A Delphi study was conducted with a multi-disciplinary group of experts attending a conference on mental illness in primary care settings. Respondents' priorities for research which could maximize benefits for service developments in this field were elicited by asking them to distribute hypothetical annual research budgets among (a) 6 mental health priority areas, and (b) 7 subjects ‘needing’ investigation within the primary care priority area. The respondents' three top-ranked priority areas for research were: (1) primary care; (2) the elderly mentally ill; and (3) chronically disabling mental illness. Their three top-ranked subjects for investigation within the primary care priority area were: (1) the effectiveness of treatment measures; (2) the problems of mental health presenting to primary care services; and (3) the training requirements for family doctors in psychiatric skills.

The results are discussed with reference to the method used and to the economic concepts of programme budgeting and marginal analysis.

Cavities in the septum pellucidum are widely regarded as incidental findings of little clinical importance. The prevalence of such cava on computerized tomography in a mixed sample of 22000 neurological and psychiatric patients is found to be 0·15%. A statistical association between this anomaly and a referral diagnosis of functional psychosis is reported, and 6 cases are described. These cases were male and characterized by an early history of developmental delay, with lifelong disturbances of emotion and behaviour prior to the onset in early adulthood of an atypical schizophrenia-like psychosis with disorders of speech and movement. It is suggested that septal cavities may signal an underlying abnormality of function relevant to the pathogenesis of these illnesses.

A sample of 77 women of high and low noise sensitivity in 1977, living in areas of high and low exposure to aircraft noise, were interviewed in the community in 1980. High, intermediate and low noise sensitive women were compared, using measures of blood pressure, heart rate, skin conductance, hearing threshold, uncomfortable loudness level and magnitude estimation of six tones. These physiological measures did not clearly distinguish different noise sensitivity groups, except that highly noise sensitive women had a consistently slower heart rate. Noise sensitivity was not related to auditory threshold. In the high aircraft noise area there were significantly more skin conductance responses than in the low aircraft noise area, irrespective of noise sensitivity. This may be the result of chronic exposure to high aircraft noise.

The cognitive theories of depression put forward by Beck and his colleagues (1980), Brown & Harris (1978) and Abramson and her colleagues (1978) are described and compared. Although each theory has its strengths, it is argued that an adequate cognitive account of depression is awaited. Such a theory must link specific experiences with each of the cognitive themes of depression, and the links postulated should be specific to depression. Refinements of description and method are required before such a theory can be tested.

A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: (1) diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; (2) the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and (3) the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.

Tests of thyroid function and pathology were carried out on 133 patients before they were treated with lithium (Li+). Of the 12 patients who subsequently became hypothyroid during treatment with lithium 9 had, before the commencement of treatment, thyroid autoantibodies and/or an exaggerated thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH), whereas 3 patients had neither of these indicators. Lithium administration was accompanied by a rise in thyroid antibody titre in 20 patients but a fall in only 5, a statistically significant difference. Evidence that it may be an immunostimulant is discussed. Li+-induced thyroid failure cannot be accurately predicted, and may occur suddenly. The best minimum safeguard, therefore, is serial thyroxine (T4) (or free T4) estimation, supplemented if equivocal by a free thyroxine index (FTI), a basal TSH and, if doubt remains, by a TRH test.

In a study of abnormal behaviour in women aged 16–25 in one large group practice a screening instrument and an interview were used to identify Briquet's Syndrome. The prevalence, 2·04 per 1000, was lower than that found in previous studies. The fact that many other patients showed both the high consultation rates and the other correlates of Briquet's Syndrome brings the usefulness of a discrete syndrome into doubt.

The role of primary care physicians in addressing the needs of chronically mentally ill patients is examined from three perspectives: (1) assessing community prevalence; (2) treating chronic medical problems in the context of other human service needs; and (3) treating specific types of chronic mental disorders. About 30% of primary care patients were found to have at least one Research Diagnostic Criteria mental disorder, five-sixths of which had a duration greater than 1 year. However, about 9% of patients had some impairment and 2% had severe impairment associated with a mental disorder. Although affective disorders have the highest overall rates, personality, psychotic, and anxiety disorders contribute the greatest proportion of severe disability.

