Questionnaires were completed by 73 volunteers with a history of probable schizophrenia, and by 67 patients admitted to the accident wards of a general hospital. A high incidence of sensory distortions was recorded in the schizophrenic group compared with the controls, distortions of brightness contrast being the most common. Many schizophrenic patients reported that such distortions were reduced or removed early in treatment. Patients who reported visual distortions also tended to report visual hallucinations. The results are discussed with reference to the hypothesis that perceptual malfunction may underlie some other schizophrenic disorders such as delusions or catatonia.

Antibodies to a variety of foods, and in particular cereals, were measured in serum from 100 patients with acute psychoses and 100 elective surgical patients. For 13 out of 14 foods to which non-IgE antibodies were detected the schizophrenics had slightly more antibodies than the controls. There was an association between a possible secondary mania and the presence of IgE antibodies to wheat or rye. However, neither the schizophrenia nor the mania findings can be regarded as evidence for food allergy causing psychiatric disorder, since the immunological findings in both cases may represent consequences of the illnesses or their treatment, rather than causes of the illness.

It has recently been claimed that Boolean Factor Analysis (BFA) is superior to more traditional approaches to empirical syndrome identification in psychopathology (Weber & Scharfetter, 1984). This paper examines the underlying assumptions and the empirical basis of this claim. A hypothetical data set, with a more complex structure than the examples used by Weber & Scharfetter to support their claim, is analysed by means of both BFA and Ordinary Factor Analysis (OFA). It is shown that, as data sets resemble empirical conditions more closely, BFA may break down completely while OFA continues to yield adequate results.

The English and Chinese versions of the General Health Questionnaire (GHQ) were administered to a sample of 72 bilingual respondents for the evaluation of version equivalence by a series of item analyses, reliability analyses and factor analyses. Although certain notable discrepancies were observed at the item level, the two versions were found to be comparable at the scale level. In addition, cogent evidence was provided for the relative robustness of the symptom dimensions as assessed by the two versions of the GHQ.

The prevalence of thirst, subjective polyuria and related side-effects was investigated in 87 patients attending a lithium clinic and in a group of 52 controls. Thirst was surprisingly common, occurring in 67% of patients, in spite of the fact that they had been maintained on relatively low levels of lithium, and was due principally to the lithium rather than to other psychotropic drugs. Urine flow and impaired renal water absorption correlated with the serum lithium level and the length of treatment in the patients, despite the fact that few were clinically polyuric. The pattern of the results confirms previous suggestions that lithium may stimulate the thirst mechanism directly as well as via an increased renal resistance to vasopressin. The possible implications in terms of clinical response are discussed.

District psychiatric services often supplement intramural mental health programmes. They usually result in an increase in the number of referrals to the mental health facilities, which reflects a cumulative need for psychiatric examination and treatment in the population. A significant decrease in the annual first referral rates per 1000 inhabitants aged 15 years and above is apparent in an analysis of the trends in the Danish Samsø community psychiatric service from its inception in 1957 until 1982. The average annual rates were 19·4 in the first 5-year period, 10·0 in the second 5-year period, and 8·4 in the ‘steady state period’ from 1967 to 1982. The conclusion is, therefore, that the work load connected with the cumulative need for psychiatric examination and treatment should be terminated in approximately 10 years. A comparison of the two 5-year periods, 1957–61 and 1978–82, demonstrated a decrease in first referral rates in almost all diagnostic groups: this is significant among manic-depressive psychoses, neurotic states and unspecified mental disorders. The rates of no mental disorders and senile and arteriosclerotic psychoses were almost unchanged. In the 10-year age groups there was a decrease in first referral rates for all groups, except for the groups aged 75 years and above whose rates were unchanged. The concept of cumulative need for psychiatric examination and treatment is discussed in relation to the reports of various district psychiatric service programmes in different European countries.

A standardized pegboard task was used to investigate changes in manipulative skill as a function of age in 119 right-handed subjects. The typical pattern of cognitive impairment in old age indicates a relative preservation of functions which depend on the integrity of the left hemisphere. In accord with these observations, we predicted that, with increasing age, right hand motor skills would be better preserved than left hand skills. We found this on initial exposure to the task (P < 0·01); however, the phenomenon was masked by practice, because older subjects (over 60 years of age) derived more improvement to their left hand motor skill, as a result of practice, than they did to their right hand skill (P > 0·05).

Sixty-four children taken to court for failure to attend school were reliably classified into 4 groups, according to whether they exhibited the features of ‘school refusal’ and/or ‘truancy’. About a fifth of them were found to exhibit ‘school refusal’; a third showed ‘truancy’; less than a sixth exhibited both ‘school refusal’ and ‘truancy’ combined; and over a third had the characteristics of neither condition. Differences between these categories were found in manifestations of psychiatric disturbance and in responsiveness to a court adjournment procedure.

In normal women sedation following intravenous administration of the α2-adrenoceptor agonist clonidine (1·3 μg/kg) was significantly greater following 3 weeks' continuous treatment with the combined contraceptive pill than at the end of the 7-day withdrawal period. In contrast, sedative responses to the dopamine agonist apomorphine (5 μg/kg subcutaneously) were decreased when subjects were taking the contraceptive pill. These findings are in agreement with animal experimental studies, indicating that oestrogen can alter α-adrenoceptor and dopamine autoreceptor sensitivity. Such interactions may be involved in the effects of female sex steroids on mood.

