The aim of this review is to integrate research findings on the role of sociocultural factors in hallucinations and to relate these factors to current psychological theory and research.

The literature was surveyed by manual search, and the more reliable studies selected for the review.

One hundred and thirteen publications were scrutinised and 30 of them were included in this review.

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences. Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations. It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.

The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations.

Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period.

Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating.

AF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.

The striking analogies between the ideas of Freud and Friedrich Nietzsche, whose works were published from one to three decades before those of Freud, have been commented upon, but no previous systematic correlation of the ideas of Nietzsche and Freud has been made.

The major works of Nietzsche were read, and each possible analogy to an idea later broached by Freud was correlated by a systematic review of his works. Any references to Nietzsche in Freud's writings and reported conversation were culled.

Concepts of Nietzsche which are similar to those of Freud include (a) the concept of the unconscious mind; (b) the idea that repression pushes unacceptable feelings and thoughts into the unconscious and thus makes the individual emotionally more comfortable and effective; (c) the conception that repressed emotions and instinctual drives later are expressed in disguised ways (for example, hostile feelings and ideas may be expressed as altruistic sentiments and acts); (d) the concept of dreams as complex, symbolic “illusions of illusions” and dreaming itself as a cathartic process which has healthy properties; and (e) the suggestion that the projection of hostile, unconscious feelings onto others, who are then perceived as persecutors of the individual, is the basis of paranoid thinking. Some of Freud's basic terms are identical to those used by Nietzsche.

Freud repeatedly stated that he had never read Nietzsche. Evidence contradicting this are his references to Nietzsche and his quotations and paraphrases of him, in casual conversation and his now published personal correspondence, as well as in his early and later writings.

This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures.

A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress.

HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress.

The HMQ is a useful measure of generic health status in liaison psychiatry settings.

Chronic fatigue syndrome (CFS) is a poorly understood condition, apparently related to both psychiatric disturbance and infectious illness. Little progress has been made in identifying aetiology, owing to a lack of epidemiological studies using case-definition criteria.

A community postal survey of a random sample of over 1000 patients registered at a local health centre comprised a fatigue questionnaire and the 12-item General Health Questionnaire (GHQ).

Total fatigue scores were modestly higher in women than men. Fatigue was most frequently attributed to psychosocial factors. Fatigue and GHQ scores were strongly correlated. Two men and two women satisfied British criteria for CFS, a prevalence of 0.56% (95% CI 0.16–1.47%); three were probable psychiatric cases.

Previously reported sociodemographic associations of CFS may reflect medical referral patterns. A strong association exists with psychological morbidity, but relabelling CFS as a psychiatric disorder is not justified.

We compared the efficacy of two neuroleptics with different receptor profiles (zuclopenthixol and haloperidol) in learning disabled patients with behavioural disturbance.

A double-blind crossover study (2×8 weeks; n = 34), interrupted by a two-week single-blind washout period, was employed. Assessments included the Schedule for Handicaps, Behaviour, and Skills (SHBS) and Clinical Global Impression (CGI).

The SHBS score was significantly reduced for the zuclopenthixol cohort only. End-point analysis between the two drugs also showed an enhanced effect for zuclopenthixol over haloperidol. CGI scores did not reveal significant differences between the two drugs.

Zuclopenthixol may be superior to haloperidol for the treatment of behavioural disturbances in mentally retarded subjects.

The aims were to determine the prevalence of the Charles Bonnet syndrome (CBS) in low-vision patients and analyse possible associated ophthalmic and sociodemographic factors.

A semi-structured interview on visual hallucinations was given to 300 adult low-vision patients and 200 elderly general ophthalmic patients. Positive cases were examined with the Geriatric Mental State Schedule and the Mini Mental State Examination. Diagnostic criteria were as follows: complex, persistent, or repetitive visual hallucinations; full or partial retention of insight; no hallucinations in other modalities; and no delusions. Ophthalmic and sociodemographic data were gathered for all patients.

