The relationships among symptoms, cognitive functioning and social functioning were investigated in 60 patients with recent-onset schizophrenia. Positive symptoms were unrelated to cognitive measures. Disorganization and depressive symptoms were correlated significantly with Card Sorting performance. Furthermore, only negative symptoms were correlated significantly with social functioning. These results replicate earlier studies with chronic and mixed samples, and support the validity of disorganization as a separate symptom dimension. In contrast to most previous studies, no significant correlations were found between negative symptoms and cognitive measures. However, some evidence was found for a non-linear association between negative symptoms and several cognitive measures. The variation explained by a curvilinear model was not high, but for some cognitive measures this model was clearly superior to a linear model. If replicated, this finding supports the position that cross-sectionally measured negative symptoms cannot be viewed as a unitary concept.

In a geographically defined area sample of 141 long-term psychiatric patients in day care in south London, the relationship between tardive dyskinesia (TD) and other aspects of illness, treatment, and social and psychological functioning were studied. The results are compared with previous findings. TD was significantly associated with parkinsonian symptoms and with the number of years in contact with the psychiatric services. There was a trend, in affective disorder only, towards an association with current neuroleptic dose. The patients with affective disorder also had higher rates of TD than patients with schizophrenia and paranoid psychosis. History of treatment with ECT correlated negatively with TD among those with schizophrenia, and positively among those with affective disorder. As in other studies, duration of neuroleptic treatment did not correlate with the presence or absence of TD. In contrast to some previous reports, age and cognitive status were not related to TD status. Possible reasons for this are discussed.

The research on attendance at out-patient psychiatric facilities has produced conflicting evidence that provides little guidance for the practitioner. It is suggested that inadequate data exploration could explain some of the discrepant findings. Analyses of multi-way tables using linear–logistic models were undertaken to demonstrate patterns of association that cannot be revealed through the use of simple chi-square tests on two-way contingency tables. The variables chosen for these analyses were those that have produced conflicting findings in the literature on children's attendance at child guidance facilities.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11·7% of males and 24·6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101·6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142·3 persons/1000 inhabitants) than males (50·0 persons/1000), a difference statistically significant (χ2 = 18·0, 1 df, P < 0·001). The highest rate of consumption was for tranquillizers (80·4/1000 inhabitants) and the general physician was found to be the leading prescriber (46·9%), being followed by cardiologists (15·3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

The present study examined the utility of a new hospital-hostel with low staffing levels. Results showed that the hostel was able to maintain 9 of the 10 initially transferred patients and has been able to provide some improvements in their quality of life. However, unlike highly staffed hospital-hostels, it was not able to decrease patients' disabilities. Implications of this are discussed in relation to staffing levels and practices.

The association between major depressive disorder (MDD) and self-reported histories of specific physical illnesses was investigated in 320 controls and 1968 first-degree relatives and 254 spouses of probands in the NIMH Collaborative Depression study. The Schedule for Affective Disorders and Schizophrenia-Lifetime Version was used to assign Research Diagnostic Criteria (RDC) diagnoses and a structured self-report instrument was used to assess lifetime medical history. Lifetime MDD was diagnosed in 914 subjects, 402 of whom had been hospitalized or received somatic treatment (‘treated’ MDD). Strong associations were observed between MDD (either treated or untreated) and both frequent/severe headaches and migraine headaches. There was a marked gender effect such that the relative odds for a woman with treated MDD to report migraine were over 5:1. Other associations were found between MDD and skin infections, respiratory illness, ulcer, hypotension, and diabetes. This is the largest non-patient sample using standardized assessment of mental disorders by direct interview in which associations between specific physical illnesses and MDD have been demonstrated. Implications for clinical practice and neurobiological research in depression are discussed.

This paper investigates factors affecting the distribution of psychiatric morbidity in the community. It identifies a close relationship between mean Chronic General Health Questionnaire (CGHQ) scores in subdivisions of a large random sample of the community (the Health and Lifestyle Survey, N = 6317) and the prevalence in these groups of abnormal, above-threshold CGHQ scores. The frequency distributions of CGHQ scores in these different populations move up and down as a whole: like other physiological and behavioural attributes, these mental health outcomes in individuals are associated with characteristics of the populations in which they arise. Populations thus carry a collective responsibility for their own mental health and well-being. This implies that explanations for the differing prevalence rates of psychiatric morbidity must be sought in the characteristics of their parent populations; and control measures are unlikely to succeed if they do not involve population-wide changes.

The CAMCOG, the cognitive section of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), was administered twice to 53 patients with a clinical diagnosis ranging from no dementia to severe dementia. The stability of the total CAMCOG score was high (0·97). Patients with less than moderate dementia were differentiated well by the total score and by subscales with a range of more than 8 points, except when education was low or age was higher than 78. Because performance on most (sub)scales is modified by age and education level, stratified norms are desirable. Only the Praxis subscale, and specifically performance on drawing tasks, appeared to be influenced by depression.

