitude, and in behaviour, to non-western societies.

This study found similar prevalence of case depression among men as among women in a sample of 339 Jews affiliated to orthodox synagogues (157 men and 182 women). There were significant gender differences in several social–situational factors and symptoms, mostly in the direction that would suggest that case depression would be higher among women than among men. That this was not so is suggested to be the result of the cultural milieu: social factors that have been found to be associated with depression in other groups of people did not function as risk or vulnerability factors among the Jews studied. In particular, the evidence indicates the importance of specific cultural–religious values in contributing towards the prevalences that were observed. These values included the esteem attached to women's central role in family management and the low use of alcohol and suicide as escape routes from depression.

Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.

In order to assess the relationship between pubertal development, sexual milestones and childhood sexual abuse in women with eating disorders, 44 patients with restricting anorexia nervosa (RAN), 26 with bulimic anorexia nervosa (BAN), 29 with bulimia nervosa and also with a history of anorexia nervosa (BN/HistAN), and 69 with bulimia nervosa but without a history of anorexia nervosa (BN) completed questionnaires on pubertal and sexual development and unpleasant sexual experiences. Forty-four female college students completed the sexual development questionnaire only. Different eating disorder groups were found to be similar in terms of their pubertal development. All eating disorder groups showed delays in aspects of their psychosexual development (age at first kiss, masturbation, genital fondling and first sexual intercourse) compared with the control group, although to a different degree.

The RAN group was delayed on almost all sexual milestones whereas the other groups were delayed on only some. On some variables, most noticeably on first sexual intercourse, restricters also were more delayed than the other eating disorder groups. Similarly, the median number of sexual partners differed significantly between groups (RAN = 1, BAN = 2, BN/HistAN = 4, BN = 4, controls = 5, P < 0·0001). Eating disorder patients, in particular RAN patients, were less positive about sexual relationships than controls, but did not differ from controls in attitudes to masturbation, marriage, children or pregnancy. Of the eating disorder patients 22−31% had been sexually abused during childhood. A history of abuse affected attitudes to masturbation, but did not appear to affect sexual development.

The objective of this study was to describe over time the course of cognitive function of elderly without cognitive impairment and of elderly with different stages of impairment, and to assess if the change in cognitive function was dependent on the initial level of function. The Mini-Mental State Examination (MMSE) was used at two time points. The first assessment (MMSE-1) was part of a community-based study and was obtained from 871 subjects. For the second assessment (MMSE-2) a sample of 166 subjects was drawn from the subjects alive at follow-up who had an MMSE-1 score. This sample was stratified by MMSE-1 score to avoid oversampling of subjects with high MMSE-1 scores. A second MMSE score was obtained from 134 elderly, whereas 18 subjects refused participation and 14 subjects were not traceable. The median age at first assessment was 89 years (25th percentile 87, 75th percentile 92), the mean follow-up period (S.D.) was 3·3 (0·5) years. The median change in MMSE score was minus 4 points (95% confidence interval (CI) − 7 to − 2) and the slope of the regression line of MMSE-2 on MMSE-1 was 1·1 (95% CI 0·9–1·3). It is likely that the slope was underestimated due to a floor effect, regression to the mean and missing observations. However, the probability of decline decreased if MMSE-1 was higher. Nevertheless, the probability ranged from 27 to 59% for subjects with the highest MMSE-1 scores aged 85 and 95 years respectively. The latter is an argument in favour of a periodical examination of all subjects aged 85 and over to reveal causes of cognitive decline that can be treated or are amenable to prevention.

A series of elderly patients with dementia of Alzheimer type (AD), multi-infarct dementia (MID) and functional (non-organic) psychiatric illness (major depressive disorder) were selected according to DSM-III-R criteria and received: a battery of cognitive tests, EEG and Single Photon Emission Computed Tomography (SPECT) using 99mTc HMPAO. The EEG and SPECT scans were examined independently of the clinical data. The former were divided into two abnormal categories, those showing AD type change and vascular change respectively, and a normal group. The SPECT scans were classified as follows: a SPECT rCBF pattern showing bilateral temporoparietal perfusion deficits (AD type); those showing single focal perfusion deficits or multiple areas of low perfusion in the cerebral cortex suggestive of ischaemic change (vascular type SPECT picture); a mixed AD/MID pattern; and those with normal scan findings. There were significant associations between clinical diagnosis, EEG rating and SPECT rCBF pattern, approximately three-quarters of AD and MID patients having the predicted EEG and scan changes. Normal EEG recordings were more common in the MID patients. The two tests agreed in about two-thirds of cases, with no consistent pattern apparent in the cases with divergent findings. Each test misclassified a minority of dementia patients, but in only one patient were both investigations normal. Almost half of the so called ‘functionally ill’ patients had abnormal rCBF changes, showing mainly vascular changes while one-fifth had abnormal EEGs.

