An investigation to determine which prognostic variables are associated with behavioural treatment failure in obsessive-compulsive disorder (OCD). Empirically established prognostic variables measured at the start of treatment may lead to adjusted treatment programmes for these patients.

Forty patients, diagnosed with OCD, received a standardised treatment consisting of 18 sessions in vivo exposure and response prevention. Compulsive behaviour (MOCI) and obsessive fear (ADS) were the outcome measures. Prognostic variables included were initial severity of OC complaints, initial level of depression, problem duration, patients' motivation for treatment, quality of the therapeutic relationship, and marital dissatisfaction.

Greater initial severity of complaints (P < 0.01), and depression (P = O.03) predicted poorer outcome for compulsive behaviour. Greater initial severity of complaints (P < 0.01), and the conjoint variables higher level of depression, longer problem duration, poorer motivation for treatment, and dissatisfaction with the therapeutic relationship predicted poorer outcome for obsessive fear (P < 0.01).

The complaint-related variables of initial severity, initial depression, and problem duration, and the non-specific treatment variables of patients' motivation and quality of the therapeutic relationship, affect behavioural treatment outcome in OCD.

Health inequalities exist for many disorders, but the contribution of deprivation to the prevalence and outcome of depressive symptoms in primary care populations has been infrequently studied.

To examine the influence of Jarman under-privileged area (UPA) scores on the prevalence and outcome of depressive symptoms in general practice patients.

18 414 patients attending 55 representative practices completed the Hospital Anxiety and Depression Scale and a questionnaire for employment status. Outcome of those screening positive was assessed at 6 weeks and 6 months.

The UPA score accounted for 48.3% of the variance between practices in prevalence of depressive symptoms. Attending a high UPA score practice predicted persistence of depressive symptoms to 6 months.

The socio-economic deprivation of a practice locality is a powerful predictor of the prevalence and persistence of depressive symptoms.

Dementia is emerging as an important health problem of elderly people in India.

To investigate the prevalence, psychosocial correlates and risk factors of various dementing disorders in an urban population in Kerala, southern India.

A door-to-door survey was conducted in the city of Kochi (Cochin) to identify residents aged ?65 years using cluster sampling. Of 1934 people screened with a vernacular adaptation of the Mini-Mental State Examination, all those scoring at or below the cut-off of 23 were evaluated further and those with confirmed cognitive and functional impairment were assigned diagnoses according to DSM–IV criteria. Identified cases were categorised by ICD–10 criteria. Ten percent of those screened as negative were evaluated at each stage.

Prevalence of dementia was 33. 6 per 1000 (95% Cl 27.3–40.7). Alzheimer's disease was the most common type (54%) followed by vascular dementia (39%), and 7% of cases were due to causes such as infection, tumour and trauma. Family history of dementia was a risk factor for Alzheimer's disease and history of hypertension was a risk factor for vascular dementia.

Dementia is an important health problem of the elderly population. Identification of risk factors points towards the possibility of prevention.

Despite the lack of consistent empirical support, modern diagnostic criteria of schizophrenia give particular emphasis to Schneider's first-rank symptoms (FRSs).

To examine the diagnostic significance of FRSs for schizophrenia by trying to overcome the limitations of previous studies.

This study examined the diagnostic accuracy of FRSs for schizophrenia in 660 in-patients with the full spectrum of functional psychotic disorders. Schizophrenia was diagnosed according to three criteria: DSM–III–R broad, DSM–III–R narrow and Feighner, the latter being considered as the gold standard because it does not give particular emphasis to FRSs.

FRSs were highly prevalent in both schizophrenia and non-schizophrenic psychoses. The likelihood ratios (and 95% Cl) of one or more FRSs for Feighner, DSM–III–R narrow and DSM–III–R broad schizophrenia were 1.06 (0.94–1.20), 1.23 (1.09–1.39) and 1.73 (1.44–2.08), respectively. These data indicate that FRSs do not significantly increase the likelihood of having schizophrenia.

FRSs are not useful in differentiating schizophrenia from other psychotic disorders. Diagnostic systems for schizophrenia that are heavily based on these symptoms may arise from a tautological definition of the disorder.

Neurological ‘soft signs’ and minor physical anomalies (MPAs) are reported to be more frequent in patients with schizophrenia than in controls.

To determine whether these disturbances are genetically mediated, and whether they are central to the genesis of symptoms or epiphenomena.

