We are conducting a two year longitudinal study of mood disorders in a group of 103 stroke patients. During the first six month period following the stroke the prevalence of symptoms of major depression increased from 23 per cent to 34 per cent while the frequency of symptoms of dysthymic depression increased from 20 per cent to 26 per cent. In addition, 10 of 13 patients who had major depresssive symptoms during the initial evaluation continued to have these symptoms at six months follow-up and 4 of 9 patients who had minor depression in hospital developed major depression, while 5 of 9 continued to have minor depressive symptoms. Thus, the duration of depression following stroke is more than six months and the prevalence of major depressive symptoms increases steadily for the first half year after a cerebral hemorrhage or ischemic lesion.

Measures of intrafamilial expressed emotion (EE) predict relapse in schizophrenic patients, but previous research has not investigated whether EE scores are representative of ongoing family transactions. Parents of 42 hospitalized schizophrenic patients were rated for level and type of EE. Following the patient's discharge, families participated in two 10-minute direct interaction tasks. Transcripts from these interactions were coded on dimensions of affective communication.

High-EE parents exhibited more negatively charged emotional verbal behaviour in direct transaction with their schizophrenic offspring than did low-EE parents. Some parents rated high-EE were distinguished by their frequent usage of critical comments during the interactions, whereas high-EE overinvolved parents used more intrusive, invasive statements. These findings support the construct validity of expressed emotion.

Ninety one patients with new episodes of minor affective disorder were selected by their general practitioners as suitable for anxiolytic medication. Half the patients were allocated randomly to a drug-group (anxiolytic medication), and half to a non-drug group (brief counselling without anxiolytics). Psychiatric and social assessments were made (i) at initial consultation when treatment was started; (ii) one month later; (iii) seven months later. Before treatment the two groups were similar on all main variables. On the General Health Questionnaire, 85 per cent of patients were psychiatric cases before treatment, 40 per cent at one month and 30 per cent at seven months. Similar improvements were found with other measures of psychiatric state (Profile of Mood States; Present State Examination) and social functioning (SAS-M). Improvements were similar and parallel in the two groups. Neither group of patients increased their consumption of alcohol, tobacco or non-prescribed drugs. The non-drug group did not make increased demands on the doctors' time.

The diagnosis of hyperkinetic syndrome is rarely used in the UK, in marked contrast to its counterpart in the USA. Most of the work on hyperkinesis is concerned with the North American concept and relatively little attention has been paid to the British approach. The present paper reviews the development of the UK concept and diagnosis, describes the characteristics of 73 hyperkinetic syndrome children seen at the Bethlem and Maudsley Hospitals over 13 years and compares them to matched psychiatric controls diagnosed as conduct disordered. Results indicate that the two groups are differentiated by a number of symptomatic and clinical features, with the conduct disorder group showing a greater frequency of aggressive, antisocial, emotional and psychosocial disturbance which contrasts with higher frequencies of motor disturbance, inattentive and articulatory disturbance in the hyperkinetic group. No differences were found between the groups in brain pathology or sensory handicap. The findings provide support, at least in terms of symptoms and clinical features, for the concept and diagnosis of hyperkinetic syndrome (ICD 9).

Twenty-one schizophrenic patients from a depot injection clinic with frequent hospital admissions (relapsers) and 28 who had remained well for 18 months (non-relapsers) were compared using the Parental Bonding Instrument (PBI) and the Influential Relationships Questionnaire (IRQ), a modified version of the PBI. The scales measured patients' past and present representations of significant others, respectively. Results indicated that only present representations of significant others differentiated relapsers from non-relapsers.

Subjects were followed up for a 9 month period. The readmitted (n = 8) and the non-readmitted (n = 41) groups were found to be different on the maternal care scales of the PBI and four of the six scales of the IRQ. The perceived attitudes of mothers of non-relapsers and non-readmitted patients tended to improve over time. The importance of the state-trait distinction of perceived attitudes in relation to re-admission to hospital is discussed.