Fifty hospitalized patients with bipolar affective disorder were interviewed on discharge from hospital. Over the subsequent 12 months, 36 of these patients were readmitted to hospital. Compared with the remainder, those readmitted had had more past hospital admissions and on interview were rated as being less able to recognize and respond to early symptoms of relapse and were less accepting of medication.

A twofold increase in the prevalence of depression among women has been consistently observed. Several possible explanations, including methodological, endocrine, psychosocial, and genetic factors, have been proposed for the increased rates of depression among women. This paper describes the analysis of data from a family-genetic study of depressed probands to examine whether genetic factors can explain the preponderance of depressed females. Our data indicate that the excess of females with major depression cannot be attributed to increased genetic loading for depression in women. Other factors which may explain increased rates of major depression in women are discussed.

While depressive reactions appear to be universal, until recently they have seldom been described outside Europe, probably because of their lack of exotic salience, but also because they are seldom identified locally as distinct entities. Where it occurs, such an identification reflects a local preference for the articulation of individual psychological notions, rather than universal moral imperatives. While the symptoms of reactive depression are recognized in rural Trinidad as a common experience, but not especially remarked, they are also identified by Afro-Caribbeans as a specific state, Tabanka, following the loss of a sexual partner to another. Tabanka is characterized by lassitude, anorexia, insomnia, feelings of worthlessness, anger, a loss of interest in work and other activities and, especially, by a preoccupation with the faithless one. It is said to be most common among married men and among the upwardly socially mobile, and to lead to heavy drinking and occasionally madness or suicide. The precipitation of Tabanka provokes hilarity rather than moral indignation, and its humour articulates an egalitarian and individualistic working-class attitude to marriage and social mobility. In contrast, Trinidadians of Asian or Venezuelan origin emphasize moral notions of honour and shame.

Ninety-eight men aged 25–50, who were unemployed because of involuntary redundancy and out of work for 2–18 months, completed the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ–30). Their scores were compared with those of a group of employed men matched for age and social class. The mean GHQ score for the redundant men was 13–0, compared with 4·0 for the employed group. The mean BDI score was 11·1 for the redundant group and 5·6 for the employed group. Eighteen per cent of the redundant men, compared with 6% of the employed group, scored 18 or more which are scores corresponding to those in depressive illness. We conclude that the prevalence of depressive illness may be increased among redundant men.

Six hundred and twenty-nine unemployed men were re-interviewed 9 months after initial measurement of their psychological health and commitment to the labour market. For those men remaining continuously unemployed between interviews, no further decrement was observed in mean General Health Questionnaire scores after 3 months without a job, but a significant deterioration was recorded for the sub-sample initially unemployed for less than 3 months. Small but significant declines were observed after 3 months on a single-item measure of reported health and on an 8-item index of commitment to the labour market. For those regaining paid work, all measures of health showed large improvements, and employment commitment was unchanged. Multiple regression analyses were used to examine factors associated with magnitude of changes during continuous unemployment, yielding a systematic pattern of significant relationships. For example, higher employment commitment at initial interview was significantly associated with a greater subsequent decline in psychological health, but not in physical health; reporting a chronic health impairment at initial interview was significantly associated with a greater subsequent decrement in physical health, but not in psychological health.

This paper investigates the memory disorder of Alzheimer-type dementia by comparing the performance of Alzheimer patients on selected memory tests with that of Korsakoff patients and healthy controls. Alzheimer patients have deficits in both primary and secondary memory, and this finding is compared with that which pharmacological studies predict would occur on the basis of cholinergic depletion. The deficits in primary memory are unlikely to be accounted for in terms of cholinergic depletion, and provide a possible explanation for the disappointing results of trials of cholinergic replacement therapy in this disorder. On the other hand, the pattern of deficit in secondary memory is entirely consistent with that expected from cholinergic depletion.

