Background. Gulf veterans report medically unexplained symptoms more frequently than non-Gulf veterans did. We examined whether Gulf and non-Gulf veterans could be distinguished by their patterns of symptom reporting.

Method. A k-means cluster analysis was applied to 500 randomly sampled veterans from each of three United Kingdom military cohorts of veterans; those deployed to the Gulf conflict between 1990 and 1991; to the Bosnia peacekeeping mission between 1992 and 1997; and military personnel who were in active service but not deployed to the Gulf (Era). Sociodemographic, health variables and scores for ten symptom groups were calculated.

Results. The gap statistic indicated the five-group solution as one that provided a particularly informative description of the structure in the data. Cluster 1 consisted of low scores for all symptom groups. Cluster 2 had veterans with highest symptom scores for musculoskeletal symptoms and high scores for psychiatric symptoms. Cluster 3 had high scores for psychiatric symptoms and marginally elevated scores for the remaining nine groups symptom groups. Cluster 4 had elevated scores for musculoskeletal symptoms only and cluster 5 was distinguishable from the other clusters in having high scores in all symptom groups, especially psychiatric and musculoskeletal.

Conclusion. The findings do not support the existence of a unique syndrome affecting a subgroup of Gulf veterans but emphasize the excess of non-specific self-reported ill health in this group.

Background. Formal thought disorder is a core symptom of schizophrenia. It is associated with a reversed lateralization of the superior temporal cortex volume, an area that is implicated in lexical retrieval. We investigated the neural correlates of word retrieval during continuous speech in patients with formal thought disorder using functional magnetic resonance imaging (fMRI).

Methods. Blood oxygenation level dependent (BOLD) contrast was measured with fMRI while six patients with schizophrenia and six healthy control subjects spoke about seven Rorschach inkblots for 3 min each. Subjects produced varying amounts of speech during each run. In a within subject design, the number of words produced was correlated with the BOLD contrast in the two runs in each participant who showed the highest variance of speech output.

Results. In control subjects, the amount of speech produced was mainly correlated with activation in the left superior temporal gyrus. In the patient group, the main correlations were in the right superior temporal gyrus.

Conclusions. During the production of continuous speech, patients with formal thought disorder showed a reversed laterality of activation in the superior temporal cortex. This is consistent with findings of perturbed hemispheric interaction in schizophrenia, particularly in patients with formal thought disorder.

Background. Research using the parental bonding instrument (PBI) has suggested that lack of parental care and/or overprotection may be important risk factors for adult mental disorders. Much of this research, however, has relied on clinical populations with one or two disorders, or has used highly select community samples.

Method. The association between parenting experiences and the occurrence of 13 common mental disorders in adulthood was evaluated in the US National Comorbidity Survey (N = 5877). The effect of sociodemographic variables (age, education, income) was statistically controlled and the effects of six parenting variables (maternal and paternal care, overprotection and authoritarianism) were examined simultaneously. The effects in men and women were examined separately.

Results. Lack of care was the parenting variable most consistently associated with adult psychopathology. Parenting experiences with one's mother were more consistently associated with adult mental disorders. In general the impact of parenting was diagnostically non-specific. However, there appeared to be some unique effects for externalizing disorders (substance use disorders and antisocial personality disorder) in males; paternal overprotection and authoritarianism conferred a reduced risk of externalizing disorders in adult males. The overall impact of parenting as assessed by the PBI was modest, accounting for about 1 to 5% of the variance in the occurrence of adult mental disorders.

Conclusion. Parenting experiences, particularly lack of care, are potentially causally related in a non-specific manner to a wide variety of forms of adult psychopathology in both men and women. The overall magnitude of the effect is small but statistically significant in a nationally representative US sample.

Background. We examined the association between parental alcohol use disorders and patterns of alcohol consumption and DSM-IV alcohol use disorders in their offspring in a community-based sample of young adults.

