An adaptation of the LIFE procedure was used with a self-report questionnaire to assess 173 medical students, close to their enrolment and again about six months later. The assessment procedure enabled changes in symptoms of anxiety and depression over the interval between interviews to be recorded and the subsequent classification of the symptom patterns into course categories. While women scored markedly higher than men at initial assessment, this was not so at follow-up. Almost 25% of students reported the co-occurrence of at least five psychological symptoms at some time during the six months. For many students these were of a persistent nature. The adapted GHQ meets the dual demands of restricted interview time and the need to assess the more minor psychological conditions.

3H-imipramine binding in 39 drug-free patients with major depression and 44 healthy controls did not differ significantly between the two groups, in male or female subjects or in subgroups of depressed patients divided by endogenicity or dexamethasone suppression test result. 3H-imipramine binding in depressed patients drug-free for less than three weeks did not differ from those drug-free for longer intervals or from controls. A significant seasonal variation of 3H-imipramine Bmax was found, with lower values in summer and autumn. Treatment of depressed patients with imipramine or lofepramine for six weeks increased KD and Bmax. Methodological modification (in preparation and storage of platelets) does not explain the major differences in results between this study (using frozen platelets), a previous one (using freshly prepared platelets) and others in general, although it might contribute to the range of values reported.

The suicide rates in England and Wales and Scotland converged during the late 1960s, and from 1970 were higher in Scotland. The convergence occurred because of differences in the falls in rates of those aged over 45 years and not because of differences in frequency and decline of coal gas suicide. Male suicide increased more rapidly in Scotland during the 1970s. In England and Wales overall female suicide rates fell during 1958–76 whereas in Scotland there was no clear trend. Suicide by car exhaust increased similarly in both countries, but that by hanging and drug poisoning increased more rapidly in Scotland.

The Social Network Schedule was successfully completed on 489 (64%) of 770 long-stay patients in Friern and Claybury Hospitals and the data on 3774 social contacts of the patients subjected to log-linear modelling. This showed that the category ‘confidant’ was salient in understanding the data. Latent-class analysis highlighted the importance of the nature of the social interaction between patients and their contacts. In particular, non-verbal exchanges of goods and services emerged as important in creating social bonds.

Two studies are reported. In the first, of 62 schizophrenic patients, no correlation between negative symptom scores (rated blindly) and any measure of positive symptoms was found. This independence was confirmed by factor and cluster analyses, which left the question of a third ‘disorganisation’ class of schizophrenic symptoms open. In the second study, of 80 patients, formal thought disorder separated unequivocally into ‘positive formal thought disorder’ and ‘alogia’ syndromes on the basis of correlations with positive and negative symptoms. Catatonic motor disorder also showed evidence of a corresponding positive: negative division, although this only emerged when severity or chronicity of illness was controlled for. Cognitive impairment showed a broad range of affiliations and its particular correlation with negative symptoms was perhaps artefactual.

Patients with a clinical diagnosis of Alzheimer's disease were studied using MRI, SPECT, and psychometric tests. Significant correlations between focal perfusion deficits and focal cognitive deficits were found. Significant correlations between regional relaxation time of white matter and psychometric tests of diffuse and focal categories were also found. Pathological examination confirmed Alzheimer's disease as the only diagnosis.

In this new era of structural and functional neuroimaging technologies, it is the unsurpassed anatomical resolution of magnetic resonance imaging (MRI) (Andreasen, 1989; and Besson, this supplement) that has resulted in a new generation of studies on cerebral morphology in schizophrenia. With the recent development of whole-body magnets of very high (⩾ 1.5T) and uniform field strength, it has become possible to extend the scope of this approach to include measurement of certain fundamental neurochemical processes, via magnetic resonance spectroscopy (MRS: Hubesch et al, 1989; Lock et al, this supplement). The purpose of this article is to introduce and review critically the existing literature on the application of MRI and MRS to schizophrenia, and to give a preliminary account of some of our own recent studies in these areas.

As a result of follow-up studies published in 1937 and 1939, Langfeldt divided schizophrenia into two groups; ‘typical schizophrenia’ which had a poor outcome, and the ‘schizophreniform psychoses' which had a less typical clinical picture of schizophrenia and a good outcome. Langfeldt's cases of schizophreniform psychoses were reclassified according to the ICD–9 and DSM–III–R diagnostic systems. Most of the schizophreniform psychoses did not appear ‘schizophrenia-like’ at all, but turned out to be mainly affective disorders. Those included in Langfeldt's diagnosis of ‘schizophreniform psychoses' were found to be too heterogenous to validate the existence of this syndrome.

This paper contrasts the usual scoring of the GHQ-30 with scoring based upon a criterion approach applied to only 12 of the GHQ items that takes account of the ‘diagnostic significance’ of the chosen items. Repeat assessments with this shorter form of the questionnaire (the l-GHQ), coupled with procedures to assess change, can be used to provide summary measures of symptom course in those research situations where available interview time precludes the use of more formal assessment methods.

Twenty schizophrenics, 20 manics, and 20 depressives were given two sets of multiple choice questions, one testing the subject's social knowledge of how people tend to act in a social situation and the other tapping their knowledge of events or objects which are relatively free of a social component. Schizophrenics were significantly impaired on the former set of questions relative to manics, and were significantly worse on both than depressives. It is suggested that these results represent an objective measure of the social naïvete of schizophrenics. The significant difference from manics indicates that the results are not merely the general effects of psychosis, particularly because the manics performed worse on an attentional test than the schizophrenics.