Many patients with mental health problems are treated in primary health care services. They are often multi-users of care. In the present investigation we have studied patients visiting primary health care clinics who have been assessed for mental health problems according to the Hopkins Symptom Check List (HSCL-25). Two quality-of-life instruments (the Nottingham Health Profile and the Mood Adjective Check List) were applied to describe further the perceived health of the sample.

A random sample of 93 patients was chosen out of 388 patients visiting a primary health care clinic in a Swedish health care district during four weeks in January and February 1990, and these patients were followed prospectively during one year. High consumers of health care during the follow-up period scored a poor perceived health. ‘Feeling worthless’, predicted a high number of days of sickness absenteeism. Hidden cases, not detected by the GPs, consumed more resources than those identified by the GPs. The importance of training and educating general practitioners in the early detection of patients with mental health problems is discussed.

Key relatives of 30 first or early admission psychotic patients (mainly with a diagnosis of schizophrenia) were interviewed (for a second time) 18 months after participating in an initial assessment of expressed emotion (EE). The patients were followed up throughout the interim period, during which time 17 experienced a psychotic relapse. Although there continued to be a negligible association between initial EE rating (established during the index admission) and relapse, a significant association between EE rating at 18 months and psychiatric status of the patient during the follow-up period emerged. Results are discussed in the context of recent interactional theories of the relationship between household EE and psychiatric morbidity.

A Cognitive Shift neurocognitive training module was developed in the attempt to ameliorate cognitive flexibility deficits in chronic schizophrenic patients. A procedural training approach hypothesized the exercise of specific neural network processes, identified from theories of frontal and prefrontal lobe functioning. Three male patients who underwent the intensive program demonstrated significant gains in Wisconsin Card Sorting Test performance, gains that were maintained at a six month reassessment. Expanded Brief Psychiatric Rating Scale (a measure of symptomatology) and Life Skills Profile (a measure of daily functioning) measures showed smaller improvements. The ability to improve cognitive flexibility could have important implications for the treatment of schizophrenia.

Service utilization measures from the psychiatric case registers for urban South-Verona and rural Portogruaro in North East Italy for the period 1983–9 were used to identify associations with socio-demographic variables from the 1981 census in schizophrenia and related disorders as well as in all diagnoses. The patterns of service use were broadly similar, except that Portogruaro has significantly more community contacts, and has about twice the treated incidence and prevalence of schizophrenia. The census data showed that unmarried and unemployed people were more likely to live alone in the urban than in the rural area. In South-Verona the most strongly associated predictor variables, both for schizophrenia and all diagnoses, are: living alone, unemployment, percentage of the total population who are dependents and the percentage who are divorced, separated or widowed. In contrast, in Portogruaro there were no consistent associations between census and service use variables. Stepwise multiple regression models using three census predictor variables accounted for over 85% of the variance in South-Verona utilization rates. The results indicate that the strongly predictive associations previously described in England hold in urban South-Verona, but not in rural Portogruaro, and may be related to the effect of cities in clustering seriously disabled psychiatric patients in areas of low-cost housing where they live in relative social isolation.

The Standardized Assessment of Personality (SAP) is a short, semi-structured interview designed to be used with an informant of the patient. The informants of 52 patients were interviewed separately by two raters for an inter-rater reliability study. The overall level of agreement was excellent, kappa = 0·76, with a range between 0·60 and 0·82 for the individual categories of personality disorder. For a temporal reliability study, the relatives of 77 patients were interviewed. The overall level of agreement was good, kappa = 0·65, with a range between 0·54 and 0·79 for individual categories. Characteristics of informants whose reports were rated with greater levels of reliability were female gender and greater length of acquaintance with the patient.

This study validates the GHQ-28 on a sample of paralysed, spinally injured outpatients under the care of the West Midlands Spinal Injuries Unit. The validity of the GHQ-28 was 0·83 (95% confidence interval: 0·70 to 0·93) using the Clinical Interview Schedule (CIS) as the validating criterion. The effectiveness of the GHQ-28 as a screening instrument using CIS 11/12 as case criterion, and thus a prevalence rate of 0·18, was judged by relative operating characteristic (ROC) analysis. The area under the ROC curve was 0·91±0·03. “Optimum’ discrimination occurred near GHQ 3/4 (0011 scoring scheme) giving a sensitivity of 0·81, a specificity of 0·82 and a misclassification rate of 18%.

This pilot study demonstrated the feasibility of providing practice nurse support as an adjunct to standard general practitioner treatment to patients with depressive disorders prescribed antidepressant medication. With respect to the measures used and pilot study objectives identified, there were no statistically significant differences between the study groups in treatment adherence to the prescription of antidepressant medication or in the incidence and severity of adverse events to medication. Large-scale randomized controlled trials are in progress to assess the effectiveness of practice nurse interventions in the management of depressive illness in general practice.