Forty-two consecutively identified Afro-Caribbean patients with a first episode of psychosis were compared with a similar group of non-Caribbean patients. A number of differences emerged, although the same proportion of patients in each group had symptoms for 6 months or more prior to psychiatric contact. Afro-Caribbean patients showed greater delay in seeking help, more ‘disturbance’ later in the course of their illness and were more likely to be admitted compulsorily. The social geography of the two groups suggests that the high rates of schizophrenia and related psychoses that we previously reported cannot be explained simply by differences in area of residence at the time of presentation.

At ten-years follow-up of 64 haemodialysis patients, 43 had died and 21 were alive, twelve with cadaver renal transplants and nine on haemodialysis. Examination of the influence of psychological, demographic, physical and biochemical factors revealed the Beck Depression Inventory and age as the two most important predictors of survival. The behaviour of the patient was directly responsible for five (11·6%) of the deaths, by suicide in three cases and dietary noncompliance in two cases. Hypothetical mechanisms linking depression with reduced survival have been reviewed. As the impact of depression on survival was maximal in the first few years of dialysis, monitoring for depression should be incorporated into routine care from the start of dialysis together with evaluative interventions that might enhance survival.

A consecutive series of school age children (7 to 16 years) with emotional disorders (N = 100) were compared with a series of community controls (N = 100) matched for age, sex and social class for the quality of their friendships. A semi-structured interview was developed to measure the quality of friendship for this purpose. Significantly more (48%) children with emotional disorder were likely to be rated as experiencing moderate to poor friendships in the 12 months prior to the onset of symptoms than were controls (16%) in the 12 months prior to interview. Prepubertal children with moderate to poor friendship patterns were classified as either predominantly anxious or depressed. Postpubertal children with moderate to poor friendships patterns were, in contrast, predominantly anxious. These findings suggest that puberty denotes a point of change for the impact of friendship deficits on the psychopathology of emotional disorder. There were no sex differences in the clinical classification of children with moderate or poor friendship patterns.

This study explored the incidence and perception of psychosocial stress among 1596 patients attending breast screening clinics and 567 controls attending a well women clinic. It was found that some major life events (e.g. death of husband, death of close friend) were significantly related to breast disease and severity. The implications of the results are discussed.

Young, old, alcohol intoxicated, and sleep deprived subjects studied weakly and strongly related word pairs, and were tested in lexical decision priming and cued recall. Results showed memory deficits for old, alcohol intoxicated, and sleep deprived subjects in cued recall of weakly related pairs. In contrast, there were no differences between these three groups and a control group of young subjects in cued recall of strongly related pairs, and there were no differences between groups in priming. This pattern of results is interpreted to support (a) a hypothesis of functional similarities between the memory deficits associated with adult ageing, alcohol intoxication, and sleep deprivation; (b) the notion that memory deficits in these subjects are more likely to occur in tasks which require effortful rather than automatic processes; and (c) the view that the memory deficits observed are due to inefficiencies at both encoding and retrieval.

The basic symptoms of minor psychiatric morbidity (MPM) reported elsewhere were also found in a community survey in Taiwan. However, differences in the patterns of and manifestations of the symptoms were evident. Contrary to most Western surveys, the prevalence of anxiety (24·7 %) was found to be higher than that of depression (8·3 %) in Taiwan. Possible explanations based on sociocultural characteristics of the Chinese family were proposed. The notion of somatization as a predominant symptom in Chinese neurotic patients advocated by some research workers was not supported in this study. As a result of findings in community cases, it is argued that the importance of somatization has been considerably overemphasized as a factor in the illness behaviour of neurotic cases in Chinese and other cultures, and it is therefore not a culturespecific disease phenomenon. It is also suggested that certain culture-specific neurotic syndromes reported in Chinese, such as shen-ching-shuai-jo (neurasthenia) and shen-k'uei (semen loss syndrome), are clinically equivalent to MPM. Implications of the present findings on crosscultural research and management of MPM were discussed.

Five hundred and eighty schoolgirls living in a small North Indian industrial town were screened using the EAT-26. Although twenty-nine per cent scored above the threshold for the questionnaire (≥ 20), closer scrutiny of the pattern of responses revealed misinterpretations of a large number of questions possibly on a conceptual basis. Linguistic and conceptual pitfalls inherent to cross-cultural epidemiological research are discussed with reference to previous work.