A survey was undertaken at the end of 1984 of all patients occupying psychiatric beds for more than six months in an inner-London health district. Excluding those with senile dementia, 30 patients were identified. Two years later, a follow-up survey traced the original cohort and the accumulation of additional patients on the wards. The finding that the rate of discharge from the original group matches the accumulation of new patients into the survey suggests a need for new types of community provision within the district.

The official suicide rate in Ireland increased markedly between 1970 and 1985. This is a genuine increase in suicide and not an apparent one due to previous deficiencies in recording practices. Possible reasons for this change include an increase in ‘anomie’ shown by a rise in the rates of crime, illegitimacy and admissions to hospital for alcoholism, a decline in social cohesion revealed by a fall in the marriage rate and a rise in the number of separated couples, and an increase in unemployment.

The introduction of single-photon emission computerised tomography (SPECT) has markedly enhanced the study of brain function. The development of SPECT was the culmination of a series of investigations of cerebral blood flow (CBF) pioneered by Kety and Schmidt in the late 1940s combined with the introduction of transmission computerised tomography (CT) in the early 1960s, in which three-dimensional images are derived from two-dimensional data. Positron-emission tomography (PET), in addition to providing information on cerebral blood flow, also allows the evaluation of brain metabolism and neurotransmitter receptor function. However, the technology required for PET is expensive and sophisticated, with little prospect for general clinical application. Fortunately, SPECT is relatively cheap and is widely available for clinical use. We aim to review the principles and basic techniques of SPECT, its present utility and application to clinical practice, and its future potential in the investigation of brain function.

The ability to shift cognitive set, which is probably subserved, at least in part, by the pre-frontal cortex, was determined for schizophrenic, bipolar (manic) and control subjects, using the Wisconsin Card Sorting Test (WCST). The schizophrenic and manic subjects both demonstrated poor performance on the WCST, suggesting that cognitive inflexibility and/or pre-frontal dysfunction, is not specific to schizophrenia (although laterality differences could exist). Moderate levels of poor performance in the non-psychiatric control group suggest the need for a review of the cut-off figures in the WCST currently used for predicting ‘brain damage’ and ‘focal frontal involvement‘, especially given the trend for the increasing use of cognitive assessment and rehabilitation in the major psychoses.

Twenty-five women who were the primary carers for a parent with dementia were rated for expressed emotion (EE) and then divided into two groups: 11 with low-EE ratings and 14 with high-EE ratings. Although there were no differences between these groups in the levels of their parents' cognitive impairment, when such impairment was taken into account, high-EE subjects were found to report higher levels of strain and distress. More efficient coping strategies were reported by subjects who made fewer critical comments and more positive remarks. High-EE subjects more frequently had no living siblings, and were more likely to have had a respite break from caring. EE status was not associated with continuing care in the community at a nine-month follow-up.

Social functioning as an outcome variable in family interventions with schizophrenic patients has been a relatively neglected area. The requirements of a scale of social functioning to measure the efficacy of family interventions include: the measurement of skill/behaviour relevant to the impairments and the demography of this group; the ability to yield considerable information with an economy of clinical time; and the establishment of ‘comparative’ need through comparison between subscales and with appropriate reference groups. Results from three samples show that the Social Functioning Scale is reliable, valid, sensitive and responsive to change.

The methods of Roth's 1948–49 Graylingwell study, previously applied to a Crichton cohort of elderly patients of the years 1974–76, were repeated in 1984–86. The results support the continuing validity of Roth's classification of mental illness in the elderly, but changes in the diagnostic distribution of the cohort, previously observed in the 1970s study, are further in evidence in the 1980s one. Admissions of dementia cases continued to increase both relatively and absolutely, while the trend of increasing survival in dementia also continued.

There is evidence to suggest that organic cerebral changes occur in elderly depressed patients. Quantitative studies of elderly depressed patients have demonstrated that they have reduced ‘radio-attenuation’ on computerised tomography (CT) scans and as a group resembled more closely a group of demented patients than normal controls (Jacoby et al, 1983). Many biochemical changes associated with ageing are similar to the pathophysiological abnormalities in depression and in dementia (Alexopoulos et al, 1988). These changes, coupled with the high frequency of depressive syndromes in demented patients, suggest a complex relationship between depression and dementia in old age. Mahendra (1985) has suggested that a variety of brain abnormalities can produce a spectrum of clinical manifestations, ranging from depression with minimal cognitive dysfunction at one end to dementia with minimal depression at the other.

The possibility that separation of a categorical depressive disease (‘melancholia’) from remaining depressive disorders can be improved by assessment of mental state signs was examined in patients treated by representative Sydney psychiatrists and patients referred to a specialised mood disorders unit. A set of signs, principally assessing retardation, was derived within the two samples by principal-components and latent-class analyses. Scores were significantly correlated with clinical, DSM–III, and RDC diagnoses, and appeared independent of severity, suggesting that melancholia can be defined phenomenologically. Scores were also associated with several ‘validating’ factors. Comparative analyses of a refined list of melancholia symptoms suggested that ratings of defined signs are likely to have greater capacity than symptom ratings to differentiate melancholia from residual depressive disorders.

Regional cerebral blood flow at rest was measured in 38 patients with major depressive disorders and 16 controls by SPECT with inhalation of xenon-133. All subjects had been withdrawn from medication. The mean hemispheric cerebral blood flow was not statistically different between the controls and the different subgroups of depressed patients defined either by biological markers or clinical characteristics. However, the predominantly cortical blood flow, measured on the outer cerebral rim of the third tomographic slice, was significantly lower on the left hemisphere in bipolar patients when compared with normals and unipolar patients. The same lateralisation was observed in patients with an endogenous depression according to the Newcastle scale.