100 randomly selected mildly or moderately mentally retarded adults were assessed for personality disorder using the Standardized Assessment of Personality devised by Mann et al. (1981). By the terms of this instrument 56% of patients showed features of abnormal personality, and in 22% this abnormality was marked, suggesting the presence of personality disorder. Personality problems may be a more significant factor in assessing a mentally retarded person's acceptability in a community setting than has hitherto been realized.

A two-stage mental illness survey of a random sample of persons aged 17 years and over from a rural community in Cantabria, Spain, is described. In the first stage newly qualified doctors and final year medical students interviewed 1223 respondents (583 males and 640 females) at their homes, using the General Health Questionnaire (GHQ-60) and other psychopathological and social questionnaires. In the second stage senior psychiatrists carried out an at-home interview on a sample composed of all those who in the first stage scored above the cut-off point on the GHQ, and of a similar number of persons selected at random from two independent batches of below-threshold scorers on the GHQ. Because of this design the prevalence figures have to be weighted in order to represent the whole first stage sample.

Of the total population, 14·7% (8·1% of the men and 20·6% of the women) had psychiatric disorders as defined by the PSE-ID system. In males depression accounted for about twice as many cases as anxiety states, but in females there was a predominance of a combination of anxiety, phobic and obsessive conditions. Men presented a higher prevalence of disorders over the age of 35, with a peak around the age of forty, while in women the rise of prevalence was over the age of 45. There was, however, no significant association with marital status.

Unemployment was related to mental illness in males but not in females, while the reverse was true of the type of work. In both sexes the presence of children under fourteen in the household was not related to a rise in prevalence. Women exhibited a high rate of mental illness in the low educational level and in the low social and religious integration groups, but in men a rise in prevalence was found in the low social status, low educational level and low social integration groups. Lastly, in both sexes the presence of physical illness was related to mental disorders.

This study examined the impact of repeated exposure to combat on combat stress reaction (CSR). Sodliers diagnosed with CSR during the Lebanon War (N = 382) were compared with a matched control group of soldiers who fought in the same units but did not manifest symptoms of CSR (N = 334). CSR in the Lebanon War was found to be related to the psychological outcome the soldier experienced in previous wars. The CSR rate in the Lebanon War was higher in soldiers who had experienced an episode of CSR in a previous war than in soldiers with no past combat experience. However, CSR rates were lower among soldiers who had not had an episode of CSR in a previous war than among soldiers with no prior combat experience. High intensity of combat in Lebanon was found to increase both the detrimental and favourable effects of prior combat experience.

The patterns of daily living, occupation and leisure activities, skills, behaviour and the structure and organization of living units were assessed for 2 groups of mentally handicapped adults, first in a large hospital and second, a year later in the new local units to which they were transferred. Similar assessments were carried out for individually matched control subjects who remained in the large hospital. For the less severely handicapped, more sociable residents who moved to an NHS hostel in the community, there were significant improvements on several of these measures. For the more severely handicapped, socially aloof people who moved to a ward in a small converted hospital in the district from which they had originally come, some changes on the environmental measures were found, but on the whole the unit was run along similar lines to the wards of the large hospital. There was little change in the pattern of the residents' day to day life. The controls who remained in the large hospital experienced very little change in environmental and life-style measures. The discussion focuses on the interaction between environmental factors and the handicaps of the individuals, and the influence of this interaction upon quality of care and life-style. The study was carried out during the early stages of the rundown to closure of the large mental handicap hospital.

The effects on depressive thinking and depressed mood of a brief, standardized distraction procedure were examined. In low endogenous patients (scoring 3 or less on the Newcastle Diagnosis Scale (NDS)), distraction significantly reduced the frequency of depressing thoughts. Consistent with Beck's cognitive model of depression, these patients were significantly less depressed after distraction than after a control procedure. In high endogenous patients (scoring 4 or more on the NDS), distraction produced less marked reductions in frequency of depressing thoughts, and no significant change in depressed mood. It is suggested that the relationship between negative thinking and depressed mood differs in the two patient groups.

Computerized axial tomography was used to compare sex and age-matched groups of controls and long-term benzodiazepine users for evidence of cerebral atrophy. No statistically significant differences were found.

A two-stage screening strategy was applied in a single-handed general practice in northern Italy. The study was designed so that all the second-stage psychiatric interviews were conducted during the first phase of the study (group A patients), while self-report questionnaire (GHQ) and GP assessments only were collected during the second phase (group B patients).