A sample of 1150 unemployed 17 year-olds, containing blacks and whites, males and females, was obtained from 11 urban regions in England. Social support was measured in respect of five different forms of help from others. Measures were also obtained of psychological distress, perceived pressure from others to obtain a job, employment commitment, contact with other young people, and contact with other unemployed young people. Two forms of social support (having someone to turn to for help with money, and having someone to suggest interesting things to do) were significantly associated with measures of distress, as were perceived pressure to obtain a job and employment commitment, but not contact with other unemployed young people. The association between distress and having someone to turn to for help with money was greater for those perceiving pressure from others to obtain a job than those not perceiving pressure. Also, the association between distress and having someone to turn to when feeling low was greater for those with a high employment commitment than for those with a low one. Other associations between support and distress were found to be affected by sex and ethnic differences in the sample. The results are discussed in the light of a stress-buffering model of social support; and the need to disaggregate social support into its component parts is emphasized.

The study examined the performance of positive symptom schizophrenics vis à vis that of demographically well-matched negative symptom schizophrenics and normals in organizing words into ideas and ideas into integrated spoken discourse. This involved applying a series of analyses to speech produced when describing pictures in an unconstrained way. The results showed that, for the most part, positive symptom schizophrenics organized their speech, both within and between ideas, as well as negative symptom schizophrenics and normals. The results did, however, show an increased tendency by the positive speech disordered schizophrenics to omit referents for noun phrases requiring referents. This constitutes a specific failure to connect ideas and does, at least in part, explain what makes positive speech disorder (incoherence of speech) unintelligible. However, taken altogether, the results do not support the extant view that positive symptom schizophrenics suffer from a general loss of control in producing speech.

A battery of tests was developed to assess verbal, non-verbal and mixed cognitive functions. Interest was based on pattern of response rather than absolute scores. The subjects were 167 men held in prison on criminal charges or in a maximum security hospital after conviction. The present paper deals exclusively with two subgroups: the 61 schizophrenic men and the 41 men with no psychiatric disorder. The schizophrenic group as a whole presented a very different cognitive pattern from the ‘normal’ men. First, with the exception of the vocabulary subtest of the WAIS, the schizophrenics were inferior on all tests, whether verbal, non-verbal or mixed function. Secondly, they showed considerably more variation within subtests. The schizophrenic sample was therefore subdivided into four clinical groups. Each showed a distinctive cognitive profile. It is argued that these cognitive differences reflect real differences in the disorder and type of illness being experienced by members of these subgroups.

A psychiatric examination was conducted on 810 community dwelling subjects previously given a diagnosis derived from the Diagnostic Interview Schedule (DIS). The agreement in allocating subjects to a particular disorder was never high enough to encourage the confident replacement of a psychiatric diagnosis with a DIS diagnosis.

Seventy-one men completed a battery of cognitive tests which were designed to reflect verbal analytic and non-verbal holistic functioning. Interest centred around pattern of response. Thirty men were suffering from an affective disorder and forty-one were well. All the men were in prison, the majority awaiting trial. The affective disorder group was subdivided into three categories: men who had a history of manic-depressive illness; a group of unipolar, psychotically depressed men; and men who were regarded as being depressed in reaction to circumstances. All three groups showed specific difficulty in dealing with spatial/holistic tasks, other factors being held constant. They were also found to differ in a number of other respects. The possible significance of these differences is discussed.

Criteria necessary for establishing the existence of qualitatively-different subtypes of a disorder are proposed. A review is made of the existing literature on Alzheimer's Dementia which proposes subtypes on the basis of either psychological or neuropathological data. It is concluded that, as yet, this research has not met the criteria for establishing qualitatively-different subtypes. However, Alzheimer's Dementia does seem to show quantitative variability in a number of respects and this appears to be related to factors of aetiological significance. The possibility that this quantitative variability could provide the basis for subtyping is discussed.