This study examines perspective construction in an autistic patient (E.C.) with quasi-normal intelligence who exhibits exceptional ability when performing three-dimensional drawings of inanimate objects. Examination of E.C.'s spontaneous graphic productions showed that although his drawings approximate the ‘linear perspective’ system, the subject does not use vanishing points in his productions. Nevertheless, a formal computational analysis of E.C.'s accuracy in an experimental task showed that he was able to draw objects rotated in three-dimensional space more accurately than over-trained controls. This accuracy was not modified by suppressing graphic cues that permitted the construction of a vanishing point. E.C. was also able to detect a perspective incongruency between an object and a landscape at a level superior to that of control subjects. Since E.C. does not construct vanishing points in his drawings, it is proposed that his production of a precise realistic perspective is reached without the use of explicit or implicit perspective rules. ‘Special abilities’ in perspective are examined in relation to existing theoretical models of the cognitive deficit in autism and are compared to other special abilities in autism.

Numerous studies have estimated the frequency of bulimia nervosa among high school girls and college women, but population-based trends in incidence in a community have not been reported.

In this study we determined the incidence of bulimia nervosa by identifying persons residing in the community of Rochester, Minnesota, who had the disorder initially diagnosed during the 11-year period from 1980 to 1990. Using our comprehensive population-based data resource (the Rochester Epidemiology Project), we identified cases by screening 777 medical records with diagnoses of bulimia; feeding disturbance; rumination syndrome; adverse effects of cathartics, emetics, or diuretics; polyphagia; sialosis; or vomiting.

We identified 103 Rochester residents (100 female and 3 male) who fulfilled DSM-III-R diagnostic criteria for bulimia nervosa during the 11-year study period. Mean ± S.D. age for females at the time of diagnosis was 23·0 ± 6·1 years (range, 14·4 to 40·2 years). Yearly incidence in females rose sharply from 7·4 per 100000 population in 1980 to 49·7 in 1983, and then remained relatively constant around 30 per 100000 population. The annual age-adjusted incidence rates were 26·5 per 100000 population for females and 0·8 per 100000 population for males. The overall age-and sex-adjusted annual incidence was 13·5 per 100000 population.

Bulimia nervosa is a common disorder in adolescent girls and young women from 15 to 24 years of age. Histories of alcohol or drug abuse, depression, or anorexia nervosa were higher than expected in the general population.

The stability of the Ways of Coping (Revised) Questionnaire over time was assessed by comparing the scores of 68 mothers and 53 fathers of school-aged children with Down's syndrome over a 3-year time interval on the five coping strategy subscales described by Knussen et al. (1992). For this analysis, mothers' and fathers' scores were analysed separately. It was shown by t tests that mothers' and fathers' scores on the coping strategy subscales had not significantly changed over the three-year period. Time 1 and Time 2 scores on all of the coping subscales were strongly positively associated, with the exception of fathers' scores on the Stoicism subscale. Test–retest reliability was adequate for all subscales except mothers' scores on the Passive Acceptance subscale and fathers' scores on the Stoicism subscale. These results, by demonstrating the stability of the Ways of Coping (Revised) Questionnaire over a 3-year time period, further illustrate the utility of this instrument for investigating coping in families with special problems.

During the 14 years between the beginning of academic year 1976–7 and the end of academic year 1989–90, 216 Oxford University students (119 females and 97 males) were referred to the general hospital in Oxford because of suicide attempts (254 in all). The rate of attempted suicide during university term-time (106/100000) was lower than in other young people of similar age in Oxford City (164/100000). The difference was particularly marked in females (178/100000 v. 269/100000). The lower rate in the students may in part reflect their generally higher socio-economic status. Very few of the attempts by the students appeared to be failed suicides. The most frequent problems faced by the students at the time of their attempts were interpersonal, especially difficulties regarding partners, followed by academic problems. The latter were usually problems with ongoing course work rather than with the Finals examinations. Approximately a quarter of the students had psychiatric problems, with personality disorders and depression being most common. At least 30% had a history of previous attempts. Suggestions are made concerning measures for improving the management and prevention of attempted suicide by students.