Data from a non-participant, ‘event-sampling’, direct observation study of 32 elderly persons in residential care were simplified and re-analysed, with the aim of developing a short, practical method of observation for use in research and training in residential care. A single, nominated hour's observation seemed to fit the data satisfactorily. This method, when applied to data from two newly observed contrasting samples, revealed the same important differences as had been found from a whole day's observation. A practical, short observation method thus emerged for use in research and training.

A computed tomographic study of 101 depressed patients and 52 normal control subjects is described. Increasing age and male sex were both associated with larger ventricular size in both patient and control groups. Controlling for these effects, the depressed patients had larger ventricles than the control subjects. In the patient group there was no association between ventricular size, course of illness or exposure to drug treatment or electroconvulsive therapy.

The construction and testing of a short self-report questionnaire identifying social problems, difficulties and dissatisfactions is described. The questionnaire covers housing, occupation, finance, social and leisure activities, child/parent and martial relationships, relationships with relatives, friends, neighbours and workmates, and legal problems. The results of the administration of the questionnaire in a number of settings are provided and discussed, and a final version is included in the Appendix.

Computed tomography (CT) research in psychiatry often relies on the assessment of minor structural changes. Recently, it has come to encompass changes in regional brain X-ray absorption density. The artefacts prone to be encountered in density measurements are reviewed, and illustrated by a series of studies carried out using a CT 1010 scanner. They are shown to be more important than hitherto assumed in the interpretation of CT scan research.

The tests that have been used to assess glomerular and tubular function in patients receiving treatment with lithium have been reviewed. The advantages and disadvantages of these are discussed. The most useful tests are the creatinine clearance, which may be predicted from the serum creatinine using a formula or nomogram, and the measurement of urine osmolality, followed if necessary by assessment of the maximum urine concentrating ability after desamino cys-1–8-D arginine vasopressin.

Clinical descriptions of families are often viewed as being too subjective for systematic scientific inquiry. This study examines the extent to which independent observers can recognize statements made about family interactions. These statements were of a type which clinicians dealing with families would make and comprised observations with varying levels of inference. A special method was devised to test a number of specific hypotheses concerning the processes of clinical observation. The results show that such descriptions are recognizable as being made about a particular family even when this involves discriminating between clinically similar families. Some of the implications of these results for observational research are discussed.

The General Health Questionnaire (GHQ-12) (Goldberg, 1972) and the Self Report Questionnaire (SRQ-20) (Harding et al. 1980) were simultaneously validated against the criterion of the Clinical Interview Schedule (CIS) (Goldberg et al. 1970) in three primary care clinics in the city of Sao Paulo, Brazil. A comparison between the two screening instruments was carried out. The product-moment correlation between the two sets of scores was +0·72, and the validation coefficients for the GHQ-12 and the SRQ-20 were respectively: sensitivity 85% and 83%; specificity 79% and 80%; overall misclassification rate 18% and 19%.

The two screening instruments were further compared by the application of Relative Operating Characteristic (ROC) analysis and, again, were found to be very similar in performance. The area under the ROC curve was 0·87 for the GHQ and 0·90 for the SRQ-20 (Z = 0·92, NS). Both psychiatric screening instruments were therefore found to be acceptably valid when assessed against the CIS in three primary care settings in Brazil.

The application of ROC analysis to studies of this kind was feasible and straightforward. It was found to be superior to the conventional method of presentation of validity data. It is recommended that the application of ROC analysis to psychiatric screening studies be further utilized and explored.

The 4th- and 5th-year pupils of four large comprehensive schools, which were broadly typical of the schools serving an urban population, were screened using a multiple criterion approach. The screen results were compared with those found in a younger population drawn from the same area, and a similar rate of efficiency was found. However, in the adolescent age group the screen was more accurate at detecting true negative cases (specificity) but less able to identify true positive cases (sensitivity). Overall, the multiple criterion screen proved more efficient than a variety of single screen criteria, and the findings also suggest that certain screen measures used in adolescence may be more effective at identifying disturbed girls while others are more effective at identifying disturbed boys. This confirms the principle that the choice of screening instruments must be made with reference to their proposed use.

A small proportion of smokers who stop smoking with the aid of nicotine chewing gum continue to use the gum for more than a year. This study shows that when these people abstain from nicotine gum use they experience withdrawal symptoms similar to those found during cigarette withdrawal, including increased irritability, difficulty in concentrating and a drop in heart rate.

Health care workers often advise patients with chronic psychiatric disability against marrying each other. A survey of a group of such marriages revealed no evidence of the predicted ill-effects, but rather a trend towards improvement after the marriage. There is a discrepancy between professional expectations and actual outcome of these marriages.

In a survey of a random sample of the general population recent life events, collected and rated for long-term contextual threat according to the methods of Brown & Harris (1978), were also recorded where possible on an inventory of life event categories (Tennant & Andrews, 1977). Of the 82·5% of all events collected which were covered by the inventory, 12 of the 67 event categories accounted for 77% of life events with an aetiologicaly significant rating of marked or moderate long-term threat. Where practical and economic constraints oblige research workers to choose the inventory method, a brief list of event categories, such as the List of Threatening Experiences, is recommended in preference to much longer lists.