Background. Recent neurobiological models provide a possible mechanism of daily life stress directly affecting the intensity of psychotic experiences in vulnerable individuals. In order to validate such a mechanism, the impact of daily life stress on psychosis intensity was investigated in two groups at increased risk of onset (relatives) and relapse (patients) of psychosis.

Method. Patients with psychosis in a clinical state of remission (n=42), first-degree relatives (n=47), and control subjects (n=49) were studied with the Experiencing Sampling Method (ESM is a structured diary technique assessing current context and psychopathology in daily life) to assess (1) appraised subjective stress related to daily activities and events, and (2) intensity of subtle psychotic experiences in daily life.

Results. Multilevel regression analyses revealed significant increases in psychosis intensity associated with increases in subjective activity – and event-related stress in patients. First-degree relatives reported increases in psychosis intensity in relation to activity-related stress but not event-related stress. No association was found in control subjects.

Conclusions. Subjects at increased risk for psychosis show continuous variation in the intensity of subtle psychotic experiences associated with minor stresses in the flow of daily life. Behavioural sensitization to environmental stress may therefore be a vulnerability marker for schizophrenia, reflecting dopaminergic hyper-responsivity in response to environmental stimuli.

Background. It has been hypothesized that the schizophrenic symptom of formal thought disorder is linked to both executive and semantic dysfunction.

Method. Intellectually preserved schizophrenic patients with (n=15) and without (n=16) formal thought disorder, plus matched normal controls (n=17) were administered four executive and four semantic tests. Tests of verbal fluency and comprehension of grammar were also given.

Results. The patients with formal thought disorder were significantly impaired on all four executive tests compared to the patients without the symptom. They were only impaired compared to non-thought-disordered patients on 1 of 4 semantic tests, which probed semantic associations between concepts. Naming performance did not distinguish the two groups, nor did a previously used measure of semantic fluency controlling for phonological fluency.

Conclusions. The results provide support for a dysexecutive hypothesis of formal thought disorder in schizophrenia, and, in line with other studies, suggest that there may be a restricted ‘higher-order’ semantic deficit which spares naming.

Background. There are no modern cross-cultural comparative studies of the frequency and clinical presentation of catatonia in a Western country and India using standardized rating instruments and diagnostic criteria.

Method. A total of 104 consecutively admitted patients in Wales and in India were screened for catatonic features using the same standardized rating instrument by the same psychiatrist to generate DSM-IV and other diagnostic criteria for catatonia, and a profile of signs in catatonia. Inter-rater reliability for the ratings made by the research psychiatrist was established with local psychiatrists at each unit.

Results. The frequency of DSM-IV criteria catatonia was 13·5% in India versus 9·6% in Wales (N.S.). The severity of catatonia did not differ between the two units. However, retarded catatonia was more common in India (12·5%) versus Wales (p<0·05) whereas the frequency of excited catatonia was equally common in both units. Catatonia was found in many different mental disorders not just schizophrenia and affective disorder.

Conclusions. Catatonia is commonly found among psychiatric in-patients with a similar frequency and severity but differing clinical presentations in Wales and India. Some classic signs of catatonia like posturing, catalepsy, staring and stupor were more frequent among psychiatric admissions in India than Wales. The differing clinical presentations may be due to differences in demographic features rather than cultural or aetiological factors.

Background. Socio-cultural factors impact on the extent of suicidal ideation and attempted suicide but the relative importance of these factors among people from different ethnic groups in Britain has not been explored. We examined the prevalence of suicidal ideation, the incidence of attempted suicide, and the extent of service utilization following attempted suicide among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England.

Method. We conducted a secondary analysis of data from the EMPIRIC study, a cross-sectional survey of 4281 adults aged 16–74 years, living in private households in England.

Results. Lifetime suicidal ideation was generally lower in ethnic minority groups but higher among those born in the UK than those who migrated to England as adults. Risk factors for suicidal ideation have much in common across different ethnic groups; current symptoms of mental distress being the most important. White British and Irish respondents were twice as likely to receive medical attention following attempted suicide than those from other ethnic groups.

Conclusions. Services need to adapt in order to ensure that people from ethnic minorities receive appropriate psychological and medical care following attempted suicide.

Background. A defining feature of personality disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about personality disorder is stable? The purpose of this study was to determine the stability of impairment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive disorder (MDD) and no PD, prospectively over a 2-year period.

Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups: schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or obsessive–compulsive (OCPD) (n=142) personality disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments.

Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs.

Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of personality disorder.

Background. Satisfaction with antipsychotic medication is an important outcome variable. To date, there is a lack of a well-established measure to quantify patient satisfaction with psychiatric medication. This paper describes the development, dimensionality, reliability and validity of the Satisfaction with Antipsychotic Medication (SWAM) scale.

Method. Clinical and academic experts devised a 33-item Likert scale satisfaction questionnaire. Following a pilot study in a sample of 69 people with schizophrenia, 315 people with schizophrenia on the caseload of local mental health services in three London boroughs completed the questionnaire. The dimensionality, internal consistency and validity of the devised instrument were assessed.

Results. Reliability of the SWAM scale was good for subscales and total scores. The α coefficient for the two subscales: treatment acceptability and medication insight were 0·92 and 0·84 respectively. The α coefficient for the SWAM scale total score was 0·91 and ranged from 0·92 to 0·90.