The prevalence of CBS in low-vision patients was 11%. CBS was significantly associated with an age over 64 years and a visual acuity in the best eye of 0.3 or less. No significant associations with ophthalmic diagnoses, patient sex, marital status, or social circumstances were found.

Our findings support association of CBS with sensory deprivation and advanced age.

A large collaborative 8-week study has shown fluoxetine to be effective and safe in treating patients with bulimia nervosa. The present study evaluated fluoxetine over 16 weeks.

Fifteen US out-patient psychiatry clinics conducted a double-blind parallel study in men and women with DSM–III–R bulimia nervosa (483 patients entered, 398 randomised [3:1 ratio, fluoxetine 60 mg/day or placebo], 225 completed). Outcome measures included change in vomiting and binge-eating episodes per week, Eating Disorder Inventory, Clinical Global Impressions and Patient's Global Impression.

Compared with placebo, fluoxetine treatment resulted in significantly greater reductions in vomiting (F [1,360] = 14.73, P< 0.0001) and binge-eating (F [1,360] = 14.39, P=0.0002) episodes per week at endpoint and improvement in other outcome measures. Adverse event, vital sign and laboratory analyses indicated that fluoxetine was safe.

Fluoxetine appeared to be safe and effective in patients with bulimia nervosa for up to 16 weeks.

This study reports the prevalence of psychiatric disorder in women from a Canadian community. The GHQ and the CES–D were compared for their utility.

A thousand women over the age of 18 were mailed the GHQ and the CES–D. Our return rate was 44.4%; 24% were personally interviewed by interviewers blind to screening information. The CIDI was used to establish DSM–III–R diagnoses. Four versions of the GHQ and one version of the CES–D were calibrated against the CIDI.

The prevalence of general psychiatric disorder was estimated as between 15% and 19%, anxiety disorders between 10% and 13%, and depression occurring with anxiety between 3% and 4%. The calibrated GHQ was the most reliable instrument.

Prevalence of DSM–III–R psychiatric disorder can be reliably determined with the calibrated GHQ. Anxiety disorders are most prevalent in this community, and were best detected using calibrated versions of the longer form GHQ.

It has been hypothesised that change in the family environment affects short-term recovery from schizophrenia.

Observation and study of 210 schizophrenic patients who were influenced by family environmental alteration show that the prognosis of schizophrenia caused suddenly by family environmental alteration is better than that of schizophrenia caused by a persistently unfavourable family environment.

Hence, we think sudden family environmental alterations do not cause psychorrhoea, but slow family environmental alteration may cause change in the mental state of patients. The prognosis is worse in the countryside than in the city. From the study group, we conclude that the first cure rate was 28%, and that 26% of patients were able to work. This indicates that there were no typical cases of the core pattern of schizophrenia, and that there was a certain potential for recovery.

In the future, the emphasis of prevention and treatment must be placed on the countryside, and attention should be paid to the improvement of living and working conditions there, to the correct administration of patients, and to the improvement of recovery measures and therapy. We advocate that efforts should be made in the countryside to raise the national educational and cultural level.

This study examines the hypothesis that more recently ill patients with chronic fatigue syndrome (CFS) might have different characteristics from more chronic patients in tertiary referral centres.

Sixty-four patients who fulfilled strict diagnostic criteria for CFS had detailed medical, viral, immunological and psychiatric assessment. Patients were advised to remain within their energy limits. Patient and doctor monitored progress using a scoring system.

Using the Schedule for Affective Disorders and Schizophrenia, patients were placed into four groups: group A (no psychiatric disorder, 35 patients), group B (psychiatric disorder before onset of CFS, 7 patients), group C (coincident psychiatric disorder and CFS, 11 patients), and group D (psychiatric disorder after onset of CFS, 11 patients). There were no viral or immunological differences between the groups. Patients in groups B, C and D had more severe illness than those in group A (P< 0.05), but patients in group A had more muscle pain (P< 0.05) than patients in group C. Counselling resulted in 52 patients becoming better; nine remained the same and three became worse.

A lower incidence of psychiatric disorder may characterise patients who are more recently ill, as may the type of associated emotional disorder and better outcome.