The estimated true case rate of psychiatric disorder (36%) did not differ between the two phases of the study, but there were marked differences in the general practitioner's diagnostic behaviour. During the first phase (when psychiatric interviews were being conducted in the practice), her behaviour was heavily biased towards diagnosing psychiatric disorder; 61% of the patients were regarded by her as psychiatric cases and the hidden psychiatric morbidity rate was only 9%. During the second phase of the study (no psychiatric interviews in the practice), only 37% of the patients were regarded as psychiatric cases by the GP, and the hidden morbidity rate was 59%.

The results are interpreted as demonstrating that the presence of a psychiatrist conducting a two-stage screening survey in the practice had a profound effect on the diagnostic threshold. They also provide support for the use of the GHQ as a case-finding instrument in general practice.

The utilization of psychotropic drugs is a topic of increasing interest. This paper describes a study of psychotropic drug use in two acute psychiatric in-patient services in Cremona, northern Italy. Almost all patients surveyed received one or more psychotropic drugs, and there was evidence of a substantial level of polypharmacy. Women patients were prescribed more psychotropic drugs than the men, while the relationship between drug prescription and psychiatric diagnosis differed between the two services. During the second phase of the study, the medical staff were aware that their prescribing was being monitored. However, this knowledge appeared to have little effect on their patterns of prescribing. The findings of Barton (1978) are thus not supported.

Interviews were conducted with 49 men just after they had become unemployed, and with a matched sample of 49 employed men. Follow-up interviews took place 6–8 months later. At follow-up 20 originally unemployed men were still without work, and were significantly more depressed than the employed. Five of these 20, but no employed men, had become clinically depressed. In a multiple regression analysis there was a significant employment × social support interaction which indicated that depression scores at follow-up were higher in those who remained unemployed and who had little social contact with others in the month before losing their jobs. Depression becomes likely when people lose a source of social interaction that is important to their sense of worth, and have no alternative means of experiencing this worth in other relationships.

The case of a 49-year-old woman who has been brushing her teeth for 12 years with large amounts of snuff is described. She was dependent on the habit and had plasma nicotine and cotinine levels similar to those found in heavy smokers. Historical and cultural aspects of the use of snuff are discussed.

This paper examines the quality of care in four types of residence for mentally handicapped adults in Britain. Data were gathered from 175 residents of 150 living units – mental handicap hospital wards, voluntary and private homes, local authority hostels and parental homes. Differences were apparent between the types of residence in terms of both residents' characteristics and care practices and routines. The findings indicate that some of the differences in care practices are not associated with differences in the residents' functioning. Additionally, alternatives to hospital care for mentally handicapped people are not providing demonstrably improved quality of care in several aspects of residential practice. A discussion of those aspects of care calling for more improvement is presented.

Jockeys based in racing stables in the Newmarket and Epsom areas of England were screened using the 26-item Eating Attitudes Test. The mean score of the EAT was 14·9, significantly above that reported for males in other studies. The response rate was poor, but 10 jockeys agreed to a full psychiatric and eating interview. The majority of jockeys interviewed reported food avoidance, the use of saunas, and the abuse of laxatives. Diuretics and appetite suppressants were also used. Bingeing was common, but self-induced vomiting was unusual. Current weights were 13% below, and the lowest reported weights 21% below, matched population mean weights. The relationship between these forms of eating behaviour and clinical eating disorders is discussed.

This study uses methods of latent trait analysis to examine the relationships between psychiatric symptoms that constitute the common psychiatric disorders encountered in primary-care settings. Two highly correlated symptom dimensions of anxiety and depression are shown to underlie these disorders. Neurovegetative sysmptoms of depression are shown to be on the same dimension as psychic symptoms of depression, but to represent a more severe manifestation of depression.

Cochrane, in his studies of psychiatric admission rates amongst immigrant groups in Britain, allocated cases for which birthplace data was lacking by assuming that the patients were most likely to be British-born. A validation study shows this may not be justified. Estimates are made of the magnitude of the possible resulting error.

We investigated the nosology of endogenous depression by numerical taxonomy. Five hundred and sixty-nine patients diagnosed as having unipolar major depressive disorder in the NIMH Clinical Research Branch Program on the Psychobiology of Depression – Clnical were studied. Thirty-six symptoms which might distinguish endogenous from non-endogenous depressions were chosen from the literature. Patients' symptom profiles assessed by structured interview were grouped by two methods: a K-means improvement of Ward's method of cluster analysis, and a latent class algorithm. The methods produced very similar groups and several internal validity criteria suggested that the groups were not spurious. Cluster 1, ‘nuclear depression,’ included a nucleus of patients common to multiple definitions of endogenous depression. The non-nuclear group scored as less neurotic than the nuclear group on personality tests administered during the index episode. The groups do not differ in frequency, number or severity of reported life events prior to onset of the index episode. The nuclear group shows a poor prognosis on two-year prospective follow-up, greater disturbance on personality inventories, and increased heritability of depression in siblings.