Thirty-eight patients suffering from severe depression were given a course of ECT (Electroconvulsive therapy) in one of three waveforms. These were high-energy sine wave (HS), high-energy pulse (HP), and low-energy pulse (LP). Patients were assigned to one of these treatments on a double-blind basis. The patients were given a battery of memory tests before ECT commenced, after three treatments, at the termination of treatment, and two weeks after the last treatment. The marked improvement in both verbal and nonverbal memory scores was attributed to the lifting of depression. No significant differences were found between the memory scores of the three treatment groups at any point during the treatment period.

Eighteen patients fulfilling DSM-III criteria for both major depression and dementia were matched by age and sex to patients with a diagnosis of irreversible dementia and patients with a diagnosis of major depression. A past history of depression, self reports of depressed mood, self blaming, hopeless and somatic delusions, an appetite disturbance and subacute onset identified the patients suffering from dementia caused by depression. Two year follow-up confirmed the initial diagnosis and demonstrated that coexisting cognitive impairment and major depression are not usually precursory to a progressive dementing illness.

The strategy of high-dose intramuscular haloperidol as routinely applied in a general hospital psychiatric ward to 74 successive patients, 33 of whom stayed only up to seven days, and a further 34 up to 15 days, led to a complete recovery in only six, and complete lack of change in 23. Adverse reactions were recorded in 42, severe enough to stop treatment in eight; there were three deaths. In view of this risk-benefit analysis, systematic application of this high dose strategy to get a more rapid turnover of patients is unjustified.

We predicted that the closer the resemblance of attempted suicide to completed suicide, the greater the risk of patients later killing themselves after an unsuccessful attempt. Using two risk scales, one of 6 and the other of 18 socio-demographic and clinical items, weighted according to their value in discriminating between suicides and attempted suicides, and a rating of intent to die during the index suicide attempt, we followed up 1263 attempted suicides for two years. Ten of the twelve suicidal deaths in the first year occurred in patients scoring in the top quartile on the 6-item scale; and among high-risk scorers there was an excess of those defined as ‘failed suicides' at the index attempt. The 18-item scale was superior to the shorter one, but both scales were improved by taking into account the rating of intent-to-die. The potential value of these findings is discussed in the light of some inherent problems of predicting suicide in the clinical setting.

Factors associated with psychiatric outcome were examined in a series of 87 patients who had presented in general practice with new episodes of minor affective disorder. Two outcome measures were used: (i) Status on Present State Examination (PSE) seven months after initial consultation; (ii) prescribing of psychotropic medication between one-month and seven-month follow-up assessments. Outcome according to the PSE was significantly associated with: worse measures of psychiatric state (General Health Questionnaire, Profile of Mood states) and of social functioning (SAS-M) at initial consultation and one month later; and with persistent anxious or depressed mood during the follow-up period; but not with life events. During the follow-up period 20 patients received at least one psychotropic prescription; they were significantly associated with worse initial GHQ scores, consumption of tobacco and non-prescribed medication, and initial anxiety. A sub-group of 11 patients received multiple psychotropic prescriptions; they were significantly associated with the same initial measures, and also with poor outcome measures (psychiatric and social).

This study questions the prevailing view that schizophrenic delusions, hallucinations and incoherence of speech (positive symptoms) reflect loss of cognitive control and that flattening of affect and poverty of speech (negative symptoms) reflect restriction of cognitive processing.

The prevailing view was examined by analysing the thematic organisation of speech produced by 18 patients describing pictures. Results showed that (a) positive and negative symptom schizophrenics did not differ in the control and restriction of thematic speech organisation; (b) speech disordered schizophrenics, positive as well as negative, showed cognitive restriction, by producing fewer inferential ideas than non-speech disordered schizophrenics.

The wider implications of these results are discussed, particularly the implications of (b) for the notion of concreteness in schizophrenia.

A signal detection analysis was used in a recognition memory task involving material of varying hedonic tone. Major differences were found between the control and depressed states. Although overall recognition rates were the same, pleasant material was recognised less and unpleasant material more easily by depressives. Neutral material was recognised equally well by both groups. In the depressed state, response biases were altered such that unpleasant material was handled in a preferential way to neutral or pleasant material.