Current clinical correlates of duration of initially untreated psychotic symptoms were investigated in a cross-sectional analysis followed by a 10-year prospective study among 88 inpatients with a long-standing schizophrenic illness, many of whom had experienced prolonged periods of untreated psychosis due to illness onset and hospital admission in the pre-neuroleptic era. After controlling for the effects of age, and duration and continuity of subsequent neuroleptic treatment, the primary clinical correlate of duration of initially untreated psychosis was muteness. Over the subsequent 10-year-period, no new cases of muteness emerged and some existing cases of muteness partially resolved, though the speech that emerged remained very sparse and revealed generally gross cognitive debility. The pathophysiology underlying active, unchecked psychosis may also constitute an active morbid process that is associated with the further progression of severe negative symptoms and cognitive dysfunction in the long-term.

The study assessed the implications of childhood life events, Holocaust background, combat experiences, war captivity and negative post-captivity life events in the mental status of ex-POWs (164) and comparable controls (184), 18 years after the war. Findings confirm the association between stressful life events in the course of the life span and five outcomes: PTSD, intrusion and avoidance tendencies, psychiatric symptomatology, and impaired social functioning. Different life events have different effects. War captivity made the strongest contribution to all dependent variables.

As part of the Health and Lifestyle Survey (HALS), 6096 adults from a representative sample of community residents completed a standardized questionnaire which elicited psychiatric symptoms – the General Health Questionnaire (GHQ-30) of Goldberg (1972). Their survival status at 7 years was determined, and 474 had died. Respondents whose GHQ score was above the conventional threshold (4/5), used when screening for psychiatric disorder, were 60% more likely to die over the 7-year interval than respondents whose GHQ score was below threshold (risk ratio 1·64 for men and 1·58 for women). The differences were statistically significant for both sexes when the effects of age, physical disorder, social class and smoking behaviour were taken into account. Personality traits (neuroticism, extraversion) were not related to mortality, neither was self-reported difficulty in sleeping. However, a low subjective rating of one's general health was associated with increased mortality. We explored a range of cut-points and found reliable effects for both sexes at all cut-points from 3/4 to 6/7. Possible differences related to natural versus unnatural causes of death were explored and found not to explain the results. The findings from this general population study confirm that it is not only psychiatric disorders, but also psychiatric symptoms, which are associated with subsequent mortality, and thereby reinforce the importance of appropriate intervention to alleviate these symptoms.

It has often been assumed that all subjects with schizophrenia will eventually be admitted to hospital and therefore little bias is introduced by restricting research to hospitalized subjects. Using the Lothian Psychiatric Case Register, 66 subjects were identified who had been diagnosed in Edinburgh as suffering from schizophrenia between 1978 and 1989 but had no history of hospital admission by December 1991. This represented an adjusted average of 6·7% of the estimated annual rate of first diagnosis of schizophrenia: the proportion of such patients did not change over the period. Using a case–control design, the index cases were compared with a control group of schizophrenic patients who had been admitted to hospital within 3 months of diagnosis. At the time of diagnosis, the cases were generally less disturbed with lower levels of violent behaviour and less evidence of neglect or hallucinations. They had a longer duration of illness prior to diagnosis, were more often diagnosed by a consultant and unemployed. In a follow-up study of the index cases, 59 (89%) were traced, of whom 6 (10%) were deceased. The outcome of the illness was heterogeneous although the course was often chronic. The general practitioner provided most of the care they received. The small proportion of such patients suggests that their exclusion from most published series does not seriously bias our picture of the natural history of schizophrenia. Moreover, as there was no increase in the proportion over the period, first admission rates for schizophrenia in Scotland are a reasonable approximation to incidence rates.

The validity of a recently developed measure of disease severity, the End-stage Renal Disease Severity Index (Craven et al. 1991) was examined in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients (total N = 82). Scores on the ESRD Severity Index were compared with three commonly identified components of disease severity: physiological indices of severity, functional status, and psychological burden of illness. For the entire group of subjects, scores on the ESRD Severity Index were negatively associated with functional ability and positively related to physiological severity. ESRD Severity Index scores showed a weaker relationship with psychological burden of illness which depended in part on treatment mode. Disease severity scores were positively related to depression in CAPD patients but not in HD patients. These findings suggest that the ESRD Severity Index is a valuable research tool with construct validity.

Four WAIS (Wechsler Adult Intelligence Scale) subtests, and tasks of memory and cognitive control were administered to a population sample of 143 men and 179 women. Subjects with a minor advantage in years of education out-performed those with only primary schooling. Gender-related effects were also remarkable. Whereas the general abilities were equal in the genders, women out-performed men on recall of word pairs and objects, on verbal cognitive control and on Digit Symbol. In contrast, men excelled on Trail Making A, and on Block Design. The findings emphasize the need for age norms by gender and education for cognitive tests.