Eighteen adults who had suffered a very severe closed head-injury more than 18 months previously and required long-term rehabilitative support were compared with a closely matched control group. Unlike previous studies, which have reported negative personality change involving an increase in aversive behaviour, our behavioural observation data suggest that a global reduction in behavioural productivity, or negative symptomatology, characterizes social interaction by this group. This resulted in their being judged less socially skilled, less likeable and less interesting, and thus less reinforcing to interact with. Speed of information processing was specifically impaired for the closed head-injury group, although this did not correlate with global behavioural ratings of social interaction behaviour. It is suggested that low behavioural productivity may be associated with family burden, and that the low quantity of social interaction experienced by severely head-injured adults may reflect the unreinforcing nature of their interactions.

Locus of control scales have been used to measure ‘effectiveness’ or personal control in patients with eating disorders. A locus of control of behaviour scale was used in a community sample of women with a spectrum of eating pathology from bulimia nervosa to chronic dieting as well as in a comparison group of non-dieters. This scale appeared to add nothing over and above general measures of psychopathology as assessed by the Clinical Interview Schedule and the Symptom Rating Test, or more specific measures such as the Eating Attitudes Test.

A model for the systematic adaptation of psychological questionnaires for epidemiological use is presented. Application of the model is illustrated using variants of the Bortner Type A scale in a representative age/sex stratified sample of 256 persons. Through the application of the model the Bortner scale was adapted to compare the effects of scale direction, scale format and example position. Overall the Bortner scale was shown to provide robust measurement which was little affected by response rate, age, sex or by the adaptations of the scale. An association was found of sex with response rate. Interaction effects of sex and scale direction on mean Type A scores, and of example position and scale format on both response rate and Type A score variability were also found. In identifying critical aspects of questionnaire performance, and in providing a coherent framework for their interrelationship, the model acts as a guide to the systematic assessment of questionnaire performance. The use of this model will, therefore, facilitate greater confidence in the interpretation of questionnaire data in epidemiological studies.

High ‘expressed emotion’ (EE) has been held to be predictive of a poor course in patients with schizophrenia, a finding that has emphasized the predictive validity of the EE measure. We review appropriate research examining properties of the EE measure to suggest that, in particular, little is known about the construct validity of the EE measure. We report a longitudinal study examining three measures of parental style (EE; Parental Bonding Instrument or PBI; and interviewer ratings). By comparing EE scale scores with ratings derived by an interviewer we find support for the accuracy of the process generating EE scale scores, and by factor analytic techniques we examine the factorial (construct) validity of the EE scales. A principal components analysis suggested two other dimensions of relevance in parents involved with a schizophrenic member (vigilance, and acceptance of illness in their child) which may be of value in predictive studies. We examined the capacity of interviewer-generated scores (as a simple clinical rating) and factor scores (as central constructs) to predict the course, and were unable to discriminate ‘relapsers’ and ‘nonrelapsers’ with either predictor.

This paper discusses three concepts, mana, tapu and noa, that lie at the heart of Maori culture. These concepts are inter-related and concern power and influence, with political (or secular) authority implicit in mana and ritual (or religious) authority determined by tapu and noa. The paper explores their importance for the understanding of the ethnic views on aetiology and management of illness, the mechanisms of social organization and control, and the behaviour of individuals. Although the belief in these concepts exists in only an attenuated form in modern Maori society, their importance becomes obvious to any psychiatrist or physician working with Maori patients.

We investigated whether somebody with a severe mental impairment could not only remember and reproduce music, but was also able to generate it. Musical improvisation requires the ability to recognize constraints and also demands inventiveness.

Musical improvisations on a traditional, tonal and also on a whole tone scale composition were produced by a mentally handicapped and by a normal control musician. It was found that not only the control but also the handicapped subject could improvise appropriately within structural constraints, although with the tonal music the idiot-savant showed some stylistic latitude. It is concluded that cognitive processes such as musical input analysis, decision making, and output monitoring are independent of general intellectual status.

This epidemiological study examines the contribution of childbearing to the sex difference in first admission rates for affective psychosis. The effects of sex, age, marital status and parity on first admission rates are examined in 114 patients admitted from a defined catchment area. The rate of first admission in females is almost twice that in males. Using logistic regression analysis one significant factor accounting for this sex difference emerges: female parity. The effect of parity is evident up to the age of 54, and it entirely accounts for the sex difference in relative risk. Non-parous females have a lower relative risk of admission than males. An apparent effect of marital status is only significant in females, and is accounted for by parity and age.