Methods. Data are based on baseline and 4-year follow-up data of 2427 respondents aged 14–24 at baseline. Alcohol use and disorders in respondents were assessed using the Munich-Composite-International-Diagnostic-Interview with DSM-IV algorithms. Diagnostic information about parents was collected by family history information from the respondents, and by direct interview with one parent (cohort aged 14 to 17 years only).

Results. Although the association between maternal and paternal alcohol use disorders and non-problematical drinking in offspring was minimal, there was a strong effect for the transition to hazardous use and for alcohol abuse and dependence; the effect of parental concordance for transition into hazardous use was particularly striking. Maternal history was associated with a higher probability of progression from occasional to regular use, whereas paternal history was associated with progression from regular to hazardous use. Parental alcoholism increased the risk for first onset of hazardous use and alcohol dependence between the ages of 14–17, and for an earlier onset of the alcohol outcomes in offspring. The impact of parental alcohol use disorders was comparable for male and female offspring.

Conclusions. Parental alcoholism predicts escalation of alcohol use, development of alcohol use disorders and onset of alcohol outcomes in offspring.

Background. The association between depression and mortality has become a topic of interest. Little is known about the association between the course of depression and mortality.

Methods. In an initially non-depressed cohort (N = 325) and a depressed cohort (N = 327), depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves over a period of 3 years. Both cohorts were then followed with respect to mortality status for up to 3·5 additional years. Clinical course types as well as theoretical course type parameters (basic symptom levels, increases in symptoms and instability over time) were distinguished to study the effect of the course of depression on mortality.

Results. Contrary to transient states of depression, both chronic depression and chronic intermittent depression predicted mortality at follow-up. Additionally, evidence was found that the effect on mortality is related to severity of depression; high basic symptom levels and increases in symptoms over time were predictive of mortality. A high degree of instability over time was not associated with mortality.

Conclusions. Since the mortality effect of depression is a function of both exposure time and symptom severity, more attention should be paid to the treatment of depression in order to prevent severe longstanding depression.

Background. Self-reported depressive symptoms among the elderly have generated considerable interest because they are readily available measures of overall well-being in a population often thought to be at special risk for mental disorder.

Method. The heritability of depression symptoms was investigated in a sample of 2169 pairs of Danish twins (1033 MZ and 1136 same sex DZ) ranging in age from 45 to over 95. Twins completed an interview assessment that identified symptoms of depression, which were scored on Affective, Somatic and Total scales.

Results. Overall heritability estimates (a2) for the Affective (a2 = 0.27, (95% CI 0.22–0.32)). Somatic (a2 = 0.26, (0.21–0.32)), and Total (a2 = 0.29, (0.22–0.34)) scales were all moderate, statistically significant and similar to results from other studies. To assess possible variations in heritability across the wide age span, the sample was stratified into age groups in increments of 10 years. The magnitude of heritable influence did not vary significantly with age or sex. Somatic scale heritability tended to be greater for females than for males, though this difference was not statistically significant. The genetic correlation between the Affective and Somatic scales was 0.71, suggesting substantial common genetic origins.

Conclusions. Though the frequency of self-reported depressive symptoms increased with age in this sample, their heritability did not.

Background. Although genes are known to influence the aetiology of ADHD, the impact of exposure to parental ADHD has received limited scientific scrutiny. This study investigated the impact of exposure to parental ADHD on clinical features and dysfunction in offspring.

Methods. We studied 1099 offspring (53% male, mean age 12·4 years) of non-ADHD, remitted ADHD, and persistent ADHD parents, using structured diagnostic interviews and a battery of cognitive and psychosocial measures. Offspring across these three groups were compared on clinical, cognitive and psychosocial outcomes, adjusting for exposure to other parental psychopathology, offspring ADHD status and social class.

Results. Parental ADHD was associated with an increased risk for ADHD in offspring relative to no parental ADHD, but no significant differences were found between children of remitted versus persistent ADHD parents. Exposure to parental ADHD predicted higher levels of family conflict and lesser levels of family cohesion relative to families without parental ADHD, independent of other psychopathological conditions in parents or ADHD status. Significant interactions were detected in which parental ADHD had a deleterious impact on measures of school performance in offspring without ADHD but not in those with the disorder.