Much of what is known about the psychological response to amputation is derived from studies of veterans. Most recent amputees come from a different group; they are typically older and have experienced medical problems prior to their amputation. In order to investigate the effects of age and time since amputation on psychological response, 66 amputees were assessed by the Symptom Checklist-90, Beck Depression Inventory and interviewed. When classified by time since amputation and by age, the results indicate that older amputees exhibited less depression and fewer psychological symptoms: in contrast, younger amputees evidenced increased depression and psychological symptomatology the longer the time since their amputation.

As part of a survey of 1011 men aged 20–60 years, a factor analysis and validation study of the General Health Questionnaire (GHQ) was carried out. Three clinically relevant factors could be isolated but factor analysis did not generally enhance the value of the GHQ.

When compared with results for a similar group of women, sex differences in answering the GHQ were found; the GHQ was perhaps a less satisfactory screening instrument in the men.

One hundred and ninety three raters drawn from six countries and representing different professional groups considered 16 case histories. Raters were asked to indicate what degree of ‘dangerousness' they attributed to each individual and what they considered to be the optimal management.

The level of agreement between raters concerning the assessment of dangerousness was generally low, the level of 60 per cent being reached for only 4 cases out of 16. Psychiatrists did not reach a higher level of agreement on the ratings of dangerousness than non-psychiatrists. Psychiatrists had a tendency to rate individuals as more dangerous than did non-psychiatrists.

The results of this exercise do not support the use of ‘dangerousness' as a scientifically or operationally valid concept.

Two hundred and eleven women between the ages of 18 and 65 years referred to a gynaecological out-patient clinic were screened for psychiatric disorder using the General Health Questionnaire (GHQ) and a Demographic Questionnaire. A random sub-sample of 35 women were interviewed using the Present State Examination (PSE) and the Brown and Harris Life Events and Difficulties Schedule (LEDS), and compared to a general population sample (N = 140) matched for life stage (LS) and social class. Forty six per cent of women in the clinic scored as cases on the GHQ. High scores were associated with being divorced, separated, or widowed, and with complaints of pelvic pain. PSE case rates were higher in the clinic sample than in the general population group (29 per cent and 17 per cent). Younger women (LS 1) and middle class women in the clinic sample had higher rates than in the general population. Only the middle class women in the clinic sample showed significantly higher rates for severely threatening life events and/or difficulties before onset of psychiatric disorder. The study supports the view that rates of psychiatric disorder are high among women referred to a gynaecology clinic and indicates the importance of associations with demographic factors and recent experience of life stress, especially marital difficulties.

Tardive dyskinesia (TD) is usually described as fluctuating in its clinical manifestations. We attempted to quantify fluctuations in TD using the Abnormal Involuntary Movement Scale (AIMS). Three psychiatrists rated multiple video-recorded examinations of four outpatients with mild TD. The unexpected finding was that within-rater variability dominated within-patient variability.

A group of first-time mothers (119) were interviewed repeatedly at fixed intervals during their pregnancies and until their babies were a year old; they were then followed up at four years. A similar investigation was carried out on 38 other primiparae and 39 multiparae, but only postnatally.

The incidence of depressive neurosis rose significantly in early pregnancy and in the first three months after delivery (10 per cent and 14 per cent of the main sample respectively). Subjects mainly suffered either from antenatal or postnatal depression, not both. Marital conflict and severe doubts about having the baby were associated with depression at either time. Bereavement and preterm birth were the only life events to relate with the onset of depression and bereavement had a greater impact during pregnancy.

Depressed mothers were more likely to express negative or mixed feelings about their three-month-old babies. Many who had become depressed for the first time in their lives continued to experience psychological problems for up to four years after childbirth.

One hundred boys and girls who were placed in two group homes by court order were studied. The girls were admitted mostly for status offences while the boys were admitted for offences to property and persons. Over half of the sample had an immediate family member who had committed a serious crime. This group differed in several ways from the group with no family history of crime. When the outcome of the entire sample was investigated, it was found that there are some indicators that could be used as predictors for the outcome in a delinquent population. This could have a definite clinical application.

The study investigated the retrieval deficit hypothesis of forgetting in senile dementia, using a cued recall technique. Memory for lists of words was tested with either no cues given at the time of recall, or alternatively by cueing the patient either with the word's first letter or its semantic category. Results do not support a retrieval deficit explanation of forgetting in dementia, but instead suggest the possibility of a processing deficit at the acquisition stage.