Using improved methods, findings of higher criminality in a psychiatric population were tested.

An unselected sample of 1265 Swiss in-patients and a matched control group drawn from the general population were studied. Detailed accounts of conviction records served as a measure of criminal behaviour.

Apart from traffic law violations by men, and violent crimes and sexual offences by women, patients were more frequently registered in all crime categories. However, there were significant differences between the diagnostic groups. Alcoholics and drug users of both sexes had a significantly higher criminality rate. A higher rate was also found among female, but not male, patients suffering from schizophrenia or related disorders and other, mostly organic, disorders.

Alcoholism and drug abuse contribute significantly to criminal behaviour, independent of sociodemographic factors; however, with a few exceptions, mental disorders such as schizophrenia and affective disorders do not contribute to criminal behaviour.

This meta-analysis assessed the equipotency of carbamazepine and lithium prophylaxis in bipolar disorder.

We selected only randomised, double-blind, controlled studies comparing carbamazepine with lithium from a manual and computerised search, and subjected them to a quality inventory. Their statistical results were weighted by their quality score and combined. Results. Four studies met our criteria, yielding, overall, P = 0.15. This result is not straightforward because the studies showed significant heterogeneity (P < 0.01).

Differences in statistical power and sensitivity of outcome measure explain this heterogeneity and the conflicting results of the studies. Therefore, the prophylactic efficacy of carbamazepine remains questionable.

Simultaneous diagnosis of more than one personality disorder (PD) has been termed ‘comorbidity’ or ‘co-occurrence’ implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5–5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.

The PDQ–R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).

Means of 6.0 (95% CI 5.7–6.3), 4.0 (3. 1–5.0) and 3.4 (3.0–3.8) PDQ–R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.

Multiple diagnosis of PD is better construed as ‘breadth’ of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of ‘breadth’ of axis–II pathology may further our understanding of PD.

This study measures psychiatric morbidity, quality of life, and cognitive function after liver transplantation.

We undertook a cross-sectional study, with a longitudinal subgroup. The setting was a tertiary referral centre for liver transplantation. The subjects were 30 post-liver-transplantation patients, including 11 also interviewed before the operation. The main outcome measures were the Clinical Interview Schedule (CIS), the General Health Questionnaire (GHQ), the Nottingham Health Profile (NHP), and the Mini-Mental State Examination (MMSE).

Of the patients, 8/30 were CIS cases, and 7/30 were GHQ cases. NHP scores were higher than a previous postal study indicated, with less impairment after than before transplant. MMSE scores were 24–30. Median GHQ was 7.0 before operation and 1.0 after operation (P = 0.03), with no significant change in CIS score.

Liver transplantation improves quality of life, but not to the level of the general population; post-transplantation patients have a prevalence of psychiatric morbidity comparable with that of general medical patients.

Contracting in psychiatric services from the NHS into prisons has been advocated to improve the care of the mentally disordered in custody. The Belmarsh Scheme is such a service.

A prospective study investigating the characteristics of a six-month cohort of remand prisoners requiring transfer to hospital and evaluating the service's effectiveness.

Fifty-three (4.3%; 95% CL 3.2% to 5.6%) of the 1229 new remands required transfer to hospital; all were accepted. The transfer group contained a higher proportion of black men (51%) than all other remands (30%) (difference 21%; 95% CL 8% to 35%, P = 0.002). Transfer times were lower than those reported for a neighbouring prison.

The Belmarsh Scheme secured in-patient psychiatric care rapidly for all those identified as needing it.

There has been discussion about the possible occurrence of post-traumatic stress disorder (PTSD) in mothers after difficult childbirth.

Four cases with a symptom profile suggestive of PTSD commencing within 48 hours of childbirth are presented.

The PTSD was in each case associated with the delivery. In each case, there was an associated depressive illness. All four had persistent disorders, and two had difficulties with mother/infant attachment.

As confirmed by other reports, the prevalence of PTSD associated with childbirth is a matter of concern.