Conclusions. These results find no support for the hypothesis that exposure to parental ADHD increases the risk for ADHD in children beyond that conveyed by the liability associated with the diagnosis in the parent. However, since exposure to parental ADHD was associated with a disruptive family environment, the identification and treatment of adults with ADHD may be an important component of the treatment plan of youth with ADHD.

Background. Female nurses appear to have an increased risk of suicide but the reasons are unknown.

Method. We have concluded a study of nurse suicides (N = 106) in England and Wales, including a psychological autopsy study (N = 42) and case–control comparison with living nurses (N = 84).

Results. Nearly three-quarters of the nurse suicides had previous contact with psychiatric services and almost half had been psychiatric in-patients in the past. There were particularly marked differences between the cases and controls for current psychiatric disorder (90·5% v. 7·1%, OR = 68·5), personality disorder (38·1% v. 1·2%, OR = 32), and history of deliberate self-harm (71·4% v. 2· 4%, OR = 58·5). Family background and social factors (especially concerning interpersonal relationships) also distinguished the two groups. Smoking and serious alcohol abuse were much more frequent in the suicides. There was some indication that while many of the suicides were in contact with psychiatric services, care may not have been optimal in some cases.

Conclusions. The most important strategies for suicide prevention in nurses are in prevention, detection and management of psychiatric disorders. In assessing suicide risk a history of DSH and the presence of comorbid psychiatric and personality disorders are particularly important.

Objective. We aimed to assess the diagnostic outcome of self-reported hallucinations in adolescents from the general population.

Method. The sample consisted of 914 adolescents between ages 11–18 participating in an ongoing longitudinal study. The participation rate from the original sample was 70%. Responses on the Youth Self-Report questionnaire were used to ascertain hallucinations in adolescents. Eight years later, Axis 1 DSM-IV diagnoses were assessed using the 12-month version Composite International Diagnostic Interview in 783 (86%) of 914 study subjects. No subjects were diagnosed with schizophreniform disorders or schizophrenia.

Results. Hallucinations were reported by 6% of adolescents and 3% of young adults. Self-reported hallucinations were associated with concurrent non-psychotic psychiatric problems in both age groups. Adolescents who reported auditory, but not visual, hallucinations, had higher rates of depressive disorders and substance use disorders, but not psychotic disorders, at follow-up, compared to controls.

Conclusions. Self-reported auditory hallucinations in adolescents are markers of concurrent and future psychiatric impairment due to non-psychotic Axis 1 disorders and possibly Axis 2 disorders. It cannot be excluded that there was selective attrition of children and adolescents who developed Schizophrenic or other psychotic disorders later in life.

Background. Psychiatric diagnoses obtained at personal interview are only moderately reliable and depend critically on accurate self-observation. Reports by family members provide additional information but may be biased. It is unclear how best to combine these two sources of diagnostic data.

Methods. Using complete data on lifetime prevalence for six disorders in ∼1200 male–male twin pairs from a population based registry, we first applied a standard bivariate twin model – which treats self-diagnoses and informant-diagnoses as separate phenotypes – and then examined a ‘multiple-rater’ model – which assumes that self-report and co-twin-report are fallible indices of one underlying disease liability. Best-fit models were chosen using Akaike's information criterion.

Results. Standard bivariate analyses indicated that the same genetic factors accounted for variation in self-reported and co-twin-reported diagnoses. The multiple-rater model produced a substantial decrease in variance attributed to individual-specific environment and a proportional increase in heritability of liability for major depression, generalized anxiety disorder, alcohol dependence and adult antisocial behaviour, but not for drug abuse/dependence or regular tobacco use. The best-fit model consistently included either a ‘bias’ or a ‘correlated error’ path. No evidence for family environmental risk factors was found for any disorder.

Conclusion. The genetic factors that influence self-report psychiatric illness also influence psychiatric illness as described by relatives. For many psychiatric disorders, incorporation of self-report and family history data in a single model may reduce measurement error and increase estimates of heritability. However, account must be taken of the fact that family history reports are systematically biased. While promising, these results are preliminary and require replication.