Conclusion. Testing of the psychometric properties of the SWAM scale demonstrate that it is a reliable instrument for measuring patient satisfaction with antipsychotic medication. The measure could be used in routine clinical practice in mental health services to assess patient satisfaction with psychiatric medication.

Background. In a broad cognitive study of schizophrenia we investigated the relationships of verbal memory impairments with cognitive underpinnings on the one hand, and clinical symptomatology on the other. The results have been reported in previous papers. In this paper we show how all these data could be integrated into a consistent pattern of associations.

Method. Fifty schizophrenic patients underwent a cognitive battery including a verbal memory task with free recall and recognition, a source memory task, and tests of processing speed and selective attention. Ratings for positive, negative and depressive symptoms were available for 40 of the patients.

Results. A factorial analysis revealed a distinction between measures of memory efficiency and measures of memory errors. The system of memory efficiency was associated with processing speed and selective attention at the cognitive level, and with depression at the symptom level. The system of memory errors was assumed to be underlain by source-monitoring deficits. These memory errors were increased by positive symptoms and decreased by certain negative symptoms.

Conclusions. All the measures drawn from various memory tasks could be integrated into a model describing their associations with cognitive underpinnings and clinical symptomatology. This model provides a heuristic for the cognitive and pharmacological treatments of verbal memory impairments in schizophrenia, as well as for the understanding of positive symptoms.

Background. We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalizing or externalizing problems.

Method. In a population-based sample of 2230 preadolescents (10–11 years) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2·5-years follow-up by self-report, teacher report and parent report. We used purified measures of temperament and psychopathology and partialled out shared variance between internalizing and externalizing problems.

Results. Familial loading of internalizing psychopathology predicted offspring internalizing but not externalizing problems, whereas familial loading of externalizing psychopathology predicted offspring externalizing but not internalizing problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas Shyness, High-Intensity Pleasure, and Affiliation acted as direction markers that steered the conditional probability of internalizing versus externalizing problems, in the event of maladjustment. Temperament traits mediated one-third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.

Conclusions. With regard to familial loading and temperament, it is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, Effortful Control, Fear), and direction markers that act as pathoplastic factors (Shyness, High-Intensity Pleasure, Affiliation) from both types of risk factors. About one-third of familial loading effects on psychopathology in early adolescence are mediated by temperament.

Background. This study sought to identify in white women risk factors specific to binge-eating disorder (BED) and for psychiatric disorders in general, and to compare black and white women on risk factors for BED.

Method. A case-control design was used. Participants were recruited from the community and included 162 women who met DSM-IV criteria for BED and two comparison groups of women with no history of clinically significant eating disorder symptoms. The comparison women were matched to BED women on age, education and ethnicity and divided into a healthy comparison (HC) group, who had no current psychiatric disorder, and a psychiatric comparison (PC) group, who had a diagnosis of a DSM-IV Axis I psychiatric disorder. The study sample size was determined by the group with the least members (PC), including 107 women with BED and 214 matched comparison women. A broad range of risk factors was assessed with a Risk Factor Interview and the Parental Bonding Instrument.

Results. No significant effects for ethnicity by diagnostic group were found. BED women reported higher exposure to childhood obesity, family overeating or binge-eating, family discord, and high parental demands than PC women. The combined BED and PC group scored significantly higher than the HC group on measures of negative affect, parental mood and substance disorders, perfectionism, separation from parents, and maternal problems with parenting.

Conclusions. These findings indicate that childhood obesity and familial eating problems are reliable specific risk factors for BED. Ethnicity does not appear to moderate risk for BED.

Background. Depersonalization has long been considered a syndrome but there is poor agreement on its constituent symptoms.

Method. In order to establish whether different symptoms of depersonalization represent the expression of a single or several underlying dimensions, an exploratory factor analysis on the Cambridge Depersonalization Scale (CDS) was carried out on 138 consecutive patients diagnosed with depersonalization disorder.

Results. Four well determined factors accounting for 73·3% of the variance were extracted. These were labelled ‘Anomalous Body Experience’; ‘Emotional Numbing’; ‘Anomalous Subjective Recall’ and ‘Alienation from Surroundings’.

Conclusions. Symptoms of depersonalization belong to distinct but related psychopathological domains.

Background. Placebo response, drug response, and drug–placebo differences appear to vary among psychiatric conditions.

Method. We evaluated the Food and Drug Administration (FDA) Summary Basis of Approval (SBA) reports to compare the magnitude of placebo response, magnitude of psychotopic drug response, and drug–placebo differences among various diagnostic groups such as depression, anxiety, and psychotic disorders.

Results. Six diagnostic groups (psychosis, obsessive–compulsive disorder (OCD), generalized anxiety disorder (GAD), depression, post-traumatic stress disorder, panic) varied in response to both placebo and active drug treatments. Response to placebo was high among patients participating in GAD, depression, and panic disorder clinical trials. Conversely, patients participating in psychotic disorder and OCD trials experienced low response to placebo.

Conclusion. Our findings indicate that the magnitude of placebo response and drug response were heterogeneous and were statistically significantly different among various psychiatric disorders. Although a noticeable degree of heterogeneity was detected in the drug–placebo ratio among various disorders, the differences did not reach statistical significance. This finding suggests that placebo use should be continued for newer agents being tested for all of the psychiatric disorders. These findings may help in the development of psychopharmacology trial designs and in the deliberations of ethics committees.