We obtained ratings in 152 individuals who were antipsychotic drug-free and at high risk, some of whom had experienced psychotic symptoms, as well as 30 first-episode patients and 35 healthy subjects.

MPAs and Neurological Evaluation Scale (NES) ‘sensory integration abnormalities’ were more frequent in high-risk subjects than in healthy controls, but there were no reliable differences between high-risk subjects with and without psychotic symptoms. MPAs were most frequent in high-risk subjects with least genetic liability and NES scores showed no genetic associations.

The lack of associations with psychotic symptoms and genetic liability to schizophrenia suggests that soft signs and physical anomalies are non-specific markers of developmental deviance that are not mediated by the gene(s) for schizophrenia.

Individuals with a mental health disorder appear to be at increased risk of medical illness.

To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.

Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.

We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.

Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.

None.

La belle indifférence refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria.

To determine the frequency of la belle indifférence in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to organic disease.

A systematic review of all studies published since 1965 that have reported rates of la belle indifférence in patients with conversion symptoms and/or patients with organic disease.

Atotal of 11 studies were eligible for inclusion. The median frequency of la belle indifférence was 21 % (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with organic disease.

The available evidence does not support the use of la belle indifférence to discriminate between conversion symptoms and symptoms of organic disease. The quality of the published studies is poor, with a lack of operational definitions and masked ratings. La belle indifférence should be abandoned as a clinical sign until both its definition and its utility have been clarified.

Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia.

Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks.

Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated.

Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.

We compared regional cerebral blood flow (rCBF) in three groups of patients with DSM–III–R anxiety disorders.

Fifteen patients with obsessive–compulsive disorder (OCD), 15 with panic disorder with agoraphobia (PA), and 16 with post-traumatic stress disorder (PTSD) and a similar group of healthy controls were assessed on brain-dedicated high-resolution SPET.

MANOVA revealed significant rCBF differences between diagnostic groups (F=4.4; d.f.=3, 57; P=0.007) and between cerebral regions (F=6.4; d.f.=1, 57; P=0.01) in OCD and PTSD compared with PA and healthy controls, limited to bilateral superior frontal cortices and right caudate nuclei. Whole brain blood flow correlated positively with anxiety (r=0.24, n=46, P=0.05). Beck depression scores correlated significantly negatively with left caudate rCBF (r= –0.24, n=46, P=0.05) and right caudate rCBF (r= –0.31, n=46, P=0.02). PTSD syndrome severity correlated significantly negatively with the left caudate (r=-0.49, n=16. P=0.03) and with right caudate rCBF (r=-0.7, n=16, P=0.001)

Functional rCBF differences in anxiety disorders could relate to repetitive, intrusive, distressing mental activity, prominent in both OCD and PTSD.

Increased risk of affective disorder in learning disability has been reported, although the extent to which this is due to adverse social and material circumstances is uncertain and there have been potential limitations in the measurement of affective disorder.

To determine risk of affective disorder in those classified with mild learning disability in the British 1946 birth cohort and to investigate whether this risk was accounted for by disadvantage in childhood and adulthood.

Learning disability was defined as the equivalent of an IQ ≤ 69 at age 15 years. The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 43 years provided psychiatric outcome measures.

Learning disability was associated with a fourfold increase in risk of affective disorder, not accounted for by social and material disadvantage or by medical disorder.

Learning disability is strongly associated with risk of affective disorder, persisting well into midlife.

There are no published studies concerning the depiction of mental illness in children's television programmes.

To determine whether mental illness was depicted in children's television.

Sample of one complete week of children's television (57 hours, 50 minutes; 128 series episodes: 69 cartoon animations, 12 non-cartoon animations, 47 real life) provided for children under the age of 10 years. Disclosure analysis of portrayals of mental illness through repeated viewings identified patterns in the use of linguistic, semiotic and rhetorical resources.

Of the 128 episodes, 59 (46%) contained one or more references to mental illness, predominantly in cartoons (n=47, 80%) compared with other episode types (χ2=17.1, d.f.=2, P<0.05). Commonly occurring terms such as ‘crazy’ (n=28), ‘mad’ (n=19) and ‘losing your mind’ (n=13) were employed to denote loss of control. The six consistently mentally ill characters were almost entirely devoid of admirable attributes.

Young viewers are being socialised into stigmatising conceptions of mental illness.