Background. Somatization is a clinical phenomenon characterized by multiple, medically unexplained somatic symptoms. The pathophysiology remains unknown. We aimed to test the hypothesis of a central nervous system dysfunction in the pathophysiology of this disorder.

Methods. We studied 10 female patients diagnosed as having somatization disorder or undifferentiated somatoform disorder with no current Axis I disorders according to DSM-IV. They were compared with 17 healthy female volunteers using brain [18F]-fluorodeoxyglucose-PET with MRI reference.

Results. The patients had lower cerebral metabolism rates of glucose (P<0·05) in both caudate nuclei, left putamen and right precentral gyrus compared with healthy volunteers.

Conclusions. This is the first study to demonstrate changes in brain metabolism in somatizing women. The regional cerebral hypometabolism is probably associated with the pathophysiology of somatization.

Background. Neuropsychological studies have suggested that memory systems reliant on medial temporal lobe structures are impaired in patients with depression. There is less data regarding whether this impairment is specific to recollection memory systems, and whether clinical features predict impairment. This study sought to address these issues.

Method. A computerized process-dissociation memory task was utilized to dissociate recollection and habit memory in 40 patients with past or current major depression and 40 age, sex and IQ matched non-psychiatric control subjects. The Cognitive Failures Questionnaire was used to assess patients’ perceptions of day-to-day memory failures.

Results. Patients had impaired recollection memory (t = 4·7, P<0·001), but no impairment in habit memory when compared to controls. Recollection memory performance was not predicted by indices of current mood state, but was predicted by self-assessments of impairment (β = −0·33; P = 0·008) and past number of depressions (β = −0·41; P = 0·001). There was no evidence that standard therapy with antidepressant medication either improved or worsened memory performance.

Conclusions. The results confirm that patients with multiple past depressions have reduced function on recollection memory tasks, but not on habit memory performance. The memory deficits were independent of current mood state but related to past course of illness and significant enough that patients detected impairment in day-to-day memory function.

Background. This experiment examines two aspects of delusional cognition that have been reported clinically but not investigated empirically. These are the incorporation of potentially conflicting information into the recall of delusion-related scripts and the type and amount of material produced additional to that presented for recall, referred to here as confabulation.

Methods. Three groups of patients – deluded schizophrenics, non-deluded schizophrenics and matched non-psychiatric controls – were asked to recall two 15-item scripts, which comprised 10 typical and five atypical components. It was hypothesized that deluded subjects whose delusion was relevant to one of the scripts would recall more of the atypical components of the script and would also be less likely to make script-atypical confabulations in the recall of this particular script.

Results. Recall was assessed for the amount and type of content remembered and the amount and type of confabulation. The results did not support the hypothesis that atypical items would be incorporated into the recall of delusion-relevant material. However, deluded subjects did retain their schema boundaries in the recall of script items relevant to their own delusion but were less able to adhere to a script framework in the recall of material unrelated to their delusion.

Conclusions. These results are discussed within a schema specific account of delusions, which conceptualizes the delusion as an overused schema whose preferential use leads to a failure to develop other scripts but whose own contents remain well-defined.

Background. Whereas a number of studies have suggested that parental loss is associated with increased risk for major depression (MD), much less is known about possible gender differences, diagnostic specificity and the time course of the impact of loss.

Method. First-onsets for MD and alcohol dependence (AD) were assessed at personal interviews in 5070 twins from same-sex (SS) and 2118 from opposite-sex (OS) twin pairs ascertained from a population-based registry. Cox Proportional Hazard (PH) and Non-Proportional Hazard (NPH) models, examining first onsets of MD and AD, were used with twins from SS pairs and conditional logistic regression for OS pairs. Parent–child separations prior to age 17 were divided into death and separation from other causes.

Results. The PH assumptions of constant increased risk were rejected for the impact of loss on risk for MD but not for AD. NPH models found significantly increased risk for MD after both death and separation with the risk lasting much longer for separations. For AD, the PH model found significantly increased risk after parental separation but not death. In both SS and OS twin pairs, no sex differences were seen in the impact of parental loss on risk for MD whereas the association between separation and risk for AD was significantly stronger in females than in males.