Out of 141 new referrals to a Social Services Department 101 were assessed at inception and twelve-month follow-up using the Present State Examination (PSE), the Social Maladjustment Schedule (SMS) and the Case Review Form (CRF). Mental illness, financial and housing problems were the three problems most frequently identified by the social workers. At inception 72 (51%) of the subjects were PSE cases (ID > 5) and 25% at follow-up. The type of social work help offered to cases and non-cases did not differ.

Social and clinical data collected at inception and follow-up were used to classify (using discriminant function analysis) caseness at inception and follow-up and clinical change. Caseness at inception (82% of subjects were correctly classified) was associated with depression, subjective social problems and poverty. Caseness at follow-up (74% correctly classified) was associated with poor coping abilities at inception and clinical features of depression. Clinical change (worsening) (71% correctly classified) was associated with seeing a Community Psychiatric Nurse and poor coping abilities at inception. The ability to classify correctly cases and change was enhanced when additional data from follow-up interviews were used. In the PSE cases, only clinical worsening was correctly classified by a high GHQ score at inception, age and poor coping abilities. The last result is similar to that obtained in general practice by Mann et al. (1981).

There has been little discussion of the advantages and disadvantages of allowing a psychiatrist to make clinical judgements about the presence or absence of symptoms in administering currently used standardized psychiatric interviews. This paper reports an examination of the value of clinical judgements in defining cases of minor psychiatric disorder, by studying existing data in which the Clinical Interview Schedule (CIS) was used. This comparison can be made because the first section of the CIS is largely self-report while interviewers are also instructed to use clinical judgement in the second section to decide on ratings. The results indicate that in the context of identifying minor psychiatric disorder the ratings requiring clinical judgement add little information to those based on self-report, may be less reliable and may lead to the biased assessment of anxiety and depression.

In 227 smokers' clinic clients who managed at least one week of abstinence, ratings of withdrawal symptoms were used to predict subsequent return to smoking. Depression, time spent with urges to smoke, and difficulty not smoking during the first week of abstinence were significantly associated with lapse back to smoking during the second week. Depression and difficulty not smoking during the second week significantly predicted smoking status during the third week. No withdrawal symptoms during the third week were associated with a return to smoking during the fourth week. The predictive power of withdrawal symptoms was over and above that of smoke intake and dependence. The findings provide some support for the view that reduction of withdrawal symptoms may be a worthwhile target in programmes for helping smokers to quit.

Seasonal variation in suicide in Italy for the years 1969–81 has been assessed in males and females by means of harmonic analysis. Cyclical fluctuations in the number of suicides, reasonably consistent over the 13 years of the study, have been observed in both sexes. Seasonal harmonics accounted for 65·3 and 48·4% of the variance in male and female suicides respectively. While in males the only important seasonal harmonic was the first (one cycle per year), in females there was an important first harmonic and a second harmonic (two cycles per year). In both sexes the peak of the first harmonic occurred in May, while in females the subsidiary peak occurred in October–November.

This study evaluates and compares aspects of residential care in a community hostel setting and a hospital setting for people with a psychiatric disability. The clients were assessed to establish their level of general functioning, the comparison indicating there was no significant difference between the two groups on the measure used. A previously published protocol was used as a method of comparing the units. The findings indicated that the hospital unit was more individually orientated both in practices and staff attitudes, and had staff who were more optimistic about clients' potential accomplishments. No differences were found between perceived involvement of staff in decision making, or staff–resident interactions.

These findings have implications for the ‘Care in the Community’ movement, as they indicate that the nature of a service is as important as its location. They suggest that the relocation of services to the community in itself will not automatically overcome some of the difficulties associated with institutional care.

We report the results of a survey of the burdens and needs for items of care of 45 supporters of long-term users of psychiatric day care facilities in Camberwell. The supporters reported high levels of disturbed behaviour and low levels of self-care skills in the attenders. They were also subject to high levels of social and economic burden, not all of which could be attributed to the attenders' problems. The needs assessment identified a large number of unmet needs, although the supporters themselves were largely resigned to their situation and expressed little dissatisfaction with the services they were offered. The advantage of conducting this kind of assessment of supporters' needs as a routine part of clinical practice was discussed.