Conclusion. Consistent sex differences in the association with parental loss were seen for AD but not MD. The analysis of the time-course of increased risk after loss suggests three different patterns which may reflect different relationships: parental death and MD (return to baseline within ∼12 years), separation and MD (return to baseline within ∼30 years) and separation and AD (no change in risk over time).

Background. Clinical and epidemiological studies have shown an association between anxiety and depression and pain in the back and neck. The nature of this relationship is not clear. This study aimed to investigate the extent to which common genetic and environmental aetiological factors contribute to the covariance between symptoms of anxiety and depression and back–neck pain.

Methods. Measures of back–neck pain and symptoms of anxiety and depression were part of a self-report questionnaire sent in 1992 to twins born in Norway between 1967 and 1974 (3996 pairs). Structural equation modelling was applied to determine to what extent back–neck pain and symptoms of anxiety and depression share genetic and environmental liability factors.

Results. The phenotypic correlation between symptoms of anxiety and depression and back–neck pain was 0.31. Individual differences in both anxiety and depression and back–neck pain were best accounted for by additive genetic and individual environmental factors. Heritability estimates were 0.53 and 0.30 respectively. For back–neck pain, however, a model specifying only shared- and individual environmental effects could not be rejected. Bivariate analyses revealed that the correlation between back–neck pain and symptoms of anxiety and depression was best explained by additive genetic and individual environmental factors. Genetic factors affecting both phenotypes accounted for 60% of the covariation. There were no significant sex differences.

Conclusion. The results support previous findings of a moderate association between back–neck pain and symptoms of anxiety and depression, and suggest that this association is primarily due to common genetic effects.

Background. This study assessed the relationship of early adolescent marijuana use to performance of developmental tasks integral to the transition to young adulthood. The tasks concerned intimacy, education, and work and social conformity.

Methods. African American (N = 617) and Puerto Rican (N = 531) youths completed questionnaires in their classrooms. Five years later they were individually interviewed. Logistic regression analysis estimated the increased likelihood that early marijuana users would make an inadequate transition to young adult social roles.

Results. Analyses examining the association between early marijuana use and 20 outcome variables found significant relationships for 10 of them: (a) having lower educational and occupational expectations; (b) being suspended or expelled from school, fired from jobs, ‘high’ at school or work, collecting welfare; and (c) rebelliousness, not participating in productive activities, not attending church, and being an unmarried parent. Marijuana use was not related to any of the intimate relationship measures. These finding emerged with controls on gender, ethnicity, age and mother's education.

Conclusions. Among African Americans and Puerto Ricans, early marijuana use predicts less adequate performance on some developmental tasks integral to becoming an independent young adult. Marijuana is not a benign drug and is associated with future risks for the individual and society at large.

Background. Neurocircuits comprising limbic, striato–pallidal and thalamo–cortical brain areas are assumed to be involved in the pathophysiology of mood disorders. All these brain regions receive serotonergic afferents arising from the rostral raphe, mainly the dorsal raphe. Although serotonergic systems appear to be involved in the pathology of mood disorders, there is uncertainty as to whether structural alterations in raphe nuclei exist alongside a functional dysregulation of the serotonergic system.

Methods. In the brains of 12 patients with mood disorders (major depressive disorder N = 6, bipolar disorder N = 6) and 12 normal subjects we performed a morphometric post-mortem study on neuronal morphology in all subnuclei of the dorsal raphe nucleus using Nissl stained 20 μm axial serial sections of the brainstem.

Results. The number of neurones of the ventrolateral subnucleus of the dorsal raphe was reduced by 31% in patients with mood disorders compared with non-psychiatric control subjects. Ventrally located subnuclei of the rostral dorsal raphe (ventrolateral, ventral, interfascicular) taken together also showed a smaller number of neurones. Neurone numbers of the dorsal and the caudal subnucleus and volumes of all single subnuclei appeared to be unchanged. Analysis of morphological neuronal types revealed a smaller number of triangular neurones in the ventrolateral subnucleus. Numbers of ovoid and round neurones in the ventrolateral subnucleus also showed a trend to reduction. No correlation was found between neurone numbers in any subnucleus of the dorsal raphe and duration of illness. Neurone numbers did not differ in any subnucleus between patients with unipolar and those with bipolar affective disorder.

Conclusions. Results indicate that patients with primary mood disorders have a circumscribed numerical neuronal deficiency in the dorsal raphe. This structural deviation may contribute to impaired serotonergic innervation of brain regions which are involved in the pathology of mood disorders.

Background. Slowing of the speed of information processing has been reported in geriatric depression, but it is not clear if the impairment is present in younger patients, if motor retardation is responsible, or if antidepressant medications play a role.

Method. Twenty unmedicated unipolar depressed inpatients were compared with 19 medicated depressed in-patients and 20 age-, sex- and verbal IQ-matched controls on inspection time (IT), a measure of speed of information processing that does not require a speeded motor response. We also examined the relationship between IT and current mood and length of depressive illness.

Results. Unmedicated depressed patients showed slowing of information processing speed when compared to both medicated depressed patients and controls. The latter two groups were not significantly different from each other. Slowing of IT was not associated with current mood, but was negatively correlated with length of illness since first episode. No differences in IT were found between patients receiving medication with anticholinergic effects and patients receiving medication with no anticholinergic effects.

Conclusions. The findings indicate that unipolar depression is associated with a slowing of speed of information processing in younger patients who have not received antidepressant medication. This does not appear to be a result of motor slowing.

Background. This paper reports the prevalence, disability, sociodemographic and clinical association of psychiatric morbidity among attenders in general health care in Taiwan where, as in the rest of non-Western countries, few studies have been carried out.

Methods. A cross-sectional survey with a two-phase design was carried out at out-patient clinics of three health stations and a general hospital.

Results. A total of 990 patients completed the brief screen in the first phase, 486 of whom completed the independent assessment in the second phase. The proportion of screening positives was 46·0% and the weighted prevalence of definite psychiatric disorder was 38·2%. Common mental disorders were associated with female gender and unemployment. Housewives, students and patients with higher educational attainment were at lower risk of having alcohol use disorders. Patients with common mental disorders were more likely to present with psychological complaints, to attribute their illness to psychosocial causes and to perceive their mental and physical health as poor. Psychiatric morbidity was associated with excess life events. Common mental disorders, particularly depressive disorders, were significantly associated with self-reported disability.

Conclusions. Psychiatric morbidity is a major health problem in general health care in Taiwan. Physicians should be aware of these health problems.

Background. Hypothalamic–pituitary–adrenal (HPA) axis function in patients with chronic depression has previously been shown to be normal when measured using the dexamethasone suppression test (DST). We examined patients with chronic depression using the sensitive dexamethasone/corticotropin releasing hormone (dex/CRH) test and the dexamethasone suppression test (DST) to establish whether HPA axis abnormalities are present in this group. We also compared the sensitivity of the two tests and compared the results with previous studies in depression that have not specifically selected chronic patients.

Method. Twenty-nine patients with the chronic subtype of major depressive disorder and 28 matched controls underwent examination of HPA axis function.

Results. Neither the cortisol response to the DST or the dex/CRH test differed significantly between the patient and control groups. There was a trend in favour of more patients than controls having an abnormal response to the dex/CRH test (P = 0.052). Neither the patients with an abnormally enhanced response, nor the magnitude of response could be predicted by any illness or demographic variable.

Conclusion. The HPA axis is not overtly abnormal in chronic depression. This contrasts with previous findings in acute depression and bipolar disorder and may suggest that the HPA axis abnormalities present in acute depression resolve, but are not accompanied by symptom resolution. Alternatively, a subgroup of depressives with less HPA dysfunction may progress to chronicity. This has implications for treatment and prognosis. The dex/CRH is a more sensitive test of HPA axis function than the DST in patients with chronic depression.